MOSBY Flashcards
Which of the following does not represent a fascial space for the spread of infection?
A. Superficial temporal space
B. Pterygomandibular space
C. Masseteric space
D. Rhinosoteric space
E. Submental space
D. Rhinosoteric space
From the list of classifications of impacted teeth below, which one(s) must always involve both bone removal and sectioning during the surgical procedure?
A. Mesioangular impaction
B. Horizontal impaction
C. Vertical impaction
D. A and B only
E. A, B, and C
B. Horizontal impaction
Which of the following does not represent a possible finding of severe infection?
A. Trismus
B. Drooling
C. Difficult or painful swallowing
D. Swelling and induration with elevation of the tongue
E. A temperature of 99˚ F
E. A temperature of 99˚ F
You are performing a 5-year follow-up on a 43-year-old implant patient. When comparing radiographs you estimate that there has been almost 0.1 mm loss of bone height around the implant since it was placed. Which of the following is indicated?
A. Removal of the implant and replacement with a larger size implant.
B. Removal of the implant to allow healing before another one can be placed 4 months later.
C. Remaking the prosthetic crown because of tangential forces on the implant.
D. The implant is doing well; this amount of bone loss is considered acceptable
D. The implant is doing well; this amount of bone loss is considered acceptable
Upon evaluation of an immediate postoperative panoramic film of a dental implant replacing tooth #30, you measure a distance of 1.5 mm from the apex of the implant to the inferior alveolar nerve canal. This is a titanium implant in an otherwise healthy patient. Which of the following actions is indicated?
A. You may proceed with immediate loading of the implant.
B. You should continue but only perform a two-stage procedure.
C. Back the implant out approximately 0.5 mm to ensure a safe distance from the nerve.
D. Remove the implant and plan a repeat surgery after 4 months of healing.
C. Back the implant out approximately 0.5 mm to ensure a safe distance from the nerve.
Myofascial pain dysfunction may be described as _____.
A. Masticatory pain and limited function
B. Clicking and popping of the joint
C. An infectious process
D. Dislocation of the disc
A. Masticatory pain and limited function
A 21-year-old man is referred to your oral and maxillofacial surgery practice for an orthognathic surgery consult. After your routine exam and review of radiographs, you note the following problem list: Class III skeletal facial deformity with a negative overjet of 6 mm and significant maxillary crowding; missing left mandibular first molar due to dental decay with multiple other early carious lesions; and calculus on the lingual surfaces of teeth #22 through #27 with gingival inflammation. Which of the following is the most appropriate order in which this patient’s oral health needs should be sequenced?
A. Definitive crown and bridge therapy, orthodontics to relieve crowding and to coordinate arches, caries management, surgery to correct the skeletal discrepancy, and periodontal therapy to control gingival inflammation.
B. Caries management, orthodontics to relieve crowding and to coordinate arches, definitive crown and bridge therapy, periodontal therapy to control gingival inflammation, and surgery to correct the skeletal discrepancy.
C. Periodontal therapy to control gingival inflammation, definitive crown and bridge therapy, orthodontics to relieve crowding and to coordinate arches, surgery to correct the skeletal discrepancy, and caries management.
D. Periodontal therapy to control gingival inflammation, caries management, orthodontics to relieve crowding and to coordinate arches, surgery to correct the skeletal discrepancy, and definitive crown and bridge therapy.
D. Periodontal therapy to control gingival inflammation, caries management, orthodontics to relieve crowding and to coordinate arches, surgery to correct the skeletal discrepancy, and definitive crown and bridge therapy.
Systemic effects of obstructive sleep apnea syndrome (OSAS) include all of the following except _____.
A. Hypertension
B. Cor pulmonale
C. Aortic aneurysm
D. Cardiac arrhythmia
C. Aortic aneurysm
Which of the following is not a vital part of the physical exam for patients with TMJ complaints?
A. Soft-tissue symmetry
B. Joint tenderness and sounds
C. Soft-palate length
D. Range of motion of the mandible
E. Teeth
C. Soft-palate length
Which of the following is considered the highest and most severe classification of maxillary fracture?
