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Oral Surgery IV > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Zygomatic implants are ___ loading implants.
a. immediate
b. early
c. delay
d. second stage

A

a. immediate

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2
Q

What is the recommended radiographic examination for work up?

A

Pano = anatomy and pathology detection
PA = supplements Pano
Lateral cephalometric = sagittal relationship of jaws
CBCT = bone volume (width and height) assessment

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3
Q

What are contraindications of zygomatic implants?

A

○ Acute sinus infection
○ Maxillary or zygoma pathology
○ Underlying uncontrolled systemic disease
○ Relative contraindications: chronic infectious sinusitis, bisphosphonates, smoking

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4
Q

What are the indications of zygomatic implants?

A

○ Sufficient anterior bone + severely resorbed posterior
○ Insufficient anterior bone + severely resorbed posterior
○ Partial edentulous maxilla with unilateral or bilateral loss of posterior teeth + severe resorption

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5
Q

Zygomatic implants require room for at least ___ conventional implants at the anterior maxilla

A

2

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6
Q

How much can you expect to lift via intracrestal lift?

A

1-2 mm

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7
Q

What is the recommended initial maxillary residual ridge for the most predictable result for an intracrestal sinus lift?

A

≥ 4 mm

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8
Q

What is the indication for lateral window lift?

A

Less than 4 mm native maxillary alveolar bone

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9
Q

What is the pseudostratified ciliated columnar epithelium with CT and periosteum membrane that lines the maxillary sinus?

A

Schneiderian membrane

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10
Q

What is the indication for alveolar ridge splitting?

A
  • Not enough width of alveolar bone therefore need to split and laterally reposition buccal cortex
  • Simultaneous implant placement
  • Reduced treatment time and cost of surgery
    Barrier membrane usually not needed
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11
Q

What is alveolar ridge splitting?

A

Ridge expansion technique with longitudinal osteotomy on alveolar ridge with lateral repositioning of the buccal cortex

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12
Q

What is the minimum ridge width for alveolar ridge splitting?

A

2-4 mm (prefer more than 3 mm)

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13
Q

Which bone graft takes tissue from the same individual?

A

Autogenous

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14
Q

Which bone graft is the gold standard?

A

Autogenous

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15
Q

What bone graft is taken from cadavers?

A

Allograft

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16
Q

What graft takes tissue from different species?

A

Xenograft

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17
Q

What graft is composed of composite crystalline or amorphous natural or synthetic material?

A

Alloplast

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18
Q

What is type of bone is primarily compact bone? How long does it take to integrate?

A

Type I (oak wood), 5 months

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19
Q

What is type of bone is thick cortical bone and dense trabecular bone? How long does it take to integrate?

A

Type II (pine wood), 4 months

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20
Q

What is type of bone is thin cortical bone and dense trabecular bone? How long does it take to integrate?

A

Type III (balsa wood), 6 months

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21
Q

What is type of bone is thin cortical bone and low density trabecular bone? How long does it take to integrate?

A

Type IV (styrofoam), 8 months

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22
Q

What are the general properties of benzodiazepine?

A

○ Sedation
○ Anxiolysis
○ Muscle relaxation
○ Anterograde amnesia
○ Anticonvulsant effects

No direct analgesic effects

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23
Q

What are common side effects of benzodiazepines?

A

○ Fatigue
○ Drowsiness
○ Respiratory depression

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24
Q

What was the first benzodiazepine discovered?

A

Chlordiazepoxide (Librium)

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25
Q

What is the first benzodiazepine used in anesthesia?

A

Diazepam (Valium)

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26
Q

What receptor does benzodiazepine work on?

A

GABA receptor (inhibitory effect)

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27
Q

What is the reversal agent of benzodiazepine? What is the dose?

A

Flumazenil (Romazicon)
0.2 mg/min IV until reversal

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28
Q

What receptor does ketamine work on?

A

NMDA receptor

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29
Q

What are the general properties of ketamine?

A

○ Dissociative
○ Hallucinogenic
○ Amnesic effect

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30
Q

What are the disadvantages of ketamine?

A

○ Hallucinogenic
○ Nightmare emergence
○ Increased salivary flow

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31
Q

What is propofol used for? What receptor does it work on? How does it affect blood vessels?

A

General anesthesia induction agent

GABA channel (enhances Cl- conductance)

Arterial and venous dilation

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32
Q

What does the μ receptor do?

A

○ μ1 = analgesia
○ μ2 = respiratory depression
○ Physical dependence
○ Muscle rigidity

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33
Q

What does the κ receptor do?

