question

What vascular tissue may be injured in a PSA injection?

answer

Pterygoid Plexus of veins

question

What cranial nerves are involved in taste?

answer

Glossopharyngeal (IX), Vagus (X), and Facial (VII)

question

The second part of the trigeminal nerve is...

answer

Maxillary division

question

What nerve supplies the maxillary central incisors?

answer

ASA

question

What nerve supplies the mucosa of the lower lip?

answer

Mental

question

What nerve supplies the palatal gingiva of the maxillary central incisors?

answer

Nasopalatine

question

What supplies taste sensation to the anterior 2/3 of the tongue?

answer

Chorda tympani

question

Which cranial nerve passes through both the internal acoustic meatus and the stylomastoid foramen to leave the skull?

answer

Facial (VII)

question

Which nerve is the terminal branch of the inferior alveolar nerve that continues forward within the mandible anterior to the mental foramen?

answer

Incisive

question

Which injection is likely to encroach on the buccinator muscle?

answer

Inferior Alveolar

question

Nodes of Ranvier....

answer

Are not covered by Schwann cells Allow nerve impulses to "Hop" over lengths of the fiber Are part of the axon

question

A (alpha) and C peripheral nerve fibers carry pain, temperature, and pressure sensations. True or False

answer

False

question

Tetracaine, Procaine, Novocaine, and Benzocaine. Which anesthetic is an ester?

answer

All are esters

question

Which topical anesthetic has the lowest solubility in water?

answer

Benzocaine

question

Which anesthetic has such outstanding diffusion that if injected via buccal infiltration in the maxilla, would anesthetize the palatal gingiva also?

answer

Bupivicaine

question

Anesthetics "numb" in the area of deposition by?

answer

Making the nerve membrane lass permeable to Na+

question

What does Action Potential refer to?

answer

The depolarization and repolarization of the nerve membrane

question

What is the normal pH of intercellular fluids?

answer

7.4-7.6

question

In infected tissue (inflammation is present)....

answer

pH of tissue will be lower than in normal tissue pH of tissue will be more acidic than normal anesthetics will be less effective anesthetics will exist more in the ionized form

question

Lidocaine, Mepivacaine, Citanest, and Etidocaine. Which one are primarily metabolized in the liver?

answer

All of them

question

The excretion of unchanged local anesthetics and their metabolites is through the kidneys. True or False

answer

True

question

Which end of an anesthetic molecule helps in diffusion of the anesthetic across the membrane?

answer

The lipophilic end

question

In which pH listed below would an anesthetic most likely lose its efficacy? 7.0, 9.0, 7.6, 6.7, & 9.3

answer

6.7

question

pKa of an anesthetic.....

answer

Defines the anesthetic disassociation propensity Is directly proportional to its rate of onset (the lower pKa the faster the onset) Is the pH at which 50% of the anesthetic is in the base form and 50% is in the ionized form.

question

One anesthetic has a pKa of 7 and another has a pKa of 20. Which will have the faster onset?

answer

pKa 7

question

What is true for Benzocaine (pKa 3)?

answer

The anesthesia will have a fast onset The anesthetic will be rapidly absorbed by the blood stream There is more likelihood of an allergic reaction from this anesthetic than from an amide with a pKa of 3. The anesthetic has a low solubility in water.

question

The topical Dyclone (diclonine) is what type of anesthetic?

answer

A Ketone

question

The hydrophilic portion of the anesthetic molecule..

answer

Contributes to the affinity of the molecule for the nerve membrane

question

The reason that esters have more allergenicity is because one of the metabolites (breakdown products) is PABA (para-amino-benzoic acid). True or False

answer

True

question

Which pair(s) of anesthetics are not correct? 1. lidocaine-Xylocaine 2. procaine-Novocaine 3. etidocaine-Duranest 4. bupivacaine-Marcaine 5. tetracaine-Pontocaine 6. benzocaine-Hurricaine 7. mepivicaine-Citanest 8. prilocaine-Carbocaine

answer

7 & 8

question

Which of the following is incorrect for max safe dose? A. lidocaine: 2mg/lb B. etidocaine: .04mg/lb C. bupivicaine: .6mg/lb D. mepivicaine: 2mg/lb E. prilocaine: 2.7mg/lb

answer

B. etidocaine: .04mg/lb

question

The correct ratio of lbs to kg is....

