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Anesthesia Board Review

Terms in this set (601)

An allergy to sulfites would be an absolute contraindication to the use of:
A. Mepivacaine 3%
B. Citanest Plain
C. Lidocaine 2%
D. Lidocaine 3%

C. lidocaine 2%

Which of the following is a name for prilocaine?
A. xylocaine
B. septocaine
C. scandonest
D. citanest
E. marcaine

D. citanest

Prilocaine is biotransformed by the:
A. liver
B. liver and blood
C. liver, kidneys, and lungs
D. liver, lungs, and large intestines

C. liver, kidneys, and lungs

The anatomical landmark for the MSA injection is:
A. Above the maxillary first premolar
B. Above the maxillary second premolar
C. Above the mesiobuccal cusp of the maxillary first molar
D. None of the above

B. above the maxillary second premolar

The long buccal injection anesthetizes which areas?
A. Maxillary tissue to the midline
B. Retromolar area
C. Tissue just buccal to the mandibular molars and premolars
D. Mandibular labial tissue from cuspid to cuspid

C. tissue just buccal to the mandibular molars and premolars

Which of the following agents would be best to administer, if one were to anticipate both severe and prolonged post-operative dental pain?
A. Mepivacaine (Carbocaine)
B. Prilocaine with epinephrine (Citanest Forte)
C. Bupivacaine with epinephrine (Marcaine)
D. Lidocaine with epinephrine (Xylocaine)
E. None of the above

C. Bupivacaine with epinephrine (Marcaine)

Because the patient complains of inadequate "numbing," eight more cartridges of lidocaine 2% with epinephrine 1:100,000 vasoconstrictor are injected. The patient then begins talking incessantly, exhibiting restlessness and fasciculations (twitching) of the extremities, and then becomes sleepy and suffers a convulsion. The blood pressure and heart rate are depressed. These symptoms are most likely caused by:
A. A toxicity reaction to the local anesthetic agent
B. A toxic reaction to the vasoconstrictor
C. A fear reaction
D. The fact that the patient is epileptic
E. None of the above

A. a toxicity reaction to the local anesthetic agent

Local anesthetic dosages should be reduced for which of the following conditions?
A. Frail elderly
B. Very young children
C. Liver disease
D. All of the above
E. None of the above

D. all of the above

What is the primary reason for a burning sensation when the anesthetic agent is injected?
A. pH of the solution
B. Psychogenic
C. Developing hematoma
D. Contaminated solution

A. pH of the solution

Your client is 75 years old and is of average height and weight. His health history includes high blood pressure for which he takes medication, and arthritis for which he takes aspirin daily. He is in the office for restorative treatment on the facial of #27, 28, and 29. Which injection would be indicated?
A. RIA
B. LPSA
C. R Incisive
4. R mental

C. R incisive

Your client is 75 years old and is of average height and weight. His health history includes high blood pressure for which he takes medication, and arthritis for which he takes aspirin daily. He is in the office for restorative treatment on the facial of #27, 28, and 29.What anesthetic will you choose?
A. Mepivacaine 3%
B. Prilocaine 4% w/epi.
C. Lidocaine 2% w/ epi
D. Bupivacaine

C. lidocaine 2% with epi

How many milligrams of mepivacaine is in 3 cartridges of a 3% solution?
A. 30 mg
B. 30 mg
C. 72 mg
D. 108 mg
E. 162 mg

E. 162 mg

[T:F] A rapid rate of injection will increase the rate of absorption at the site of injection, thereby decreasing local anesthetic blood levels

false: increasing the rate increases local anesthetic blood levels

The most common emergency in relation to local anesthesia that will be encountered is:
A. Allergy to the anesthetic
B. Syncope
C. Hyperactivity
D. Shock

B. syncope

What size and gauge needle is used most commonly for the MSA?
A. 30 gauge extra short
B. 27 gauge long
C. 25 gauge short
D. 27 gauge short

27 gauge short

For the MSA injection to be successful, where should the anesthetic solution be deposited?
A. in the mucobuccal fold
B. into the attached gingiva
C. at apex of premolars
D. at the infraorbital foramen

C. apex of the premolars

[T:F] Vasoconstrictors are absolutely contraindicated in a well-controlled cardiovascular patient.

false

The action of epinephrine when combined with a local anesthetic is to:
A. increase the amount of local anesthetic needed for an effect
B. decrease the effective length of action of an anesthetic
C. enhanced circulation and wash the anesthetic from site of action more quickly
D. increase the duration of anesthesia

D. increase the duration of anesthesia

Epinephrine is added to local anesthetic solutions to:
A. Prevent circulatory collapse if the local anesthetic is accidentally injected intravenously
B. Prevent asthmatic attacks if the local anesthetic is accidentally injected intravenously
C. Increase the rate of diffusion and absorption from the injection site
D. Decrease the rate of diffusion and absorption from the injection site

D. Decrease the rate of diffusion and absorption from the injection site

Hematomas are most likely to occur with which of the following injections?
A. PSA
B. MSA
C. ASA
D. All of the above
E. None of the above

A. PSA

To facilitate penetration of the needle, tissues at the site of an injection should typically be:
A. Flaccid
B. Taut
C. Bunched
D. Depressed

b. taut

For a healthy adult male patient of average size, what is the maximum safe dose of mepivicaine 3% without epinephrine?