A

○ Miosis
○ Sedation

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34
Q

What does the δ receptor do?

A

Behavioral response to pain

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35
Q

What does the σ receptor do?

A

○ Dysphonia
○ Hallucinations

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36
Q

What are the desirable effects of opioids?

A

○ Analgesia
○ Sedation
○ Euphoria
○ Anti-tussive (cough relief)

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37
Q

What are the undesirable effects of opioids?

A

○ Respiratory depression
○ Coma
○ Emesis
○ Constipation
○ Histamine release
○ Potential for addiction

38
Q

Which is more potent: morphine or fentanyl?
How much more potent?

A

Fentanyl is 100x more potent

39
Q

Does morphine or fentanyl result in histamine release?

A

Morphine

40
Q

Is morphine or fentanyl contraindicated in renal patients?

A

Morphine

41
Q

Does morphine or fentanyl have a faster onset of action? Which lasts longer?

A

Faster onset = fentanyl
Lasts longer = morphine

42
Q

How are morphine and fentanyl eliminated?

A

Morphine = kidney
Fentanyl = inactive metabolite accumulates in body fat

43
Q

What is the reversal agent of opioids? What is the dosage?

A

Naloxone (Narcan)
0.4 mg IV

44
Q

Who started the ASA classification?

A

American Society of Anesthesiologists

45
Q

What is ASA Class I?

A

Normal, healthy patient without systemic disease

46
Q

What are examples ASA class II patients?

A

○ Type II or non-insulin dependent DM
○ Well-controlled epilepsy (no seizure in past year)
○ Well-controlled asthma
○ Hypothyroid/hyperthyroid patient under treatment and currently euthryoid

47
Q

What are examples of ASA class III patients?

A

○ Type I diabetes mellitus, well controlled

○ Symptomatic thyroid disease patient

○ > 6 months without any residual complications with MI or CVA

○ BP (169-199) systolic/(95-114) diastolic

○ Epilepsy (several seizures per year)

○ Asthma

○ Angina pectoris (stable angina)

○ CHF

○ COPD
□ Emphysema
□ Chronic bronchitis

48
Q

What are examples of ASA class IV patients?

A

○ Unstable angina

○ < 6 months without any residual complications with MI and CVA

○ BP > 200 systolic/> 115 diastolic

○ Uncontrolled dysrhythmias

○ Severe CHF or COPD
□ Wheelchair bound or need supplemental oxygen

○ Uncontrolled epilepsy

○ Uncontrolled IDDM

49
Q

What is ASA class V?

A

Moribound patient not expected to survive 24 hours

50
Q

What is ASA class VI?

A

Braindead patient awaiting organ harvesting

51
Q

What is ASA class E?

A

Patient requires emergency operation (precedes number status)

52
Q

Who are the qualified sedation providers according to the Missouri sedation laws?

A

○ Currently licensed dentist in MO with a valid permit to administer enteral, parenteral, or pediatric moderate sedation
○ Currently licensed anesthesiologist
○ Currently licensed certified registered nurse anesthetist

53
Q

Regardless of intent, what type of sedation would a pediatric patient fall under?

A

Moderate sedation (regardless if you want only minimal sedation)

54
Q

What is minimal sedation?

A

Minimally depressed level of consciousness produced that retains patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command

Ventilatory and cardiovascular functions are unaffected

55
Q

What is moderate sedation?

A

conscious sedation; drug induced depression of consciousness during which patients respond purposefully to verbal commands either alone or accompanied by light tactile stimulation

No interventions required to maintain a patent airway, and spontaneous ventilation is adequate

Cardiovascular function is usually maintained

56
Q

What is deep/general sedation?

A

drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation

Ability to independently maintain ventilatory function may be impaired

Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate

Cardiovascular function is usually maintained

57
Q

What are the qualifications of deep/general sedation?

A

Document satisfactory completion of
□ Advanced educational program accredited by ADA
□ ADA-accredited post-doctoral training program in OMFS
□ Anesthesia training program that is approved and accredited to teach postgraduate medical education by AMA
□ Diplomate of American Dental Board of Anesthesiology

Document completion of
□ Advanced Cardiac Life Support (ACLS) course of board-approved equivalent during past 5 years
□ Minimum of 15 hours of other board-approved CE pertaining to medical emergencies, anesthetic complications, or patient management while under deep sedation/general anesthesia

Undergo and successfully complete an on-site evaluation by consultants appointed by the board

Document that facility has been issued a deep sedation/general anesthesia site certificate

58
Q

What is the OMS anesthesia training requirement?

