Local Anesthesia Final

All of the following local anesthetics are available in dental cartridges in the US EXCEPT one. Which one is the EXCEPTION?

A. Articaine

B. Etidocaine

C. Bupivacaine

D. Mepivacaine

B

Regarding the maximum recommended dose of local anesthetics:

A. clinicians should use the largest clinically effective dose

B. administered dosages exceeding the recommended maximum will always cause an overdose

C. the dosages should always be based on the patient's actual weight

D. the calculated dosages should be decreased for medically compromised patients

D

Which of the following is the correct maximum recommended dose for lidocaine with epinephrine?

A. 7 mg/kg

B. 90 mg total

C. 5 mg/kg

D. 300 mg total

A

Which of the following local anesthetics has the longest duration of action when administered successfully for an inferior alveolar nerve block?

A. 2% lidocaine with 1:100,000 epinephrine

B. 0.5% bupivacaine with 1:200,000 epinephrine

C. 4% articaine with 1:100,000 epinephrine

D. 2% mepivacaine with 1:20,000 levonordefrin

B

Articaine is:

A. metabolized exclusively in the liver

B. classified only as an ester anesthetic

C. not recommended for use for inferior alveolar nerve blocks

D. capable of producing profound vasoconstriction

C

Which of the following is the correct value for the approximate duration of 2% lidocaine with 1:100,000 epinephrine?

A. 15 minutes (pulpal anesthesia)

B. 30-60 minutes (soft tissue anesthesia)

C. 120 minutes (pulpal anesthesia)

D. 180 minutes (soft tissue anesthesia)

D

When performing a PDL injection:

A. patients should be informed they may experience pain while chewing postoperatively

B. there should not be significant back pressure while injecting

C. the anesthetic solution accesses the nerves by diffusing down through the ligamental fibers

D. local anesthetics with vasoconstrictors are absolutely contraindicated

A

Which of the following statements is true regarding supplemental anesthetic techniques?

A. intraseptal injections reliably produce pulpal anesthesia

B. the needle should be placed anterior to the target tooth during an intraosseous injection

C. the cortical bone is perforated using a quarter-round bur and a high speed hand piece

D. brief, intense pain is common for intrapulpal injections

D

When considering supplemental techniques for anesthetizing the maxilla, a prudent clinician must remember that:

A. infiltration of the palate reliably produces pulpal anesthesia

B. a successful V-2 block will provide profound anesthesia of the midface and posterior tongue

C. the high tuberosity approach has an increased risk of positive aspiration

D. the needle should be gently forced past bony obstructions when utilizing the greater palatine canal approach

C

Which of the following statements is true regarding mandibular supplemental anesthetic techniques?

A. the target site for Gow-Gates injections is the lateral aspect of the condylar head

B. the tip of the needle when performing an Akinosi injection is superior to an inferior alveolar nerve block

C. the Gow-Gates technique is ideal for patients with limited opening

D. If the anterior ramus is contacted during an Akinosi block, the needle should be repositioned laterally

B

Regarding local complications from administering local anesthetics:

A. a 27 gauge needle is more likely to fracture or break than a 30 gauge needle

B. any noted transient motor paralysis is cause for immediate medical care (911)

C. trismus is relatively common and should be managed initially with palliative measures

D. hematomas are more common in highly vascular areas and should be immediately drained

C

What is the appropriate management for a patient who complains of a persistent paresthesia following injection of local anesthesia?

A. have your front office person reassure the patient and reappoint for follow up in one year

B. immediately discuss and plan for surgical exploration of the nerve

C. personally evaluate the degree and extent of the paresthesia

D. re-administer a longer lasting local anesthetic, such as bupivacaine

C

Regarding potential systemic complications that can arise during administration of local anesthetics:

A. patients who report an allergy to epinephrine can receive local anesthetics with vasopressors (epinephrine)

B. anaphylactic allergic reactions are equally common between amide and ester class local anesthetics

C. seizures or seizure-like activity most likely indicate overdose of vasopressors (epinephrine)

D. patients who report a sulfa allergy should not be given local anesthetics with vasoconstrictors

A

Which of the following statements is true regarding proper documentation of the administration of local anesthetics?

