Local Anesthesia Review 1

Question 1

All of the following are TRUE about the definition of local anesthesia, EXCEPT:

a. it occurs in a circumscribed area
b. involves loss of sensation
c. occurs with a loss of consciousness

Answer 1

c. occurs with a loss of consciousness

Question 2

Which of the following are IDEAL properties of a local anesthetic?

a. non-tissue irritating
b. low systemic toxicity
c. time onset - short
d. lasts long enough for the procedures
e. no permanent alteration of nerve structure
f. all of the above
g. a, b, d

Answer 2

f. all of the above

Question 3

1. A nerve is at -70mV in its resting state (electric potential). #2. During the slow depolarization stage, the interior of the nerve becomes slightly less negative.

a. both statements are true
b. both statements are false
c. #1 True; #2 False
d. #1. False; #2 True

Answer 3

a. both statements are true

Question 4

Local anesthesia works in part by:

a. raising the firing threshold (need more than the 15mV change)
b. lowering the firing threshold (need less than the 15mV change)
c. it does not really affect the firing threshold
d. decreasing the permeability of the ion channels to Na+
e. a, d
f. b, d

Answer 4

e. a, d

Question 5

The absolute refractory period is:

a. when the nerve can respond again to another stimulus right after an impulse
b. when the nerve cannot respond again to another stimulus right after an impulse
c. when the nerve can respond again to another stimulus right after an impulse but the stimulus must be stronger than normal

Answer 5

b. when the nerve cannot respond again to another stimulus right after an impulse

Question 6

Effects of local anesthetic on the nerves include which of the following?

a. allows less sodium into the nerve interior
b. local currents do not develop and self perpetuating impulse propagation is stalled
c. an impulse that arrives at the blocked segment is unable to release its energy for its continued propagation
d. all of the above
e. b, c

Answer 6

d. all of the above

Question 7

1. Induction time is the time from deposition of the local anesthetic to complete conduction blockade. #2. Tachyphylaxis is a decreasing tolerance to a drug administered repeatedly.

a. both statements are true
b. both statements are false
c. #1 True; #2 False
d. #1. False; #2 True

Answer 7

c. #1 True; #2 False

* increasing

Question 8

1. The most widely accepted theory is the Specific Receptor Theory. #2. The above theory says, “Local anesthesia binds to specific receptors in the sodium channel.

a. both statements are true
b. both statements are false
c. #1 True; #2 False
d. #1. False; #2 True

Answer 8

a. both statements are true

Question 9

The mechanism whereby Na+ gains access to the axoplasm of the nerve, thereby initiating an action potential that is altered by the local anesthesia is called:

a. conduction blockade
b. tachyphylaxis
c. induction time
d. none of the above

Answer 9

a. conduction blockade

Question 10

Concerning the trigeminal nerve:

a. V2 is the mandibular division
b. V3 is the maxillary division
c. V1 is the maxillary division
d. V3 is the mandibular division

Answer 10

d. V3 is the mandibular division

V1 ophthalmic, V2 maxillary

Question 11

The nasopalatine nerve:

a. supplies the palatal mucosa from canine to canine
b. supplies the palatal mucosa in the molar areas
c. supplies the buccal mucosa in the molar areas
d. supplies the pulps of the anterior teeth

Answer 11

a. supplies the palatal mucosa from canine to canine

Question 12

The following are true about the MSA nerve, EXCEPT:

a. it supplies the maxillary premolars pulpal tissue unilaterally
b. it is present in 98% of the population
c. if it is not present, either the ASA or PSA supply the innervation

Answer 12

b. it is present in 98% of the population

28%

Question 13

The following are branches of the inferior alveolar nerve, EXCEPT:

a. mental nerve
b. incisive nerve
c. long buccal nerve

Answer 13

c. long buccal nerve

Question 14

1. The maxillary bone is more dense than mandibular bone.

#2. Local anesthesia cannot diffuse thru maxillary bone.
a. both statements are true
b. both statements are false
c. #1 True; #2 False
d. #1. False; #2 True

Answer 14

b. both statements are false

#1. Less, #2. Can

Question 15

The inferior alveolar nerve:

a. supplies the pulps and periodontal tissue of all mandibular teeth (unilaterally)
b. at the mental foramen, it turns into (splits into) the mental and incisive nerve
c. the above split occurs at the mental foramen
d. a & b
e. all of the above

Answer 15

e. all of the above

Question 16

The three essential parts of the local anesthetic armamentarium are:

a. forceps, cartridge, cotton tip
b. syringe, cartridge, needle
c. needle, topical gel, hemostat

Answer 16

b. syringe, cartridge, needle

Question 17

The most common type of syringe used is:

a. nondisposable, breech loading, metallic, cartridge type, aspirating
b. disposable, breech loading, plastic, cartridge type, self-aspirating
c. disposable, breech loading, metal, cartridge type, aspirating

Answer 17

a. nondisposable, breech loading, metallic, cartridge type, aspirating

Question 18

The harpoon:

a. engages the rubber stopper in the cartridge so when negative pressure is applied we can aspirate.
b. is part of the needle that engages soft tissue
c. must be adjusted depending on the type of local anesthetic used
d. is essential for Captain Ahab to catch The Great White Whale!

