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Semester 3 Local Anesthesia > Local Anesthetic For Dental Professionals Book Questions: Exam 1 > Flashcards

Local Anesthetic For Dental Professionals Book Questions: Exam 1 Flashcards

1
Q

Which statement best describes pain as a protective response?

A. Pain is a physiological, conscious reaction.

B. Pain is a psychological reaction based on blood flow to the injured site.

C. Pain is a rapid, reflexive, subconscious reaction.

D. Pain is a slow, deliberate reaction to avoid further
tissue injury.

A

C. Pain is a rapid, reflexive, subconscious reaction.

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2
Q

Which of these groups of variables does not affect the experience of pain?

A. Sex, genetics, mental health

B. Personality, age, hormones

C. Attitudes, learned responses

D. Body weight, height

A

D. Body weight, height

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3
Q

Which one of the following statements regarding nociception is true?

A. Nociception is polymodal.

B. Nociceptive receptors can distinguish between chemical and thermal stimuli.

C. Nociception is a physiological and psychological process.

D. Nociceptive pain is identical in somatic and visceral structures.

A

A. Nociception is polymodal.

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4
Q

Which one of the following is an example of neuropathic pain?

A. Fractured bone

B. Psychological disorder

C. Postsurgery pain

D. Trigeminal neuralgia

A

D. Trigeminal neuralgia

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5
Q

Which one of the following will help patients cope with anxiety and fear?

A. Avoid discussions about anxiety and fear.

B. Only the dentist should ask about anxiety and fear to avoid patient embarrassment.

C. Assure the patient that difficulties during past dental visits could not have been avoided.

D. Prepare, rehearse, empower, and praise patients to reduce anxiety and fear.

A

D. Prepare, rehearse, empower, and praise patients to reduce anxiety and fear.

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6
Q

In the process of debriefing, which one of the following is not useful when managing fearful patients?

A. Patient and clinician discussion period at the end of each appointment.

B. Patient gives input on the duration and plan for the next appointment.

C. Future appoints are modified based on the insights from the patient/clinician discussion.

D. Clinicians select strategies for the patient for his or her next appointment.

A

D. Clinicians select strategies for the patient for his or her next appointment.

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7
Q

Which of the following statements most accurately describe(s) the major differences between sensory and motor neurons?

  1. Sensory neurons are afferent and conduct impulses toward the CNS.
  2. Motor neurons are efferent and conduct impulses to effector tissues and organs.
  3. Sensory neuronal cell bodies do not participate in impulse conduction and they are located away from the axon.
  4. Motor neuronal cell bodies participate in impulse conduction and are located along the length of the neuron at their terminal arborizations.

A. 3 only

B. 1 and 2

C. 1, 3, and 4

D. all of the above

A

D. all of the above

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8
Q

Which of the following sequences best describes the events in a successful impulse generation?

A. Stimulation, slow depolarization, firing threshold, rapid depolarization, recovery

B. Stimulation, firing threshold, rapid depolarization, slow repolarization, resting state

C. Resting state, stimulation, slow depolarization, rapid depolarization, firing threshold

D. Resting state, stimulation, slow depolarization, rapid depolarization, slow depolarization

A

A. Stimulation, slow depolarization, firing threshold, rapid depolarization, recovery

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9
Q

How are Schwann cells and nodes of Ranvier related?

A. Schwann cells are nodes of Ranvier.

B. At the nodes of Ranvier, Schwann cells are one layer thick.

C. Gaps between Schwann cells are called nodes of Ranvier.

D. They are not related.

A

C. Gaps between Schwann cells are called nodes of Ranvier.

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10
Q

Which fiber types are responsible for providing sensory information from dental and periodontal tissues?

A. C and B fibers

B. B and A delta fibers

C. Gamma and C fibers

D. A delta and C fibers

A

D. A delta and C fibers

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11
Q

What are three divisions of the dental plexus?

A. Interdental, interradicular, and periodontal

B. Inner dental, interradicular, and dental

C. Interdental, interradicular, and dental

D. Inner dental, interradicular, and periodontal

A

C. Interdental, interradicular, and dental

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12
Q

Elimination half-life refers to which one of the following?

