P/M Quiz Q's&A's

T/F A short needle is 12mm long

False

T/F Local anesthetic overdose and allergy are both dose dependent and can be prevented by adhering to MRD guidelines.

False

Piston

attached to the finger ring on one end and the harpoon on the other

Informed consent

communication to patient about the procedure including injections to be given

Aspiration

one of the two most important safety steps in delivering anesthetic

One handed recapping technique

the final safety step

Needle adaptor

threaded area on the end of the barrel

Match the injection type with the correct site of penetration and deposition 1. Penetration and deposition site of the MSA injection Height of MB fold over maxillary 2nd premolar 2. Penetration and deposition site of ASA injection Height of MB fold over maxillary canine-anterior to canine fossa 3.Penetration and deposition site of Infiltration

1. Height of the MB fold over maxillary 2nd premolar 2. Height of the MB fold over maxillary canine- anterior to the canine fossa 3. Height of the MB fold over maxillary tooth to be anethetized

How much solution is in a dental cartridge (standard amount in ml)?

1.8mL

Select the areas anesthetized by the MSA injection A: maxillary first and second premolars B: MB root of maxillary molar in some people C: facial gingiva, PDL, and alveolar bone of mandibular first and second molars D: MB root of maxillary first molar in almost everyone

A and B

Which of the following are not desirable characteristics of local anesthetic drugs? (choose all that apply) A: irritable to tissues B: slowest onset possible C: biotransformable D: nontoxic to nerves

A and B

What factor decreases the effectiveness of local anesthesia when tissues are inflamed? Choose all correct answers. A: A decrease in the pH of surrounding tissue B: An increase of the pH of the surrounding tissue+ C: Insufficient numbers of RN base molecules penetrating the nerve membrane D: Too many RN base molecules penetrating nerve membrane

A and C

The elimination half-life of mepivacaine is: A: 1.9 hours B: 2.3 hours C: 3 hours D: 1.6 hours

A: 1.9 hours

The typical rate of positive aspiration for an IA nerve block is: A: 10%-15% B: 10%-20% C: 5%-15% D: 15%-25%

A: 10%-15%

A typical short needle is ____________ in length A: 20-25 B: 40 C: 12 D: 32

A: 20-25

A 130-pound patient has received three cartridges of 4% prilocaine, 1:200:00 epinephrine. How many more milligrams of prilocaine can this patient receive before reaching the MRD? A: 304 B: 520 C: 216 D: 72

A: 304

What is the optimum depth of penetration for the MSA injection? A: 4-8 mm B: 3-6 mm C: most of the length of a short needle D: 1-2 mm

A: 4-8 mm

If a long needle is injected 3/4 of the way into the tissue, how much will be showing in the mouth? A: 8 mm B: 24 mm C: 4 mm D: 32 mm

A: 8 mm

What factor decreases the effectiveness of local anesthesia when tissues are inflamed? A: A decrease in the pH of surrounding tissues B: An increases in the number of base molecules C: A decrease in the number of H+ ions available to form base molecules D: An increase in the pH of surrounding tissues

A: A decrease in the pH of surrounding tissues

Which one of the following drugs is absolutely contraindicated for patients with bisulfite sensitivity? A: All injectable local anesthetics with vasoconstrictors B: All injectable anesthetics with amides C: All injectable anesthetics with esters D: All topical anesthetics

A: All injectable local anesthetics with vasoconstrictors

Which of the following best explains why infiltration techniques are highly successful in the maxilla? A: Ease of diffusion through bone B: volume of anesthetic delivered C: multiple nerves in the area D: minimum penetration depth

A: Ease of diffusion through bone

Which teeth and soft tissues are innervated by the inferior alveolar nerve? A: Mandibular teeth to the midline and buccal soft tissue from premolars to the midline B: Mandibular teeth from the premolars to the incisors and buccal soft tissues C: Mandibular molars and premolars, and buccal gingiva D: Mandibular teeth to the midline and the buccal soft tissues

A: Mandibular teeth to the midline and buccal soft tissue from premolars to the midline

Which of the following statements is true when considering hematoma formations following inferior alveolar nerve blocks? A: Outward signs of hematoma are uncommon during or immediately following injection because the pterygomandibular space accommodates large quantities of blood medial to the ramus. B: Outward or intraoral signs of hematoma occur immediately during or following injections because the blood leakage quickly follows the facial planes. C: Outward signs of hematoma are immediately noticeable under the mandible due to the large unrestricted areas of soft tissue. D: Hematoma is very rare following inferior alveolar nerve blocks because the venous plexus is located superior to the IA nerve.

