Anesthesia Mock Exam

The coronoid notch is a landmark for which nerve block? A. Buccal block B. Mental block C. Inferior alveolar block D. Infraorbital block

C. Inferior alveolar block

The dental hygienist 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

At the first indication of a hematoma, the clinician should: A. Apply ice to the area B. Apply heat to the area C. Apply pressure to the area D. Apply ice for 10 minutes followed by heat for 10 minutes

C. Apply pressure to the area

Which of the following local anesthetics has the longest duration of action? A. Prilocaine 4% 1:200,000 epinephrine B. Articaine 4% 1:100,000 epinephrine C. Bupivacaine 0.5% 1:200,000 epinephrine D. Articaine 4% 1:200,000 epinephrine

C. Bupivacaine 0.5% 1:200,000 epinephrine

What does the clinician need to know about a possible epinephrine overdose? A. The body is not very efficient at removing vasoconstrictors. B. Adverse effects associated with epinephrine may last 20 minutes or longer. C. Epinephrine overdose produces overstimulation of adrenergic receptors. D. Normal signs and symptoms of an epinephrine overdose resemble CNS depression.

C. Epinephrine overdose produces overstimulation of adrenergic receptors.

During manufacturing, local anesthetics are formulated as which of the following to render them water-soluble? A. Muriatic acid B. Sodium bisulfite C. Hydrochloride salt D. Sodium bicarbonate

C. Hydrochloride salt

Undesirable side effects of incorporating sympathomimetic agents such as epinephrine into local anesthetic solutions include: A. Increased force of air exchange B. Increased bronchi dilation C. Increased rate and force of heart contractions D. All of the above

C. Increased rate and force of heart contractions

What is tachyphylaxis? A. A term used to describe the anesthetic's inability to reach the nerve membrane because of anatomical barriers B. Reinjection of anesthetic before the mantle fibers have fully recovered C. Increased tolerance to a drug that is administered repeatedly D. A term used to describe only partial anesthesia

C. Increased tolerance to a drug that is administered repeatedly

What are the causes of burning upon injection?

- Acidic (low) pH of solution - LA injected too fast - Cartridge being wiped with sterilizing solution (alcohol)

What causes a needle to break?

- Bending needle - Patient movement

How do you manage an allergic reaction?

- For an immediate reaction, give epinephrine - For a delayed reaction, give Benadryl

Management of trismus

- Heat therapy - Saline rinses - Asprin - Jaw exercises

What do vasopressors do?

- Increases duration of LA - Hemostasis (stops blood flow) - Reduces chance of toxicity

What happens during depolarization?

- Sodium comes in - Potassium goes out

How do you calculate the amount of epinephrine in a solution?

1% solution = 10 X 1.8 (or 1.7) = 18mg (or 17mg) 2% solution = 20 X 1.8 (or 1.7) = 36mg (or 34 mg) 3% solution = 30 X 1.8 (or 1.7) = 54 mg (or 51 mg)

What is the solution volume of a single cartridge of LA?

1.7-1.8 ml

What is anesthetic suggested deposit rate?

1ml/min

Which teeth does the PSA injection innervate?

1st, 2nd, and 3rd maxillary molars * Does not innervate the mesiobuccal cusp of the maxillary 1st molar

How far do you insert the needle on an IANB?

20-25 mm or 3/4 the length of the needle

What needle should be used for infiltration?

27 short

If a patient receives three 1.7 ml cartridges of 3% mepivicaine, how much drug did she receive?

3% equals =(1.7 x 30) x 3 =51 mg x 3 The answer is 153 mg.

Needle gauge: which lumen is smallest?

30 gauge * Smaller number, larger the lumen

Where do you inject if infiltrating the lingual aspect of molars?