A. LeFort I
B. LeFort II
C. LeFort III
D. LeFort IV
C. LeFort III
NOTES:
LeFort I: (Horizontal / Guerin’s / Transmaxillary)
LeFort II: (Pyramidal)
LeFort III: (Craniofacial separation/disjunction)
Which of the following is not a relative contraindication for routine, elective oral surgery?
A. Unstable cardiac angina
B. History of head and neck radiation
C. Chronic sinusitis
D. Hemophilia
C. Chronic sinusitis
Which of the following is true regarding temporomandibular disorders?
A. The primary treatment for the majority of patients with facial pain is TMJ surgery.
B. Disc displacement without reduction can cause a decrease in interincisal opening.
C. Myofascial pain is commonly related to parafunctional habits, but not commonly related to stress.
D. Systemic arthritic conditions do not affect the TMJ because it is not a weight-bearing joint
B. Disc displacement without reduction can cause a decrease in interincisal opening.
The following are those properties deemed most desirable for a local anesthetic, except _____.
A. It should not be irritating to the tissue to which it is applied
B. It should cause a permanent alteration of nerve structure
C. Its systemic toxicity should be low
D. It must be effective regardless of whether it is injected into the tissue or applied locally to mucous membranes
B. It should cause a permanent alteration of nerve structure
The majority of injectable local anesthetics used today are _____.
A. Tertiary amines
B. Secondary amines
C. Primary amines
D. Esters
A. Tertiary amines
_____ has a shorter half-life than other amides because a portion of its biotransformation occurs in the blood by the enzyme plasma cholinesterase.
A. Lidocaine
B. Bupivacaine
C. Mepivacaine
D. Articaine
D. Articaine
NOTES
Lidocaine- amide
Bupivacaine- amide
Mepivacaine- amide
Articaine- esther+amide
Esters are biotransformed much more rapidly than amides, articaine has a much shorter half-life than the others.
Which of the following local anesthetics is marketed for dentistry in the United States in more than one concentration?
A. Bupivacaine
B. Mepivacaine
C. Lidocaine
D. Articaine
B. Mepivacaine
NOTES:
Bupivacaine- 0.5% solution
Mepivacaine- 2% and 3% solution
Lidocaine - 2% solution
Articaine- 4% solution
The major factor determining whether aspiration can be reliably performed is _____.
A. The needle gauge
B. The needle length
C. The injection performed
D. The patient
A. The needle gauge
The _____ is recommended for palatal soft-tissue management from canine to canine bilaterally in the maxilla.
A. Posterior superior alveolar
B. Inferior alveolar
C. Long buccal
D. Nasopalatine
D. Nasopalatine
Which of the following local anesthetics has the highest pKa?
A. Lidocaine
B. Prilocaine
C. Mepivacaine
D. Bupivacaine
D. Bupivacaine
NOTES:
NOTES:
Lidocaine- 7.8 pka
Prilocaine- 7.8 pka
Mepivacaine- 7.7 pka
Bupivacaine- 8.1 pka (highest pKa); most hydrophobic; higest degree of protein binding
Three cartridges of 2% lidocaine with 1:100,000 epinephrine contain _____ lidocaine.
A. 36 mg
B. 54 mg
C. 54 μg
D. 108 mg
D. 108 mg
NOTES:
A 2% solution of any drug contains 20 mg/mL, by definition. A dental cartridge of local anesthesia has a fluid volume of 1.8mL.20mg×1.8=36mg of lidocaine per cartridge. Three cartridges of 2% lidocaine with 1:100,000 epinephrine therefore contain 108 mg.
Which injection anesthetizes the distobuccal aspect of the mandibular first molar?
A. Posterior superior alveolar (PSA)
B. Middle superior alveolar (MSA)
C. Anterior superior alveolar (ASA)
D. Inferior alveolar (IA)
D. Inferior alveolar (IA)
NOTES:
MAXILLARY- PSA, MSA, ASA
MANDIBULAR-IA
Which of the following is the longest-acting local anesthetic?
