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PEDS final exam > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

what is the pH of commercial lidocaine?

A

3.9

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2
Q

why is the pH of amide local anesthetic acidic compared to the tissue pH?

A

this enhances the solubility of the anesthetic salts to prolong the shelf life

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3
Q

what are the two forms of the anesthetic salt?

A
  • the uncharged, de-ionized or ACTIVE free base form- lipid soluble
  • the charged or ionized cationic form which is not lipid soluble.
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4
Q

what form of the anesthetic salt is important in penetrating into the nerve membrane?

A

the DEIONIZED form-because its lipid soluble and can more readily penetrate the nerve membrane to enter nerve axon.

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5
Q

how much lidocaine does a 1.7 ml carpule of 2% lidocaine 1:100K epi have and how much epi?

A

34 mg lid and .017 mg epi

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6
Q

if you have 3% lido how many mg?

A

3%=30 mg/ml * 1.7 ml/carpule = 51 mg. easy

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7
Q

what is the max dose of EPI you should memorize???

A

4.4 mg/kg
(although you should still take into account rate of absorption, patient health status, tissue conditions, age considerations, etc.)

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8
Q

where is the mandibular foramen in a child relative to an adult?

A

in a child, it is slightly below the plane of occlusion

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9
Q

if the patient has an infection, what can you do to

A

give preoperative ibuprofen, 1 hour before the local anesthesia injection.

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10
Q

what is the risk of anesthesia and opioids?

A

higher risk of epi toxicity

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11
Q

describe symptoms of anesthesia overdose?

A
  • CNS excitation
  • CNS depression
  • CVS excitation
  • Cardiac arrest
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12
Q

this occurs when iron in hemoglobin is changed from its ferrous to its ferric form

A

methemoglobinemia.

CANNOT ACCEPT oxygen to carry to tissues

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13
Q

methemoglobin concentration greater than ___ of total hemoglobin can cause cyanosis

A

10-15%

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14
Q

what is it in the local anesthetic that can cause methemoglobinemia?

A

the nitrates and aniline derivitaves which are part of all local anesthetics

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15
Q

what its the major cause of deaths due to local anesthetic administration?

A

overdose

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16
Q

what is the purpose of sodium bisulfite?

A

added with vasoconstrictors to increase the shelf life.

so if patient has allergies/sensitivites, should NOT recieve anesthetic with a vasoconstrictor

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17
Q

what part of the topical anesthetic may cause an allergic reaction?

A

PABA- the metabolite that’s used

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18
Q

where are amides metabolized? except which one?

A

in the liver!

PRIOLCAINE is expcetion- it’s in the kidney and plasma

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19
Q

What if your patient has atypical pseudocholinesterase…what should you be aware of?

A

esters! topical anesthetic

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20
Q

what is the purpose of the buffer?

A

increases the pH and produces more DEIONIZED fom of anesthetic to cross the lipid barrier.

Sodium bicarbonate is used as the buffer

*patients physiology is generally the buffer???**

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21
Q

canines emerge when __ of the root if formed.

A

3/4

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22
Q

premolars emerge when __ - ___ of the root if formed?

A

1/2-3/4

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23
Q

for each mm of alveolar bone overlying a succedaneous tooth, approx ___ months of eruption should be anticipated

A

6 months

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24
Q

most space loss occurs within the first __ - __ months?

A

4-6 months

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25
Q

what are the indications for band and loop space maintainer?

A

loss of ONE primary MOLAR

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26
Q

what is the disadvantage of band and loop?

A

the opposing tooth may super erupt

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27
Q

what is the advantage of denovo band and loop?

A

it’s better for reduced space?

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28
Q

advantage of an upper holding arch?

A

NO acrylic button

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29
Q

disadvantages of an upper palatal holding arch?

A

may interfere with occlusion

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30
Q

what is a groper appliance?

A

can replace missing incisors – good for a pedi partial if patient doesn’t want to be completely edentulous!

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31
Q

what are the indications for a distal shoe?

A

loss of Es prior to the eruption of maxillary and mandibular MI or ectopic eruption of M1

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32
Q

what are the contraindications for the distal shoe?

A
  • immuocompromised patients
  • require SBE prophylaxis
  • have diseases that affect healing in general
  • cannot cooperate
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33
Q

advantage of the distal shoe?

A

maintains the 2nd primary molar space

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34
Q

disadvantages of the distal shoe?

A

difficult to make, and poor oral hygiene may cause infection

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35
Q

what do you use if you are missing two maxillary molars?

A

nance
TPA
Band and loop

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36
Q

This device prevents the rotation of M1?

A

nance

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37
Q

if A and J are missing, can you use NANCE?

A

no, because M1 will tip mesially

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38
Q

describe what primary teeth roots look like?

A

ribbon like- thin and divergent

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39
Q

does the absence of pain indicate the absence of pulp pathology?

A

no!