A. The time it takes for a drug to be half-metabolized

B. The time it takes for half of a drug to be out of the system

C. The time it takes for half of a drug to be out of the circulation

D. The time it takes for a drug to be out of half of the circulation

A

C. The time it takes for half of a drug to be out of the circulation

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13
Q

Ester local anesthetics are metabolized in which one of the following pathways?

A. In the liver

B. In the blood

C. In the kidneys

D. In the brain

A

B. In the blood

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14
Q

CNS toxicity occurs because of:

A. The expected response of neurons in the CNS to the drug dose.

B. Frank neural tissue damage due to the excessive dose.

C. Compromised vascular supply in the CNS due to vasoconstrictor doses.

D. None of the above.

A

A. The expected response of neurons in the CNS to the drug dose.

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15
Q

CVS toxicity occurs because of:

A. Compromised vascular supply.

B. Frank tissue damage.

C. Decreased myocardial contractility, vasodilation and hypotension.

D. Decreased myocardial contractility, vasoconstriction, and hypertension.

A

C. Decreased myocardial contractility, vasodilation and hypotension.

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16
Q

Which portion of the anesthetic molecule is responsible for binding to the receptor site inside the nerve membrane, thereby preventing depolarization?

A. Calcium ion

B. Anesthetic free base

C. Anesthetic anion

D. Anesthetic cation

A

D. Anesthetic cation

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17
Q

Which part of a local anesthetic molecule determines the classification of the drug as an ester or amide?

A. Lipophilic portion

B. Hydrophilic portion

C. Intermediate chain

D. Caine linkage

A

C. Intermediate chain

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18
Q

Which of the following is not a systemic reaction to an overdose of a local anesthetic agent?

A. CNS stimulation

B. Depression of myocardium

C. Vasodilation of peripheral blood vessels

D. Respiratory arrest

A

A. CNS stimulation

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19
Q

The definition of the maximum recommended dose (MRD) of a drug best fits which one of the following definitions?

A. A safe dose to administer in all situations

B. A dose that a 150-lb individual can have

C. A dose that cannot be exceeded under any circumstance

D. A safe guideline when administering local anesthetic drugs

A

D. A safe guideline when administering local anesthetic drugs

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20
Q

Which one of the following best describes articaine’s metabolism?

A. Articaine is metabolized approximately 25% in the liver.

B. Articaine is metabolized primarily via plasma cholinesterase.

C. Much of articaine is excreted unchanged.

D. Articaine’s metabolism is similar to prilocaine’s.

A

B. Articaine is metabolized primarily via plasma cholinesterase.

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21
Q

You are treating a patient with significant cardiovascular compromise who suffers from significant liver damage. Which one of the following drugs would be most appropriate for this patient when you are anesthetizing the maxillary right quadrant?

A. 2% lidocaine, 1:100,000 epinephrine

B. 3% mepivacaine plain

C. 4% articaine, 1:200,000 epinephrine

D. 0.5% bupivacaine, 1:200,000 epinephrine

A

C. 4% articaine, 1:200,000 epinephrine

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22
Q

A periodontist requires hemostasis on palatal tissues in the maxillary left quadrant before elevating a surgical flap. Which one of the following drugs would furnish the most vigorous hemostasis?

A. 2% mepivacaine, 1:20,000 levonordefrin

B. 4% prilocaine, 1:200,000 epinephrine

C. 2% lidocaine, 1:50,000 epinephrine

D. 4% articaine, 1:100,000 epinephrine

A

C. 2% lidocaine, 1:50,000 epinephrine

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23
Q

Which characteristic of a local anesthetic drug determines how well it works without a vasoconstrictor?

A. Potency

B. Vasoactivity

C. pKa

D. Lipophilic ability

A

B. Vasoactivity

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24
Q

If a patient is taking a tricyclic antidepressant and a beta-blocker, which one of the following drugs would be most appropriate to administer?

A. 2% lidocaine, 1:100,000 epinephrine

B. 2% mepivacaine, 1:20,000 levonordefrin

C. 3% mepivacaine plain

D. 4% articaine, 1:200,000 epinephrine

A

C. 3% mepivacaine plain

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25
Q

Methemoglobinemia is a life-threatening condition that may be precipitated by which one of the following drugs?