A. preoperative vital signs are only necessary for patients who are ASA II or greater

B. the total dose of all drugs administered should be recorded for each patient visit

C. any abnormal responses should not be documented in case of future patient litigation

D. written consent is not necessary when performing an injection on a pediatric patient

B

The ADA maximum recommended dose for Lidocaine is:

A. 91 mg

B. 300 mg

C. 500 mg

D. 1000 mg

B

In children, you must dose Lidocaine at _____ mg/kg to be safely within the MRD.

A. 0.5

B. 2.0

C. 4.4

D. 6.6

C

Which local anesthetic has been associated with nerve injury if given as a mandibular block?

A. 2% lidocaine

B. 0.5% bupivacaine

C. 4% articaine

D. 2% mepivacaine

C

Individual variation in response to local anesthesia follows a:

A. chi-square distribution

B. direct linear curve/relation

C bell-shaped distribution

D. gamma distribution

C

T/F: A hypo-responder metabolizes local anesthetics faster than average.

False

Which area is most vascular when injecting local anesthesia?

A. neck of condyle (Gow-Gates)

B. greater palatine

C. IANB

D. nerve to mylohyoid

C

In most individuals, deliberate injection of lingual nerve is:

A. always necessary

B. rarely necessary

C. dangerous, as you may impale the nerve

D. only occurs with a Gow-Gates injection

B

The failure rate for traditional IANB is approximately:

A. 5%

B. 20%

C. 50%

D. 95%

B

The approximate rate of positive aspiration with the IANB is:

A. 1-2%

B. 10-15%

C. 40-50%

D. zero

B

T/F: Bilateral mandibular blocks is inherently unsafe.

False

Accessory innervation to mandibular molars is thought to be which nerve?

A. lingual

B. long buccal

C. mylohyoid

D. auriculotemporal

C

The Gow-Gates injection will anesthetize all of the following nerves EXCEPT one. Which one is the EXCEPTION?

A. mylohyoid

B. lingual

C. long buccal

D. auriculotemporal

D

The MRD of the anesthetic Bupivacaine is:

A. 91 mg

B. 300 mg

C. 420 mg

D. 500 mg

A

Methemoglobinemia is usually associated with which anesthetic?

A. Bupivacaine

B. Lidocaine

C. Prilocaine

D. Procaine

C

A patient with significant cardiovascular problems should receive _____ ug maximum during a dental appointment.

A. 9

B. 17

C. 36

D. 40

D

T/F: One of the purported advantages of plain Mepivacaine is that it is less vasodilating.

True

In a 1.7 mL cartridge of 1:50,000 epinephrine, how much epinephrine is present?

A. 8.5 ug

B. 17 ug

C. 34 ug

D. 40 ug

C

The maximum dose for epinephrine in a healthy patient is:

A. 2.0 mcg

B. 300 mcg

C. 40 mcg

D. 200 mcg

D

The depth of penetration of topical anesthesia is approximately:

A. 2-3 mm

B. 5-6 mm

C. to bone

D. negligible

A

One of the problems with lidocaine is that its metabolites are:

A. irritating to veins

B. tend to result in liver damage

C. sedating

D. less water soluble

C

T/F: Bupivacaine has a longer onset of action.

True

If your patient develops methemoglobinemia, what is the usual clinical finding?

A. seizures

B. hepatitis

C. bone marrow failure

D. cyanosis

D

Bupivacaine is _______ compared to other amides.

A. extremely expensive

B. extremely vasodilating

C. non-toxic

D. extremely irritating to tissues

B

T/F: The speed of onset of a local anesthetic is related to the pKa.

True

While performing an injection, each time you move the needle, you _______ first before injection.

A. withdraw the needle

B. deposit a very small amount of LA

C. aspirate

D. go back to touch bone

C

What is the ADA maximum recommended dose of Bupivacaine for adult patients?

A. 300 mg

B. 90 mg

C. 400 mg

D. 500 mg

B

How would you dose a thin, adolescent patient with Bupivacaine?

A. 2.0 mg/lb

B. 2.7 mg/lb

C. 0.6 mg/lb

D. 4.4 mg/lb

C

The chart actually says 0.9 mg/lb as the MRD for bupivacaine

Which of the following diseases extends the half-life of LA's due to decreased liver perfusion?

A. coronary artery disease

B. hypothyroidism

C. cirrhosis

D. congestive heart failure

D

What is the ADA maximum recommended dose of Lidocaine with epinephrine?

