ORS 1001 Exam 1

What are the ASA Classes

I: Normal healthy without systemic disease

II: Pt with mild systemic disease

III: Pt with severe systemic disease but not life-threatening

IV: Pt with severe systemic disease constantly life-threatening

V: Not expected to live beyond 24 hour with or without operation

VI: Brain dead

E: Emergency

What is hyphema

blood in the anterior chamber of eye

What is a battle’s sign

bruising over mastoid process

Can indicate skull fracture

What is ranula

Swelling in base of mouth

What is mallampati score

Class 1: Complete visual of soft palate

Class 2: Complete visual of uvula but not soft palate

Class 3: Visual only base of uvula

Class 4: Soft palate not visible at all

3 criteria of hypertension

SBP of 140 mmHg

DBP of 90 mmHg

Current antihypertensive medicine

Hypertensive Urgency vs Hypertensive Emergency

Urgency: above 180/120 with no organ damage

Emergency: above 180/120 with organ damage

Clots in legs will typically go to ______

Clots in heart will typically go to ______

lung

brain

When is antibiotic prophylaxis recommended?

Prosthetic valve

Previous IE

CHD

Cardiac transplantation

INR greater than 4

High risk for bleeding

A1C

Fasting Blood Sugar

Glucose Tolerance

Above 6.5% (average over 2-3 months)

126 mg/dL

200 mg/dL

Diabetic pt and leukocyte function

Neutrophils glycosylated and cannot attack infections as efficiently

Low blood sugar or high blood sugar that needs defer treatment

Less than 70 mg/dl

More than 200 mg/dl

When do you treat dialysis pt

Day after dialysis treatment

Lidocaine can induce ______ via sodium channels

Seizures (Arrhythmias)

UCG vs HCG

Both test pregnancy

UCG (blood)

HCG (urine)

What is the max dose epinephrine in pregnant pt?

2 carpules of 1:100,000

Pain control for pregnancy

No Aspirin, Ibuprofen, NSAIDS, Codeine

Only Acetaminophen

Which hip up in pregnant pt when lying down

Right hip up

What is benadryl used for

Treat allergic symptoms

What to give acute asthmatic attack

Sit upright

2 puff albuterol

Epi pen

Local anesthesia produces loss of sensation _______ inducing loss of consciousness

without

Piston and Harpoon

Piston used to push anesthetic out cartridge

Harpoon is sharp hook penetrate thick silicone rubber

Why do we aspirate

Determine needle tip is within blood vessel

In artery or vein can cause toxicity and increased heart rate

Pressure syringes is designed to inject into the ______

PDL

What is bevel of needle

Point or tip of needle

Point centered on long axis (face bone)

Prevent insertion into a blood vessel

Plunger should be ______ the glass rim

below

Above means its contaminated

How many ml should be the cartridge we use

1.8 ml

Is there difference in pain on injection based on needle gauge

No

_______ needles can penetrate thicker tissues and reach distant anatomy

Longer

The diaphragm is a semipermeable membrane through which _______ penetrates the cartridge

needle

25 gauge vs 27 gauge diameter of lumen

25 gauge would have greater diameter of the lumen

Know this

Can pt with sulfur allergies take LA with sodium metabisulite?

Yes

How to calculate mg per cartridge

(Mg/ML is 10x percent solution) mg per mm * volume of cartridge (Always 1.8 mL)

5 mg/mm × 1.8 mm = 9 mg

If you have a 2 percent solution how many mg per cartridge?

2.0×10 = 20×1.8 = 36 mg per cartridge

What is the another name for trigeminal ganglion

Gasserian Ganglion

Afferent or Efferent

Ophthalmic

Maxillary

Mandibular

Afferent

Afferent

Both

Foramen of Trigeminal Nerve

V1: Superior orbital fissure

V2: Foramen Rotundum

V3: Foramen Ovale

_______ gives sensation for maxillary centrals, laterals, canines, and associated soft tissues

ASA (anterior superior alveolar branch)

ASA may cross over _______

midline

Work number 8 may need to numb both sides

________ gives sensation for maxillary premolars and mesiobuccal root of 1st molar and buccal gingiva

MSA (Middle Superior Alveolar branch)

The _______ gives sensation for maxillary 1st except _______ root) 2nd and 3rd molars, buccal gingiva and maxillary sinus