answer

1kg = 2.2lbs

question

The maximum safe dose for epinephrine is what?

answer

.2mg for a healthy client and .04mg for a cardiac risk client

question

The amount of epinephrine in a 1:100,000 solution is 1/100=.01 mg/ml. True or False

answer

True

question

The treatment choice for the emergency that can occur from vasoconstrictors will include delivery of diazepam (Valium) IV. True or False

answer

False

question

Which of the following positive notations on the medical history would NOT be cause for more than usaual judiciousness in using a vasopressor? a. MAOI b. TCA c. APC (atypical plasma cholinesterase) d. Beta blockers e. ASA Class III

answer

e. ASA III

question

Concern for use of amides (prilocaine and articaine) would be necessary if a positive notation of what was on the Medical history?

answer

Methemoglobinemia

question

A client who has had a myocardial infarction in the last 3 months is in ASA Class ___, and should be scheduled for routine scaling until it has been ___ months post MI.

answer

IV, 6

question

A client who has been having a seizure every week for the past month and for whom the physician has just changed medications is an ASA Class what?

answer

ASA III

question

The needle has broken off within the tissue while you were doing an infiltration in the PSA region and it cannot be seen. What should you do?

answer

Send the client to the oral maxillofacial surgeon

question

What is the correct treatment for someone who experiences syncope?

answer

Place in the supine position and administer oxygen

question

For a mild allergic skin reaction, what is the treatment of choice?

answer

Oral benadryl

question

What is the first step, after BLS in anaphylaxis?

answer

Epinephrine administered either sublingually or IM in the arm

question

True or False. The management of a hematoma includes pressure applied to the site and ice; an antibiotic should always be prescribed for 10 days after the incident.

answer

False

question

True or False. An inadvertent intravascular injection is one of the most common reasons for an overdose.

answer

True

question

When comparing a 27 gauge short needle and a 25 gauge short needle, the 27 gauge needle is ___ in length and ___ in bore than the 25 gauge.

answer

26mm, smaller

question

The bevel of the needle should be oriented toward the bone to prevent a position aspiration. True or False

answer

False

question

An aspiration check should be performed upon initial insertion and at anytime that the needle is advanced or redirected. True or False

answer

True

question

A positive aspiration requires that the clinician withdraw the needle and change to a new cartridge. True or False

answer

False

question

Anesthetic solutions no longer contain methylparaben as a preservative. True or False

answer

True

question

True or False. Anesthetic solutions that contain epinephrine will have sodium bisulfite as a preservative and might cause a bronchospasms in asthmatic clients.

answer

True

question

Salt (sodium chloride) is in the anesthetic solution to make them more isotonic to the body. True or False

answer

True

question

In an infiltration, What is the average depth that a clinician will penetrate the tissue?

answer

6mm

question

In an infiltration for scaling and root planing of 3, 4, and 5, the least amount of injections the clinician will give will be __ injections and will deposit approximately __ carpule at each site.

answer

2, 1/4

question

Your client needs the maxillary and mandibular right quadrants scaled and root planed and is particularly sensitive around #31, where there is a small periodontal abscess. The best treatment plan is what?

answer

Have your dentist give a mandibular block and the appropiate maxillary field blocks. or You give the maxillary infiltrations and begin working on the maxillary quadrant until the dentist arrives to do the mandibular block.

question

Inability to achieve profound anesthesia might be due to what?

answer

Low pH Too little anesthetic deposited Anesthetic deposited short of the root apices Needle orientation too lateral into the buccal tissue

question

Soft tissue anesthesia with 3% Carbocaine will last about __ hours and will last __ hours with 3% Carbocaine, 1:20,000 Neocobefrin.

answer

2, 5

question

True or False. Pulpal anesthesia will last longer than soft tissue anesthesia.

answer

False

question

How can you achieve a nerve block for the mandibular incisors?

answer

By anesthetizing the incisive nerve through massage of anesthetic back into the mental foramen.