A. 400 mg

B. 4.4 mg/kg

C. 300 mg

D. 500 mg

C

The answer key has "C" marked, but according to the table, the MRD for lidocaine with epinephrine = 500 mg and lidocaine w/out epinephrine = 300 mg.

What is the ADA maximum recommended dose of plain Lidocaine?

A. 4.4 mg/lb

B. 300 mg

C. 500 mg

D. 400 mg

B

The 3 main types of injections are infiltration, nerve block, and...

A. Gow-Gates

B. IANB

C. field block

D. trigeminal V-2 block

C

The success rate of a PSA injection is approximately:

A. 95%

B. 50%

C. 25%

D. 1%

A

Which root of 1st maxillary molar is not consistently innervated by the PSA nerve?

A. palatal

B. distal buccal

C. mesio buccal

D. all roots are innervated by PSA 100% of the time

C

In which palatal injection do you enter the greater palatine canal?

A. IANB

B. Nasopalatine nerve block

C. Lesser palatine nerve block

D. Trigeminal V2 nerve (maxillary) block

D

Which injection provides palatal, buccal, and pulpal anesthesia to all maxillary teeth?

A. Greater palatine nerve block

B. ASA nerve block

C. Trigeminal V2 block (maxillary)

D. IANB

C

Accessory innervations to lingual side of mandibular molars is usually by the:

A. long buccal nerve

B. nerve to mylohyoid

C. lesser palatine nerve

D. inferior alveolar nerve

B

The lingual of the mandible is:

A. in a constant position relative to occlusal plane

B. in a variable position relative to occlusal plane

C. always 6-10 mm below the occlusal plane

D. always found about 1 cm above occlusal plane

B

Is it possible to anesthetize the lingual nerve and not the inferior alveolar nerve by an IANB?

A. Yes

B. No

A. Yes

Injection on the lateral aspect of the ramus may result in:

A. parotitis

B. Bell's palsy

C. stroke

D. penetration of the lingula

B

Intraosseous injections are:

A. deposition of LA into cortical bone

B. deposition of LA into cancellous bone

C. injection of LA into a nerve canal

D. injection into mental foramen

B

In the PDL injection, LA solution diffuses through:

A. the alveolar bone surrounding the tooth

B. the PDL itself to the apex of a tooth

C. the attached gingival

D. a hole drilled into cancellous bone

A

Should you use a PDL on primary teeth?

A. Yes

B. No

B. No

The risk of aspiration from a PDL injection is:

A. none

B. 20%

C. 80%

D. nearly 100%

A

In the PDL, approximately how much LA solution is deposited to achieve anesthesia for each root?

A. 2 mL

B. 1.7 mL

C. 0.2 mL

D. 72 mg

C

A successful inferior alveolar nerve block will provide:

A. soft tissue anesthesia for the anterior 2/3rds of the tongue

B. pulpal anesthesia for the mandibular incisors and premolars

C. anesthesia for the lower lip and entire buccal mucosa of the mandible

D. neural blockade for the facial nerve that provides motor innervation to the tongue

B

When performing an inferior alveolar nerve block, the tip of the needle should:

A. contact the medial aspect of the mandible

B. pass through the masseter muscle

C. rest against bone superior to the condyle

D. penetrate through the tail of the parotid gland

A

The correct sequence when performing mandibular anesthetic injections is:

A. if a positive aspiration occurs, remove the needle entirely, then reinsert and inject

B. aspirate, inject 1/2 cartridge for the inferior alveolar nerve block, then advance the needle until bone is contacted

C. administer 1/2 cartridge for the long buccal nerve block, then administer 1/4 cartridge for inferior alveolar and lingual nerve blocks

D. after a negative aspiration, inject 1/2 cartridge for inferior alveolar and continue injecting 1/4 cartridge for lingual nerve block while removing the needle

D

Inadequate anesthesia in the mandible can occur due to:

A. overlapping innervation of the canines and premolars

B. placement of the needle slightly above the lingula

C. additional innervation by mylohyoid accessory nerves

D. misalignment of the soft tissues when the patient opens maximally

C

When performing mandibular injection techniques, it is important to remember:

A. the patient should be positioned with the occlusal plane of the mandibular teeth parallel to the floor

B. the mental nerve provides pulpal sensory information for the premolars and molars

C. a successful inferior alveolar nerve block should result in numbness of the lower lip only at the commissure

D. the tip of the needle should never contact bone

A