Local Anesthetic Midterm and Quizzes
How long is oxygen administered at the completion of sedation? 1 minute 2 minutes 5 minutes 8 minutes
5 minutes
The maximum recommended dose for lidocaine is: 5 mg/lb 500 mg per appointment 4.4 mg/lb 2.0 mg/kg
500 mg per appointment
What is the recommended liter flow rate of oxygen prior to the induction of N2O? 2 4 6 8
6
Which statement best describes pain as a protective response? Pain is a physiological, conscious reaction. Pain is a rapid, reflexive, unconscious reaction. Pain is a psychological reaction based on blood flow to the injured site. Pain is a slow, deliberate reaction to avoid further tissue injury.
Pain is a rapid, reflexive, unconscious reaction.
Which statement best describes pain as a protective response? Pain is a slow, deliberate reaction to avoid further tissue injury. Pain is a physiological, conscious reaction. Pain is a psychological reaction based on blood flow to the injured site. Pain is a rapid, reflexive, unconscious reaction.
Pain is a rapid, reflexive, unconscious reaction.
Three days after receiving an inferior alveolar block, a patient calls and complains that the numbness has not worn off and she is experiencing sharp pains in her lower jaw on the same side as the numbness. Which of the following describes what she is experiencing? Paresthesia and dysesthesia Persistent anesthesia and hypoesthesia Paresthesia and anesthesia Paresthesia and an idiosyncratic reaction
Paresthesia and dysesthesia
What does the reservoir bag monitor? Patient's respirations Flow of N2O Flow of oxygen Total flow of nitrous and oxygen
Patient's respirations
What is the maximum recommended dose of epinephrine for patients in category ASA III with cardiovascular disease? 1.8 mg 0.4 mg 0.2 mg 0.04 mg
0.04 mg
The correct onset of action for lidocaine is: 30 seconds to 1 minute with vasoconstrictor 2 to 3 minutes 5 to 7 minutes 6 to 10 minutes
2 to 3 minutes
What will the gauge on an oxygen tank read when it is full? 2200 psi 1100 psi 750 psi 32 psi
2200 psi
A 120-pound patient received 102 mg of 2% lidocaine. How many mg of 4% articaine can this patient receive? Provide mathematical formulas to calculate the correct answer.
282 mg of articaine. 120 lb patient can receive 384mg total of anesthetic drug based off of weight, since both articaine and lidocaine have an MRD of 3.2mg/lb. Subtract the 102mg of lidocaine already given leaves 282mg left.
Mepivacaine is available in the following formulation: 2% plain 3% plain 1% with 1:20,000 levonordefrin 3% with 1:20,000 levonordefrin
3% plain
What is the maximum recommended dose of mepivacaine? 0.5 mg/lb 1.8 mg/lb 3.0 mg/lb 600 mg per appointment
3.0 mg/lb
What is the maximum recommended dose of mepivacaine? 0.5 mg/lb 1.8 mg/lb 400 mg 600 mg per appointment
400 mg
The treatment plan for Florence Anderson includes restoration of teeth #6, #7, and #8.Which injection(s) is/are needed for pulpal and facial soft tissue anesthesia for #6, #7, and #8 with the least number of needle penetrations?
ASA
A patient with well-controlled, noninsulin-dependent diabetes is classified as: ASA I ASA II ASA III ASA IV
ASA II
A patient with with high blood pressure that is well-controlled by medication is: ASA I ASA II ASA III ASA IV
ASA II
Which one of the following drugs is absolutely contraindicated for patients with bisulfite sensitivity? All injectable local anesthetics with amides All injectable local anesthetics with esters All injectable local anesthetics with vasoconstrictors All topical anesthetics
All injectable local anesthetics with vasoconstrictors
The most common adverse events related to local anesthetic include all of the following except Syncope Postoperative discomfort Self-injury Anaphylaxis
Anaphylaxis
The optimal site of penetration for an ASA injection is at the height of the mucobuccal fold __________ to the canine eminence.