5-10 mm from the free gingival margin

Levonordefrin has how many mg/mL of vasoconstrictor? A. 0.05 mg/mL B. 0.01 mg/mL C. 0.9 mg/mL D. 0.005 mg/mL

A. 0.05 mg/mL

If the dental hygienist administered 105 mg of bupivacaine to a 150-pound patient, how many cartridges were administered? A. 11.6 cartridges B. 10 cartridges C. 10.5 cartridges D. 12 cartridges

A. 11.6 cartridges

What is the recommended needle gauge for an inferior alveolar block? A. 25 gauge B. 27 gauge C. 30 gauge D. Any gauge is fine

A. 25 gauge

How should a clinician respond if after administering an inferior alveolar block the anesthesia is not adequate? A. Administer a second inferior alveolar block more superior than the first block B. Administer a second inferior alveolar block more inferior than the first block C. Administer a second inferior alveolar block more medial than the first block D. Administer a second inferior alveolar block more lateral than the first block

A. Administer a second inferior alveolar block more superior than the first block

What is the primary reason that catecholamines are added to local anesthetic solutions? A. Decrease the risk of toxicity B. Decrease the duration of action C. Decrease the risk of postoperative pain D. Decrease the risk of infection

A. Decrease the risk of toxicity

After the administration of a local anesthetic, what causes a droopy eyelid? A. Depositing the solution in the parotid gland B. Depositing the solution medial to the mandibular foramen C. Depositing the solution above the infraorbital foramen D. Depositing the solution at the anteromedial border of the neck of the mandibular condyle

A. Depositing the solution in the parotid gland

How much epinephrine does a 1:200,000 dilution contain compared with a 1:100,000 dilution? A. Half B. Twice C. One quarter D. One forth

A. Half

What part of the syringe indicates it is an aspirating syringe? A. Harpoon B. Syringe adaptor C. Thumb ring D. Piston

A. Harpoon

Which characteristic enhances the onset and effectiveness of local anesthetics? A. High lipid solubility B. High pKa C. Low pH D. High concentration of cation molecules

A. High lipid solubility

Which component of the local anesthetic molecule renders the molecule water-soluble? A. Hydrophilic amino group B. Intermediate hydrocarbon ester or amide chain C. Lipophilic aromatic ring D. All of the above

A. Hydrophilic amino group

Which anesthetic falls under pregnancy risk category B? A. Lidocaine B. Bupivacaine C. Articaine D. Mepivacaine

A. Lidocaine

Which of the following nerves when anesthetized provides soft tissue anesthesia of the lower lip and chin? A. Mental nerve B. Incisive nerve C. Inferior alveolar nerve D. Buccal nerve

A. Mental nerve

Sodium bicarbonate is added to local anesthetic solutions: A. Only when a vasoconstrictor is added B. To prevent the oxidation of the amide C. To make the solution isotonic D. To help increase the pH of the vasoconstrictor

A. Only when a vasoconstrictor is added

Which of the following local anesthetic blocks can produce hematomas that cause severe swelling and extraoral bruising as a result of nicking a blood vessel? A. Posterior superior alveolar block B. Inferior alveolar block C. Gow-Gates mandibular block D. Mental or incisive blocks

A. Posterior superior alveolar block

Which of the following local anesthetic blocks has the HIGHEST risk of hematoma for the patient after administration? A. Posterior superior alveolar block B. Inferior alveolar block C. Gow-Gates mandibular block D. Mental or incisive blocks

A. Posterior superior alveolar block

What is the best explanation as to why a patient has a lesion on his or her lip the day after receiving an inferior alveolar block? A. Self-mutilation B. Allergic to the anesthetic C. Trauma induced during dental hygiene instrumentation D. Prolonged use of topical anesthetic

A. Self-mutilation

Why does anesthesia fail to work near an abscessed tooth?

Abscessed tooth= infection * Infection causes pH to lower, which does not allow the ionization of sodium molecules

You just administered anesthetic to your patient, and within minutes a rash forms on the patients neck. She complains of having difficulty breathing. What would you do?

Administer epinephrine

Where is epinephrine naturally found in the body?

Adrenal gland (endocrine system)

What is an antiseptic that is not used when giving local?

Alcohol

What would cause a dry cornea?

Anesthetizing the facial nerve (VII) - The facial nerve can be anesthetized if bone is not contacted during an IANB injection and anesthetic is deposited into the parotid gland causing bell's palsy - Temporary bell's palsy will not allow the patients eyelid to blink or close, causing a dry cornea

Where is the injection site for infiltrating the lingual aspect of tooth 13?