A. Mepivacaine
B. Lidocaine
C. Prilocaine
D. Bupivacaine
D. Bupivacaine
NOTES:
Lidocaine- 7.8 pka
Prilocaine- 7.8 pka
Mepivacaine- 7.7 pka; do not have vasoconstrictor
Bupivacaine- 8.1 pka (highest pKa); most hydrophobic (longest duration of action); higest degree of protein binding
If your patient has a history of liver disease, which of the following would be the safest local anesthetic?
A. Articaine
B. Prilocaine
C. Lidocaine
D. Bupivacaine
A. Articaine
NOTES:
All amide local anesthetics are biotransformed in the liver. One available local anesthetic also has an ester side chain, which means it has some degree of extrahepatic biotransformation (outside the liver). This drug is articaine and is therefore the most appropriate drug for patients with liver disease.
Which of the following injections has the highest degree of failure?
A. Posterior superior alveolar
B. Lingual
C. Nasopalatine
D. Inferior alveolar
D. Inferior alveolar
All of the following are possible reasons why some local anesthetics have a longer duration of action than others, except
A. The addition of a vasoconstrictor
B. Percent protein binding
C. Degree of lipid solubility
D. pKa of the drug
D. pKa of the drug❌
You have placed a dental implant for replacement of tooth #9. Preoperatively you obtained a panoramic and a periapical film. During the surgery, you used a crestal incision, series of drills, and paralleling pins as necessary. Upon restoration of the crown, obtaining ideal esthetics is difficult because the implant is placed too close to the labial cortex, causing the restoration to appear overcontoured. Which of the techniques below could most adequately have prevented this problem?
A. Using an anterior surgical template
B. Obtaining preoperative tomograms of the alveolus
C. Using a tissue punch technique
D. Using a smaller size of implant
A. Using an anterior surgical template
The third molar impaction most difficult to remove is the _____.
A. Vertical
B. Mesioangular
C. Distoangular
D. Horizontal
C. Distoangular
On a panoramic radiograph of a 13-year-old patient, there is evidence of crown formation of the third molars but no root formation yet. These teeth fall into the category of impacted teeth.
A. True
B. False
B. False
Which of the following is not appropriate treatment for an odontogenic abscess?
A. Placing the patient on antibiotics and having them return when the swelling resolves
B. Surgical removal of the source of the infection as early as possible
C. Drainage of the abscess with placement of surgical drains
D. Close observance of the patient during resolution of the infection
E. Medical management of the patient to correct any compromised states that might exist
A. Placing the patient on antibiotics and having them return when the swelling resolves
Before the exploration of any intrabony pathologic lesion, which type of biopsy must always be done?
A. Cytologic smear
B. Incisional biopsy
C. Excisional biopsy
D. Aspiration biopsy
D. Aspiration biopsy
You are performing a 5-year follow-up on a 43-year-old implant patient. When comparing radiographs, you estimate that there has been almost 0.1 mm of lost bone height around the implant since it was placed. Which of the following is indicated?
A. Removal of the implant and replacement with a larger-size implant.
B. Removal of the implant to allow healing before another one can be placed 4 months later.
C. Remaking the prosthetic crown because of tangential forces on the implant.
D. The implant is doing well; this amount of bone loss is considered acceptable.
D. The implant is doing well; this amount of bone loss is considered acceptable.
The major mechanisms for the destruction of osseointegration of implants are _____.
A. Related to surgical technique
B. Similar to those of natural teeth
C. Related to implant material
D. Related to nutrition
B. Similar to those of natural teeth
After completing your postoperative instructions for dental implant placement for replacement of tooth #14, your patient asks you how long it will be before she can get her new tooth. Which of the following is most correct to allow complete osseointegration?
A. 3 weeks
B. 6 weeks
C. 3 months
D. 6 months
D. 6 months
The imaging evaluation of the temporomandibular joint is most likely to include any of the following except
A. Panoramic radiographs
B. TMJ tomograms
C. Xeroradiography
D. Magnetic resonance imaging
C. Xeroradiography❌
When is distraction osteogenesis preferred over a traditional osteotomy?