A

5 months of anesthesia training
(Minimum 4 consecutive months + 1 month of pediatric anesthesia)

Senior resident must have at least 150+ office-based sedation cases

59
Q

What are monitoring equipment used in IV sedation?

A

BP cuff, pulse oximeter, ECG, temperature monitor, capnography

60
Q

What is capnography? How does it work?

A

Monitors concentration or partial pressure of CO2

Breath-to-breath ventilation; makes a graph of expiratory CO2 by expired volume

Gives real-time feedback on treatment

61
Q

What does the pulse oximeter measure?

A

Measures oxygen saturation of arterial blood to determine percent of oxyhemoglobin in capillaries

62
Q

How does the red light in a pulse oximeter work?

A

2 wavelengths = 650 nm and 950 nm
Red light is shined through the fingertip to calculate % oxygenated Hb vs reduced Hb

63
Q

What is the most reliable airway?

A

Endotracheal intubation

64
Q

What is the surgical airway?

A

Cricothyroidotomy

65
Q

What are the adjunctive airways?

A

Nasal and oropharyngeal airways
Combitube
Laryngeal tube
Laryngeal Mask airway
King tube
Cricothyroidotomy

66
Q

Who should perform patient evaluation during sedation?

A

The doctor/dentist

67
Q

What are the different formats of the medical history questionnaire?

A

Short and long

68
Q

What is the Mallamapti classification used for?

A

Airway examination prior to IV sedation

69
Q

What is Mallamapti class I?

A

Complete visualization of soft palate

70
Q

What is Mallamapti class II?

A

Complete visualization of the uvula

71
Q

What is Mallamapti class III?

A

Visualization of only the base of the uvula

72
Q

What is Mallamapti class IV?

A

Soft palate is not visible at all

73
Q

How is nitrous oxide manufactured?

A

Made from ammonium nitrate via 240 degrees C heat

Compressed in cylinder where 30% is liquified

N2O must be 97% pure

74
Q

What is the special property/characteristic of N2O gas to humans?

A

Only non-organic compound other than CO2 that has CNS depressant properties

75
Q

What is the concentration effect of nitrous oxide?

A

The higher the concentration of the gas inhaled, the more rapidly arterial tension of the gas increases

76
Q

What is the 2nd gas effect of nitrous oxide?

A

extreme update of N2O will form a vacuum at alveoli that forces other air (in this case, other inhalational agent) into the lungs

Occurs when a second inhalation anesthetic is administered along with N2O-O2

77
Q

Chronic exposure of nitrous oxide is detrimental to ___? Why?

A

CNS
It creates transient bone marrow depression

78
Q

What is the green gas cylinder? What is the size and pressure?

A

Oxygen
Size E
1900 Psi

79
Q

What is the blue gas cylinder? What is the size and pressure?

A

Nitrous
Size E
745 Psi

80
Q

Who was the first person to write a book on nitrous oxide?

A

Sir Humphrey Davy

81
Q

Who were the first people to start a dental practice using nitrous?

A

Horace Wells and William Morton

82
Q

In the 1850s and 60s, nitrous was replaced with what?

A

Ether and chloroform

83
Q

Who re-introduced nitrous oxide to dentistry in 1863 and made it more widespread?

A

Gardner Colton

84
Q

What did Edmund Andrews do for nitrous oxide?

A

Introduced 20% oxygen

85
Q

What replaced nitrous oxide as the ideal drug for eliminating pain?

A

Lidocaine

86
Q

What is the minimum O2 concentration mandated by the ADA to be delivered by inhalation sedation devices?

A

Atmospheric concentration (30%)

87
Q

In the state of MO, what is the age that is considered a child?

A

≤ 12 years old

88
Q

Use of what drug automatically makes a sedation procedure general anesthesia?
a. Fentanyl
b. Morphine
c. Versed
d. Ketamine

A

d. Ketamine

89
Q

T/F: In 1845 Horace Wells demonstrated N2O at Harvard Medical School.

A

True

90
Q

What color is the oxygen cylinder internationally (outside of the US)?

A

White

91
Q

Where did Dr. Crawford perform the first anesthesia procedure?

A

Jefferson, GA

92
Q

Which adjunctive airway is the most appropriate?

A

Nasopharyngeal airway
(patient gags if conscious with the oropharyngeal airway)

Oral Surgery IV (1 decks)

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