Surgery1 Flashcards
1
Q
The gold standard test for primary adrenal failure is the: • blood glucose test • ACTH stimulation test • serum creatinine level • BUN test
A
ACTH stimulation test
2
Q
About 20 mg of hydrocortisone is secreted by the adrenal cortex daily. During stress, the cortex can increase the output to ?
A
200 mg daily
3
Q
A person who has been on suppressive doses of steroids will? Select all that apply.
• take as long as a year to regain full adrenal cortical function
• take as long as a month to regain full adrenal cortical function
• may show signs of hyperpigmentation
• does not require consultation with a physician prior to surgery
A
- take as long as a year to regain full adrenal cortical function
- may show signs of hyperpigmentation
4
Q
Some guidelines of adrenal function suppression before performing surgery:
A
- People on small doses (5 mg prednisone/day) will have suppression when they have been on the regimen for a month.
- People taking the equivalence of 100 mg cortisol/day (20-30 mg prednisone/day) will have abnormal cortical function in a week.
- Short-term therapy (1-3 days) of even high-dose steroids will not alter adrenal cortical function.
- A person who has been on suppressive doses of steroids will take as long as a year to regain full adrenal cortical function
5
Q
an adrenally insufficient patient have adequate steroid replacement since the stress of oral surgery can precipitate ?
A
adrenal crisis
6
Q
Patients with glucocorticoid hypersecretion have: • ectopic ACTH Syndrome • MEN • cushing syndrome • addison disease
A
cushing syndrome
7
Q
what is important in cushing syndrome?
A
The patient’s cardiovascular status must be evaluated and treated if necessary prior to surgery
8
Q
A 52-year-old woman requests removal of a painful mandibular second molar. She tells you that she has not rested for 2 days and nights because of the pain. Her medical history is unremarkable, except that she takes 20 mg of prednisone daily for erythema multiforme. How do you treat this patient?
• have patient discontinue the prednisone for 2 days prior to the extraction
• give steroid supplementation and remove the tooth with local anesthesia and sedation
• instruct the patient to take 3 grams of amoxicillin 1 hour prior to extraction
• no special treatment is necessary prior to extraction
A
give steroid supplementation and remove the tooth with local anesthesia and sedation
9
Q
Which of the following foramen/location pairings are correct? Select all that apply.
• greater palatine foramen/distal to the apex of maxillary 1st molar
• incisive foramen/posterior to the interproximal space of the central incisors
• lesser palatine foramen/lateral to the greater palatine foramen
A
incisive foramen/posterior to the interproximal space of the central incisors
10
Q
Motor Innervation of palate?
A
the tensor veli palatini is innervated by a muscular branch from the mandibular division of the trigeminal nerve (CN V). All other muscles are innervated by the pharyngeal plexus (motor portion from the vagus nerve and cranial part of the accessory nerve)
11
Q
The facial nerve carries which of the following? Select all that apply. • efferent components • afferent components • sympathetic components • parasympathetic components
A
- efferent components
- afferent components
- parasympathetic components
12
Q
the facial nerve exits the skull by way of the ? of the temporal bone, innervating ?.
A
- stylomastoid foramen
* the muscles of facial expression
13
Q
The afferent component of facial nerve serves ?
A
a tiny patch of skin behind the ear, taste sensation, and the body of the tongue
14
Q
Bell palsy cause?
A
One theory of its cause is that the facial nerve becomes inflamed within the temporal bone, possibly with a viral etiology
15
Q
- Trigeminal neuralgia (tic douloureux) involves the ? nerves of the trigeminal nerve
- Trigeminal neuralgia cause?
- its treatment?
A
- afferent (the maxillary or mandibular nerve branches but not the ophthalmic branch)
- pressure on the sensory root of the trigeminal ganglion by area blood vessels
- Carbamazepine (Tegretol) is still the mainstay of treatment
16
Q
Which component of the TMJ has the most vasculature and innervation? • articular fossa • anterior band of the articular disc • posterior band of the articular disc • articular eminence • retrodiscal tissue
A
retrodiscal tissue
17
Q
The maxillary sinus opens into the middle meatus of the nose through the: • frontonasal duct • bulla ethmoidalis • hiatus semilunaris • nasolacrimal duct
A
hiatus semilunaris
18
Q
- Chronic bacterial sinusitis is treated with ?