A. When a large advancement is needed.
B. When a small advancement is needed.
C. When exacted interdigitation of the occlusion is needed.
D. When the treatment needs to be done in a very short period of time.
E. Distraction osteogenesis is always preferred over a traditional osteotomy.
A. When a large advancement is needed.
NOTES:
Distraction osteogenesis is preferred over traditional osteotomies when large skeletal movements are required, and the associated soft tissue cannot adapt to the acute changes and stretching that results. Larger movements may be at increased risk of some relapse. This is particularly true in a patient with a cleft palate, where there is significant soft tissue scarring from previous surgeries.
The most common mandibular surgical osteotomy to advance the mandible is _____.
A. A LeFort I osteotomy
B. A segmental maxillary osteotomy
C. A bilateral sagittal split osteotomy
D. An intraoral vertical ramus osteotomy
C. A bilateral sagittal split osteotomy
Obstructive sleep apnea syndrome (OSAS) often results in all of the following except _____.
A. Excessive daytime sleepiness
B. Aggressive behavior
C. Personality changes
D. Depression
B. Aggressive behavior❌
Which of the following procedures would be considered the least invasive surgical treatment for TMJ complaints?
A. Splint therapy
B. Arthrocentesis
C. Arthroscopy
D. Disc removal
E. Total joint replacement
C. Arthroscopy
Your patient is a 23-year-old college student whom you suspect may have sustained a mandible fracture during an altercation. Which of the following is false?
A. At least two x-rays should be obtained.
B. The most common x-ray obtained would be a panoramic radiograph.
C. The most likely area for this patient’s mandible to be fractured is the mandibular dental alveolus.
D. Point tenderness, changes in occlusion, step deformities, and gingival lacerations should all be noted on physical exam.
C. The most likely area for this patient’s mandible to be fractured is the mandibular dental alveolus.❌
The most likely area for this patient’s mandible to be fractured is the mandibular CONDYLE.
CAS BARC
Condyle= 29.1%
Angle= 24.5%
Symphysis= 22%
Body =16%
Alveolar process= 3.1%
Ramus= 1.7%
Coronoid process= 1.3%
Which of the following is not a classification of mandible fractures?
A. Anatomic location
B. Description of the condition of the bone fragments at the fracture site
C. Angulation of the fracture and muscle pull
D. LeFort level
D. LeFort level
Even though the state-of-the-art treatment for facial fractures is with internal rigid fixation using bone plates and screws, a proper occlusal relationship must be established prior to fixation of the bony segments if the reduction is to be satisfactory.
A. True
B. False
A. True
NOTES:
A proper occlusal relationship is a prerequisite for satisfactory bony reduction. This is most commonly accomplished by the use if intermaxillary fixation, or wiring the jaws closed, during surgery.
Which of the following is true regarding possible complications resulting from dental extractions?
A. Patients with numbness lasting more than 4 weeks should be referred for microneurosurgical evaluation.
B. Infections are common, even in healthy patients.
C. Dry socket occurs in 10% of third molar patients.
D. Teeth lost into the oropharynx are usually swallowed, and thus do not require further intervention.
A. Patients with numbness lasting more than 4 weeks should be referred for microneurosurgical evaluation.
Which of the following is true regarding the possibilities for reconstruction of an atrophic edentulous ridge prior to denture construction?
A. Dental implants are used only as a last resort after bone grafting attempts have failed.
B. Distraction osteogenesis is too new a technique to be applied to ridge augmentation.
C. Potential bone graft harvest sites for ridge reconstruction include rib, hip, and chin.
D. The need for ridge augmentation is more common in the maxilla than in the mandible.
C. Potential bone graft harvest sites for ridge reconstruction include rib, hip, and chin.
You are evaluating a patient 5 days after extraction of tooth #17. The patient complains of a severe throbbing pain that started yesterday, 4 days after extraction. The patient most likely has which of the following conditions?
A. Dry socket
B. Subperiosteal abscess
C. Periapical periodontitis in tooth #18
D. Neuropathic pain
A. Dry socket
Which of the following would not be expected to cause delayed healing of an extraction site?