400 mg

[T:F] The excretion of prilocaine is through the kidney

true

What is the one absolute contradiction for the use of prilocaine?
A. periodontitis
B. anemia
C. allergy
D. asthma

C. allergy

What is one of the symptoms of methemoglobinemia?
A. hyperactivity
B. anxiety
C. cyanotic appearance, usually in the nail beds and lips
D. depression

C. cyanotic appearance, usually in the nail beds and lips

A dental hygienist gives an inferior alveolar nerve block injection on the left side. The left central and lateral incisors remain sensitive. What is the best explanation for this?
A. an insufficient amount of solution was given
B. the needle placement was incorrect
C. the sensitive teeth are receiving innervation from the right side
D. the sensitive teeth are receiving innervation from the cervical plexus

C. the sensitive teeth are receiving innervation from the right side

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. allergy
B. overdose
C. idiosyncrasy
D. hypertension
E. syncope

A. allergy

Why don't patients always demonstrate the expected duration of anesthesia?
A. variability of individual response
B. inaccurate deposition of local anesthesia
C. tissue status (vascularity, pH)
D. anatomic variation
E. type of injection (infiltration vs. nerve block)
F. all of the above

F. all of the above

How long does it take a topical anesthetic to reach maximum soft tissue analgesia?
A. 2-3 minutes
B. 45 seconds
C. 15 seconds
D. the effect is immediate

A. 2-3 minutes

You are giving Mepivicaine to a 150lb patient.
1. what is the absolute MRD?
2. What is the weight based MRD?
3. What is the number of cartridges you can give this patient?

1. 400 mg
2. 450 mg
3. 7.4 cartridges

You are giving Lidocaine to a 150 lb patient:
1. What is the absolute MRD?
2. What is the weight based MRD?
3. What is the number of cartridges you can give this patient?

1. 500 mg
2. 480 mg
3. 13.33 cartridges

You are giving Bupivicaine to a 150lb patient.
1. What is the absolute MRD?
2. what is the weight based MRD?
3. what is the number of cartridges you can give this patient?

1. 90 mg
2. there is no weight based MRD
3. 10 cartridges

What is the absolute MRD for bupivacaine?
A. 25 mg
B. 35 mg
C. 45 mg
D. 90 mg

D. 90 mg

Which of the following local anesthetic drugs is available in a 0.5% concentration?
A. prilocaine
B. mepivacaine
C. articaine
D. bupivacaine

D. bupivacaine

You are giving Articaine to a 150lb patient.
1. What is the absolute MRD?
2. What is the weight based MRD?
3. What is the number of cartridges you can give this patient?

1. there is no absolute MRD
2. 480 mg
3. 6.6 cartridges

Which of the following local anesthetic nerve blocks anesthetizes the buccal gingival tissue of the maxillary first molar?
A. Inferior alveolar nerve block
B. Anterior superior alveolar nerve block
C. Buccal nerve block
D. Posterior superior alveolar nerve block

D. posterior superior alveolar nerve block

A patient is missing the mandibular right molars, and surgery is to be performed on the remaining mandibular teeth across the arch. Which combination of local anesthetic nerve blocks would most likely be administered and still be successful?
A. Right mental and left inferior alveolar nerve blocks
B. Left inferior alveolar and right incisive nerve blocks
C. Right posterior superior alveolar and left inferior alveolar nerve blocks
D. Right mental and left incisive nerve blocks
E. Bilateral inferior alveolar nerve blocks

B. left inferior alveolar and right incisive nerve blocks

A 9-year-old child is having a restoration placed on the occlusal surface of the mandibular left first molar. Which of the following heights of the inferior alveolar local anesthetic nerve block sites should be followed during the pain control procedure?
A. Only 6 to 10 mm superior to the occlusal plane of the mandibular molars
B. Slightly inferior to the occlusal plane of the mandibular molars
C. At the same height as the occlusal plane of the mandibular molars
D. More than 10 mm superior to the occlusal plane of the mandibular molars

C. At the same height as the occlusal plane of the mandibular molar

A restoration will be placed on the distal surface of the maxillary first premolar. Which of the following local anesthetic nerve blocks must be administered?
A. Anterior superior alveolar nerve block
B. Middle superior alveolar nerve block
C. Nasopalatine nerve block
D. Inferior alveolar nerve block

B. middle superior alveolar nerve block

As a result of a bicycle accident, a patient has suffered trauma to the upper lip and maxillary central incisors. Which of the following local anesthetic blocks may be used when treating the injured tissue?
A. Anterior superior alveolar, infraorbital, and incisive nerve blocks
B. Anterior superior alveolar, infraorbital, and nasopalatine nerve blocks
C. Anterior superior alveolar, middle superior alveolar, and greater palatine nerve blocks
D. Infraorbital, greater palatine, and Gow-Gates mandibular nerve blocks

B. Anterior superior alveolar, infraorbital, and nasopalatine nerve blocks

From the following list of complications involving the eyelid, nose, and upper lip, select the two most common ones associated with the infraorbital nerve block.
a. Hematoma
b. Stimulation of the gag reflex
c. Tingling
d. Numbness

c. tingling
d. numbness

From the following list of descriptions all can be commonly used when describing paresthesia and its progression except:
A. Abnormal area sensation
B. Burning or prickling
C. Can occur after local anesthesia
D. Can occur with infections
E. Can occur with nonsurgical procedures

E. Can occur with nonsurgical procedures

From the following list of landmarks, select those which are noted by dental professionals when administering the inferior alveolar nerve block.
A. Occlusal plane
B. Maxillary tuberosity
C. Pterygomandibular fold
D. Coronoid notch
E. Mandibular notch

A, C, and D

From the following list of landmarks, select those which are noted when administering the posterior superior alveolar nerve block by dental professionals.
A. Mucobuccal fold
B. Coronoid notch
C. Maxillary first molar
D. Maxillary tuberosity

A and D

[T:F] The dental professional must know the location of certain adjacent soft tissue structures, such as major blood vessels and glandular tissue. This is to make sure to allow for injecting these structures.

first statement true
second statement false: one should not inject in these areas