A. Lidocaine

B. Mepivacaine

C. Prilocaine

D. Bupivacaine

A

C. Prilocaine

26
Q

Arrange the injectable local anesthetic drugs in descending order of overall CNS and CVS toxicity.

A. Bupivacaine, mepivacaine, lidocaine, prilocaine, articaine

B. Bupivacaine, mepivacaine, lidocaine, articaine, prilocaine

C. Bupivacaine, mepivacaine, articaine, lidocaine, prilocaine

D. Bupivacaine, lidocaine, mepivacaine, articaine, prilocaine

A

B. Bupivacaine, mepivacaine, lidocaine, articaine, prilocaine

27
Q

Which one of the following vasoconstrictors is most useful in providing hemostasis?

A. Phenylephrine

B. Epinephrine

C. Levonordefrin

D. Felypressin

A

B. Epinephrine

28
Q

A patient has significant cardiovascular disease and requires a restorative procedure on tooth #5. Retraction cord and hemostasis are needed in order to keep the restorative site dry. Which one of the following drugs would be most indicated in this situation?

A. 4% articaine, 1:200,000 epinephrine

B. 2% mepivacaine, 1:20,000 levonordefrin

C. 2% lidocaine, 1:50,000 epinephrine

D. 4% prilocaine plain

A

A. 4% articaine, 1:200,000 epinephrine

29
Q

Which one of the following statements is true?

A. Levonordefrin is more potent compared with
epinephrine.

B. Cardiac stimulation from levonordefrin is greater
compared with epinephrine.

C. Cardiac stimulation from levonordefrin is less compared with epinephrine.

D. Levonordefrin is equal in potency compared with
epinephrine.

A

C. Cardiac stimulation from levonordefrin is less compared with epinephrine.

30
Q

Epinephrine’s metabolism is relatively rapid after local anesthesia administration.

A. True

B. False

A

A. True

31
Q

Metabolic enzymes for epinephrine include which of the following?

A. COMT and MAO

B. Hepatic isoenzymes

A

A. COMT and MAO

32
Q

A diabetic patient requires periodontal therapy on the upper and lower right quadrants. She is well controlled and otherwise healthy. Which one of the following represents the safest and most effective local anesthesia regime?

A. 4 cartridges of 2% lidocaine, 1:100,000 epinephrine

B. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 3% mepivacaine plain

C. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 4% articaine, 1:200,000 epinephrine

D. 2 cartridges of 2% lidocaine 1:100,000 epinephrine and 2 cartridges of 2% mepivacaine, 1:20,000 levonordefrin

A

B. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 3% mepivacaine plain

33
Q

All of the following are correct when considering MRDs, except:

A. Articaine = (3.2 mg/lb, 2.0 mg/kg)

B. Bupivacaine = 90 mg (0.9 mg/lm. 2.0 mg/kg)

C. Lidocaine = 600 mg (4.0 mg/lb, 8.0 mg/kg)

D. Mepivacaine = 400 mg (3.0 mg/lb, 6.6 mg/kg)

A

C. Lidocaine = 600 mg (4.0 mg/lb, 8.0 mg/kg)

34
Q

Relevant information and mathematical operations required when calculating drug doses for local anesthetics and vasoconstrictors include all but which one of the following?

A. Dilution percentages

B. Standard cartridge volumes

C. Defined MRD for each drug

D. Height and weight

A

D. Height and weight

35
Q

Which one of the following is not related to the MRD for 2% lidocaine, 1:100,000 epinephrine?

A. ~11 cartridges absolute maximum

B. ~13 cartridges absolute maximum

C. 3.2 mg/lb

D. 500 mg absolute maximum

A

B. ~13 cartridges absolute maximum

36
Q

What is the MRD for vasoconstrictors when administering 2% lidocaine, 1:100,000 epinephrine to a healthy individual?

A. 0.02 mg

B. 0.1 mg

C. 0.2 mg

D. 1 mg

A

C. 0.2 mg

37
Q

An individual has received 4 cartridges of 2% lidocaine, 1:100,000 epinephrine, and is not profoundly anesthetized. How many cartridges of 4% articaine, 1:200,000 epinephrine, may be administered if the individual weighs 160 lbs?

