quizzes

The advantages of Cetacaine are its low risk of allergy, rapid onset, and long duration of anesthesia.

False

Which of the following local anesthetic drugs is safest to use in the case of a known family history of methemoglobinemia?

Lidocaine

Which of the following drugs has the shortest duration of action?

Lidocaine 2% plain

Which of the following medical conditions does not require precautions when using vasoconstrictors?

Liver disease

Which of the following is the most important safety step following an injection?

Recapping the needle with a one-handed technique

What is the penetration site for a GP nerve block?

Slightly anterior to the greater palatine foramen

Following a myocardial infarction, what is the current guideline recommended when considering elective dental treatment?

a. A minimum of 4weeks delay, following appropriate consultation and risk analysis

The mental foramen can typically be palpated

a. At the facial apices of the mandibular first or second premolar

Which of the following is not a helpful landmark when determining the penetration site and needle pathway for a Gow-Gates nerve block?

a. Depth of the coronoid notch

Which statement is true regarding fear and local anesthesia?

a. Fear can be a barrier to obtaining adequate anesthesia.

Which statement is true regarding tachyphylaxis?

a. It is most likely to occur once sensation has returned to normal levels.

Why is 3% mepivacaine plain associated with a higher number of local anesthetic toxicity reports in children compared with other agents?

a. Lack of vasoconstrictor

Which of the following muscles experiences trismus more frequently?

a. Medial pterygoid

Which local anesthetic drugs would it be advisable to avoid when a patient is taking significant amounts of acetaminophen?

a. Prilocaine and benzocaine

Depolarization refers to a potential change across a nerve membrane from -70 mV to +40 mV.

true

In response to stimulation, calcium ions release from the receptor sites, allowing an influx of sodium ions into the axoplasm.

true

A patient with well-controlled, noninsulin-dependent diabetes is classified as:

b. ASA II

Which statement best describes pain as a protective response?

b. Pain is a rapid, reflexive, unconscious reaction.

Which of the following is the best option to assure anesthesia in the presence of inflammation?

b. Select an injection that will provide anesthesia of the nerve trunk medial to the area of inflammation

What is the minimal volume of anesthetic solution recommended for a Gow-Gates nerve block?

c. 1.8 mL

A patient with chronic obstructive pulmonary disease (COPD) requiring oxygen is classified as:

c. ASA IV

Which one of the following drugs is absolutely contraindicated for patients with bisulfite sensitivity?

c. All injectable local anesthetics with vasoconstrictors

Shortly after returning home, a mother calls to report that her child has bitten his lower lip causing redness and swelling. What is the appropriate treatment?

c. Apply a cold pack to reduce swelling

In the process of debriefing, which one of the following is not helpful for a fearful patient?

c. Clinicians select strategies for appointments according to their observations of patient behavior.

Which of the following vasoconstrictors is the best known in providing hemostasis?

c. Epinephrine

Which of the following injections would most likely solve inadequate anesthesia on the palatal root of tooth #3?

c. Greater palatine

Which of the following is not a helpful landmark to identify the penetration site for an inferior alveolar nerve block?

c. Maxillary occlusal plane

Which of the following initial signs and symptoms should alert the clinician to a potential overdose reaction?

c. Metallic taste and circumoral tingling/numbness

Why is 4% articaine used with frequency in pediatric care?

c. More effective in its ability to diffuse through bone

Which of the following is a possible complication of an IA nerve block when penetration is too deep?

c. Piercing the parotid gland and numbing the facial nerve

What is the main cause of hematoma?

c. Tearing a blood vessel

The Gow-Gates is successful in providing anesthesia of mandibular molars in the presence of accessory innervation from the mylohyoid or lingual nerves because

c. The IA nerve trunk is anesthetized higher on the inferior nerve.

The most common adverse events related to local anesthetic include all of the following except

d. Anaphylaxis

Which of the following local anesthetic drugs is a concern for patients with atypical plasma cholinesterase?

d. Benzocaine

What is the most critical risk factor for toxicity of local anesthetics in pediatric patients?

d. Children typically weigh less than adults

Which teeth and soft tissues are innervated by the inferior alveolar nerve?

d. Mandibular teeth to the midline and buccal soft tissue from premolars to the midline

In response to pain from injection, the CNS activates the sympathetic nervous system to:

increase heart rate, blood pressure, and skeletal muscle vasculature.