[T:F] there is only one type of local anesthetic injection used commonly in dentistry, the nerve block. The type of injection used for a given dental procedure is determined by the type and length of the procedure.

first statement false: there is also the infiltration and field block injections
second statement is true

[T:F] When administering the inferior alveolar local anesthetic nerve block, it is important to contact bone because this will decrease the risk of depositing a local anesthetic agent into the parotid salivary gland.

both statements are true

Which local anesthetic nerve block would be necessary for a patient undergoing surgery on an edentulous mandibular left alveolar process in the area of extracted molars?
A. Left buccal nerve block
B. Right buccal nerve block
C. Left mental nerve block
D. Right infraorbital nerve block

A. left buccal nerve block

Which of the following local anesthesia nerve blocks is usually not used bilaterally due to possible complications associated with swallowing and speech?
A. Incisive nerve block
B. Inferior alveolar nerve block
C. Posterior superior alveolar nerve block
D. Greater palatine nerve block

B. inferior alveolar nerve block

Which of the following local anesthetic nerve blocks uses the apex of the maxillary canine for a landmark during administration?
A. Infraorbital nerve block
B. Anterior superior alveolar nerve block
C. Middle superior alveolar nerve block
D. Posterior superior alveolar nerve block

B. anterior superior alveolar nerve block

Which of the following angulations of the needle MUST be followed during the administration of the posterior superior local anesthetic nerve block?
A. Superiorly at 45 degrees and medially at 90 degrees to the occlusal plane
B. Superiorly at 90 degrees and medially at 45 degrees to the occlusal plane
C. Superiorly at 45 degrees and medially parallel to the occlusal plane
D. Superiorly at 45 degrees and medially at 45 degrees to the occlusal plane

D. Superiorly at 45 degrees and medially at 45 degrees to the occlusal plane

Which of the following locations is the injection site for the inferior alveolar local anesthetic nerve block?
A. the pterygomandibular fold
B. Lateral to the pterygomandibular fold
C. Superior to the pterygomandibular fold
D. Inferior to the pterygomandibular fold

B. lateral to the pterygomandibular fold

Which of the following complications can occur during the administration of the inferior alveolar local anesthetic nerve block, resulting in inability to close the eyelid?
A. Motor function of the abducens nerve
B. Motor function of the facial nerve
C. Motor function of the oculomotor nerve
d. Sensory function of the facial nerve

B. motor function of the facial nerve

A client develops paralysis of a half of his face and inability to close his eye on the side of an attempted inferior alveolar nerve block. The most logical explanation is that the injection was given into the:
A. Parotid gland
B. Masseter muscle
C. Maxillary artery
D. Posterior facial vein
E. Pterygo-mandibular ligament

A. parotid gland

All of the following statements about intraoral injections are false except:
A. IANB does not block the mylohyoid nerve
B. Periodontal ligament (PDL) injections are only administered using a specialized syringe
C. Infraorbital injections block the entire maxillary nerve
D. The success rate of the IANB is 80% to 85%

D. The success rate of the IANB is 80% to 85%

All of the following statements about intraoral injections are false except:
A. The incisive nerve block provides lingual soft tissue anesthesia
B. An initial negative aspiration ensures no risk for intravascular injection, and additional aspiration is unnecessary during solution deposition
C. The site of needle insertion for a posterior superior alveolar nerve block is the height of the mucobuccal fold above the maxillary second molar
D. The recommended amount of time to inject a 1.8-mL cartridge with regard to client safety and comfort is 30 seconds

C. The site of needle insertion for a posterior superior alveolar nerve block is the height of the mucobuccal fold above the maxillary second molar

All of the following statements about local anesthesia are true except:
A. Hemostasis is only achieved when the vasoconstrictor is deposited into the area of bleeding
B. Maximum dosages of all drugs administered by injection should be calculated by body weight
C. Children can tolerate adult doses of local anesthetics because of their faster metabolism, and overdose is of little concern
D. The possible causes of decreased anesthetic effect include edema, pH, and vascularity
E. Overdose reactions are dose related; allergic reactions are not dose related

C. Children can tolerate adult doses of local anesthetics because of their faster metabolism, and overdose is of little concern

All of the statements concerning local anesthetic cartridges are true except:
A. The glass dental cartridge should not be autoclaved
B. No alcohol should be present around the cartridges when they are stored outside the packaging container
C. The rubber plunger is treated with silicone to decrease the incidence of "sticky stoppers"
D. Cartridges exposed to extended periods of direct sunlight may have their contents undergo accelerated destruction
E. Manufacturers recommend freezing cartridges so that they may be used beyond the posted expiration date

E. Manufacturers recommend freezing cartridges so that they may be used beyond the posted expiration date

All of the statements concerning local anesthetic needles are true except:
A. The term gauge refers to the diameter of the lumen of the needle
B. The weakest portion of the needle is at its hub
C. Larger needles provide more reliable aspirations
D. Disposable needles will not normally become dull for at least 10 insertions
E. Larger needles should be employed when a greater risk of positive aspiration exists

D. Disposable needles will not normally become dull for at least 10 insertions

Complete the sentence with the most accurate phrase. Local anesthetics______________________.
A. Combine lipid-soluble acids and basic esters
B. Form water-soluble salts with strong acids, which are unionized
C. Dissociate in the tissues, liberating free base, which can diffuse through the nerve membrane
D. Form amides, which transform to esters in tissues
Are synthetic and do not contain amino groups

C. Dissociate in the tissues, liberating free base, which can diffuse through the nerve membrane

How many milligrams of epinephrine are in a cartridge of local anesthetic with 1:200,000?