A. A patient older than 60 years of age
B. A patient younger than 10 years of age
C. A patient with diabetes
D. A patient with a heavy smoking habit
B. A patient younger than 10 years of age❌
The following are all desirable properties of an ideal local anesthetic, except _____.
A. It should have potency sufficient to give complete anesthesia even if harmful results occur at therapeutic doses
B. It should be relatively free from producing allergic reactions
C. It should be stable in solution and readily undergo biotransformation in the body
D. It should either be sterile or capable of being sterilized by heat without deterioration
A. It should have potency sufficient to give complete anesthesia even if HARMFUL results occur at therapeutic doses❌
What is the direct effect of local anesthetics on blood vessels in the area of injection?
A. Constriction
B. Dilation
C. Sclerosis
D. Thrombosis
B. Dilation
NOTES:
All local anesthetics are vasodilators to some degree.
All of the following describe lidocaine as packaged in dental cartridges except _____.
A. Provided in a 2% solution
B. Provided with or without epinephrine
C. Has a pKa = 8.1
D. Has a rapid onset
C. Has a pKa = 8.1❌
Has a pKa=7.9
25-gauge needles are preferred to smaller-diameter ones due to all of the following reasons except _____.
A. Greater accuracy in needle insertion for 25-gauge needles
B. Increased rate of needle breakage for 25-gauge needles
C. Aspiration of blood is easier and more reliable
through a larger lumen
D. There is no difference in pain of insertion
B. Increased rate of needle breakage for 25-gauge needles
A 1.0-ml volume of a 2% solution contains _____.
A. 18 mg
B. 20 mg
C. 36 mg
D. 54 mg
B. 20 mg
NOTES:
A 2% solution is 20 mg/mL. 1.0 mL of a 20 mg/mL solution is 20 mg.
During local anesthetic administration, the patient should be placed in a _____ position.
A. Trendelenburg
B. Supine
C. Reclined
D. Semi-supine
B. Supine
According to Malamed, slow injection is defined as the deposition of 1 ml of local anesthetic solution in not less than _____.
A. 15 seconds
B. 30 seconds
C. 60 seconds
D. 2 minutes
B. 30 seconds
The _____ nerve block is recommended for management of several maxillary molar teeth in one quadrant.
A. Posterior superior alveolar (PSA)
B. Inferior alveolar (IA)
C. Long buccal (LB)
D. Nasopalatine (NP)
A. Posterior superior alveolar (PSA)
NOTES:
Posterior superior alveolar (PSA)- is the only injection listed that leads to pulpal anesthesia in the maxilla.
Inferior alveolar (IA)- mandibular injection
Long buccal (LB)- mandibular injection
Nasopalatine (NP)- is a maxillary injection that leads to soft-tissue anesthesia of the premaxilla only.
In an adult of normal size, penetration to a depth of _____ mm places the needle tip in the immediate vicinity of the foramina, through which the posterior superior alveolar (PSA) nerves enter the posterior surface of the maxilla.
A. 10
B. 16
C. 20
D. 30
B. 16
The _____ nerve block is useful for dental procedures involving the palatal soft tissues distal to the canine.
A. Nasopalatine (NP)
B. Greater palatine (GP)
C. Long buccal (LB)
D. Inferior alveolar (IA)
B. Greater palatine (GP)
NOTES:
The greater palatine (GP) injection provides soft- tissue anesthesia of the hard palate from the junction of the premaxilla to the junction of hard and soft palate and from the gingival margin to the midline of the palate.
Elevation of cardiovascular signs with epinephrine, injected in a local anesthetic solution in a cardiovascularly compromised patient, occurs at about what threshold?
A. 40 μg
B. 100 μg
C. 200 μg
D. 1000 μg
A. 40 μg
According to Malamed, the maximum local anesthetic dose of lidocaine (with or without vasoconstrictor) is
A. 1.5 mg/kg.
B. 2.0 mg/kg.
C. 4.4 mg/kg.
D. 7.0 mg/kg.
C. 4.4 mg/kg.
LOCAL ANESTHESIA:
- Usual maximum dose used is: 4.4 mg/kg
Example
- 2% lidocaine HCL with 1:100,000 epinephrine in 1.8 ml carpule
- 3% mepivacaine in 1.8 ml carpule
- 4% articaine in 1.7 ml carpule
Which of the following injections, when properly performed, does not lead to pulpal anesthesia?