PSA, MB

If maxillary 1st molar not numb give a MSA

______ ______ give sensation to posterior hard palate and posterior lingual gingiva

Greater Palatine Nerve

Greater palatine enters incisive canal to anastomose with the _______ _______

septal artery

Lesser Palatine give sensation to ______ ______ and palatine tonsillar pillars

soft palate

Inferior Alverolar Nerve branches into

Mental and Incisive nerves

Esters vs Amides

Amides have 2 I (metabolized by liver)

Esters metabolized by plasma

What is the central core theory

Anterior teeth fails more to numb because they are innervated by central core of the nerve in IAN

________ is the only LA with a natural vasoconstrictive property

Cocaine

All other LA need vasoconstrictor because they are vasodilators

Drug with ______ pKA possess a more rapid onset of action

lower

More _______ the anesthetic, the more potent

More lipophilic more potent

Know this

What is nefenhydramine

Benadryl 50 mg

Given to allergic reaction causing hives

Which anesthetic cannot be used for lower block

Can cause paresthesia

Articaine

What is the maximum recommended dosage of LA

1kg = 2.2 lb

7.0 mg/kg

What is the longest LA

Bupivicaines

What are the 5 branches of Facial Nerve

Temporal

Zygomatic

Buccal

Marginal Mandibular

Cervical

Where do you insert for

PSA

MSA

ASA

Mucobuccal fold above max second molar

Mucobuccal fold above max second premolar

Infraorbital foramen (over first premolar)

Area of insertion and landmark of IAN

Mucous membrane of medial side of mandibular ramus

Landmark: Coronoid notch, ptergymandibular raphe, occlusal plane of mandibular posterior teeth

What is intralipid emulsion therapy

Scavenges LA from high blood flow and redistributes to muscles

Last step

What is Molt 9

Periosteal Elevatorused in oral surgery to detach periosteum from bone.

Caution when using Adson Forceps

Might tear gingiva

What is the Baumgartner

Needle Holder

How to remove bone using a bone file

Use pull stroke

Which liver lab test for

PT/INR

What is surgical curette used for

Remove soft tissue from bony defect

What degree do bone necrose

47 celsius

What is the problem of using dental handpiece in extraction

exhaust air can cause tissue emphysema (air trapped in tissue)

Saline water is ____tonic

Hypo

What does number of Frazier tip affect

High number larger diameter

Blade of straight elevator has a ______ surface on one side that is placed toward the tooth to be elevated

concave

What is cryer elevator

East West Elevator

Turned in wheel and axle to remove root

What are forceps for?

Remove teeth from alveolar bone

Promote expansion of alveolar bone

Deliver previously luxated teeth from sockets

150 vs 151 forceps

150 maxillary

151 mandibular

What is 23 forceps

Cowhorn forceps

Designed to extract mandibular molars

What nerves to you have to anestheize for maxillary 1st molar

PSA (does not cover MB root)

MSA

Greater Palatine

The first force applied durign forceps luxation is

Apical

What are the steps for pt with MI

ONAM

Oxygen, Nitroglycerin, Aspirin, Morphine

Local Anesthesia ______ permeability of ion channels to sodium

Decreases

Metabolism of Amides

Liver Enzymes

What determines the duration of LA

Protein binding

pka (onset time)

lipid solubility (potency)

The onset of LA is determined by

pka

Where is the most common site of hematoma in PSA

Pterygoid plexus

Landmarks for IAN block

Coronoid notch, occlusal plane, pterygomandibular raphe

Procaine Metabolism

Plasma esterases

The East West is used as a

Wheel and axle

Pain management for dialysis pt

Acetaminophen

Avoid NSAID

Treatment of Syncope

Aminister oxygen

Ammonia inhalents

Trendelenburg position

(No epinephrine)

Dose of epi for anaphylaxis

0.3 mg IM

Dose of epinephrine in cardiac pt

0.04 mg

First sign of LA toxicity

Numbness of tongue

_______ causes methemoglobinemia

Prilocaine

What LA is both ester and amide

Articaine

What is impacted tooth

Fails to erupt into dentla arch within usual range

Often due to inadequate space

Most common impacted teeth in order

Max and Man 3rd molars

Max canines

Mandibular premolars

Removal of impacted teeth become more difficult with _______

age (more dense bone and fully formed roots)