0.009 mg

Inadvertent rapid intravenous injection of a local anesthetic containing a vasoconstrictor may cause:
A. Convulsions
B. Palpitations
C. Unconsciousness
D. Depressed respiration
E. All of the above

E. all of the above

Terminal deposition for the inferior alveolar nerve block is:
A. Mental foramen
B. Mandibular foramen
C. Cingulum
D. Infraorbital foramen

B. mandibular foramen

The following injection(s) should be administered when scaling and root debridement of a mandibular second molar:
A. Mental nerve block
B. Buccal nerve block
C. Inferior alveolar nerve block
D. B and C
E. None of the above

D. B and C

the gauge of a dental needle most recommended for intraoral injections with high risk of aspiration is:
A. 18 gauge
B. 30 gauge
C. 27 gauge
D. 25 gauge
E. 23 gauge

D. 25 gauge

The maximum safe dose of epinephrine for the healthy adult is 0.2 mg. How many cartridges of 1:100,000 epinephrine can be administered?
A. 2 cartridges
B. 5 cartridges
C. 9 cartridges
D. 10 cartridges
E. 11 cartridges

E. 11 cartridges

The problem(s) with topical anesthesia is(are):
A. Dosage control
B. All are esters except 5% lidocaine
C. Concentrations used exceed concentrations administered by injection
D. Topical anesthetic agents containing benzocaine are, by far, the most common
E. All of the above

E. all of the above

The purpose of aspirating before injecting a local anesthetic solution is to prevent:
A. Allergic reactions
B. Intravascular injections
C. Traumatic injections
D. Trismus

B. intravascular injections

Trismus noted in a client the day following an inferior alveolar nerve block most likely results from:
A. Failure to use an aspirating syringe
B. Irritation of the medial pterygoid muscle
C. Accidental injection of the solution near a branch of the facial nerve
D. Allowing the needle tip to rest beneath the periosteum during injection
E. Accidental injection of the solution near a major branch of the trigeminal nerve

B. irritation of the medial pterygoid muscle

What is the average adult depth of penetration for the mental nerve block?
A. 12 mm
B. 6 mm
C. 9 mm
D. Until the bevel is covered
E. Until bone is contacted

B. 6 mm

What is(are) the overdose effect(s) of epinephrine?
A. Palpitation
B. Tachycardia
C. Hypertension
D. Headache
E. All of the above

E. all of the above

Which of the following is not a sign or symptom of an epinephrine overdose reaction?
A. nausea
B. heart racing
C. bronchospasm
D. weakness

C. bronchospasm

Which of the following statements about the metabolism of local anesthetic agents is true?
A. Amides undergo biotransformation by pseudo-cholinesterase
B. Vasoconstrictors are broken down in the liver
C. The rate of metabolism does not have any effect on potential toxicity
D. The location of biotransformation is dependent on drug classification
E. The metabolism of local anesthetic agents occurs in the kidneys

D. The location of biotransformation is dependent on drug classification

Which of the following nerves should be adequately anesthetized to scale and root-debride a maxillary first molar?
A. GP and PSA
B. LP, GP, and NP
C. PSA, MSA, and GP
D. ASA, MSA, and GP
E. PSA, MSA, and LP

C. PSA, MSA, and GP

Which of the following would be the LONGEST lasting for inferior alveolar nerve block (IANB) anesthesia?
A. Prilocaine
B. Lidocaine
C. Mepivacaine
D. Procaine
E. Articaine

A. prilocaine

Within seconds following a posterior superior alveolar injection, a client's face becomes distended and swollen on the injected side. What condition is suspected in this situation?

hematoma

Within seconds following a posterior superior alveolar injection, a client's face becomes distended and swollen on the injected side. The appropriate action by the hygienist would be to:
A. Have the dentist administer an antihistamine
B. Have the dentist administer an antibiotic
C. Have the dentist incise and drain
D. Counsel the client, apply pressure to the site, and ice to the area
E. Ask the client to exhale

D. Counsel the client, apply pressure to the site, and ice to the area

A crown preparation for tooth #19 is planned for a patient who takes a tricyclic antidepressant. Which of the following drugs represents the best choice for this procedure?
A. 4% prilocaine, 1:200:000 epinephrine
B. 4% articaine, 1:100,000 epinephrine
C. 2% mepivacaine, 1:20,000 levonordefrin
D. 0.5% bupivacaine, 1:200,000 epinephrine

A. 4% prilocaine, 1:200,000 epinephrine

[T:F] High blood pressure is always a contraindication to the use of vasoconstrictors in dentistry.

False: Use of a local anesthetic drug without a vasoconstrictor may not provide profound or durable anesthesia. The lack of profound anesthesia can result in unmanageable pain, which, in turn, can lead to a spike in blood pressure due to the release of endogenous epinephrine in response to the pain. This endogenous release may be greater than administered doses of epinephrine.

[T:F] Vasoconstrictors speed the absorption of local anesthetic drugs.

False: Vasoconstrictors slow the absorption of local anesthetic drugs.

