MIDTERM Anesthesia

1. What is the main purpose of adding a vasoconstrictor to the local anesthetic?

a. To increase the rate of absorption of the anesthetic

b. To reduce the rate of absorption of the anesthetic

c. To reduce systemic toxicity

d. To increase hemostasis

b. To reduce the rate of absorption of the anesthetic

2. Marcaine is the proprietary name for which of the following?

a. Mepivacaine

b. Bupivacaine

c. Carbocaine

d. Xylocaine, alphacaine, octocaine

b. Bupivacaine

3. What is the name of the type of injection that anesthetizes a small area of one or two teeth, and the associated structures, when the local anesthetic agent is deposited near the terminal nerve endings?

a. Nerve block

b. Supraperiosteal injection

c. Transdermal injection

d. Intraseptal injection

e. Intraligamentary injection

b. Supraperiosteal injection

4. The nasopalatine nerve block provides anesthesia to:

a. The gingiva lingual to the anterior teeth

b. The gingiva lingual to the anterior teeth and their associated pulps

c. The gingiva lingual to the anterior teeth, associated pulps and periosteum

d. The entire hard palate on the ipsilateral side

a. The gingiva lingual to the anterior teeth

5. All of the following statements are true regarding core fibers EXCEPT:

a. They are the last to achieve anesthesia

b. They are more tightly bound than other fibers to the Na channels

c. They have a lower concentration of local anesthesia than other fibers

d. They innervate the incisors during a mandibular nerve block

b. They are more tightly bound than other fibers to the Na channels

6. What is the MRD of 1:100,000 epinephrine per appointment for a healthy patient?

a. 1.0 mg

b. 0.02 mg

c. 0.04 mg

d. 0.2 mg

d. 0.2 mg

7. Loss of sensation to the tongue is due to damage to which nerve?

a. Inferior Alveolar Nerve

b. Mylohyoid Nerve

c. Hypoglossal Nerve

d. Lingual Nerve

d. Lingual Nerve

8. When administering the inferior alveolar (IA) nerve block injection, what other nerve may inadvertently be anesthetized?

a. PSA

b. Facial nerve

c. Lingual nerve

d. Mandibular nerve

b. Facial nerve

9. Which amide anesthetic agent is metabolized in both the plasma and the liver?

a. Lidocaine

b. Mepivacaine

c. Prilocaine

d. Articaine

d. Articaine

10. What type of injection would be best for a patient that requires hemostasis?

a. Nerve block

b. Local infiltration

c. Intraseptal injection

d. Periodontal ligament injection

e. Intrapulpal injection

b. Local infiltration

11. The second division of the trigeminal nerve passes through which foramen of the sphenoid bone?

a. Foramen Rotundum

b. Sella Turcica

c. Foramen Ovale

d. Superior orbital fissure

a. Foramen Rotundum

12. When comparing large gauge numbers to smaller gauge numbers, what does the larger gauge number of the needle mean?

a. It refers to a short needle

b. It refers to a longer needle

c. It refers to the smaller diameter of the needle

d. It refers to the larger diameter of the needle

c. It refers to the smaller diameter of the needle

13. The buccal nerve block anesthetizes:

a. Buccal gingiva up to the first molar

b. Buccal gingiva up to the canine

c. Buccal gingiva and pulps of molars only

d. Buccal gingiva and pulps up until the mental foramen

a. Buccal gingiva up to the first molar

14. The injection sites for an ASA and an MSA nerve block are respectively within the mucobuccal folds of:

a. The lateral incisor and the 1st premolar

b. The canine and the 1st premolar

c. The lateral incisor and the 2nd premolar

d. The canine and the 2nd premolar

d. The canine and the 2nd premolar

15. If an oral surgeon needed to do a biopsy on an oral lesion that was present on the buccal gingiva between teeth #30 and #31, what injection would they have to perform?

a. Inferior alveolar nerve block

b. Buccal Nerve Block

c. Mental Nerve Block

d. Lingual Nerve Block

b. Buccal Nerve Block

16. Which of the listed anesthetics could produce an emergency situation characterized by the inability of the blood to bind to oxygen?