Apex of tooth

Which local anesthetic should be avoided in patients with a sulfa allergy?

Articaine

What is the cardiac dose for epinephrine? A. 0.2 mg B. 0.04 mg C. 1.0 mg D. 2.0 mg

B. 0.04 mg

Which of the following vasoconstrictor dilutions provides the greatest hemostasis? A. 1:20,000 levonordefrin B. 1:50,000 epinephrine C. 1:100,000 epinephrine D. 1:200,000 epinephrine

B. 1:50,000 epinephrine

How many cartridges could a patient from the answer in question #7 safely receive if administering a 1:200,000 epinephrine dilution? A. 1.1 cartridges B. 4.4 cartridges C. 2.2 cartridges D. 3.3 cartridges

B. 4.4 cartridges

Signs and symptoms of a vasoconstrictor overdose are manifested as: A. CNS depression B. CNS stimulation C. Cardiovascular depression D. Respiratory depression

B. CNS stimulation

Supraperiosteal injections are less successful on the mandible because of the: A. Porous bone of the mandible B. Density of the bone of the mandible C. pH of the tissue on the mandible D. Large nerve trunks of the mandible

B. Density of the bone of the mandible

What is the main reason anesthesia fails to occur near an abscessed tooth? A. Infection causes an increase in the tissue pH B. Infection causes a decrease in the pH of the tissue C. Infection causes a neutral pH D. None of the above; infection has no relationship to the success of anesthesia

B. Infection causes a decrease in the pH of the tissue

You have administered 2% lidocaine, 1:50,000 mg/ml epinephrine to a healthy patient. The patient experiences restlessness and nausea and begins to hyperventilate. What should you suspect? A. Central nervous system stimulation B. Overdose of epinephrine C. Metabolic rise in blood sugar D. Local anesthetic overdose

B. Overdose of epinephrine

Which of the following is responsible for allergic reactions to ester anesthetics? A. The parent compound B. Para-amino benzoic acid C. Pseudocholinesterase D. Sodium bisulfite

B. Para-amino benzoic acid

The dental hygienist successfully administers an inferior alveolar block, but the patient does not get numb. What is the possible reason why the patient does not get numb? A. Solution deposited superior to the mandibular foramen B. Solution deposited inferior to the mandibular foramen C. Solution deposited too rapidly D. Solution deposited too slowly

B. Solution deposited inferior to the mandibular foramen

Which of the following maintains the resting potential of a nerve fiber? A. The K+ pump B. The Na+ pump C. The concentration gradient D. The electrical impulse

B. The Na+ pump

In the above question number #34, what occurred? A. The dental hygienist administered the absolute maximum dose. B. The dental hygienist administered an overdose. C. The dental hygienist safely administered 0.6 more mg of anesthetic. D. The dental hygienist may administer an additional cartridge.

B. The dental hygienist administered an overdose.

During the inferior alveolar block the patient feels a sudden electrical shock. This is due to: A. The needle touching the inferior alveolar nerve B. The needle touching the lingual nerve C. The needle touching the buccal nerve D. The needle touching the pterygomandibular raphe

B. The needle touching the lingual nerve

What is the most common medical emergency observed in the dental office? A. Cardiac arrest B. Vasodepressor syncope C. Seizures D. Allergic reaction

B. Vasodepressor syncope

When is lidocaine 1:50,000 epinephrine most effective? A. When postoperative pain control is needed B. When hemostasis is needed C. When treating a cardiovascularly involved patient D. When more profound pain control is needed

B. When hemostasis is needed

While administering the inferior alveolar local anesthetic block, the clinician contacts bone at a depth of 10 mm on an adult patient. What should the clinician do? A. Aspirate correctly and then deposit anesthetic agent at the site B. Withdraw the needle almost completely and redirect the syringe barrel more anterior C. Withdraw the needle partially or completely and redirect the syringe barrel more posterior D. Withdraw the needle partially and redirect the syringe barrel more perpendicular to the occlusal plane