Answer 18

a. engages the rubber stopper in the cartridge so when negative pressure is applied we can aspirate.

Question 19

Disengagement of the harpoon from the stopper (plunger) is usually caused by:

a. a dull harpoon
b. too much negative pressure applied during aspiration
c. a, b
d. none of the above

Answer 19

c. a, b

Question 20

The two most important characteristics of a needle that we use to CLASSIFY them by are:

a. hardness and gauge
b. gauge and length
c. length and elasticity

Answer 20

b. gauge and length

Question 21

The two most common needle gauges we will use are:

a. 23 and 25
b. 25 and 27
c. 21 and 23

Answer 21

b. 25 and 27

Question 22

Which of the following is FALSE about care and handling of the needle?

a. can use the same needle on more than one patient if family members
b. change the needle after 3 or 4 penetrations
c. use protective sheath when not in use
d. always be aware of the position of an uncovered tip
e. use proper scoop recapping technique and disposing in sharps container

Answer 22

a. can use the same needle on more than one patient if family members

Question 23

1. A BB size 1-2 mm bubble is from nitrogen gas and is considered normal. #2. A larger bubble with an extruded plunger (stopper) was probably frozen and should be discarded.

a. both statements are true
b. both statements are false
c. #1 True; #2 False
d. #1. False; #2 True

Answer 23

a. both statements are true

Question 24

The following are considered contents of the cartridge except:

a. local anesthetic drug
b. vasopressor and preservative for it
c. alcohol
d. sodium chloride
e. distilled water

Answer 24

c. alcohol

Question 25

The following are TRUE about the care and handling of cartridges except:

a. store in the original container at room temperature, in darkness
b. store in solution of alcohol
c. don’t use cartridge warmers

Answer 25

b. store in solution of alcohol

Question 26

When preparing your armamentarium, which of the following is the correct order:

a. attach the needle before loading the cartridge
b. attach the needle after loading the cartridge
c. the order does not matter

Answer 26

b. attach the needle after loading the cartridge

Question 27

The following are true about sodium bisulfite except:

a. acts as a preservative and antioxidant
b. reacts with oxygen and oxidizes to bisulfate
c. bisulfate has a higher pH than bisulfite so the patient feels less burning

Answer 27

c. bisulfate has a higher pH than bisulfite so the patient feels less burning

(Lower pH and more burning)

Question 28

True OR False
Leakage during an injection is usually from leaving needle on when changing cartridge where the puncture is ovoid and eccentric.

Answer 28

True

Question 29

True OR False

If placing an additional cartridge in a syringe, it is best to remove the needle before placing in the new cartridge

Answer 29

True

Question 30

True OR False
A needle should never be inserted to its hub as that is its weakest point and if it breaks there the soft tissue can cover it up.

Answer 30

True

Question 31

True OR False

It is usually OK to bend a needle.

Answer 31

False

Question 32

Most needle stick incidents occur when

a. recapping the needle
b. removing the needle from the syringe
c. withdrawing the needle from the tissue

Answer 32

a. recapping the needle

Question 33

The following are true except:

a. most negative reactions from local anesthesia occur after 15 minutes
b. most negative reactions from local anesthesia occur in the first 5 to 10 minutes
c. the most common negative reaction to local anesthesia is syncope

Answer 33

a. most negative reactions from local anesthesia occur after 15 minutes

Question 34

True OR False

Allergies to local anesthesia are relatively common.

Answer 34

False

uncommon

Question 35

Slow injection is vital for the following two statements:
#1. Safety factor {in case in vessel, slow rate lessens chances of a serious reaction}
#2. Prevents solution from tearing the tissues, rapid injection
a. both statements are true
b. both statements are false
c. #1 True; #2 False
d. #1. False; #2 True

Answer 35

a. both statements are true

Question 36

The best rate to give a full cartridge of anesthetic is:

a. from 1 to 2 minutes (we usually do 1 minute)
b. 30 seconds
c. rate is not really important
d. it can vary with the patient’s weight

Answer 36

a. from 1 to 2 minutes (we usually do 1 minute)