Most amide local anesthetics are biotransformed in the:

liver by P450 isoenzymes.

MRD stands for:

maximum dose recommended that can be safely administered in most situations.

CNS toxicity occurs due to:

normal function of nerve cells.

Elimination half-life refers to the time it takes for half of a drug to be:

out of the circulation.

Which of the following is important but is not a recommended step in the PREP strategy?

plan debriefing

Which of the following maxillary injection techniques has the highest risk of hematoma?

psa

Which form(s) of a local anesthetic drug is(are) responsible for the actions of the drug on nerve membranes?

. Cation and neutral base

What is the maximum dose of epinephrine a patient with significant cardiovascular disease should receive in an appointment?

0.04 mg

What is the maximum dose of epinephrine per appointment for a healthy adult?

0.2 mg

What is the correct deposition rate for an AMSA nerve block?

0.5 mL over 60 seconds

Which of the following is the most appropriate documentation following local anesthesia injections?

03/03/2014: Review health history. BP 115/78. Two cartridges of 4% prilocaine (144 mg) w/epi 1:100,000 (0.036 mg), benzocaine topical, Rt PSA, MSA, GP, (-) aspiration. No adverse reactions.

What is the half-life of lidocaine?

1.6 hours

Which of the following best explains the needle choice for an infiltration of a maxillary lateral incisor?

27 gauge short based on the low risk of positive aspiration

Which of the following drugs would be the safest for a patient with cardiovascular disease?

4% prilocaine plain

What is the maximum recommended dose of mepivacaine?

400 mg per appointment

The anesthetic duration of lidocaine plain is:

5 to 10 minutes pulpal; 60 to 120 minutes soft tissue

Studies have demonstrated the absence of the MSA nerve in:

50% to 72% of individual

The maximum recommended dose for lidocaine 1:100,000 is:

500 mg per appointment

What is the maximum recommended dose per appointment for prilocaine?

600 mg

In a typical adult, how far below the inferior orbital ridge is the IO deposition site located?

8 to 10 mm

The elimination half-life of lidocaine is:

96 minutes

An injection that deposits anesthetic solution near a major nerve trunk is called:

A nerve block injection

Which of the following best describes the nerves anesthetized by the AMSA nerve block?

ASA, MSA, NP, GP

An injection technique that deposits anesthetic solution near terminal nerve endings is called:

An infiltration injection

What are the two most important safety steps during a local anesthetic injection?

Aspiration before depositing and administering drugs slowly

What is the FDA pregnancy category of lidocaine?

B

Which portion of the local anesthetic molecule passes through the nerve membrane?

Base

Which statement is FALSE regarding the absorption and distribution of local anesthetic drugs?

Bone and epithelium will receive more drug.

What is the FDA pregnancy category for mepivacaine?

C

During normal nerve function, which ion is easily displaced when a membrane is stimulated?

Calcium

Which of the following is an anatomical landmark for an ASA injection?

Canine fossa anterior to the canine eminence

What is the most common cause of failure of a PSA nerve block?

Deposition of solution too far away from the PSA foramina

Which of the following is not a desirable characteristic of local anesthetic drugs?

Distributed easily

Local anesthetics are CNS stimulants and should be used with caution when patients have taken large doses of narcotics.

False

Most local anesthetic injections through tissue are considered invasive and require premedication for at-risk patients.

False

Which of the following best explains why infiltration techniques are highly successful in the maxilla?

Ease of diffusion through bone

Which of the following describes the field of anesthesia for the buccal nerve block?

Facial soft tissue and periodontium of mandibular molars

Compared to injectable local anesthetic drugs, topical products do not require MRDs because they are potentially less toxic.

False

Compounding rules for topical anesthetics allow multidose packaging for use with multiple patients.

False

Which of the following reasons best describes why it is advantageous to use a 25 gauge long needle for an IA nerve block?

Greater depth of penetration, greater accuracy of aspiration outcomes, less needle deflection

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

What factor decreases the effectiveness of local anesthesia when tissues are inflamed?

Inflammation causes a decrease in the pH of surrounding tissues.

Which statement best describes why retraction of tissue keeping the tissue taut is important during injections?

It allows for ease of needle penetration and establishes a point of stability for the syringe.