question

What fibers do nerves impulses travel faster on?

answer

Myelinated A fibers

question

True or False. A concentration of 1:100,000 epinephrine means 1mg/cc of epinephrine is in the anesthetic.

answer

False

question

Depolarization of the axon during the generation of the action potential occurs due to the influx of what?

answer

Na+

question

At which pH would the greatest concentration of Xylocaine be needed? 7.8, 7.6, 7.4, 7.2

answer

7.2

question

Where does lidocaine metabolize?

answer

Liver

question

Which anesthetic has the breakdown product known as PABA?

answer

procaine-Novocaine

question

What do vasoconstrictors cause?

answer

The duration of the local anesthetic to increase.

question

Four carpules of 2% lidocaine would exceed the toxic dose for a 31 kg person. True or False

answer

True

question

True or False. Benzocaine should never be used as a topical.

answer

False

question

Myelinated nerves are easier to anesthetize than nonmyelinated nerves. True or False

answer

True

question

True or False. Local anesthetics are weak acids.

answer

False

question

Topical tetracaine must be used in low concentrations because of high solubility in water and possible overdose. True or False

answer

False

question

What is the maximum number of carpules of 2% lidocaine that should be used in 20kg child.

answer

2.3

question

During the provision of local anesthesia via infiltration, which is not a protocol?

answer

Anesthetics should be warmed to body temperature of 98.6 F.

question

Pain during injections is most likely due to what?

answer

The injection of the fluid.

question

Why is aspiration performed?

answer

To avoid injection into a blood vessel

question

You have anesthetized the maxillary left area for scaling #9-15. You notice an immediate swelling in the cheek. What is the most likely cause?

answer

You have traumatized the pterygoid plexus.

question

You have given 2% Carbocaine with Neocorbefrin to a 30 year old client. The client stated that it really burned and there is an ashen gray spot beneath his eye that is about the size of a dime. What is the most likely cause?

answer

Vasonconstrictor infarct of the t. facial artery.

question

True or False. Anesthetic carpules should be stored in 91% isopropyl alcohol for one week to achieve disinfection.

answer

False

question

Gluteraldhyde should not be used to soak LA. True or False.

answer

True

question

True or False. One of the first steps in managing an acute asthmatic attack would be to place the client in a supine position.

answer

False

question

The Trigeminal nerve has both motor and sensory function. Which division of the trigeminal has both of these functions?

answer

Mandibular

question

Which nerve runs just medial to the mandible at the place where the 3rd molar roots are?

answer

Inferior Alveolar

question

In order to achieve a nerve block, on should enter the foramen with the needle. True or False

answer

False

question

Name the three branches of the trigeminal nerve:

answer

Opthalmic V1 Maxillary V2 Mandibular V3

question

Which of the following arteries supply blood to the face? A. Lingual B. Maxillary C. Palatal D. Mental E. All of the above

answer

E. All of the above

question

Which nerve is the nerve supply to the palatal gingiva of the maxillary central incisors?

answer

Nasopalatine

question

What is a Hematoma?

answer

Effusion of blood into extra vascular spaces

question

Definition: Motor disturbance of the trigeminal nerve.

answer

Trismus

question

What is parestesia?

answer

Loss of sensation in nerve fiber

question

Definition: Ischemia resulting from use of local anesthesia with vasoconstrictor.

answer

Sterile abscess

question

True or False. A 30 guage needle has a smaller internal diameter than a 25 gauge needle.

answer

True

question

An anesthetic cartridge contains ___ ml of solution.

answer

1.8

question

A long needle is approximately __ long.

answer

32mm

question

How should topical anesthetic be stored?

answer

At room temperature

question

What will not increase the duration of anesthesia?

answer

Infiltration anesthetic technique

question

Which injection would anesthesize the facial gingiva only of teeth #25 and 26?

answer

Mental

question

What blood vessel(s) are a potential for causing a hematoma when administering the PSA?

answer

Pterygoid venous plexus

question

What is the most common reason for unsuccessful nerve block of the inferior alveolar nerve?