B. Withdraw the needle almost completely and redirect the syringe barrel more anterior

A barbed needle causes pain upon: A. Insertion B. Withdrawal C. Deposition of anesthetic D. Aspiration

B. Withdrawal

How many mg of epinephrine are in one cartridge of a 1:100,000 dilution? A. 0.009 mg B. 0.01 mg C. 0.018 mg D. 0.02 mg

C. 0.018 mg

Which of the following anesthetics has the shortest duration when administering a local anesthetic block? A. Lidocaine 1:100,000 B. Mepivacaine 1:20,000 C. Mepivacaine 3% D. Prilocaine 4%

C. Mepivacaine 3%

When a nerve is in its resting state, the: A. K+ is concentrated outside the cell B. Cell membrane is positive on the outside of the cell C. Na+ is concentrated outside the cell D. Cell membrane is more positive on the inside of the cell

C. Na+ is concentrated outside the cell

Which of the following local anesthetics is metabolized in the lungs and liver? A. Mepivacaine B. Bupivacaine C. Prilocaine D. Articaine

C. Prilocaine

How can the clinician correct the problem of hitting bone while administering the PSA injection? A. The needle needs to be bent slightly in order to accomplish the necessary needle angulation. B. The syringe needs to be farther away from the occlusal plane, thereby increasing the angle to more than 45 degrees. C. The syringe needs to be closer to the occlusal plane, thereby reducing the angle to less than 45 degrees. D. The patient most likely has a larger size skull, so a long needle should be utilized for patient comfort.

C. The syringe needs to be closer to the occlusal plane, thereby reducing the angle to less than 45 degrees.

What is the first sign of local anesthesia toxicity?

CNS excitement

What is the maximum epinephrine dose for cardiac & normal patients?

Cardiac- .04mg Normal- .2mg

Management of hematoma

Cold compression & pressure to bleeding site

What is the landmark for the IANB injection?

Coronoid notch

Which of the following local anesthetics will provide the longest duration of action following a nerve block when a vasoconstrictor is absolutely contraindicated? A. 3% mepivacaine B. 0.5% bupivacaine C. 2% lidocaine D. 4% prilocaine, plain

D. 4% prilocaine, plain

Which of the following BEST describes the (long) buccal nerve? A. Efferent nerve for the facial gingival tissue of the mandibular anterior teeth B. Afferent nerve for the facial gingival tissue of the mandibular anterior teeth C. Efferent nerve for the buccal gingival tissue of the mandibular posterior teeth D. Afferent nerve for the buccal gingival tissue of the mandibular posterior teeth

D. Afferent nerve for the buccal gingival tissue of the mandibular posterior teeth

Which anesthetic is primarily metabolized in the blood? A. Lidocaine B. Mepivacaine C. Prilocaine D. Articaine

D. Articaine

What are the nerves that conduct signals away from the brain or spinal cord called? A. Neurotransmitters B. Electrical synapses C. Afferent nerves D. Efferent nerves

D. Efferent nerve

Which nerve when anesthetized also anesthetizes BOTH the anterior and middle superior alveolar nerves? A. Posterior superior alveolar B. Inferior alveolar C. Incisive D. Infraorbital

D. Infraorbital

Prolonged paresthesia of the anterior part of the tongue is caused by which nerve being traumatized? A. Inferior alveolar nerve B. Mental nerve C. Incisive nerve D. Lingual nerve

D. Lingual nerve

Local anesthetics work by penetrating the nerve to inhibit: A. Cl+ influx B. Na+ influx C. K- efflux D. Na+ efflux E. K- influx

D. Na+ efflux

Delayed signs and symptoms of an allergic reaction are more intense and serious. If skin reactions develop immediately following the injection, anaphylaxis may occur. A. Both statements are true. B. Both statements are false. C. The first statement is true; the second statement is false. D. The first statement is false; the second statement is true.

D. The first statement is false; the second statement is true.

What do beta blockers do?

Decrease blood pressure

Where is the location for the long buccal injection?

