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Local Anesthesia Board Review Questions

Terms in this set (90)

local anesthesia is the __
reversible depression of peripheral nerve condition
which of the following are characteristics of the "ideal" local anesthetic agents?
absence of allergic reactions, absence of systemic reaction, long duration
all local anesthetics produce vasodilation which __
increases the rate of absorption
the greatest percentage of local anesthetics can be found in the __ after absorption into the blood stream
skeletal muscle
amide local anesthetic agents are metabolized in the __
liver
which of the following is NOT an indication of CNS toxicity?
unilateral numbness of the tongue
the weakest vasoconstrictor used in dentistry is __
levonordefrin
sodium bisulfite is added to anesthetics with vasoconstriction to __
prolong the shelf life of the solution
in the US, local anesthetic cartridges contain a volume of __
1.8ml
you have just administered an IA injection. The patient experiences pain as you remove the needle. The most likely explanation is:
there is a barb on the end of the needle
the greatest efficiency in aspirating is determined by __
needle gauge
what design feature of a syringe is necessary for a syringe to be an aspirating syringe?
the harpoon
prilocaine plain has a very __ toxicity
low
at high blood levels of local anesthetic, signs of cardiovascular overdose may include __
depressed BP
for patients with history of heart disease, the maximum number of cartridges of xylocaine 1:100,000 epic is __
2
Lidocaine __
is the gold standard against which all new local anesthetics are measured
of the following, the most frequent cause of needle breakage is __
sudden unexpected patient movement
psychogenic responsies __
can be life threatening
the most common psychogenic response is __
vasodepressor syncope
for which of the following injections would topical anesthetic be the LEAST effective?
greater palatine
as a rule, topical anesthetic agents __
are used in greater concentration than injectable anesthetics
dyclonine hydrochloride __
has a long duration of action
benzocaine, a topical anesthetic __
is minimally absorbed
which local anesthetic agent can limit the need for post surgical opioid analgesic agents?
bupivacaine
your patient has a history of cardiac disease. The cardiologist requests that you do not use a vasoconstrictor. Which local anesthetic agent would be the best choice for scaling and root planing this patient?
3% mepivacaine
Ester local anesthetics agents are metabolized in the blood by the enzyme __
psuedocholinesterase
local anesthetic cartridges should be __
kept in their original container
a __ needle is recommended for IA nerve blocks
25 gauge long needle
a __ needle is NOT recommended
25 gauge long needle for PSA
warming cartridges before use may lead to __
patient discomfort
topical nonbenzocaine anesthetics __
are absorbed rapidly into the cardiovascular sysem
Overdose =
dose related
allergic reaction =
NOT dose related
your patient has atypical pseudocholinesterase". How would this affect your decision to use LA?
the patient would NOT be able to tolerate ESTER local anesthetics
the dentist has administered 2 cartridges of 2% xylocaine with 1:50,000 epi. Within a few minutes, the patient complains of a throbbing headache and a rapid heart rate. He sweats profusely and becomes dizzy. The patient is experiencing __
overdose to epinephrine
you plan to scale and root plane the entire right side. You apply topical lidocaine ointment to 6 sites and then administer 4 cartridges of 3% mepivacaine. Immediately after the last injection, the patient loses consciousness and begins to convulse. The most likely cause is __
local anesthetic overdose
To reduce systemic complications associated with local anesthesia, __
use the weakest effective concentration of anesthetic solution in the smallest effective dose
amide local anesthetics are ___
less likely than esters to cause allergic reactions
post anesthetic oral lesions are caused by __
an exacerbation of latent condition
post injection facial nerve paralysis __
blocks the corneal reflex
post injection infection __
may lead to trismus if not properly treated
extruded stoppers in anesthetic cartridges indicate that __
the anesthetic has been frozen
the weakest part of the dental needle is __
the junction of the hub and needle
the most likely causes of an overdose from a local anesthetic:
solution administered too rapidly
solution administered intravenously
to effectively aspirate, the operator must retract the finger/ring piston
1-2mm
you have just administered 1 cartridge of lidocaine with 1:100,000 epic. The patient tells you after the injection that he experienced a burnin sensation during the injection. This is due to the __
presence of vasoconstrictor
what effect do vasoconstrictors have on LA solutions?