a. Prilocaine

b. Mepivacaine

c. Lidocaine

d. Epinephrine

a. Prilocaine

17. All of the following can result in trismus in the jaw muscles except:

a. Multiple needle penetrations in the same site

b. Administration of a contaminated anesthetic solution

c. Administration of an anesthetic with a bicarbonate additive

d. Deposition of large amounts of vasoconstrictor in a restricted area

e. Hemorrhage within the tissue

c. Administration of an anesthetic with a bicarbonate additive

18. What factor/factors determine the severity of an overdose reaction to a local anesthetic?

a. Degree of drop in blood pressure

b. Time lapse between the administering of the local anesthetic to the overdose

c. Number of symptoms patient experiences

d. All of the above

d. All of the above

19. Which nerve innervates the soft palate?

a. The Greater Palatine nerve

b. The Nasopalatine nerve

c. The Lesser Palatine nerve

d. The Posterior Palatine nerve

c. The Lesser Palatine nerve

20. Which root does not receive an anesthetic effect after the administration of a PSA injection?

a. The distobuccal root of the 1st molar

b. The mesiobuccal root of the 1st molar

c. The mesiobuccal root of the 2nd premolar

d. The palatal root of the 2nd premolar

e. None of the above

b. The mesiobuccal root of the 1st molar

21. What is the best choice of injections to anesthetize a patient for scaling and root planing who only has teeth 21 and 28?

a. Bilateral incisive nerve blocks with localized lingual infiltrations

b. Bilateral mental nerve blocks with localized lingual infiltrations

c. Bilateral inferior alveolar nerve blocks

d. Multiple infiltrations (enough for adequate pain control)

a. Bilateral incisive nerve blocks with localized lingual infiltrations

22. Which best describes the mechanism by which local anesthetic drugs work?

a. Anesthetic drugs bind to the sodium channels, the influx of sodium is interrupted, the action potential cannot rise, and the signal conduction is inhibited.

b. Anesthetic drugs bind to the potassium channels, the influx of sodium is interrupted, the action potential cannot rise, and the signal conduction is inhibited.

c. Anesthetic drugs bind to the sodium channels, the influx of potassium is interrupted, the action potential cannot rise, and the signal conduction is inhibited.

a. Anesthetic drugs bind to the sodium channels, the influx of sodium is interrupted, the action potential cannot rise, and the signal conduction is inhibited.

23. Which anesthetic drug has a short half-life of 45 minutes and is the least toxic of the anesthetics?

a. Articaine

b. Lidocaine

c. Mepivacaine

d. Prilocaine

d. Prilocaine

24. What should the clinician do if he/she accidently positions the anesthetic needle against the periosteum and bony contact is made too early?

a. Withdraw the needle and reinsert farther away from the periosteum

b. Withdraw the needle and change it because it may be dull

c. Withdraw the needle, apply more topical anesthetic, and select a different injection to perform first

d. Without withdrawing the needle, move the needle slightly, aspirate, and administer the anesthetic

a. Withdraw the needle and reinsert farther away from the periosteum

25. Which nerve is considered to be the most involved when a patient experiences paresthesia/complications?

a. Lingual nerve

b. Posterior superior alveolar nerve

c. Anterior superior alveolar nerve

d. Inferior alveolar nerve

a. Lingual nerve

26. What is the appropriate technique that a clinician should follow in order to find the location of the mental foramen? They should begin to palpate:

a. Directly below the mandibular notch on the ramus of the mandible

b. Between the mandibular first and second premolars

c. From the mandibular first molar to the distal surface of the canine

d. On the lingual and at the apex of the mandibular incisors

c. From the mandibular first molar to the distal surface of the canine

27. What is the propagation of action potentials along myelinated axons from one node of Ranvier to another called?

a. Nonmyelinated

b. Saltatory conduction

c. Polarization

d. Refractory period

b. Saltatory conduction

28. What is the duration of Oraqix?

a. 5 - 10 minutes

b. 15 - 30 minutes

c. 30 - 45 minutes

d. 45 - 60 minutes

b. 15 - 30 minutes

29. Which foramen is being targeted when we administer a nasopalatine nerve block?

a. The Nasopalatine foramen

b. The Incisive foramen

c. The Greater Palatine foramen

d. The Palatine foramen

b. The Incisive foramen

30. What does the membrane expansion theory of the action of local anesthetics suggest?

a. Anesthetics that are highly hydrophilic cause the matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization

b. Anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization

c. Anesthetics cause the sodium channels to expand, thus allowing the increase in protein binding within the channels

d. All of the above

b. Anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization

31. Prilocaine is the generic name for which of the following?

a. Citanest

b. Marcaine

c. Carbocaine

d. Xylocaine, Alphacaine, Octocaine

a. Citanest

32. All of the following are branches of the mandibular nerve EXCEPT:

a. The incisive nerve

b. The long buccal nerve

c. The mental nerve

d. The infraorbital nerve

e. All of the above are branches of the mandibular nerve

d. The infraorbital nerve

33. What is the most commonly cited error contributing to missed inferior alveolar (IA) nerve blocks?

a. Injection being too low

b. Injection being too high

c. Inadequate aspiration

d. Incorrect fulcrum

a. Injection being too low

34. When administering a greater palatine nerve block, what areas will become anesthetized?

a. Posterior hard palate from the site of injection up to the 1st premolar

b. Posterior hard palate from the midline, up to the 1st premolar

c. Posterior hard palate, bilaterally up to the 1st premolars

d. Posterior hard palate from the midline to the 1st premolar, including the pulps of the associated teeth

b. Posterior hard palate from the midline, up to the 1st premolar

35. What is the term used to describe the persistent anesthesia or the altered sensation of tingling or itching beyond the expected duration of local anesthetic?