Distal and buccal to the 2nd mandibular molar

Select the following anesthetic(s) available in the US that is(are) formulated with epinephrine 1:200,000 A. Lidocaine B. Mepivacaine C. Prilocaine D. Articaine E. C and D

E. C and D

Which Ester has the highest occurrence of allergic reactions?

Ester option; Benzocaine * Only applied topically

Which type of local anesthetic is metabolized by pseudocholinesterase (PABA)?

Esters

Where does the mandibular nerve pass through in the skull?

Foramen Ovale

#15 has a perio abscess and you've already given the PSA - what other injection will you need to numb the linguals of tooth 15?

Greater Palatine

Which injections are needed to anesthetize the entire palate on one side?

Greater Palatine & Nasopalatine

What part of the syringe indicates it is an aspirating syringe?

Harpoon

What injection numbs the lower lip?

IANB

Which injection are you MOST likely to use a long needle?

IANB

Which injection causes a transient facial paralysis and how is it caused?

IANB - Caused by anesthesia entering into the parotid gland

Why would a patient receive an electric shock during delivery of anesthesia?

If the needle contacts/touches the nerve sheath

Where does the nasopalatine nerve pass through?

Incisive foramen

Which injection is best for hemostasis?

Infiltration

Which nerve is NOT associated with the mandibular nerve branch?

Infraorbital nerve

What causes a hematoma?

Injecting in the pterygoid plexus during a PSA injection

What kind of tissue is topical anesthetic least effective on?

Keratinized tissues

What is the benefit of slow deposition rate?

Less pain & less complications

What nerve innervates the soft palate?

Lesser Palatine Nerve

What is trismus?

Limited opening of mouth

Numbness of the anterior 2/3 of the tongue is caused by which nerve being anesthetized?

Lingual nerve

What is the cause of a patient having a lesion on the lower lip the next day after local?

Lip bite

What function does sodium chloride provide in LA solutions?

Makes the solution isotonic

The IANB goes through what foramen?

Mandibular foramen

Do myelinated nerves travel faster or slower than unmyeliated nerves?

Myelinated nerves travel faster than unmyelinated

A central incisor has a periodontal defect on the lingual root surface, which injection would you use?

Nasopalatine

Which injection is needed to anesthetize linguals of maxillary anteriors?

Nasopalatine

What is a possible cause of pain upon removal of a needle?

Needle barb

Psychogenic pain

No organic base for the pain

Hematoma can occur if needle penetrates into the pterygoid plexus of veins during which injection?

PSA

Which injection causes a risk of a hematoma?

PSA

What sensation is lost first?

Pain

If you were going to anesthetize the maxillary incisors, where would you inject?

Papilla

Which anesthetic is not an amide?

Procaine * All amides have an "i" before "caine" & usually have two "i"

When do you aspirate?

Right before anesthetic is deposited * This makes sure you do not insert the needle into a blood vessel

What is the maxillary division of the trigeminal nerve?

Sensory

Which antioxidant prevents biodegration of LA by stoping oxidation of a vasopressor?

Sodium bisulfite

What type of injection is local anesthesia?

Subcutaneous

What is the significance of giving an amide anesthetic to a patient with Cirrhosis?

The amide anesthetic is metabolized by the liver

When giving an injection, the patient experiences no pain until anesthetic is deposited - what happen?

The anesthetic was deposited too fast

Why do infiltrations work better in maxilla than mandible?

The mandible is more dense than the maxilla

You are seeing a patient for SRP and they have Cirrhosis of the liver, what complications could arise from using an amide local anesthetic?

The patient will have complications metabolizing the drug

What is true about topical anesthetics?

There are no systemic problems with them

What is the least preferable way to recap a needle?

Using the 2 hand method

How does a self aspirating syringe work?

When pressure is let off the syringe, it automatically aspirates

When giving a IANB injection, at what point will the needle contact the bone?

When the needle is inserted 2/3, it will contact the ramus

When energy for conduction is derived from the nerve cell membrane itself and is no longer dependent on the stimulus for continuance, the conduction is considered to be: A. Below the minimal threshold level B. Above the minimal threshold level C. Self-propagating D. In the absolute refractory period

`C. Self-propagating