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

D. 4% prilocaine plain

Which of the following medical conditions does not require precautions when using vasoconstrictors?
A. Liver disease
B. Diabetes with significant cardiovascular disease
C. Radiation therapy of the jaws
D. Cerebrovascular accident/stroke

A. liver disease

Which one of the following patients has a relative contraindication for vasoconstrictor?
A. Heart attack 2 years ago with no current complications
B. Controlled hyperthyroid condition
C. Non-selective beta blocker medication
D. Controlled blood sugar

C. non-selective beta blocker medication

[T:F] 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 membranes compared to which ion(s)?
A. Chlorine and hydrogen
B. Hydrogen and sodium
C. Calcium
D. Sodium

C. calcium

Which statement does not describe the typical onset of anesthesia?
A. Anesthesia will affect smaller nerves before larger nerves.
B. Anesthesia will affect sensory nerves before motor nerves.
C. Mantle bundles will be anesthetized before core bundles.
D. Onset is faster on incisors, soft tissues of chin, and labial tissues

D. onset is faster on incisors, soft tissues of chin, and labial tissues

[T:F] There are more positively charged ions outside the depolarized nerve cell than inside because the nerve membrane is relatively impermeable to sodium.

true

Why do manufacturers alter the pKa of local anesthetic drugs?
A. Increase the duration of anesthesia
B. Decease the duration of anesthesia
C. Provide useful onset time of anesthesia
D. Provide more profound anesthesia

C. provide useful onset time of anesthesia

Which local anesthetic drug can be harmful at higher blood levels however useful in treating cardiac arrhythmias?
A. Bupivacaine and procaine
B. Procaine and prilocaine
C. Lidocaine and procaine
D. Lidocaine and prilocaine

C. lidocaine and procaine

The anesthetic duration of lidocaine plain is:
A. 60 minutes pulpal; 60 to 120 minutes soft tissue
B. 10 to 30 minutes pulpal; 60 to 120 minutes soft tissue
C. 5 to 10 minutes pulpal; 180 to 300 minutes soft tissue
D. 5 to 10 minutes pulpal; 60 to 120 minutes soft tissue

D. 5-10 minutes pulpal; 60-120 minutes soft tissue

A 180-pound patient received 108 mg of 3% mepivicaine. How many cartridges were used?

30 ml/cartridge by ml in one cartridge (30 x 1.8 = 54 mg). Next divide 108 mg received by mg/ml in each cartridge of 3% mepivicaine (108 ÷ 54 = 2). A total of 2 cartridges of 3% mepivicaine were received.

A patient has received four cartridges of 4% articaine, 1:200,000 epinephrine. How many milligrams of vasoconstrictor has the patient received?
A. 0.018
B. 0.036
C. 0.072
D. 0.36

B. 0.036 * there are .009 mg in one cartridge of 1:200,000. take .009X4=.036

Using Clark's rule, a 12-year old, 90 pound child has received two cartridges of 2% lidocaine. How many more cartridges of lidocaine can this child receive before reaching MRD?
A. 3
B. 6
C. 7
D. 8

B. 6 * take 90 lbs/150 lbs (the average weight for adult patient)= .6 then take .6x500 (MRD for lidocaine)=300 mg is the total MRD for this patient. There are 36 milligrams per cartridge of lidocaine. take 300/36=8.3. The child can receive a total of 8 cartridges. Patient already had cartridges so can have 6 more

Using Clark's rule, calculate the maximum number of milligrams of 3% mepivacaine a 5-year old, 40-pound child can receive before reaching the MRD?
A. 40 mg
B. 80 mg
C. 106 mg
D. 117 mg

C. 106 mg

How is young's rule calculated?

the child's dose is equal to the adult dose by the child's age multiplied by adult MRD. Then divided by the sum of 12 plus the child's age

Using Young's rule, calculate the mg of 2% lidocaine a 10-year old, 60-pound child can receive before reaching the MRD?
A. 125 mg
B. 136 mg
C. 200 mg
D. 227 mg

D. 227 * 500 mgx 10= 5000
5000/(10+12)=227

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

C. 8

What is a common preservative in topical anesthetic?

methylparaben

[T:F] 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

Which of the following is not a benefit of eutectic mixtures of anesthetic drugs for use in dentistry?
A. Greater depth of penetration on mucosa
B.Higher concentrations of base forms of anesthetics
C.Increased therapeutic range
D. Typical pulpal anesthesia

D. typical pulpal anesthesia

Which of the following, when considering patient evaluation, is the least pertinent when obtaining local anesthetic informed consent?
A. Specific risks of procedure in light of medical status
B. Benefits of the procedure
C. Identifying a surrogate to provide health information
D. The timing of appointments and cost

D. the timing of appointments and cost

pain management of the mandibular teeth in a single quad when jaw opening is limited

akinosi nerve block technique

true mandibular blocks

gow-gates nerve block

_______ ______ is the mental nerve block target

mental foramen

medial border of the retromolar triangle?

internal oblique ridge

the _______ _______ is the target for the IA

mandibular foramen

persistent anesthesia

parasthesia

contact made with bone before reaching an optimum deposition site

premature contact

motor disturbance of the trigeminal nerve or more simply, an inability to open the mouth

trismus

[T:F] The deposition site for an IA nerve block is superior to the mandibular foramen on the medial surface of the ramus.

true

[T:F] The three key landmarks for the IA nerve block are the pterygomandibular raphe, the coronoid notch, and the external oblique ridge.

false: it is the internal oblique ridge not the external

Which of the following correctly describes the needle pathway for an IA nerve block?
A. Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
B. Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing medial to the medial pterygoid muscle; posterior and medial to the lingual nerve, lateral to the sphenomandibular ligament; and superior to the lingula and mandibular foramen
C. Medial to the pterygomandibular raphe, into the infratemporal space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
D. Medial to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen

A. Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen

What is the recommended volume of local anesthetic solution for an inferior alveolar nerve block for an adult?
A. 0.6 to 1.0 mL
B. 0.9 to 1.5 mL
C. 1.2 mL
D. 1.5 to 1.8 mL

D. 1.5 to 1.8 ml (3/4 cartridge)

What is the position of the lingual nerve in relation to the inferior alveolar nerve?
A. Anterior and lateral
B. Inferior and lateral
C. Anterior and medial
D. Posterior and medial

C. anterior and medial

naturally occurring catecholamine that is both a hormone and a neurotransmitter; It is a direct-acting sympathomimetic drug, and is used in some local anesthetic solutions

epinephrine

How much vasoconstrictor is there in 1 cartridge of Lidocaine 2% w/ 1:50,000 epinephrine?