Anterior
During an inferior alveolar block, a patient makes a sudden movement in response to needle contact with bone. The needle bends and breaks off at the hub. The broken shank of the needle is visible. Which of the following is a recommended first response? Gently remove the needle with gloved fingers Contact an oral surgeon and transport the patient to the oral surgeon's office Ask the patient to keep the mouth open and attempt to remove the needle with a hemostat Take a radiograph to determine if the needle remains in contact with bone. If not, remove the needle with a sterile hemostat
Ask the patient to keep the mouth open and attempt to remove the needle with a hemostat
Which of the following local anesthetic drugs is a concern for patients with atypical plasma cholinesterase? Lidocaine Prilocaine Dyclonine hydrochloride Benzocaine
Benzocaine
Which description of nerve membranes is correct? Have fatty cores that allow large hydrophilic molecules to pass into the axoplasm Hydrophilic ends facing inward Bilayered phospholipid membranes Trilayered sandwich-like membranes
Bilayered phospholipid membranes
Which description of nerve membranes is correct? Trilayered sandwich-like membranes Bilayered phospholipid membranes Hydrophilic ends facing inward Have fatty cores that allow large hydrophilic molecules to pass into the axoplasm
Bilayered phospholipid membranes
Which positively charged ion functions as a gatekeeper in ion channels? Calcium Sodium Potassium Hydrogen
Calcium
Which positively charged ion functions as a gatekeeper in ion channels? Potassium Hydrogen Calcium Sodium
Calcium
The PSA injection technique may be contraindicated in patients with: Clotting disorders due to risk of hematoma Diabetes due to high risk of infection TMD because of difficulty opening the mouth wide Missing maxillary second molars due to difficulty locating the posterior aspect of the tuberosity
Clotting disorders due to risk of hematoma
Which of the following is a safety feature of a central supply delivery system? Sterile plastic tubing Diameter-Index System Pin index system Non latex nasal hoods
Diameter-Index System
Which of the following conditions contraindicates the use of N2O-O2 sedation? Anemia Diabetes Ear infection High blood pressure
Ear infection
An absolute refractory period occurs when a nerve fiber can be restimulated only by a much stronger stimulus than the initial stimulus. True False
False
Atypical plasma cholinesterase is a relative contraindication to amide type anesthetics. True False
False
Bupivacaine's high pKa translates into a slow onset time, which explains why it is a long-acting anesthetic. True False
False
In the United States oxygen is stored in blue cylinders, and it is odorless, colorless and tasteless. True False
False
In the event a needle breaks and embeds in the tissue, it should be removed as soon as possible to avoid infection. True False
False
Local anesthetics are CNS stimulants and should be used with caution when patients have taken large doses of narcotics. True False
False
N2O tanks maintain a constant pressure of approximately 1100 psi until all the liquid has evaporated, making residual volume difficult to determine. True False
False
Oil, grease, or lubricants can be used on tanks, piping, and regulators during routine maintenance. True False
False
Patient mouth breathing not only increases the amount of N2O that is available for sedation but also allows N2O to be exhaled into the environment. True False
False
Pre-sedation preparation includes confirming the proper function of the scavenging system by delivering 45% N2O according to the manufacturer's instructions. True False
False
Saltatory conduction is the term for the process by which impulses are slowly conducted along nonmyelinated nerves. True False
False
The best local anesthesia drug choice for a nursing mother is prilocaine. True False
False
Which two ions are responsible for the uninterrupted maintenance of the resting potential across the nerve membrane? K+ and Cl- Ca+ and Na- H+ and Cl- K+ and Na+
K+ and Na+
Due to the effectiveness of local anesthetic drugs, exposure of a 1 to 3 millimeter section of nerve membrane to an anesthetic solution is adequate to ensure profound anesthesia. True False
False Eight to ten millimeters of the nerve membrane must be flooded by an anesthetic solution in order to achieve anesthesia in larger, heavily myelinated nerves, such as the inferior alveolar nerve.
The large window of the syringe barrel should be positioned away from the clinician throughout the injection to prevent injury in the event the cartridge shatters during injection. True False
False The large window of the syringe barrel should be positioned toward the clinician throughout the injection to provide for direct visibility of the cartridge throughout the injection procedure.
Which of the following are initial signs and symptoms of methemoglobinemia? Dizziness and headache CNS depression and seizures Gray cyanosis of mucous membranes, lips, nail beds Flushed, clammy skin
Gray cyanosis of mucous membranes, lips, nail beds
Which of the following conditions does not contraindicate the administration of N2O? Chronic obstructive pulmonary disease Hypertension or cardiovascular disease Gastrointestinal obstructions Psychiatric disorders
Hypertension or cardiovascular disease
Which injection will most easily remedy cross-over innervation to a central incisor? Infiltration over the same side central incisor with a larger volume of solution Infiltration over the opposite side central incisor ASA nerve block Bilateral AMSA nerve blocks
Infiltration over the same side central incisor with a larger volume of solution
The axoplasm of a nerve at rest: Is electrically positive at +70 mV. Is electrically negative compared to the extracellular environment. Contains more sodium ions than the extracellular environment. Contains less calcium ions than the extracellular environment.