A. 2.5

B. 3.5

C. 4.5

D. 5.5

A

C. 4.5

38
Q

How many cartridges of 4% articaine, 1:200,000 epinephrine may be administered to an individual with significant cardiovascular compromise?

A. 1

B. 2

C. 3

D. 4

A

D. 4

39
Q

Which one of the following accurately describes available formulations?

A. 2% lidocaine, 1:100,000 epinephrine; 3% lidocaine, 1:200,000 epinephrine

B. 2% lidocaine, 1:100,000 epinephrine; 4% lidocaine, 1:200,000 epinephrine

C. 2% lidocaine, 1:100,000 epinephrine; 2% lidocaine,1:50,000 epinephrine

D. 2% lidocaine, 1:200,000 epinephrine; 2% lidocaine,1:20,000 levonordefrin

A

C. 2% lidocaine, 1:100,000 epinephrine; 2% lidocaine,1:50,000 epinephrine

40
Q

The maximum dose per weight of 4% articaine, 1:100,000 epinephrine for children is:

A. 2 mg/lb

B. 3 mg/lb

C. 2.2 mg/lb

D. 3.2 mg/lb

A

D. 3.2 mg/lb

41
Q

0.5% bupivacaine, 1:200,000 epinephrine contains how many milligrams of anesthetic drug per cartridge?

A. 9

B. 18

C. 36

D. 54

A

A. 9

42
Q

Eutectic mixtures have which of the following characteristics?

A. They work more rapidly than most other topicals.

B. They penetrate more deeply on skin than mucosa.

C. Their melting points exceed that of their ingredients acting alone.

D. Their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingredients acting alone.

A

D. Their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingredients acting alone.

43
Q

Which of the following lists is most accurate when describing topical anesthetic uses?

A. Before exposing radiographs, before injections, before placing retraction cord

B. Before dental hygiene therapy and in subgingival tissues

C. In procedures confined to mucosa and before taking impressions

D. All of the above

A

D. All of the above

44
Q

Which one of the following statements is incorrect regarding maximum recommended doses of topical anesthetics?

A. They are sometimes difficult to track.

B. MRDs are not always provided.

C. Spray forms have easy-to-track dosing.

D. Oraqix has easy-to-track dosing.

A

C. Spray forms have easy-to-track dosing.

45
Q

Generous quantities of topical and injected anesthesia have been administered, when the patient begins to shake and appears agitated and anxious. Is there a reason for concern?

A. Yes, because these may be early signs of CNS depression.

B. No, because this is a very nervous patient and he or she hates dental appointments.

C. No, because the doses of injectable anesthetic were within safe guidelines.

D. Yes, because the patient is a dental phobic.

A

A. Yes, because these may be early signs of CNS depression.

46
Q

Topical anesthetic mixtures may be of benefit in all but which one of the following ways?

A. Combinations may increase therapeutic ranges.

B. Combinations may increase penetration depths.

C. Mixtures may allow drugs to be used as topicals that are not suitable when used alone.

D. Mixtures decrease the potential for adverse reaction

A

D. Mixtures decrease the potential for adverse reaction

47
Q

All of the following statements are true regarding compounded drugs, except:

A. Compounded drugs are formulated for individuals for whom they are prescribed.

B. Compounded drugs may be used on other individuals as long as the use is the same as the original use.

C. Compounded drugs may contain much larger quantities of drug compared with multiuse commercial preparations.

D. Compounded topicals are dispensed by prescription.

A

B. Compounded drugs may be used on other individuals as long as the use is the same as the original use.

48
Q

The predominantly base form of lidocaine topical anesthetic is safer than the predominantly hydrochloride salt.

A. True

B. False

A

A. True

49
Q

Dyclonine hydrochloride is an excellent and very durable topical anesthetic and belongs to which one of the following classes of anesthetic?

A. Amide

B. Ketone

C. Ester

D. None of the above

A

B. Ketone

50
Q

Which one of the following statements is correct?

A. The standard aspirating syringe is designed to provide negative pressure on aspiration, unlike the self-aspirating syringe.