A: Outward signs of hematoma are uncommon during or immediately following injection because the pterygomandibular space accommodates large quantities of blood medial to the ramus

Of the nerve trunks originating from the Trigeminal ganglion, only the ______ carries both sensory and motor nerve fibers A: V3 B: V1 C: V2 D: V4

A: V3

Which of the following is the most important precaution in order to avoid hematoma formation? A: avoid multiple needle penetrations B: avoid PSA injections C: avoid using large gauge needles D: carefully assess anatomy before injection

A: avoid multiple needle penetrations

Which of the following is NOT in a cartridge of local anesthesia? A: bicarbonate phosphate B: local anesthetic C: sodium chloride D: distilled water

A: bicarbonate phosphate

Which portion of the anesthetic molecule is responsible for binding to the receptor site inside the nerve membrane thereby preventing depolarization? A: cations B: anion C: lipophils D: hydrophils

A: cations

Which is the best explanation for incomplete anesthesia of the central incisor following an ASA nerve block? A: cross innervation from the opposite side of injection B: poor angulation of the needle C: accessory innervation from the mandible D: depth of penetration too deep

A: cross innervation from the opposite side of injection

How are Schwann cells and Nodes of Ranvier related? A: gaps between Schwann cells are called Nodes of Ranvier B: they are the same thing C: they are not related D: Schwann cells are very thick at the Nodes of Ranvier

A: gaps between Schwann cells are called Nodes of Ranvier

In order to perform proper aspiration the ______ must be fully engaged into the anesthetic cartridge. A: harpoon B: thumb ring C: rubber stopper D: needle cap

A: harpoon

Amide local anesthetics are metabolized in which one of the following ways: A: in the liver B: in the pancreas C: in the blood via cholinesterase D: they break down into PABA

A: in the liver

Which one of the following could be an anatomical barrier to the success of an infiltration technique? A: large exostoses B: a petite face C: a swollen lip D: size of syringe

A: large exostoses

Tissue damage caused by disease or injury is best defined as: A: nociceptive pain B: neuropathic pain C: acute pain D: chronic pain

A: nociceptive pain

Which of the following will help patient with anxiety and fear at a dental appointment? A: prepare, rehearse, empower, and praise B: do not discuss past experiences, especially if stressful C: move quickly so patient doesn't have time to worry D: sing loudly to distract the patient

A: prepare, rehearse, empower, and praise

What is the best method of managing an anxious patient? A: prevention B: local anesthesia C: general anesthesia D: don't tell them what you are doing

A: prevention

Which of the following is NOT a possible systemic reaction to an overdose of local anesthetic: A: profuse sweating B: disorientation C: elevated blood pressure D: slurred speech

A: profuse sweating

The PSA nerve joins the infraorbital nerve to help form the maxillary nerve within the: A: pterygopalatine fossa B: infraorbital canal C: retromolar pad D: temporomandibular fossa

A: pterygopalatine fossa

Which of the following best describes the sequence for successful impulse generation: A: resting state, stimulation, slow depolarization, rapid depolarization, repolarization B: stimulation, resting state, rapid depolarization, repolarization C: stimulation, slow depolarization, resting state, firing threshold, depolarization D: resting state, stimulation, slow repolarization, rapid repolarization, depolarization

A: resting state, stimulation, slow depolarization, rapid depolarization, repolarization

The treatment plan for Florence Anderson includes restoration of teeth #6, #7, and #8. 1) 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? A: right ASA B: Right MSA C: left ASA D: 3 infiltrations

A: right ASA

To facilitate penetration of the needle, tissues at the site of injection should typically be: A: taut B: flaccid C: bunched D: loose