Is electrically negative compared to the extracellular environment.
Which statement correctly describes pain threshold? It is identified when a stimulus begins to produce pain. It indicates the amount of pain an individual is able to endure. It is altered by environmental, personal, and social attitudes. It is an individual's reaction to a painful stimulus.
It is identified when a stimulus begins to produce pain.
Which of the following is a possible anatomical barrier to the success of an infiltration technique? Root angulations Syringe angulations Frenal attachments Large exostoses
Large exostoses
Which of the following local anesthetic drugs is safest to use in the case of a known family history of methemoglobinemia? Benzocaine Prilocaine Tetracaine Lidocaine
Lidocaine
Which of the following local anesthetic drugs may represent a relative contraindication for patients with compromised liver function? Levonordefrin Benzocaine Lidocaine Epinephrine
Lidocaine
The field of anesthesia of an ASA nerve block includes each of the following except Upper lip, cheek, lower nose Pulps of the maxillary central incisor through canine Facial periodontium of central incisor through canine Lingual periodontium of central incisor through canine
Lingual periodontium of central incisor through canine
What is the primary site of biotransformation of lidocaine? Kidney Liver Lungs Blood
Liver
Which statement is true regarding the specific protein receptor theory? Local anesthetic molecules compete with sodium ions for receptor sites. It explains why local anesthetic molecules affect only sensory nerves. It blocks proteins that cover specific protein receptors on Schwann cells. Local anesthetic molecules displace calcium ions at receptor sites.
Local anesthetic molecules displace calcium ions at receptor sites.
What is the correct relationship of Schwann cells to the nodes of Ranvier? Schwann cells are twice as thick as the nodes of Ranvier. Nodes of Ranvier are gaps between Schwann cells. Schwann cells are located in the nodes of Ranvier. Nodes of Ranvier are wrapped around the Schwann cells.
Nodes of Ranvier are gaps between Schwann cells.
Which of the following strategies helps patients cope with anxiety and fear? Prepare, rehearse, empower, and praise patients to reduce anxiety and fear. Avoid discussions about anxiety and fear. Assure patients that difficulties during past dental visits could not have been avoided. Only dentists should ask about anxiety and fear to avoid patient embarrassment.
Prepare, rehearse, empower, and praise patients to reduce anxiety and fear.
Which local anesthetic drugs would it be advisable to avoid when a patient is taking significant amounts of acetaminophen? Prilocaine and benzocaine Lidocaine and mepivacaine Bupivacaine and benzocaine Procaine and cocaine
Prilocaine and benzocaine
The field of anesthesia of an IO nerve block includes the: Pulps of maxillary central incisors through canine, and upper lip, side of nose, and lower eyelid. Pulps and periodontium of maxillary central incisors through canine and premolars, mesial buccal root of the first molar, upper lip, side of nose, and lower eyelid. Pulps of maxillary incisors, canine and premolars, upper lip, and side of nose. Pulps and maxillary periodontium of incisors, canine, premolars.
Pulps and periodontium of maxillary central incisors through canine and premolars, mesial buccal root of the first molar, upper lip, side of nose, and lower eyelid
Which cells produce myelin? Schwin cells Schwann cells Sensory neurons Myelinated neurons
Schwann cells
Which cells produce myelin? Sensory neurons Myelinated neurons Schwin cells Schwann cells
Schwann cells
The recommended first step in paresthesia management is Explain that most paresthesias resolve over time Diagram the extent and degree of sensory deficit Speak personally with and reassure the patient Schedule an appointment to evaluate the paresthesia
Speak personally with and reassure the patient
Which of the following sequences best describes the events in a successful impulse generation? Resting state, stimulation, slow depolarization, rapid depolarization, slow depolarization Resting state, stimulation, slow depolarization, rapid depolarization, firing threshold Stimulation, firing threshold, rapid depolarization, slow repolarization, resting state Stimulation, slow depolarization, firing threshold, rapid depolarization, recovery
Stimulation, slow depolarization, firing threshold, rapid depolarization, recovery
Which statement is not accurate when describing nerve impulses? Electrical in nature Depend on ionic activity on nerve membranes Require firing threshold to transmit to CNS Successive impulses decrease in size
Successive impulses decrease in size
he treatment plan for Jim Martin includes an MOD restoration on tooth #14.Which injection(s) is/are needed for pulpal anesthesia of #14?
Supraperiosteal of tooth 14 if that is the only tooth that needs restoration, otherwise you could do a PSA and MSA in order to get all of the roots anesthetized, since the PSA does not work on the mesiobuccal root of a first molar.
