LA crdts
The RDH administers 3 cartridges of articaine. How many mg of local anesthetic were administered? A. 200 mg b. 162 mg c. 216 mg d. 172 mg
C. 216 mg
Your patient had a IA the the day before. He calls & says he can't open his mouth. What condition is this?
Trismus
If your primary purpose is hemostasis, what is the best technique to use?
infiltration
What tissue is topical local anesthetic least effective on?
keratinized
Where are amides metabolized/biotransformed?
liver
3 cartridges of Mepi (1.7 per cartridge) how many mg?
(30 x 1.7= 51, 51 x 3= 153 mg)
What is the epi in 1:100,000
.018
What is the max dose of epi for a cardiact pt?
0.04 mg
How many mg of epi are given to a healthy pt?
0.20 mg
Inject your patient at
1 ml per minute
When you hit bone with the IA injection, how far into the tissue should the needle be?
2/3 (you use a long needle, 30-35mm, & inject 20-25 mm)
You have 2 cartridges of 2% lidocaine. How much local anesthesia do you have? (Use 1.7 mg for amount in cartridge)
68 mg
What is the disadvantage of esters compared to amides?
Allergic reaction
The patient had a liver problem. What is the reason for using caution with amide anesthetics?
Amides are metabolized/biotransformed in the liver
Immediately after giving a pt 2% lido w/1:00 k epi the experience sharp paim on their left side traveling down their arm and up their face. It subsides 3-5 mins later. What is it?
Angina Pectoris
You are doing local infiltration on the palatial side of tooth #13. What is the correct insertion point?
Apex of the tooth
What anesthetic should you not use in patients with sulfa allergy?
Articaine
If your patient is allergic to both esters and amides, what can you administer?
Benadryl
Which of the following anesthetic is the most allergic?
Benzocaine
Your patient informs you they were diagnosed with contact dermatitis by their dermatologist after using a sunscreen containing PABA (para-aminobenzoic acid) which would you avoid using on them?
Benzocaine
Signs and symptoms of a vasoconstrictor overdose are manifested as OR The initial reaction to a moderate to severe overdose of LA is
CNS stimulation CNS excision
Prilocaine can be used on all of the following medical conditions except?
COPD
What would be an indication your patient has high blood pressure?
Calcium channel blockers
Long term treatment of a hematoma is what?
Cold compression for first 12 hours then with warm compression.
What is the insertion point for the long buccal?
Distal & lateral to the disto-buccal cusp of the mandibular second molar
After the injection, the patient has an anaphylactic reaction (can't breathe, swells up, etc.) what do you administer?
Epi
You give an IA but the pt didn't get numb. However, their eyelid is numb and cannot close. What happened?
Facial nerve paralysis, symptoms of bells palsy
What foramen does the V3 branch of the trigeminal nerve exit?
Foramen ovale
Tooth number 15 needs to be anesthetized for perio surgery. You already gave the PSA what other injection can you give?
Greater palatine nerve.
You want complete anesthesia on the right side of the palate. What injection do you need to give the patient?
Greater palatine & nasopalatine block
Patients with cirrhosis may:
Have a hard time metabolizing amides
The nasopalatine nerve exists out of what foramen?
Incisive foramen
Topical anesthesia is less effective on what tissue?
Keratotic tissue
If a patient is using tricyclic anti depressants (Elavil) what is an absolute contraindication
Levo
A pt is allergic to sulfites. Which anesthetic would you not use?
Lido 2% w/1:00k epi
During injection the patient feels slight burning. What is the more likely reason?
Low pH of the anesthetic
A hematoma should immediately be treated with what?
Pressure & ice
Which of the following nerves when anesthetized provides soft tissue anesthesia of the lower lip & chin
Mental nerve
What anesthetic is least vasodilating?
Mepivicaine
Topical anesthetic is applied on what type of tissue?
Mucous membrane
You need to work on the lingual aspect of a maxillary incisor. What injection do you need?
Nasopalatine
What is the function of the small bubble in cartridge?