A. Inferior alveolar (IA)
B. Lingual
C. Posterior superior alveolar (PSA)
D. Infraorbital (IO) (true anterior superior alveolar nerve block)
B. Lingual
NOTES:
LEADS TO PULPAL ANESTHESIA:
- Inferior alveolar
- Posterior superior alveolar (PSA)
- Infraorbital
LEADS TO SOFT TISSUE ANESTHESIA:
- Lingual
The optimal volume of local anesthetic solution delivered for a true anterior superior alveolar (ASA) nerve block is usually about _____.
A. 0.5 mL
B. 1.0 mL
C. 1.5 mL
D. 1.8 mL
B. 1.0 mL
The local anesthetic agent that is most appropriate for use in most children is _____.
A. 3% mepivacaine
B. 2% mepivacaine with 1:20,000 levonordefrin
C. 2% lidocaine with 1:100,000 epinephrine
D. 0.5% bupivacaine with 1:200,000 epinephrine
C. 2% lidocaine with 1:100,000 epinephrine
Which of the following local anesthetics causes the least amount of vasodilation?
A. Lidocaine
B. Mepivacaine
C. Bupivacaine
D. Articaine
B. Mepivacaine
NOTES:
Lidocaine- 7.8 pka
Prilocaine- 7.8 pka
Mepivacaine- 7.7 pka; do not have vasoconstrictor
Bupivacaine- 8.1 pka (highest pKa); most hydrophobic (longest duration of action); higest degree of protein binding
According to Malamed, how many cartridges of 2% lidocaine can be safely administered to a child weighing 40 lb?
A. Three cartridges
B. One cartridge
C. Nine cartridges
D. Two cartridges
D. Two cartridges
NOTES:
2% lidocaine contains 36 mg of lidocaine per cartridge. Since 80 mg is the amount of lidocaine that can safely be administered to this child, the number of cartridges that can be administered is 80 mg divided by 36 mg per cartridge, which is roughly two cartridges.
If a local anesthetic has a low pKa, then it will usually have a _____.
A. Greater potency
B. Higher degree of protein binding
C. Faster onset of action
D. Greater vasodilating potential
C. Faster onset of action
NOTES:
LOW pKa= FAST onset of action
Hydrophobic= LONG duration of action
Anticipating correct administration of the (long) buccal injection, what areas will be anesthetized?
A. Soft tissues and periosteum buccal to the mandibular molar teeth
B. Soft tissues and periosteum lingual to the mandibular molar teeth
C. Soft tissues and periosteum lingual to the mandibular premolar teeth
D. Soft tissues and periosteum buccal to the mandibular premolar teeth
A. Soft tissues and periosteum BUCCAL to the mandibular MOLAR teeth
Which local anesthetic is most hydrophobic and has the highest degree of protein binding?
A. Mepivacaine
B. Lidocaine
C. Bupivacaine
D. Procaine
C. Bupivacaine
NOTES:
Lidocaine- 7.8 pka; shortest half life
Prilocaine- 7.8 pka
Mepivacaine- 7.7 pka
Bupivacaine- 8.1 pka (highest pKa); most hydrophobic (long duration of action); highest degree of protein binding
A portion of which cranial nerve is anesthetized when performing an infraorbital nerve block?
A. VII
B. V
C. III
D. II
B. V (Trigeminal)
Which of the following local anesthetics has the shortest half-life?
A. Lidocaine
B. Prilocaine
C. Bupivacaine
D. Articaine
D. Articaine
NOTES:
Lidocaine- amide
Bupivacaine- amide
Mepivacaine- amide
Articaine- esther+amide
Esters are biotransformed much more rapidly than amides, articaine has a much shorter half-life than the others.