A: taut

What is the maximum recommended dose of epinephrine for patients in category ASA III with cardiovascular disease? A: 1.8 mg B: ,04 mg C: .2 mg D: .4 mg

B: ,04 mg

The trade names for prilocaine include: A: Polocaine and benzocaine B: Citanest and Citanest forte C: Novocaine D: Zorcaine

B: Citanest and Citanest forte

Which of the following are initial signs and symptoms of methemoglobinemia? A: seizures B: Gray cyanosis of mucous membranes, lips, nail beds C: dizziness D: flushed, clammy skin

B: Gray cyanosis of mucous membranes, lips, nail beds

Which statement correctly describes chronic pain? A: It responds well to pain medication and limited interventions. B: It follows a period of acute pain that persists for more than six months. C: It always has an identifiable cause and duration. D: It follows inception of nociceptive processes.

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

Which of the following statements related to an individual's response to a pain experience is not correct? A: It is proportionate to the intensity of physical injury and degree of harm. B: It is not influenced by an individual's gender and physical health. C: It is affected by attitudes and learned responses D: It is complex and includes both physiological and psychological factors.

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

Compare the potency of levonordefrin to the potency of epinephrine. A: Levonordefrin is one eighth as potent B: Levonordefrin is one sixth as potent C: Levonordefrin is one fourth as potent D: Levonordefrin is the same potency

B: Levonordefrin is one sixth as potent

Which of the following initial signs and symptoms should alert the clinician to a potential overdose reaction? A: Itching and hives B: Metallic taste and circumoral tingling/numbness C: visual hallucinations and confusion D: Hypotension and bradycardia

B: Metallic taste and circumoral tingling/numbness

Which statement is true regarding nociception? A: Nociceptors are deactivated by stimuli to minimize pain perception B: Nociceptors are activated without conscious awareness. C: Nociceptors trigger muscular neurons. D: Pain perception and nociception are synonymous.

B: Nociceptors are activated without conscious awareness.

Which of the following maxillary injection techniques has the highest risk of hematoma? A: Infiltration #7 B: PSA C: ASA D: Infiltration #10

B: PSA

Which of the following pieces of information is not required in order to calculate doses for local anesthetics and vasoconstrictors? A: Concentration of drug and dilution percentages B: Patient factors such as height, gender and anxiety level C: Maximum recommended dose and patient weight D: Standard cartridge volume and dilution percentages

B: Patient factors such as height, gender and anxiety level

Which of the following correctly describes the needle pathway for an MSA injection? A: The needle advances perpendicular to the long axis of the second premolar at the height of the mucobuccal fold through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings. B: The needle advances parallel to the long axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings. C: The needle advances parallel to the long axis of the first premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings. D: The needle advances distal to the second molar through thin mucosal tissue to superficial fascia consisting of dense connective tissue, microvasculature, and nerve endings.

B: The needle advances parallel to the long axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings.

The fundamentals of pain management include all of the following except: A: knowledge of drug effects B: periodontal assessment C: mastering multiple injection techniques D: comprehensive health history review

B: periodontal assessment

Which of the following needles gauges has the smallest lumen? A: 27 B: 23 C: 30 D: 25

C: 30

A 90-pound child has received two cartridges of 2% lidocaine, 1:100,000 epinephrine. How many more cartridges of the same drug solution can this patient receive before reaching the MRD? A: 20 B: 8 C: 6 D: 2

C: 6

Following a relatively severe heart attack, how long should elective dental treatment be delayed? A: 3 months B: 12 months C: 6 months D: 6 weeks

C: 6 months

A patient with poorly controlled chronic obstructive pulmonary disease (COPD) requiring oxygen is classified as: A: ASA I B: ASA II C: ASA IV D: ASA III

C: ASA IV

Which of the following agents would be best to administer if one were to anticipate both severe and prolonged post-operative dental pain? A: lidocaine with epinephrine B: Prilocaine with epinephrine C: Bupivacaine with epinephrine D: Mepivacaine 3%

C: Bupivacaine with epinephrine

Epinephrine is metabolized by: A: renal isoenzymes B: hepatic enzymes C: COMT and MOA D: COMT only