Which statement correctly describes chronic pain?

It follows a period of acute pain that persists for more than six months.

Which statement correctly describes pain threshold?

It is identified when a stimulus begins to produce pain.

Which of the following statements related to an individual's response to a pain experience is not correct?

It is not influenced by an individual's gender and physical health.

Which vasoconstrictor should be considered for a diabetic patient with poorly controlled blood sugar levels when hemostasis is not needed?

Levonordefrin 1:20,000

Which statement is true regarding nociception?

Nociceptors are activated without conscious awareness.

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

Which one of the following conditions does not indicate the need to limit the dose of vasoconstrictors?

Patient with cardiovascular disease and controlled hypothyroidism

Which of the following statements best describes the technique error(s) that results in premature contact with bone immediately after penetration for an IA nerve block?

Penetration too low and too lateral to pterygomandibular raphe

Which of the following is not a clinical advantage of the AMSA nerve block?

Profound pulpal anesthesia of maxillary first molar

The PSA nerve branches from the maxillary nerve within the:

Pterygopalatine fossa

Inadequate anesthesia may typically be caused by all of the following, except

Quality of manufactured solutions

The most common cause of failure of palatal nerve blocks is:

Solution deposited too far from deposition site

Which statement describes the correct positioning of the long window of the syringe?

Toward the clinician to permit visibility throughout the injection

A 25 gauge needle has less potential for deflection than a 27 gauge needle, although deflection is not a common cause of anesthetic failure.

True

Benzocaine topical can induce methemoglobinemia.

True

Benzocaine topical exists nearly 100% in the base form and is poorly absorbed into the systemic circulation.

True

Epinephrine can cause dangerous elevations in blood sugar in patients with cardiac compromise and severe diabetes.

True

If there are repeated positive aspirations at the same injection site, rescheduling should be considered.

True

Metabolism of both amide and ester-type local anesthetics may be compromised in patients with serious liver dysfunction.

True

Precautions for toxicity increase when topical anesthetic is applied to abraded tissue.

True

The most common concentration of benzocaine topical is 20%, which will provide a 30 second onset of anesthesia with peak effectiveness in approximately 2 minutes.

True

What is the correct dose of OraVerse following the administration of two cartridges of a local anesthetic drug?

Two cartridges or 0.8 mg

Which of the following signs and symptoms are NOT signs of CVS overdose toxicity?

Vasoconstriction of peripheral vasculature

Which of the following is not a special consideration when administering anesthetic drugs to obese children?

d. Obesity may require administration of greater volumes of anesthetic for effectiveness

Which of the following strategies helps patients cope with anxiety and fear?

d. Prepare, rehearse, empower, and praise patients to reduce anxiety and fear.

Which of the following is not an indication for the use of a vasoconstrictor?

d. Providing vasodilatation following treatment

patient calls the office and complains of sloughing of the mucosal tissue on the side of the mouth that was treated. What is the most likely cause?

d. Topical anesthetic was in contact with a large area of mucosa for too long

What is the best correction to make during an IA injection when premature bony contact is met immediately after penetration?

d. Withdraw the syringe

Which of the following is classified as nociceptive pain?

d. traumatic tooth fracture

All cell bodies of sensory nerves that innervate oral tissues are located in the trigeminal ganglia and participate in impulse transmission.

false

Depolarization is a reversal of ion concentrations in the recovery phase.

false

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.

false

Nodes of Ranvier are small, raised areas on the neurolemma that permit ions to pass into the axoplasm.

false

Saltatory conduction is the term for the process by which impulses are slowly conducted along nonmyelinated nerves.

false

Schwann cells release neurotransmitters when stimulated by impulses.

false

The most numerous fiber type on peripheral nerves is the A fiber, which is nonmyelinated and transmits sharp pain sensations.

false

The strength of nerve impulses weakens as the energy transfers from one section of nerve membranes to the next.

false

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

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

Needle bevel orientations are not considered critical to the success of any injection.

true

The electrical potential of a nerve axoplasm in the resting state is approximately -70 mV.

true

The epineurium surrounds all of the fasciculi, their associated supporting connective tissue including blood vessels and lymphatics, and the perineuria.

true

The mantle bundles are located on the outer area of the nerve membrane and the core bundles are located in the central area. Both have significance in the order of anesthesia development.

true