* Chronic noninfectious sinusitis often is treated with ?
A
- antibiotics (ampicillin or augmentin)
* steroids (topical or oral) and nasal washes
19
Q
The arises from the anterior surface of the external carotid artery and then passes near the greater cornu of the hyoid bone. • submental artery • inferior alveolar artery • lingual artery • ascending pharyngeal artery
A
lingual artery
20
Q
The loop of the lingual artery is crossed superficially by ? nerve
A
the hypoglossal nerve (does not accompany the lingual nerve throughout its course)
21
Q
If the lingual nerve is cut after the chorda tympani joins, there will be loss of ?
A
both taste and tactile sensation
22
Q
? muscle forms the roof of the pterygomandibular space
A
The lateral pterygoid
23
Q
The buccinator and superior pharyngeal constrictor muscles of the pharynx are attached to each other at the:
• pterygomandibular raphe
• mastoid process
• epicranial aponeurosis
• genial tubercles on the internal surface of the mandible
A
pterygomandibular raphe (fold) (extends from the hamulus and attach to the posterior end of the mandible’s mylohyoid line)
24
Q
When draining purulent exudate from an abscess of the pterygomandibular space using an intraoral approach, ? muscle is most likely to be incised
A
the buccinator
25
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Which of the following are involved in the path for parasympathetic innervation of the parotid gland? Select all that apply.
• trigeminal nerve
• glossopharyneal nerve
• vagus nerve
• otic ganglion
• pterygopalatine ganglion
```
* glossopharyneal nerve
| * otic ganglion
26
The pterygopalatine ganglion is responsible for innervation of ?
* the lacrimal gland
| * other glands of the nasal cavity
27
* Postganglionic parasympathetic fibers reach the parotid gland via ? nerve, which lies in contact with the deep surface of the gland.
* Postganglionic sympathetic fibers reach the gland as ?
• the auriculotemporal
• a plexus of nerves around the external carotid artery
(Although it passes through the parotid gland, the facial nerve does not provide any innervation to it)
28
A dentist is performing a routine restoration on the left mandibular first molar. He is giving an inferior alveolar nerve block injection, where he deposits anesthetic solution right next to the lingula and mandibular foramen.
Which ligament is most likely to get damaged?
• sphenomandibular ligament
• temporomandibular ligament
• stylomandibular ligament
sphenomandibular ligament
29
The temporomandibular ligament (also called ?) runs from the articular eminence to ?. It provides ?. This ligament prevents ? displacement of the condyle (it is the main stabilizing ligament of the TMJ).
* the lateral ligament
* the mandibular condyle
* lateral reinforcement for the capsule
* posterior and inferior
30
Collateral ligaments (medial and lateral) also referred to as ? are ligaments that arise from ?, are attached to, the medial and lateral poles of the condyle, respectively, and ? the disc on the top of the condyle. They are composed of ? connective tissue; thus they do not stretch.
* discal ligaments
* the periphery of the disc
* stabilize
* collagenous
31
```
Which of the following injuries would cause a patient to deviate toward the side of injury when protruding?
Select all that apply.
• damage to the lateral pterygoid muscle
• ankylosis of the condyle
• condylar hyperplasia
• unilateral condylar fracture
```
• damage to the lateral pterygoid muscle
• ankylosis of the condyle
• unilateral condylar fracture
(The mandible will deviate away from the affected side with condylar hyperplasia)
32
Which lymph nodes directly receive lymph from the anterior two-thirds of the tongue (except the tip)?
• submental lymph nodes
• submandibular lymph nodes
• parotid lymph nodes
submandibular lymph nodes
33
```
Which artery descends on the posterior surface of the maxilla and supplies the maxillary sinus and the maxillary molar and premolar teeth?