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40
Q

is percussion and palpation reliable in primary teeth?

A

no, or traumatized and immature permanent teeth. difficult to diagnose

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41
Q

can you use electric pulp testing in primary teeth?

A

hail no

or traumatized and immature permanent = no, nos

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42
Q

what does pulp calcification reflect?

A

acute and rapid response to pulp irritation

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43
Q

where do anterior teeth feature resorption initially?

A

on the root’s lingual surface! so it’s difficult to tell the apical foramen vs. the anatomic apex

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44
Q

primary teeth with yellow discoloration often have what associated?

A

radiographic pulp canal calcification but low incidence pulp necrosis

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45
Q

injured primary teeth with gray discoloration have necrotic pulps in what percentage of cases?

A

50-80% of cases

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46
Q

what is the diagnosis of pulp necrosis in primary incisors primary based on?

A

dark gray color change and radiographic pathology

47
Q

what are the options if the tooth is vital but traumatized?

A

protective base
indirect pulp cap
direct pulp cap
pulpotmoy

48
Q

non vital options for immature permanent teeth?

A

apexification
pulpectomy (RTC)
Regeneration

49
Q

do you need a protective base following restorative procedures?

A

no, because it is mild and transitory = doesn’t require protective base

50
Q

describe decal as a protective base

A
  • weak and soluble
  • DON”T put amalgam over
  • no composite placed over- thus cannot be acid etched
  • So why use it??
51
Q

*carious dentin left overlying pulp to prevent exposure?

A

IPC indicated.

if the decay is >1 mm from coronal pulp, prognosis is good

52
Q

if yu have a deep carious lesion, no clinical/radiographic pulp deregulation, and symptom free, what might you use?

A

Direct pulp cap`

so indirect leaves a little dentin in place?

53
Q

what is the one base you should NEVER use during pulpotomy procedure?

A

DO NOT USE CaOH!!!!

you can you ZOE, IRM, MTA… that’s all

54
Q

what is the “Gold Standard”?

A

formocresol

Ferric sulfate can be used though as well?

55
Q

what is the purpose of ferric sulfate?

A
  • could be used as astringent
  • Hemostatic– coagulation reaction of blood with ferric and sulfate ions.
  • the agglutinated blood proteins occlude capillary orrifices
56
Q

if patient has pulp calcifications, can you perform a pulpotomy?

A

no

57
Q

apexogenesis vs.apexification?

A 
apexogenesis = vital therapy
Apexificaiton= non vital therapy.
58
Q

what is the gold standard for treating the open apex purples tooth?

A

MTA

also used for apexogenesis in vital teeth

59
Q

is the BL or MD the last site of apical closure?

A

BL

60
Q

is the BL or MD width generally greater in most roots?

A

BL is usually greater

61
Q

when is apical closure determined?

A

determined but the time of tooth eruption- because radiographs show MD, not BL, and BL is the last to close

62
Q

if there is pulp exposure to HEALTHY pulp, would you perform IPC or DPC?

A

IPC

63
Q

how long odes it take for clinical action of Nitrous oxide?

A

2-3 min

64
Q

how many minutes does it take for peak clinical effect of Nitrous?

A

3-4 mins

65
Q

how fast is recovery after N2o?

A

3-5 mins after 100% O2 inhalation and patient is able to function normally afterwards

66
Q

how many seconds does it take for N2O to go from Pulmonary circulation to the brian?

A

20 seconds

67
Q

Can you use Nitrous oxide if patient has sickle cell disease?

A

NO! may cause neuropathy in conjunction with low vitamin B12 levels and prolonged administration

68
Q

Describe relative contraindications to N2O?

A
  • Some COPD– apnea can result if patient is on hypoxic drive
  • medications that induce sleep
  • Nasal congestions- URI, allergies
  • Pulmonary HYPETENSION
  • Cobalamin deficiency
  • vomitting
  • sinus or ENT infection
  • Pneumothorax (collapsed lung)
  • BOWEL OBSTRUCTION
  • recent pneumoencaphalography
69
Q

What are the ABSOLUTE CONTRAINDICATIONS????

A
  • 1st trimester of PREGNANCY
  • Methylenetretrahydrofolate reductase deficiency
  • Bleomycin sulfate therapy (this is a chemotherapeutic antibiotic used in the tx of scc, testicular, and lymphomatous cancers)
70
Q

what is bleomycin sulfate therapy, and why is this relative?

A

it’s a chemotherapeutic antibiotic
-if O2 admin > 25% can lead to interstitial pneumonia and PO respiratory failure.

**so if patient had preexisting pulmonary damage, exposure within the past 1-2 months, dose > 450, or creatine clearance

71
Q

what are some pharmacological agents that potentiate the effects of other sedatives? name 3?

A
  • Chloral hydrate (+ N2O= deep not conscious sedation in children)
  • Diazepam- may augment the effect of diazepam section of young children.
  • Midazolam- appears to provide more comfort to pediatric patients
72
Q

what happens to pain threshold and O2 consumption with anxiety?