C: COMT and MOA

Oraqix is a eutectic mixture of which anesthetic drugs? A: prilocaine and benzocaine B: benzocaine and lidocaine C: Prilocaine and lidocaine D: lidocaine and cetacaine

C: Prilocaine and lidocaine

Which of the following is not an indication for the use of a vasoconstrictor? A: reducing the toxicity of local anesthetic drugs B: prolonging the duration of local anesthetic drugs C: Providing vasodilatation following treatment D: providing hemostasis (less bleeding)

C: Providing vasodilatation following treatment

Saltatory conduction is defined as the: A: Rapid diffusion of sodium chloride into the nerve cell during impulse conduction. B: Slow transmission of a nerve impulse due to diffusion of sodium across nerve membrane. C: Rapid transmission of nerve impulses along a myelinated nerve fiber. D: Slow conduction of an impulse along an unmyelinated nerve at the nodes of Ranvier

C: Rapid transmission of nerve impulses along a myelinated nerve fiber.

Which statement describes the correct positioning of the long window of the syringe? A: Towards the patient to permit assessment of the duration of the injections B: Away from the patient to block visibility throughout the injections C: Toward the clinician to permit visibility throughout the injections D: Either toward or away from the clinician because both side of the syringe have openings

C: Toward the clinician to permit visibility throughout the injections

A recommended treatment for hematomas includes the immediate application of pressure and A: heat B: topical anesthetic C: ice D: gauze

C: ice

Which one of the following patients has a relative contraindication for vasoconstrictor? A: controlled hypothyroidism B: well controlled blood sugars C: non-selective beta blocker medication D: heart attack 2 years ago with no current complications

C: non-selective beta blocker medication

What is the primary reason for a burning sensation upon injection of the anesthetic? A: contaminated solution B: psychogenic factors C: pH of the solution

C: pH of the solution

The following are the anesthetics used to formulate Cetacaine except one, which one is incorrect? A: tetracaine B: benzocaine C: prilocaine D: butamben

C: prilocaine

Local anesthetics block nerve conduction by preventing _____ ions from _______ the nerve. A: potassium entering B: sodium-leaving C: sodium-entering D: potassium-leaving

C: sodium-entering

In the resting state, a nerve membrane has an electrical potential of: A: +70 mV to +90 mV. B: -40 mV to +40 mV. C: +40 mV. D: -70 mV.

D: -70 mV.

What VOLUME of local anesthetic is the minimum recommended for the Anterior Superior Alveolar injection? A: .3 ml B: 1.8 ml C: 18 ml D: .9 ml

D: .9 ml

What type of needle will we be using with the inferior alveolar nerve block? A: 25 gauge short B: 27 gauge long C: 30 gauge long D: 25 gauge long

D: 25 gauge long

A 180-pound patient has received three cartridges of 2% lidocaine, 1:100,000 epinephrine. How many additional milligrams of 4% articaine, 1:200,000 epinephrine can be administered before reaching the MRD? Remember the rule that lowest MRD is the limiting factor. A: 228 B: 109 C: 72 D: 392

D: 392

Which of the following drugs would be the safest for a patient with cardiovascular disease? A: 2% lidocaine; 1:50,000 epinephrine B: 2% mepivacaine; 1:20,000 levonordefrin C: 4% articaine; 1:200,000 epinephrine D: 4% prilocaine plain

D: 4% prilocaine plain

A one-hour non surgical periodontal therapy appointment is planned for a patient with significant cardiovascular compromise. Past appointments indicate hemostasis is needed. Which of the following drugs would be safest and still have adequate duration? A: 2% lidocaine, 1:50,000 epinephrine B: it doesn't matter, any will be fine C: 3% mepivacaine plain D: 4% prilocaine, 1:200,000 epinephrine

D: 4% prilocaine, 1:200,000 epinephrine

The duration of a benzocaine topical anesthetic is A: 20-25 minutes B: 30-60 seconds C: 30-60 minutes D: 5-15 minutes

D: 5-15 minutes

What is the MRD in cartridges for 4% prilocaine with 1:200,000 epinephrine for a healthy 150 pound patient? A: 5 B: 6 C: 11 D: 8

D: 8

What is the FDA pregnancy category of Articaine? A: B or C depending on dosage B: A C: B D: C