a. Paresthesia

b. Paralysis

c. Prolonged anesthesia

d. None of the above

a. Paresthesia

36. What is the most likely reason that a patient would feel pain upon injection?

a. Topical anesthetic was not placed for long enough

b. Anesthetic was left at room temperature in a dark closet

c. Anesthetic was injected at too rapid of a rate

c. Anesthetic was injected at too rapid of a rate

37. All of the following statements are true about the mental nerve block EXCEPT:

a. It exits at the mental foramen

b. It provides anesthesia to the lips, cheek and chin anterior to the molars

c. It provides anesthesia to the pulps of the premolars and incisors

d. It is the same injection location as the incisive nerve block

c. It provides anesthesia to the pulps of the premolars and incisors

38. In a resting neuron, what ion is most abundant outside the plasma membrane?

a. Potassium ions

b. Sodium ions

c. Calcium ions

d. Chloride ions

b. Sodium ions

39. The Greater Palatine Nerve Block is most commonly used in conjunction with which injection for periodontal surgery of maxillary molars?

a. The infraorbital nerve block

b. The Posterior superior alveolar nerve block

c. The inferior alveolar nerve block

d. The Long Buccal nerve block

b. The Posterior superior alveolar nerve block

40. What is the weakest part of the dental needle?

a. Bevel

b. Shaft

c. Hub

d. Needle penetrating end

c. Hub

41. Once the penetration site has been determined, the clinician should pick up the prepared anesthetic syringe, making certain the large window is ___ and the clinician's hand is ___.

a. Facing down, palm down

b. Facing down, palm up

c. Facing up, palm up

d. Facing up, palm down

c. Facing up, palm up

42. What should the clinician do while waiting for local anesthetic to take effect for her patient?

a. Clean the other operatory

b. Bag instruments in the sterilization area

c. Take a much-needed break

d. Observe the patient for possible signs of an adverse reaction

d. Observe the patient for possible signs of an adverse reaction

43. A needle must be replaced in a patient after all of the following except when:

a. A barb is noticed

b. A patient complains of pain on injection

c. The needle has been used for 4 injections

d. The operator has an accidental needle stick during setup of the armamentarium

b. A patient complains of pain on injection

44. What is the name of a common ester topical anesthetic?

a. Lidocaine

b. Dyclonine hydrochloride

c. Prilocaine 2.5%

d. Benzocaine

d. Benzocaine

45. The mandibular division of the trigeminal nerve is:

a. A sensory nerve

b. A motor nerve

c. A mixed nerve

d. None of the above

c. A mixed nerve

46. When the Middle Superior Alveolar nerve is present, the Middle Superior Alveolar Nerve Block is used for anesthesia to the:

a. Maxillary premolar pulps and associated buccal tissues

b. Maxillary premolar pulps and associated lingual tissues

c. Mesiobuccal root pulp of the maxillary first molar

d. All of the above

e. a & c only

e. a & c only

47. Soreness of the muscles caused by muscle spasms is called what?

a. Nerve Paralysis

b. Hematoma

c. Trismus

d. Paresthesia

e. Hemangioma

c. Trismus

48. If an injection occurs into the ___ facial paralysis will occur.

a. Submandibular

b. Parotid

c. Submental

d. Sublingual

b. Parotid

49. Which of the following are best practices for the maxillary supraperiosteal injection technique?

a. The bevel orientation of the needle should be away from the bone

b. The needle should be inserted parallel with the long axis of the tooth

c. The needle tip is placed inferior to the apex of the selected tooth

d. All of the above

d. All of the above

50. In the specific receptor theory, how does nerve blockade occur?

a. The cation molecules penetrate the nerve membrane and reequilibrate to base ions, causing blockade of channels

b. The base ions penetrate the nerve membrane and reequilibrate to cations, causing blockade of channels

c. The base ions penetrate the nerve membrane and bind to the sodium receptors

d. The cation molecules penetrate the nerve membrane and bind to the sodium receptors

b. The base ions penetrate the nerve membrane and reequilibrate to cations, causing blockade of channels