Nitrogen gas - prevents O2 from being trapped in cartridge potentially destroying vasoconstriction
You have administered 2% lidocaine 1:50k epi to a healthy patient. The pt experiences restlessness and nausea and begins to hyperventilate. What should you suspect?
Overdose of epi
Over insertion of which injection could penetrate the pterygoid plexus?
PSA
Which anesthetic is metabolized in the lungs and liver?
Prilocaine
What is psychogenic pain?
Real pain w/out organic causes
Benzocaine is an
Topical ester (may cause allergy)
Your PT has has hx of liver failure you should?
Use caution with Amides
Which of the following is an absolute contradiction for a vasoconstrictor?
Use of cocaine within 24 hours
What can your patient do for trismus?
Use warm compression & exercise jaw muscles
Which preservative is used in dental cartriges? a. sodium bisulfite b. sodium chloride c. sodium bisulfate d. methylparaben
a. sodium bisulfite
While administering the inferior alveolar, clinician contacts bone at 10 mm depth on adult pt. What should she do?
Withdraw the needle completely and redirect the syringe barrel more anterior.
The length of the rubber stopper in a cartrige is equivilant to a. 0.2 ml b. 2.0 ml c. 0.02 ml d. 1.8 ml
a. 0.2 ml
Which blood pressure medication is a contrainindication to epi? a. Beta blocker b. Ace inhibitors c. MAOI
a. Beta blocker
Which of the following can produce hematomas that cause severe swelling and extraoral bruising as a result of nicking a blood vessel? a. PSA b. IA c. GG d. Mental/incisive
a. PSA
Which of the following local anesthesia has highest risk of hematoma after administartion? a. PSA b. IA c. GG d. Mental/incisive
a. PSA
Which of the following structures are innervated by the mental nerve? a. buccal soft tissues of the premolars b. lingual soft tissue of the incisors c. pulp of the incisors d. buccal soft tissue of the incisors
a. buccal soft tissues of the premolars
The clinician is injecting the solution at a speed of 1ml/min. The patient will most likely be : a. comfortable b. in pain c. feeling a sudden shock d. experiencing overdose symptoms
a. comfortable
Local anestetics mainly: a. decrease rate of depolarization b. lower the threshold potential c. accelerate the rate of repolarization d. all of the above
a. decreasing the rate of depolarization
The 25 gauge needle has a _____ lumen compared to a 30 gauge needle a. larger b. smaller c. equal
a. larger
Which of the following provide sensory innervation of the soft palate? a. lesser palatine b. greater palatine c. nasopalatine d. PSA
a. lesser palatine
What is the recommended needle recapping technique a. one hand scoop technique b. two hand scoop technique c. no specific technique
a. one hand scoop technique
What color is used for a 27 gauge needle? a. yellow b. red c. blue d. green
a. yellow
Local anesthetic molecules bind to which part of the nerve?
axolemma
A bubble of which size is considered "normal" in a new dental cartrige? a. 0 mm b. 1-2 mm c. 2-3 mm d. any size under 3 mm
b. 1-2 mm
Which is not a branch of the maxillary nerve? a. PSA b. IA c. Pterygopalatine d. IO
b. IA
What part of the standard syringe penetrates the rubber stopper of the dental cartridge? a. needle adapter b. harpoon c. finger grip d. thumb ring
b. harpoon
What is the main advantage of using computer controlled local anesthetic delivery systems? a. releasing of the thumb ring provides aspiration b. prevents discomfort associated with rapid anesthetic delivery c. designed for single use d. a sheath locks over the needle and prevents needle stick injuries
b. prevents discomfort associated with rapid anesthetic delivery
Sodium bisulfite is added to the dental cartrige because it: a. makes the solution isotonic b. prevents oxidation of epinephrine c. prevents burning on injections d. provides volume
b. prevents oxidation of epinephrine
Ultra short needles are a. 30-35 mm b. 20-25 mm c. 10-15 mm d. 5-10 mm
c. 10-15 mm
Which has the longest duration of action? a. Prilocaine 4% 1;200k epi b. Articaine 4% 1:00 k epi c. Bupivicaine 0.5% 1:200 k epi d. Articaine 4% 1:200 k epi
c. Bupivicaine 0.5% 1:200 k epi
Which nerve is not affected by the IO? a. ASA b. MSA c. PSA d. Infraorbital
c. PSA
Which of the following is NOT an ideal fulcrum when providing local anesthesia? a. clinicians finger on the patients face b. clinicians elbow on the patients stable body part c. clinicians arm against the patients arm d. all of the above
c. clinicians arm against the patients arm
Which of the following is the weakest part of a needle? a. bevel b. shaft c. hub d. cartridge penetrating end
c. hub
During aspiration you see blood rapidly coming through the dental cartridge. What should the next step be? a. turn syringe 45 degrees and aspirate again b. pull back the needle and re insert it c. remove the needle and replace the cartridge d. no action is needed
c. remove the needle and replace the cartridge
A needle barb can cause a. dull pain b. burning pain c. sharp pain
c. sharp pain
The GP innervates: a. all max teeth on one side b. the buccal tissues from the premolars to the central incisors on one side c. the palatal area from the premolar to the last molar on one side d. the anterior portion of the palate, canine to canine
c. the palatal area from the premolar to the last molar on one side
What system is most susceptible to the actions of LA?