D: C

Which of the following local anesthetic drugs is safest to use in the case of a known family history of methemoglobinemia? A: Benzocaine B: Prilocaine C: Tetracaine D: Lidocaine

D: Lidocaine

Which of the following MRD's is NOT correct for the adult patient? A: Articaine = (3.2 mg/lb) B: Mepivacaine = (3.0 mg/lb) C: Prilocaine = (4 mg/lb) D: Lidocaine = (2 mg/lb)

D: Lidocaine = (2 mg/lb)

Epinephrine is contraindicated in a patient with: A: Diabetes B: Heart disease C: Asthma D: Uncontrolled hyperthyroidism

D: Uncontrolled hyperthyroidism

As a group, ester-type local anesthetics are more likely than amide-type local anesthetics to provoke which of the following adverse drug reactions? A: remote overdose B: idiosyncrasy C: vasovagal syncope D: allergy

D: allergy

Which portion of the local anesthetic molecule binds to the receptor site inside the nerve membrane, preventing depolarization? A: lipophils B: neutral base ions C: nitrogen D: cation

D: cation

Which of the following vasoconstrictors is the most useful in providing hemostasis? A: felypressin B: phenylephrine C: levonordefrin D: epinephrine

D: epinephrine

An altered sensation and/or a persistent partial or complete numbness is referred to as ________. A: hematoma B: trismus C: anesthesia D: paresthesia

D: paresthesia

Youngs rule of pediatric calculations is based off of which theory? A: patients weight divided by 150 lb B: patients weight times mg/age C: patients weight times mg/lb D: patients age multiplied by adult dosage divided by the patients age plus twelve

D: patients age multiplied by adult dosage divided by the patients age plus twelve

Why do manufacturers alter the pKa of local anesthetic drugs? A: make it difficult to get numb B: decrease duration of drug C: increase duration of drug D: provide useful onset time

D: provide useful onset time

Which of the following is the most important consideration when preventing overdoses of local anesthetic drugs? A: identify allergies B: calculating safe dosage C: aspiration D: slow administration

D: slow administration

Which of the following is not an ideal indication for the solo use of topical anesthetic drugs in dentistry? A: needle penetrations B: periodontal evaluations C: radiographic film placement D: tooth extraction

D: tooth extraction

What anatomical feature may restrict the penetration site for an MSA injection? A: maxillary tuberosity B: canine eminence C: missing mucogingival junction D: zygomaticoalveolar crest

D: zygomaticoalveolar crest

In a few sentences, describe to me how you would respond to a patient who you are about to give an injection to who tells you, "I hate shots! It always hurts too much". Tell me what you would say to reassure this patient.

In order to reassure my patient, I would first sympathized with the patient . I would also explain the procedure to them if they felt comfortable with it, so that they will know what to expect. I would explain that there would be a small pinch at first, but it will not last long. If they felt uncomfortable at all, I would ask that they raise their left hand slowly, and that that would be my sign to stop what I am doing and assess the situation. This will give them a sense of empowerment. I would also use distraction techniques such as having them wiggle their toes or have them visualize a place that they are most relaxed and comfortable.

harpoon

Part of the piston that penetrates the stopper

T/F A clinician evaluates if a needle is in a blood vessel by aspirating. In the MSA, ASA, and infiltration injections, there is a high risk of positive aspiration.

The first statement is true, the second statement is false

T/F All vasoconstrictors in dentistry stimulate adrenergic receptors.

True

T/F Local complications occur more frequently than systemic complications following injections of local anesthetic.

True

T/F Most amide local anesthetics are biotransformed in the liver

True

T/F Pain threshold is highly reproducible in individuals

True

T/F The following explains the membrane expansion theory: Membrane ion channels narrow due to diffusion of local anesthetic molecules into lipophilic regions of the membranes

True

T/F The higher the pKa of a local anesthetic solution, the slower the onset on anesthesia.

True

T/F The lingual nerve is most frequently involved in paresthesia following dental injections.

True

Syringe barrel

designed to hold the cartridge of anesthetic

Patient assessment

first step in administering anesthesia

thumb ring

where your thumb goes to advance or retract the piston