B. The standard aspirating syringe is designed to provide positive pressure on aspiration, unlike the self-aspirating syringe.

C. Neither the standard nor the self-aspirating syringes provide negative pressure on aspiration.

D. The standard aspirating syringe is designed to provide negative pressure on aspiration similar to the self-aspirating syringe.

A

D. The standard aspirating syringe is designed to provide negative pressure on aspiration similar to the self-aspirating syringe.

51
Q

Which one of the following is correct when addressing OSHA requirements for medical device safety in dentistry?

A. Two hands are allowed as long as one hand only secures the needle cap.

B. Contaminated needles may be bent as long as the bend is accomplished with cotton pliers or a hemostat.

C. Two hands are never allowed to recap needles even when one hand is holding a hemostat or locking pliers to secure the protective caps.

D. Uncontaminated needles may be bent.

A

D. Uncontaminated needles may be bent.

52
Q

In comparing a 25-gauge needle with a 30-gauge needle, the 25-gauge needle:

  1. Has better aspiration.
  2. Breaks more easily.
  3. Is less comfortable than the 30 gauge.
  4. Has a smaller diameter.
  5. Can be used in highly vascular areas.

A. 2,4,5

B. 2,4

C. 1,3,5

D. 1,5

A

D. 1,5

53
Q

Long needles are approximately ______long.

A. ~12 to 22 mm

B. ~32 to 36 mm

C. ~40 to 42 mm

A

B. ~32 to 36 mm

54
Q

When a stopper is extruded, what has likely caused the problem?

A. The cartridge was overfilled during manufacturing.

B. Freezing occurred during shipping or handling.

C. Overheating has caused pressure in the cartridge.

D. Oxidation of sodium bisulfate has created gas in the cartridge.

A

B. Freezing occurred during shipping or handling.

55
Q

During an infiltration injection you give the patient three stopper-widths of local anesthetic. How much solution have you injected into the patient?

A. 0.2 mL

B. 0.9 mL

C. 1.8 mL

D. 0.6 mL

A

D. 0.6 mL

56
Q

What substance is used as the preservative for epinephrine in local anesthetic cartridges?

A. Sodium bisulfite

B. Sodium hypochlorite

C. Methylparaben

D. Nitrogen

A

A. Sodium bisulfite

57
Q

The delivery of local anesthesia requires both medical and technical skills. Which one of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia?

A. Pre-anesthetic evaluation of the patient

B. Comprehensive tooth charting

C. Remain present during the course of the anesthesia

D. Providing indicated post-anesthesia care

A

B. Comprehensive tooth charting

58
Q

The ASA (American Society of Anesthesiologists) Physical Status Classification System categorizes patients based on their overall health. Classification P3 describes which one of the following?

A. Normal Healthy Patient

B. Severe Systemic Disease

C. Moribund Patient

D. Severe Systemic Disease (constant threat to life)

A

B. Severe Systemic Disease

59
Q

Which of the following is not considered a main tool for patient assessment when planning for local anesthesia?

A. The medical/dental questionnaire

B. The clinical examination

C. Drug MRDs

D. Medical consultation

A

C. Drug MRDs

60
Q

Which one of the following drugs is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism?

A. Lidocaine

B. Bupivacaine

C. Epinephrine

D. Felypressin

A

C. Epinephrine

61
Q

Your patient has identified or you suspect that your patient has used methamphetamines approximately 20 hours ago. Which of the following would be the most appropriate action when considering the use of local anesthetics?

A. Continue with procedures, as it has been more than
12 hours since the use.

B. Restrict the dose of vasoconstrictors to 20% of standard dose.

C. Consider postponing care for a full 24 hours.

D. Use only bupivacaine as the local anesthetic agent.

A

C. Consider postponing care for a full 24 hours.

62
Q

For which one of the following medical conditions is it unnecessary to obtain a medical consultation from the patient’s physician before dental treatment?

A. Significant liver disease

B. Myocardial infarction within 3 weeks

C. Kidney dialysis patients

D. Organ transplant patients

A

B. Myocardial infarction within 3 weeks

Semester 3 Local Anesthesia (9 decks)

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