• sphenopalatine artery
• greater palatine artery
• posterior superior alveolar artery
• infraorbital artery
```
posterior superior alveolar artery
34
The venous return of both dental arches is the ?
pterygoid plexus of veins
35
```
Which oral landmark marks the opening of the submandibular duct?
• lingual frenum
• nasolacrirnal duct
• parotid raphe
• sublingual caruncle
```
sublingual caruncle (Wharton duct)
36
The blood supply of submandibular gland comes from branches of ?
the facial and lingual arteries
37
? is the most common cause of swelling of the tissues in the submandibular triangle.
Lymphadenopathy
38
The TMJ is a/an:
• arthrodial joint
• ginglymus joint
• ginglymoarthrodial joint
ginglymoarthrodial joint (Because the TMJ has characteristics of both a hinge joint and a gliding joint)
39
Components of the TMJ:
* Mandibular condyle
* Articular fossa (the anterior three-fourths of the larger mandibular fossa)
* Articular eminence (functional portion of the joint, lined with a thick dense layer of fibrous connective tissue)
* Articular disc (fibrocartilaginous disk)
40
```
When a maxillary third molar is displaced into the infratemporal fossa, it is usually displaced through the periosteum and located ? to the lateral pterygoid plate and ? to the lateral pterygoid muscle with displacement
• medial, inferior
• medial, superior
• lateral, inferior
• lateral, superior
```
lateral, inferior
41
If no functional problems exist after displacement of a maxillary third molar into the infratemporal fossa, the patient may elect not to have the tooth removed but ?
proper documentation of this is critical
42
```
The carotid sheath contains which of the following?
Select all that apply.
• carotid artery
• sympathetic trunk
• jugular vein
• vagus nerve
```
• carotid artery
• jugular vein
• vagus nerve
(sympathetic trunk lies posterior to the carotid sheath and anterior to the prevertebral fascia)
43
```
Which nerve may, in some cases, also serve as an afferent nerve for the mandibular first molar, which needs to be considered when there is failure of the inferior alveolar local anesthetic block?
• posterior superior alveolar nerve
• glossopharyngeal nerve
• facial nerve
• rnylohyoid nerve
```
rnylohyoid nerve
44
When the floor of the mouth is lowered surgically, ? muscles are detached.
the mylohyoid and genioglossus
45
If the parotid capsule injection (when attempting to administer an inferior nerve block) happens, care must be taken to protect ?
the eye from injury and drying using lubrication and an eye patch.
46
```
Which of the following provides branches for the most direct blood supply to the temporomandibular joint
• internal carotid artery
• external carotid artery
• common carotid artery
• aorta
```
external carotid artery
47
The two terminal branches of the external carotid artery are ?
* the superficial temporal artery
| * the maxillary artery
48
the TMJ is innervated from ?
* the auriculotemporal
| * anterior region from masseteric nerve and from the posterior deep temporal nerve all from CN V (trigeminal)
49
Most synovial joints have hyaline cartilage on their articular surface surface; however, several joints, such as the stemoclavicular, acromioclavicular, and TMJs have ?
fibrocartilage articular surfaces
50
Which of the following muscle nerve combinations are correct? Select all that apply.
• trapezius m. / accessory n.
• stylopharyngeus m. / glossopharyngeal n.
• sternocleidomastoid m. / accessory n.
• cricothyroid m. / superior laryngeal n.
* trapezius m. / accessory n.
* stylopharyngeus m. / glossopharyngeal n.
* sternocleidomastoid m. / accessory n.
* cricothyroid m. / superior laryngeal n.