.036 mg vaso in a cartridge

DentiPatch provides approximately _____ minutes of soft tissue anesthesia and contains lidocaine and ________

45, benzocaine

What teeth can be anesthetized with tetracaine nasal mist?

#4-13

[T:F] tetracaine nasal mist is easier on the kidneys, liver, and lungs. It doesn't circulate in the body for hours, but takes a long time to wear off

first statement true
second statement false: wears off rapidly

What is the duration of anesthetic action for lidocaine 1:50,000 and 1:100,00 used in dentistry

60 min. pulpal
180-300 soft tissue

What are the two key considerations that determine the duration of action of bupivacaine?
A. biotransformation and elimination
B. distribution and volume
C. receptor binding and vasoactivity
D. receptor binding and biotransformation

C. receptor binding and vasoactivity

Amides are inactivated by the enzyme:
A. plasma cholinesterase
B. protease
C. lipase
D. monoamine oxidase
E. amylase

E. monoamine oxidase

How is lidocaine metabolized?

by hepatic enzymes, oxidases, and amidases.

What percentage of lidocaine is excreted unchanged by the kidneys?

less than 10%

What is the pKa of lidocaine?

7.7

What is the pH of lidocaine plain solution?

6.5

the correct onset of action for lidocaine is:
A. 30 seconds to 1 minute with vasoconstrictor
B. 2 to 3 minutes
C. 5 to 7 minutes
D. 6 to 10 minutes

B. 2 to 3 minutes

How long is the elimination half-life of lidocaine?

1.6 hours (96 minutes)

What is the onset of action of articaine for nerve block anesthesia?

2-3 minutes

What is the duration of anesthetic action of each formulation of mepivacaine used in dentistry?

3% mepivacaine plain (Short duration) 20-40 minutes pulpal; 120-180 minutes soft tissue
2% mepivacaine with 1:20,000 levonordefrin (Intermediate duration) 60 minutes pulpal; 180-300 minutes soft tissue

How is mepivacaine metabolized?

liver primarily by oxidases; amidase activity is insignificant

What is the onset of action for mepivacaine?

1.5-2 minutes

What is the elimination half-life of mepivacaine?

1.9 hours (114)

How is prilocaine metabolized compared to lidocaine and mepivacaine?

Prilocaine has a simpler hepatic metabolism compared with lidocaine and mepivacaine. Much of the drug is cleared before it is able to reach the liver. The lungs and kidneys are alternate sites of breakdown when the liver is not utilized.

What is the onset of action for bupivacaine?

6-10 minutes

What is the maximum dose of levonordefrine for a healthy patient?

1 mg

What is the maximum dose of levonordefrin for a medically compromised patient?

0.2 mg

What is the maximum dose for 4% prilocaine plain for a 120-pound patient?

120x4= 480 mg

Is the 30 gauge or 25 gauge the larger diameter?

About how long is the long needle?

about 32 mm (1 1/2 inches)

About how long is a short needle?

25 mm (1 in.)

Local anesthetic cartridges contain several ingredients. Which is NOT an ingredient found in these cartridges
A. Vasoconstrictor
B. Isotonic sodium chloride
C. Glucose
D. Anesthetic agent

C. glucose *distilled water is another component

What is the volume of solution delivered when two stopper widths are expelled?

0.4 ml *1 stopper width is 0.2 ml

What is the typical shelf life of local anesthetic with vasoconstrictor?

18 months

a technique that deposits solution near larger terminal branches for treatment near site of an injection is called:
A. infiltration technique
B. ligamental technique
C. field block technique
D. nerve block technique

C. field block technique

what are some anatomical variations related to the MSA?

absence of MSA nerve *between 50-72% of people don't have the MSA nerve

mixtures of local anesthetic drugs used as topical that contain higher concentrations of base molecules

eutectic mixture

Benzocaine is available in a range of __________ to __________ % formulations.

6, 20

[T:F] Benzocaine topical can induce methemoglobinemia.

true

[T:F] Benzocaine topical exists nearly 100% in the base form and is poorly absorbed into the systemic circulation.

true

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

False: MRDs do not exist for many topical products. Since they are formulated in concentrations exceeding those approved for use in injectable local anesthetic drugs, topical preparations are potentially more toxic.

Overdose reactions from lidocaine topical are similar to injectable forms with progression to CNS __________ without the initial excitation phase.

depression

Which of the following types of topical anesthetics has a pregnancy category B?
A. benzocaine
B. dyclonine
C. lidocaine
D. both A and C
E. all of the above

C. lidocaine * all other topical anesthetics are pregnancy category C

ester topical anesthetic that exists almost entirely in the base form

benzocaine

[T:F] Precautions for toxicity increase when topical anesthetic is applied to abraded tissue.

true

[T:F] The advantages of Cetacaine are its low risk of allergy, rapid onset, and long duration of anesthesia.

False: The advantages rapid onset and long duration. All three drugs are esters. The potential for allergy to para-aminobenzoic acid (PABA), a metabolite of benzocaine, does exist.

What three anesthetics is cetacaine formulated with?