answer

Anatomical variations

question

Given a 140 lb patient with no known contraindications to local anesthetic agents or vasoconstrictors, what is the maximum mg of lidocaine 2% with epinephrine 1:100,000 you may safely administer? How many cartridges can this patient receive?

answer

280 mg and 7.7 cartridges

question

What is the needle penetration for the PSA nerve block injection?

answer

16 mm

question

During the long buccal injection which fibers will the needle pass through?

answer

buccinator muscle

question

After giving a right posterior superior alveolar injection, you find that there is still sensitivity while root planing tooth #3. Teeth numbers one and two exhibit adequate anesthesia. What is the most likely cause?

answer

Normal neuroanatomy

question

After performing the inferior alveolar injection, you find the mandibular first molar is not completely anesthetized. What is most likely the cause?

answer

Accessory innervation from the mylohyoid nerve

question

If one of your patients reports limitation of movement of the mandible and pain upon opening the day following an inferior alveolar nerve injection, what would you recommend to that patient for their trismus?

answer

Heat therapy An analgesic such as aspirin Physiotherapy (No cold packs)

question

If a hematoma should begin to develop immediately following an incisive nerve block, what would you do?

answer

Apply pressure to the area immediately for at least one minute and then give the patient an ice pack to hold over the area

question

What is the most significant factor in the prevention of intravascular injection of the anesthetic?

answer

Aspiration at the point of deposition

question

What would minimize the chances of toxic overdose reaction if the needle is inserted into the lumen of a blood vessel during an injection?

answer

Slow (min of 60 sec per cartridge) deposition of anesthetic solution

question

After performing a left inferior alveolar injection, it is found that the left mandibular central and lateral incisors are still sensitive to root planing but the rest of the quadrant exhibits adequate anesthesia. What is most likely the cause?

answer

Accessory innervation from the right incisive nerve

question

To avoid injection of anesthetic solution into the medioposterior aspect of the parotid gland during the inferior alveolar nerve injection, what should the operator do?

answer

Contact the bone before deposition

question

Which injections will completely anesthetize the pulp of the maxillary first molar?

answer

MSA and PSA

question

Positive aspiration while performing the PSA injection can occur when the needle enters what?

answer

Pterygoid venous plexus or the Maxillary artery

question

What is the recommended physiological position for administration of local anesthesia?

answer

Supine

question

The position of the barrel of the syringe during a PSA injection should be...

answer

45 degrees to the midsagital plane and 45 degress to the occlusal plane

question

What is the penetration site for the middle superior alveolar nerve block at the height of the mucobuccal fold?

answer

Over the maxillary second premolar.

question

What is the point of insertion for the inferior alveolar nerve block?

answer

At the level of the coronoid notch

question

The barrel of the syringe during the inferior alveolar injection and the lingual injection should be positioned..

answer

Over the [premolars of the opposite side

question

The deposition site for the anterior superior alveolar nerve block is...

answer

Over the apex of the maxillary canine

question

To anesthetize the pulps of the mandibular molars and the buccal and lingual mucosa adjacent to them, which injections would be needed?

answer

Inferior alveolar Long buccal Lingual

question

What is the recommended needle size for the IA injection for an average size adult?

answer

25 long

question

What is the recommended needle size for the PSA injection?

answer

25 g short

question

What blood pressure levels would a patient be considered unsuitable for elective dental care with a local anesthetic agent?

answer

200(or greater)/115(or greater)

question

What is the most common reason syncope occurs?

answer

Anxiety

question

Six steps in the universal treatment of emergencies

answer

Recognize Activate Position Evaluate Diagnose EMS

question

What is the correct number of compressions per minute for CPR?

answer

80 - 100

question

Your patient presents for root planing and gingival curettage. You find that his blood pressure is 195/121. The patient reports that he is taking his "blood pressure pills" What should you do?

answer

No elective treatment should be performed

question

Your patient reports a history of rheumatic fever and heart murmur. You plan to use local anesthesia. What should you know?

answer

Vasocontrictors are contraindicated for patients with a heart murmur.

question

Your patient reports a history of epilepsy and is taking his medication. You are planning root planing and curettage. What should you know?