51
After a stroke on the right side of the brain that affects the right upper motor neurons, the tongue deviates to the:
• left on protrusion
• right on protrusion
• neither of the above, the tongue would not be affected
left on protrusion — and the left half of the tongue will atrophy
injury to the lower motor neuron, the hypoglossal nerve lesion occurs and the tongue deviates to the ipsilateral (same) side
52
If the genioglossus muscle is paralyzed, the tongue has a tendency to ?
fall back and obstruct the oropharyngeal airway with risk of suffocation
53
```
The sublingual gland is located in the oral cavity between the mucosa of the oral cavity and the:
• masseter muscle
• mylohyoid muscle
• buccinator muscle
• temporalis muscle
```
mylohyoid muscle
54
The trigeminal ganglion is located:
• superior to the deep lobe of the submandibular salivary gland
• posterior surface of the maxillary tuberosity of the maxilla
• anterior to the infraorbital foramen of the maxilla
• the apex of the petrous part of the temporal bone in the middle cranial fossa
the apex of the petrous part of the temporal bone in the middle cranial fossa
55
Proprioceptive fibers from muscles and the TMJ are found only in the mandibular division. The cell bodies of proprioceptive first order neurons are found in the ?, not the trigeminal ganglion
mesencephalic nucleus
56
```
The tongue receives its blood supply from which of the following? Select all that apply.
• tonsillar branch of the facial artery
• lingual artery
• vertebral artery
• ascending pharyngeal artery
```
* tonsillar branch of the facial artery
* lingual artery
* ascending pharyngeal artery
57
lingual artery terminates as ?
the deep lingual artery
58
Motor innervation of tongue?
the hypoglossal nerve (CNXII)
59
Sensory innervation of tongue?
* lingual (branch of trigeminal CN V3) supplies the anterior two-thirds,
* glossopharyngeal (CN IX) supplies the posterior one-third (including vallaie papillae),
* vagus (CN X) through the internal laryngeal nerve supplies the area near the epiglottis.
60
Taste of tongue ?
* facial (CN VII) via chorda tympani supplies the anterior two-thirds;
* glossopharyngeal supplies the posterior one-third.
61
```
Which of the following nerves exits the skull through the foramen ovale?
• ophthalmic nerve
• maxillary nerve
• facial nerve
• mandibular nerve
```
mandibular nerve
62
```
Which of the following muscle/nerve pairings are correct? Select all that apply.
• lateral rectus m. / abducens n.
• superior oblique m. / trochlear n.
• medial rectus m. / abducens n.
• inferior rectus m./ occulomotor n.
```
• lateral rectus m. / abducens n.
• superior oblique m. / trochlear n.
• inferior rectus m./ occulomotor n.
(SO4)LR6
63
Which of the following teeth could be removed without pain after administration of an inferior alveolar and lingual nerve block?
• all anterior teeth on the side of the injection
• canine and first premolar on the side of the injection
• all teeth in that quadrant on the side of the injection
• both premolars and first molar on the side of the injection
canine and first premolar on the side of the injection
(You need to give a long buccal injection to extract the molars and second bicuspid, The needle is inserted in the mucous membrane distal and buccal to the most distal molar in the arch)
(Incisors may need local infiltration for extractions)
64
Vazirani-Akinosi closed-mouth mandibular block technique?
in patients with trismus, The injection is performed blindly because no bony end points exist, the needle is advanced 25 mm into tissue. The distance is measured from the maxillary tuberosity
65
the Cow-Gates technique is used when a conventional inferior alveolar nerve block is unsuccessful. how is it done?
Patient must extend his or her neck and open wide for the duration of the technique (the condyle then assumes a more frontal position and is closer to the mandibular nerve trunk). the needle is positioned so that it is inserted just distal to the maxillary second molar at the height of its mesiolingual cusp. The needle is then slowly advanced until bone (neck of the condyle) is contacted. The average depth of soft tissue penetration to bone is 25 mm. The needle tip is withdrawn 1 mm, aspirate, and slowly deposit solution
66
```
The maxillary first molar is innervated by which of the following nerves? Select all that apply.
• anterior superior alveolar
• middle superior alveolar
• posterior superior alveolar
• greater palatine
• ascending pharyngeal
```
• middle superior alveolar (is present in only about 28% of the population)
• posterior superior alveolar
as well as the greater (anterior) palatine nerve for its extraction
67
```
Which of the following characterize shock? Select all that apply.