1) benzocaine 2) tetracaine 3) butamben

The onset of action for benzocaine is __________

30 seconds to 1 minute

Why do topical anesthetics require a higher concentration of drug than the same drug used as an injectable local anesthetic?
A. More base molecules of drug are needed to diffuse through membrane barriers
B. They are less likely to produce toxicity when applied topically
C. Decreased amounts are applied topically than when locally injected
D. They do not contain vasoconstrictors

A. More base molecules of drug are needed to diffuse through membrane barriers

Which of the following is not an indication for topical anesthetic drugs in dentistry?
A. Needle penetration
B. Radiographic film placement
C. Periodontal evaluation
D. Sedation

D. sedation

Eutectic mixtures have which of the following characteristics?
A. they work more rapidly than most other topicals
B. they penetrate more deeply on skin than mucosa
C. their melting points exceed that of their ingredients acting alone
D. their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingrediants acting alone

D. their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingrediants acting alone * eutectic refers to a substance that has a lower melting point than any of its ingredients. Eutectic topicals not only have lower melting points to facilitate penetration through tissue barriers, but they are formulated primarily in the base form so that they can provide anesthesia more rapidly

Which of the following is incorrect regarding MRDs of topical anesthetics?
A. they are sometimes difficult to track
B. MRDs are not always provided
C. spray forms have easy-to-track dosing
D. Oraqix has easy-to-track dosing

C. spray forms have easy-to-track dosing *metered sprays are easy to track but unmetered are not

generous quantities of topical and injected anesthesia have been administered, when the patient begins to shake and appears agitated and anxious. Is there a reason for concern?
A. yes, because these may be early signs of CNS depression
B. No, because this is a very nervous patient
C. No, because the doses of injectable anesthetic were within safe guidelines
D. Yes, because patient is dental phobic

A. yes, because these may be early signs of CNS depression

topical anesthetic mixtures may be of benefit in all but one of the following ways ?
A. combination may increase therapeutic range
B. combinations may increase penetration depths
C. mixtures may allow drugs to be used as topicals that are not suitable when used alone
D. mixtures decrease the potential for adverse reactions

D. mixtures decrease the potential for adverse reactions *they usually increase the potential

Which of the following application methods are considered safest when preventing toxicity?
A. Metered sprays and single dose application systems
B. Patches and metered sprays
C. Gels and liquids
D. Swabs and two-phase applications

B. patches and metered sprays

[T:F] the predominately base form of lidocaine topical anesthetic is safer than the predominately hydrochloride salt

true

Dyclonine hydrochloride is an excellent and very durable topical anesthetic and belongs to which one of the following classes of anesthetic?
A. amide
B. ester
C. ketone
D. none of the above

C. ketone

drugs formulated by compounding pharmacies

compound drug

topical anesthetic with a ketone linkage

dyclonine hydrochloride

Which of the following is not a typical sign of CNS toxicity related to overdoses of topical anesthetic drugs?
A. Shaking and agitation
B. Talkativeness and excitedness
C. Disorientation and drowsiness
D. Loss of consciousness

B. talkativeness and excitedness

[T:F] Local anesthesia allergy is dose related. Re-exposure typically produces increased reaction with allergy

first statement false: allergy is exposure related, overdose is based on the dose
second statement true

what are some examples of relative contraindications to local anesthetic?

1) atypical plasma cholinesterase 2) methemoglobinemia 3) malignant hyperthermia 4) liver dysfunction 5) renal dysfunction

What drugs can have negative interactions with vasoconstrictors?

1) tricyclic antidepressants 2) non-selective beta blockers 3) cocaine 4) methamphetamine

rapid or gradual elevation of the drug level in the blood

overdose

Which of the following is not a sign of overdose reaction?
A. talkativeness, apprehension, increase in vitals, slurred speech
B. tinnitus, disorientation, drowsiness, loss of conscious
C. seizure activity, depressed vitals
D. systemic anaphylaxis

D. systemic anaphylaxis *this is a sign of an allergy

What are the patient factors that can impact overdose?

1) age 2) body weight 3) disease factors 4) genetics 5) mental attitude

[T:F] the greater the body weight of the patient the larger the drug dose can be tolerated. This is why obese individuals can tolerate more drugs.

Both statements false: lean body weight of a patient can tolerate larger drug doses. Obese individuals have a lower lean body weight

What is the most common cause of serious local anesthetic overdose reactions in dentistry?

too large local anesthetic dose in relation to the age and weight of the patient

What are the drug factors that influence overdose?

1) LA have vasodilating properties 2) drug dosage 3) route of administration 4) rate of injection 5) vascularity of site 6) presence of vasoconstrictors

How do you manage an overdose reaction to local anesthesia?

1) position in supine position 2) check airway 3) check breathing 4) circulation 5) administer oxygen

What are tips to prevent overdose?

1) know MRD 2) keep a reserve of anesthetic to allow for failure 3) administer anesthetic as you go, not all at once 4) aspirate 5) inject slowly 6) don't dispose cartridge until complete 7) document amount used

[T:F] informed consent is required for injections

true

The rate of positive aspiration in the inferior alveolar nerve block is the highest of all techniques and approximates which of the following?
A. 2-5%
B. 5-10%
C. 10-15%
D. 15-20%

C. 10-15%

A __________ needle is recommended for an inferior alveolar nerve block.

25-gauge long

why is it difficult to determine the dose of topical anesthetics used?

maximum dose recommendations for many topical products do not exist. Even when manufacturers provide MRD information, clinicians often have difficulty determining how much was dispensed or absorbed.

What is the onset time and duration of lidocaine topical?

onset: 1-2 minutes and peak effects may take up to 5-10 minutes
duration: 15 minutes.

What is the MRD for lidocaine topical?

200 mg

What is the onset and average duration of anesthesia for tetracaine?

onset: slow and variable, with peak effects taking up to 20 minutes
duration: 20-60 minutes

where is the penetration site for the IA nerve block in relation to the three key anatomical landmarks for the IA.

slightly lateral to the pterygomandibular raphe, at a height 2-3 mm superior to the greatest concavity of the coronoid notch, and well medial to the internal oblique ridge

Where is the deposition site for an IA nerve block?