Which of the following are properties of N2O? Odorless, blue colored gas that is flammable Sweet smelling, colorless gas that supports combustion Odorless, colorless gas that supports combustion Sweet tasting; colorless gas that is flammable
Sweet smelling, colorless gas that supports combustion
What is the main cause of hematoma? Poor operator technique Failure to aspirating Tearing a blood vessel Anatomical anomalies
Tearing a blood vessel
Nitrous oxide-oxygen sedation has a positive effect on myocardial ischemia due to its provision of supplemental oxygen, sedative properties, and tendency to dilate peripheral vessels. True False
True
Which of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia? Pre-anesthetic evaluation of the patient Prescription of the anesthetic plan Remain present during the course of the anesthesia Tooth charting and periodontal evaluation to determine treatment plan
Tooth charting and periodontal evaluation to determine treatment plan
Which of the following is classified as nociceptive pain? Trigeminal neuralgia Phantom limb pain Chronic muscle pain Traumatic tooth fracture
Traumatic tooth fracture
A 25 gauge needle has a larger internal diameter than a 30 gauge needle. True False
True
Abnormally slow or fast breathing can be an indicator of disease or anxiety, or both. True False
True
Articaine may be the anesthetic drug of choice for a patient with liver dysfunction because only 5 to 10 % is metabolized in the liver. True False
True
As a consequence of local anesthetic, the primary causes of trismus are hemorrhage and muscle trauma following injection. True False
True
Average adult tidal volume is 500 mL based on an average of 6-7 liters/minute. True False
True
Epinephrine can cause dangerous elevations in blood sugar in patients with cardiac compromise and severe diabetes. True False
True
Epinephrine is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism. True False
True
Excessive exposure to N2O may occur as a result of leaks from the anesthetic delivery system during administration. True False
True
Hematomas on the palate are generally well-confined due to the tight tissue covering the bone. True False
True
Lip biting following local anesthesia is not uncommon in children even when both patient and parent are warned of the risk. True False
True
Local anesthetic drugs are effective only at the nodes of Ranvier and in order to be effective, multiple nodes must be exposed to the drug to block impulses. True False
True
Local anesthetic molecules have a greater affinity for protein receptor sites within the nerve membrane compared to calcium ions; therefore, they displace the calcium ion and block impulse transmission. True False
True
Nitrous oxide can also enhance the CNS depressant effects of agents such as barbiturates, tranquilizers, narcotics, and recreational drugs. True False
True
Patients diagnosed with congestive heart failure (CHF) should not be placed in a supine position because this can quickly lead to serious pulmonary edema. True False
True
Pin index safety systems are used only for portable equipment. True False
True
Prilocaine has demonstrated a higher than typical incidence of inducing methemoglobinemia True False
True
Prilocaine has demonstrated a higher than typical incidence of inducing methemoglobinemia due to its metabolite, ortho-toluidine. True False
True
The drug of choice for a patient with significant liver disease is articaine because it is metabolized primarily by plasma cholinesterase. True False
True
The epineurium surrounds all of the fasciculi, their associated supporting connective tissue including blood vessels and lymphatics, and the perineuria. True False
True
The higher the pKa of a local anesthetic solution, the slower the onset on anesthesia. True False
True
The pre-induction of sedation begins with establishing tidal volume of 100% oxygen for at least two minutes. True False
True
o calculate the milligrams of drug delivered, multiply the total number of cartridges by the total milligrams of drug in each cartridge. True False
True
Epinephrine is contraindicated in a patient with: Uncontrolled hyperthyroidism Diabetes Heart disease Asthma
Uncontrolled hyperthyroidism
Match the items in column A to the items in Column B column A bevel long needle short needle gauge lumen column B 32mm hollow part of needle internal diameter of needle angled tip of needle 22mm
bevel - angled tip of needle long needle - 32 mm short needle - 22 mm gauge - internal diameter of needle lumen - hollow part of needle
Nerve impulses travel rapidly on myelinated nerves because: impulses bypass nodes and travel up to 8 to 10 mm to subsequent nodes, decreasing the length of nerve over which impulses must be generated. impulses travel through the membrane, generating new impulses at each node. transmit rapidly because they are small nerves. myelin allows for a consistent incremental impulse over the membrane surface.
impulses bypass nodes and travel up to 8 to 10 mm to subsequent nodes, decreasing the length of nerve over which impulses must be generated.
In myelinated nerves, local anesthetic molecules are effective: only at the Nodes of Ranvier. as they diffuse through the myelin sheath. only at the cell body. as they diffuse at the synapse.
only at the Nodes of Ranvier.
