Local Anesthesia Review 3

Question 1

1. Allergic clinicalreactions are produced by exaggerated response of the immune system. #2. Overdose clinical reactions are related directly to the pharmalogical properties of the causative agent.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 1

a. both statements are true

Question 2

In an overdose reaction: 
#1. The rate of injection is the most important factor in the case of an intravascular injection. #2. The vascularity of the tissue and presence of vasoconstrictors are not factors.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 2

c. #1 is true and #2 is false

Question 3

Which of the following are true about an overdose reaction?

a. local anesthetics exert a depressant effect on all excitable membranes
b. local anesthetics cross the blood brain barrier
c. respiratory depression and respiratory arrest, and cardiac arrest are possible
d. giving oxygen helps prevent acidosis
e. all of the above
f. a, c

Answer 3

e. all of the above

Question 4

1. Signs and symptoms for mild overdose reactions are usually: retention of consciousness, talkativeness, agitation, increased heart and respiratory rate. #2. Most overdose reactions are mild and self-limiting.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 4

a. both statements are true

Question 5

In a severe, rapid onset overdose reaction:
#1. Patient is unconscious, with or without convulsions. 
#2. Call 911, basic life support, oxygen for convulsions, possible anticonvulsants.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 5

a. both statements are true

Question 6

1. Vasoconstrictors decrease rate of absorption into the blood, reducing toxicity potential. #2. In dental local anesthetics, the drug has to enter the blood to have its effect.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 6

c. #1 is true and #2 is false

Question 7

1. The three main groups of allergenic responses to local anesthetic are: Dermatitis, bronchospasm and systemic anaphylaxis.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 7

c. #1 is true and #2 is false

Question 8

1. The most common dermatological signs/symptoms of an allergy from local are urticaria and angioedema. #2. Urticaria is associated with wheals, but has no itching.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 8

c. #1 is true and #2 is false

Question 9

Concerning generalized anaphylaxis:
#1. Usually from penicillin and bee stings, not local anesthetics. #2. Epinephrine 1:1000 is given and then 10 minutes later if not better.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 9

a. both statements are true

Question 10

Which of the following may be performed in management of laryngeal edema with full blockage?

a. call 911
b. give epinephrine IM or SC
c. maintain airway
d. give antihistamine IM/IV, corticosteroid IM/IV
e. all of the above
f. a, b

Answer 10

e. all of the above

Question 11

1. Taking a thorough medical history and having patient dialogue can reduce systemic complications. #2. Using a vasoconstrictor (if not contraindicated), slow rate of injection and avoiding intravascular injections can all help prevent overdose and its complications.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 11

a. both statements are true

Question 12

1. There are 4 main levels of sedation. #2. Minimal sedation (anxiolysis) is the best level to use for dental hygiene.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 12

a. both statements are true

Question 13

The following is true about general anesthesia except:

a. the patient loses consciousness
b. the patient is not able to respond verbally and physically
c. patient usually maintains own airway
d. patient cannot be aroused

Answer 13

c. patient usually maintains own airway

Question 14

During nitrous oxide use, if the patient becomes agitated or excited after being calm:

a. the patient needs a higher concentration of nitrous
b. the patient needs a lower concentration of nitrous
c. leave the concentration of nitrous alone and try to reason with the patient

Answer 14

b. the patient needs a lower concentration of nitrous

Question 15

The following are true about nitrous except:

a. enters into a chemical combination in the body
b. does not chemically combine in the body
c. it is not metabolized in the body

Answer 15

a. enters into a chemical combination in the body

Question 16

Some of the advantages of using nitrous oxide are:

a. alleviates anxiety and mild discomfort
b. easily and quickly induced (relatively)
c. can be titrated for the patient
d. all of the above
e. a, b

Answer 16

d. all of the above

Question 17

#1. Atoroxin is a feeling of well being and tranquility.
#2. Hyperalgesia is an increased pain threshold.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 17

a. both statements are true

Question 18

Concerning nitrous oxide and oxygen: 
#1. Nitrous oxide cylinders are blue in color.
#2. Oxygen cylinders are green in color.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 18

a. both statements are true

Question 19

1. To calculate the percentages of the 2 gases, the flow rate of each gas is divided by the tidal volume and multiplied by 100.

a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 19

a. both statements are true

Question 20

In the incremental induction technique the following are true except:

a. start at a rate of 100% oxygen flow at 6-7 liters/minute tidal volume
b. increase the nitrous by 10 to 15% for 1 minute
c. then the percentage of nitrous is increased 5% to 10% more per minute
d. most patients reach the desired effect between 50% and 75% nitrous oxide

Answer 20

d. most patients reach the desired effect between 50% and 75% nitrous oxide

Question 21

At the end of the appointment the patient:

a. should be given 100% oxygen for a minimum of 5 minutes or more if needed
b. allow the patient to sit up to avoid syncope
c. patient should have normal reflexes and feel normal
d. take post vitals
e. have sit and wait if there are any questions about their state before letting them go and or drive
f. all of the above

Answer 21

f. all of the above

Question 22

#1. If the N2O percentage gets too high, comfort and relaxation may disappear and be rapidly replaced with discomfort.
#2. If the patient begins to become uncomfortable, then raise the percentage of N2O immediately.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 22

c. #1 is true and #2 is false

lower

Question 23

Symptoms of oversedation can be the following except:

a. restlessness and figidity
b. out of body experiences
c. combative
d. dizzy, spinning
e. nausea
f. speaks clearly

Answer 23

f. speaks clearly

Question 24

#1. A very serious negative effect of nitrous oxide can be vomiting.
#2. Silent regurgitation can cause aspiration of vomit into lungs and needs immediate advanced attention and call 911.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 24

a. both statements are true

Question 25

#1. The ideal maximum amount of N2O in the healthcare environment is 350 ppm. 
#2. The scavenger should be set at 45 liters/minute.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 25

d. #1 is false and #2 is true

Question 26

True OR False

Nitrous oxide use can usually be easily titrated to meet the patient’s needs.

Answer 26

True

Question 27

True OR False

Nitrous oxide can have some amnesic properties (hard to remember the severity of pain or anxiety).

Answer 27

True

Question 28

The following are uses of the reservoir bag except:

a. mixes gases
b. monitors breathing
c. assists in emergency to provide pressure O2
d. Is used to quickly induce the effects we want
e. all of the above

Answer 28

e. all of the above

Question 29

Which of the following are true about the reservoir bag?

a. if bag too inflated -> too many liter/min being given
b. if bag too deflated -> not getting enough gas
c. keep it about 2/3 to 3/4 full
d. all of the above
e. b, c

Answer 29

d. all of the above

Question 30

Which of the following are causes of leakage of gases?

a. patient talking
b. patient breathing out of mouth not the nose
c. ill fitting masks
d. tubage and connection leaks
e. all of the above
f. a, b

Answer 30

e. all of the above

Question 31

#1. Vascularity of injection site: the greater the vascularity, the greater the rate of absorption into blood, and shorter effect.
#2. Presence of vasoconstrictors: decreases perfusion of area - decreased rate of absorption and this reduces clinical toxicity.
a. both statements are true
b. both statements are false
c. #1 is true and #2 is false
d. #1 is false and #2 is true

Answer 31

a. both statements are true

Question 32

True OR False
The main overdose cause is administration of too large of an amount (dose) in relation to age and weight and usually in kids 2-6 years with quadrant dentistry, who are well behaved.

Answer 32

True

Question 33

True OR False
The best protocol to use if we are unsure if the patient has an allergy to local anesthetic or not is to give them some so we can see if they react.

Answer 33

False