1 mm lateral to the medial aspect of the ramus and above the mandibular foramen.

situations in which local anesthetic or vasoconstrictor drugs or nitrous oxide sedation cannot be administerd safely

absolute contraindications

form of cholinesterase that results from a genetic, autosomal, recessive condition in which there is an impaired ability to metabolize ester local anesthetics

atypical plasma cholinesterase

drug that has been administered while other drugs are still in effect

concomitant

highly addictive stimulant drugs, avoid administration of vasoconstrictors for a minimum of 24 hours after use

methamphetamines

condition induced by drugs and other substances, including prilocaine, benzocaine, and articaine, which can result in a life-threatening depletion of oxygen in the tissues

methemoglobinemia

contraindications to local anesthetic delivery that allow procedures to proceed but only after appropriate modifications

relative contraindications

acute, life-threatening state induced by excessive release of thyroid hormones

thyrotoxic crisis (thyroid storm)

[T:F] ASA III and IV are contraindicated with use of anesthetics

false: ASA III may still be considered for elective dental procedures

blood pressure over _______ dental treatment should be deferred and referred to a physician

180/110

patients that have had an MI within _____ _______ is considered an absolute contraindication to dental treatment

1 month, consultation with doctor is recommended as well to make sure they are at 4 MET level

[T:F] vasoconstrictors should be used at all times while treating a patient with sickle cell anemia

false: plain drugs are preferred

[T:F] epinephrine is an absolute contraindication in patients with uncontrolled hypothyroidism

false: hypothyroidism is okay to treat, epinephrine is not to be used for uncontrolled hyperthyroidism

if a patient had a stroke dental treatment must wait until after _____ months

[T:F] local anesthesia can be administered safely to Alzheimer patients in all stages

false: if in the middle to late stage they may not be good candidates because they don't cooperate

Which one of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia?
A. pre-anesthetic evaluation of the patient
B. comprehensive tooth charting
C. remain present during the course of the anesthesia
D. providing indicated post-anesthesia care

B. comprehensive tooth charting *Although useful for planning a course of anesthesia, tooth charting is not one of the ASA Medical Components of Care

Which of the following is not considered a main tool for patient assessment when planing for local anesthesia?
A. medical/dental questionnaire
B. clinical exam
C. drug MRD's
D. medical consultation

C. drug MRD's *although important, it is not considered a patient assessment tool

Which of the following drugs is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism?
A. lidocaine
B. bupivacaine
C. epinephrine
D. felypressin

C. epinephrine

Your patient has identified or you suspect that your patient has used methamphetamines approximately 20 hours ago. Which of the following would be the most appropriate action when considering the use of local anesthetics?
A. continue with procedures because it has been more than 12 hours since the use
B. restrict the dose of vasoconstrictors
C. consider postponing care for a full 24 hours
D. use only bupivacaine as the local anesthesia agent

C. postpone care for a full 24 hours

For which one of the following medical conditions is it unnecessary to obtain a medical consultation from the patient's physician before dental treatment?
A. significant liver disease
B. Myocardial infarction within 3 weeks
C. kidney dialysis patient
D. organ transplant patients

B. MI within 3 weeks *at this time it is an absolute contraindication

What are 4 reasons it is important for a clinician to know what concomitant drugs a patient is taking?

1) They may influence the choice of local anesthetic drug and quantity administered 2) They may affect the efficacy, metabolism, and elimination of a local anesthetic drug.
3) They may potentiate the action or delay the metabolism of local anesthethic drugs. 4) Their actions may be affected by local anesthetic drugs.

What are some examples of the need for medical consultation prior to the administration of local anesthesia?

1) patient has symptoms of undiagnosed disease 2) pregnant 3) cardiovascular conditions 4) recent surgeries 5) uncontrolled hypertension 6) psychological conditions that may influence oral procedures 7) compromised liver and/or kidney function 8) immune system compromise

[T:F] Typically, most local anesthetic injections through tissue are not considered to be invasive and do not require antibiotic premedication

true

[T:F] Patients with hemophilia and clotting disorders require antibiotic premedication and modification of injection types, drug selection, and doses of local anesthetics.

false: Patients with hemophilia and clotting disorders do not require antibiotic premedication; however, these patients may require modification of injection types, drug selection, and doses

[T:F] In children, anxiety related to the administration of local anesthesia may provoke syncope or hyperventilation. In adults, anxiety more commonly provokes asthmatic episodes.

False: should be reversed

[T:F] The systemic effects of local anesthesia on the respiratory system are typically minimal. Epinephrine acts on β receptors of the smooth muscles of the bronchioles to dilate air passages.

true

[T:F] A patient has taken a large dose of narcotics prior to local anesthetic administration. Local anesthetic drugs can have a profound effect on the central nervous system (CNS) because local anesthetic drugs are CNS stimulants.

False: anesthetic drugs are CNS depressants. This depression is additive to any existing CNS depression.

[T:F] Pregnancy poses a temporary and relative contraindication to local anesthetics, and the second trimester of pregnancy is considered the safest period for both the fetus and the mother.

true

[T:F] Individuals taking nonselective beta-blocking agents for hypertension or other conditions such as migraines should never be given epinephrine

False: Individuals taking nonselective beta-blocking agents should be given epinephrine with caution

adrenergic drugs that are combined with local anesthetic drugs in order to increase their efficacy and safety

vasoconstrictors (vasopressor)

Which of the following is not an indication for the use of a vasoconstrictor?
A. reducing the risk of toxicity of local anesthetic drugs
B. prolonging the duration of local anesthetic drugs
C. providing hemostasis
D. providing vasodilation following treatment

D. providing vasodilation following treatment

[T:F] Epinephrine and Levonordefrin are indirect-acting on the adrenergic receptors

false: they are direct acting

What are the concentrations of epinephrine?