A

they both increase

73
Q

what happens to anxiety and O2 consumption with nitrous oxide?

A

they both decrease

74
Q

does nitrous oxide produce any significant physiologic changes?

A

no, minimal depression in cardiac output. Peripheral resistance is UP so the BP is the same

75
Q

If patient has atherosclerosis, anginga pectoris, myocardial infarction, bleeding diathesis- can you use N2O?

A

YES

76
Q

if patient has pneumothorax, can you give N2O?

A

no, postpone till resolved

77
Q

if patient has COPD, what should you do before giving N2O?

A

must consult with physician first

78
Q

Can you use N2O with anemia, sickel cell anemia, leukemia, hemophilia etc?

A

yes…

79
Q

can you use N2O with hepatic disease?

A

yes

80
Q

can you use N2O if patient has bowel obstructions?

A

NO! postpone till resolved.

81
Q

Does N2O have negative effects o the GI/REPRO system?

A

no

82
Q

If patient has a suspected or known V12 deficiency - from vegan diet or PKU related, what should you do before giving nitrous?

A

consult with physician

83
Q

If patient has metabolic disease, can you administer N2O?

A

careful evaluation is necessary

84
Q

If patient is having middle ear disturbances can you give N2O?

A

pressure changes can cause damage, so you want to postpone until its resolved.

If patient had a recent ENT infection, consult physician first

85
Q

Allergies to N2O?

A

no reported allergies since last 150 years!

86
Q

Can you use N2O if patient has CNS problems?

A

YES…can be given with conditions such as seizure disorder, fainting spells, parkinson’s disease, MS, Cpm etc

IF NO CARDIOMYOPATHY (disease of the heart muscle)

87
Q

why is the mechanism action of N2O on the gas containing spaces of body?

A

N2O enters the body cavity MORE RAPIDLY than N2 exits== expansive nature of gas insufflates closed spaces

88
Q

can you give N2O sedation after 1st trimester?

A

Postponement of N2O sedation is recommended.

89
Q

If N2O is needed during pregnancy, what percent O2 must be delivered?

A

20% O2.

always consult obstetrician before administration

90
Q

Is N2O soluble in the blood?

A

NO - insolbule

91
Q

Does N2O combine with blood elements?

A

NO! otherwise you would have major issues

92
Q

Is the O2 molecule from N2O available for use in tissues?

A

no! again, that would be no bueno

93
Q

N2O is rapildy absorbed into pulmonary circulation, and replaces __ in the blood?

A

replaces N2 in blood

94
Q

N2O is __ times more soluble than N2?

A

35 x

95
Q

can N2O produce GA ?

A

only when combined with other sedative/analgesix agents and should be used with caution

IN GENERAL though, you only want to use with local/regional anesthetics

96
Q

what is the MAC of N2O?

A

105%

97
Q

what is 50% N2O = to mg morphine?

A

15 mg morphine

98
Q

what is the purpose of the scavenging system?

A

ambinent air hygiene
collects the exhaled and leaking gases
-must be calibrated to 45LPM

99
Q

what is the minimum O2?

A

30%

100
Q

what is the purpose of the reservoir bag functions?

A

monitor device for proper breathing

  • means of providing O2 during assisted ventilation
  • positive pressure ventilation is possible with a tight fitting mask
101
Q

Once nasal hood is placed on nose, start __ flow at ____ L/Min for 1-2 mins?

A

O2 flow at 3-4 L/min for 1-2 mins

102
Q

determine proper flow rate by monitoring _____ bag?

A

reservoir bag

**it should pulsate with the patients breathing

103
Q

what do you adjust the N2O flow rate depending on?

A

depends on the patients behavior

104
Q

what is important about N2O and reflexes?

A

N2O depresses cough, gag, and swallowing reflexes and can blunt protective laryngeal reflexes

105
Q

BP and HR slightly (increase or decrease) and then go back to normal?

A

increase

106
Q

Flushing of extremities and face is caused by what?

A

peripheral vasodilation

107
Q

signs and symptoms of heavy sedation?

A

HR and BP are UPPPP!

otherwise signs are like they’re on drugs

108
Q

is excessive perspriation a concern?

A

no…if not accompanied by decrease BP and increase HR

109
Q

what is the shivering caused by?

A

vasodilation

110
Q

at the end of treatment, what do you do to the flow of N2O?

A

TERMINATE- do NOT titrate out

111
Q

how long should patient breath O2?

A

100% for less than 4 mins

112
Q

what happens if N2O is terminated abrubtly and no O2 is administered?

A

More CO2 than normal is removed as the N2O rushes out= depression of respiration

O2 dilution in the alveolus = headaches

113
Q

what is the benefit of rapid induction of N2O?

A

saved resources

TIME AND WITH RAPID!

PEDS final exam (3 decks)

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