answer

Adequate pain control is essential thus local anesthesia is indicated

question

Which of following is false about the trigeminal nerve? A. Largest cranial nerve B. Has motor and sensory fibers C. Has three major branches D. Exits the cranium at the pons E. All are true

answer

D. Exits the cranium at the pons

question

What does the long buccal nerve innervate?

answer

Skin of the cheek and gingiva of mandibular molars

question

Conduction blockage of which nerve would anesthetize the pulp of the mandibular canine?

answer

inferior alveolar

question

What should you do to assist your client who is having a seizure?

answer

Lower the chair and clear the area

question

What is considered to be chest pain that is relieved by nitroglycerin?

answer

Angina

question

What is the depth of compression for an adult in CPR?

answer

1 1/2 to 2 inches

question

For which situation is additional oxygen NOT part of the recovery management?

answer

Hyperventilation

question

True or False. During the clonic phase of a grand mal seizure it is important to physically restrain the patient to avoid injury.

answer

False

question

The most common reason for inability to ventilate a patient sufficiently in CPR is due to inadequate patient head tilt. True or False

answer

True

question

True or False. Never administer insulin to a diabetic patient in emergency distress.

answer

True

question

Headache, confusion, dizziness, varied respiration, distorted speech are signs and symptoms of a stroke. True or False

answer

True

question

Lidocaine Facts

answer

Xylocaine Greatest vasodilatory effects Tagamet and antacids should only get half of the dose 2% Safe Dose: 2 mg/lb or 4.4 mg/kg MRD: 300 mg

question

Mepivicaine Facts

answer

Carbocaine Least vasodilatory effects 3% plain, 2% 1:20,000 levonordefrin Safe Dose: 2 mg/lb or 4.4 mg/kg MRD: 300 mg

question

Procaine Facts

answer

Novocaine Ester Metabolized in plasma Can cause Atypical plasma cholinesterase

question

Prilocaine Facts

answer

Citanest Metabolized by Lungs, Kidneys, then Liver May cause paresthesia very low vasodilation, least toxic May produce Methemoglobinemia 4% Safe Dose: 2.7 mg/lb or 6 mg/kg MRD: 400 mg

question

Articaine Facts

answer

Septocaine, Articadent, or Ultracaine Metabolized in plasma and liver 4% Safe Dose: 3.2 mg/lb or 7 mg/kg MRD: 500mg 1.7 ml in a cartridge

question

Bupivacaine Facts

answer

Marcaine, Sensorcaine Most potent and toxic amide Half life 3 1/2 hours 0.5% Safe Dose: .06 mg/lb or 1.3 mg/kg MRD: 90 mg

question

Primary effects of local anesthesia are during what phase?

answer

Depolarization

question

What are the 3 components of an anesthetic molecule?

answer

Lipophilic aromatic ring (for lipid solubility) Intermediate hydrocarbon chain (Determines ester or amide) Hydrophilic terminal amine (dissociation and H+ pick up)

question

The greater the lipid solubility = ?

answer

The greater the potency

question

Which part loses local anesthetic first?

answer

Mantle bundles then core bundles

question

Sodium chloride

answer

A buffer that creates an isotonic solution

question

Sodium hydroxide

answer

A buffer that alkalizes and adjusts the pH between 6-7

question

Direct-Acting

answer

Acts directly on adrenergic receptors

question

Indirect-Acting

answer

Acts by releasing norepinephrine from adrenergic nerve terminals

question

Alpha receptor

answer

Constricts smooth muscles of vessels

question

Beta receptors

answer

Relaxes broncial and vascular smooth muscle

question

Contraindications for Vasoconstrictors

answer

Tricyclic Antidepressants Beta Blockers Cardiac Drugs Phenothiazides Cocaine and Meth Hyperthyroidism Atypical plasma cholinesterase

question

Contraindications for Anesthetics

answer

Methemoglobinemia Asthma Malignant hyperthermia Histamine Blockers Antacids/Tagamet Beta Blockers Liver Disease End Stage Renal Disease

question

Calculation Steps

answer

1. Calculate mg of anesthetic per cartridge 2. Calculate patients MRD 3. Convert MRD to cartridges

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