central nervous system
Which is NOT a branch of the mandibular V3 nerve? a. auriculotemporal b. lingual c. IA d. IO
d. IO
Which of the following is a sensory nerve branch to the mandibular V3 anterior trunk? a. masseteric b. deep temporal c. medial pterygoid d. buccal
d. buccal
Which of the following statements is false a. needles should be changed for every patients b. needles should be changed after 3-4 insertions c. dispose needles in specific sharps container d. contaminated needles should be discarded into open trash containers
d. contaminated needles should be discarded into open trash containers
Which of the following innervates the anterior 2/3 of the tongue? a. buccal b. mental c. mylohyoid d. lingual
d. lingual
Which part of the nerve carries the electrical propagation of a stimulus? a. nucleus b. mitochondria c. endoplasmic reticulum d. nerve membrane
d. nerve membrane
If a pt has atypical plasma cholinesterase what drug will they have a problem metabolizing?
esters
What does the mental nerve anesthetize?
facial gingiva from premolars to central incisors, lower lip and skin of the chin
Which foramina is the opening for the mandibular division pf the trigeminal nerve?
foramen ovale
After administering anesthetic the hygienist notes a faint bluish mark next to the injection site and also on the skin. The most likely cause of this is
hematoma
If you gave your pt a local infiltration on the max canine the day before. Today he is calling the office saying the area near the mesiobuccal fold is black & blue. What is this an indication of?
hematoma
The IA enters what foramen to innervate mandibular teeth?
mandibular foramen
does Sclerosis of liver effect metabolism or excretion?
metabolism
Are there more base ions or cations with a low pKa?
more base ions (RN)
Are there more base ions or cations with a high pKa?
more cations (RNH+)
The incisive opening is the foramen for which nerve?
nasopalatine
A woman has immediate swelling on her face following a PSA injection, what was the cause?
needle entered the ptyergoid plexus of veins
If a pt has _______ medication, and is given epi, pt has increased risk of hypertension
nonselective Beta-blocker
Which of the following is a contraindication for a pt with COPD?
prilocaine
does a high pKa result in a quicker or slower onset of anesthetic action?
quicker
What is the best explanation as to why a pt has a lesion on their lip the day after receiving IA block?
self injury/mutilation
Esters onset and duration
slow onset, short duration
What happens during depolarization?
sodium enters and potassium exits Na+ channels open, Na+ flows in reversing polarity enters, K flows out to restore neutrality
Local Anesthesia is ____
subcutaneous
What is the most common cause of needle breakage?
sudden pt movement
Where are esters metabolized?
the blood plasma by pseudocholinesterase
Why do we take pre op blood pressure?
to something to compare to during a medical emergency/to establish baseline
What is the initial RXN to moderate to severe overdose?
tonic clonic seizure
What is the reason for contacting periosteum during PSA
too medial/anterior
Local anesthetics are vasodilators or vasoconstrictors?
vasodilators