Lower the pH of the anesthetic solution
which of the following factors should be considered when selecting a LA agent for your patient?
- the length of time that you anticipate you will require pain control
- the potential for your patient to have discomfort post treatment
- the possibility that your patient may accidentally self-mutilate themselves
- the medial status of the patient
what is the absolute MRD of 2% lidocaine 1:100,000 epic for a medically compromised cardiac patient?
2 cartridges
the only LA agent that is a vasoconstrictor is __
cocaine
trismus is most often caused by __
multiple injections in the same site
which cranial nerve provides sensory innervation to the periodontium of the maxillary teeth?
trigeminal
if you are scaling and root planing teeth 2-5, which injections would you use?
PSA, MSA, GP
after administering a left IA injection, the patient complains of tooth 24 still being sensitive. What is the likely reason for this?
cross-over innervation by the right incisive nerve
the nerve that produces innervations to the gingival tissues of tooth 18 is __
buccal (long buccal)
name the nerve that provides sensory innervations to the gingival tissues of teeth 7-10
ASA
the anatomical landmark to determine the penetration site to anesthetize teeth 6-8 is:
mucobuccal fold
the nerve that provides innervations to the lingual gingiva of teeth 20 and 21 is __
lingual
name the nerve that provides innervation to the pulp of tooth 15:
PSA
comparing the speed of a nerve impulse traveling to the brain, which of the following statements is true?
impulse travels faster in a myelinated nerve
the generation of a nerve impulse follows which sequence?
slow depolarization, rapid depolarization, and repolarization
depolarization occurs as a result of __
sodium ions moving inside a nerve cell
the coronoid notch is the anatomical landmark for which injection?
IA
if the patient reports tingling of the lower lip, what nerve is losing sensation?
mental
the hamulus and retromolar triangle are landmarks for which structure?
ptyergomandibular raphe
where is axoplasm located?
inside of nerve cell
a pain stimulus acts on what part of the nerve?
dendritic zone
you are doing a left IA nerve block. What needle would you use?
25 gauge long
the maxillary division of the trigeminal nerve is __
sensory only
when do you aspirate?
before deposition of solution
infiltration is not as effective in the mandible compared to the maxilla because __
mandibular cortical bone is denser
the process of salutatory nerve conduction __
- produces faster impulse propagation
- is due to nodes of Ranvier
- involves the leaping of impulse
the purpose of aspiration is to:
determine the needle is not in blood vessel
you are scaling and root planing the mandibular right quadrant which includes the teeth 25-27, 29, 31. Which injections should you use?
IA, long buccal, mental
the ideal rate of solution deposition of atraumatic injections is:
1 cartridge in 1 minute
the importance of contacting bone during the IA block injection is the prevent:
injecting into parotid gland
after administering a left IA nerve block, your patients left eyelid starts to droop. What has occurred?
facial nerve is anesthetized
the needle was inserted too deep
what is the deposition site for the IA nerve block?
slightly superior to mandibular foramen
pressure anesthetics is recommended for which injections?
GP and NP
faulty technique and __ are the most common reasons for failure to achieve adequate anesthesia
patients anatomical variations
your patient complains of burning as you deposit the solution. You can minimize burning by __
depositing the solution more slowly
which injection has the highest rate of positive aspiration?
IA
5 minutes ago, you administered a PSA injection and now your patient says his lower lip is tingling. What is likely the reason?
needle not angled enough posteriorly
after administering an IA nerve block, your patient still complains of sensitivity of tooth 30. The other teeth have adequate anesthesia. The likely reason for this sensitivity is:
accessory innervations by mylohyoid
numbness of the anterior 2/3 of the tongue is due to which nerve been anesthetized?
lingual
how far do you insert the needle for the IA nerve block?
2/3 the needle length
what sensation is lost first when local anesthetist is used?
pain
the patient complains of an electric shock sensation when you administer an IA block. This is likely due by __
contacting nerve sheath
depolarization is the result of __
changes in permeability of nerve membrane
influx of sodium ions into axoplasm
local anesthesia works by:
- binding receptor sites in sodium channels
- preventing depolarization from occuring
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