• decreased vascular resistance
• bradycardia
• myocardial ischemia
• mental status changes
• adrenergic response
```
* myocardial ischemia
* mental status changes
* adrenergic response
68
```
A full E cylinder of oxygen contains approximately:
• 150 L at a pressure of 2000 psi
• 300 L at a pressure of 2000 psi
• 600 L at a pressure of 2000 psi
• 750 L at a pressure of 2000 psi
```
600 L at a pressure of 2000 psi
69
Nitrous oxide is excreted ?
unchanged by the lungs
70
* Nitrous oxide should be stored under pressure in steel cylinders painted ?.
* Oxygen is stored in ? tanks.
* blue
| * green
71
At 2 L/min, a full E cylinder will deliver oxygen for approximately ?
5 hrs
72
```
According to Guedel's stages of anesthesia, the proper use of nitrous oxide achieves which level of anesthesia?
• stage I
• stage II
• stage III
• stage IV
```
stage I (amnesia and analgesia) [Stage IV is premortem]
73
```
Which of the following are drugs that help to reduce salivary flow during treatment? Select all that apply.
• scopolamine
• atropine
• local anesthesia
• benztropine
```
all answers are correct (anticholinergic drugs reduce saliva, local anesthesia is not anticholinergic)
74
The duration of action of local anesthetics is directly proportional to ?
protein binding and lipid solubility
75
Increased blood flow results in ? duration of action of local anesthetics
shorter
76
? can produce methemoglobinemia in patients with subclinical methemoglobinemia
The local anesthetic prilocaine and topical anesthetic benzocaine
77
The administration of ? should be avoided in patients receiving tricyclic antidepressants
levonordefrin
78
The administration of vasoconstrictors in patients being treated with nonselective beta-blockers (i.e., propranolol) increases ?. Use vasoconstrictors cautiously.
the likelihood of a serious elevation of the blood pressure accompanied by a reflex bradycardia
79
Epinephrine and levonordefrin are added to local anesthetics because of their:
• ability to increase the potency of the local anesthetic
• ability to decrease the pain (burning) caused by the injection of the local anesthetic
• vasoconstrictive properties
• ability to decrease the possibility of an allergic reaction to the local anesthetic
vasoconstrictive properties
80
The use of a ?-containing local anesthetic also may actually be responsible for the sensation of burning on injection
vasopressor
81
* local anesthetic solution pH with vasopressor?
| * local anesthetic solution pH with vasopressor and an antioxidant (sodium bisulfite)?
* 5.5
| * 3.5 (more acidic, patients are more likely to feel the burning sensation with these solutions)
82
Cardiovascular manifestations of local anesthetic are usually ? and are characterized by ?
* depressant
| * bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest
83
* For a normal healthy patient, the maximum dose of epinephrine is 200 mg, this equates to ?. (epinephrine is usually the limiting factor not the lidocaine.)
* In a cardiac risk patient, the maximum dose of epinephrine is 40 mg, which equates ?
* roughly 11 cartridges of 1:100,000 epinephrine
| * roughly to 2 cartridges of 1:100,000 epinephrine.
84
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After receiving an injection of a local anesthetic containing 2% lidocaine with 1:100,000 epinephrine, the patient loses consciousness. Which of the following is the most probable cause?
• acute toxicity
• allergic response
• syncope
• hyperventilation syndrome
```
syncope (caused by transient cerebral hypoxia)
85
Proper management of syncope:
* Place patient in supine position with feet slightly elevated (Trendelenburg position)
* Establish airway (head tilt/chin lift) Administer 100% oxygen via face mask. O2 is indicated for the treatment of all types of syncope except for hyperventilation syndrome.
* Monitor vital signs and support patient. Pupils may dilate from brain not getting oxygen.
* Maintain your composure. Apply cool, wet towel to patient's forehead.
* Follow-up treatment
86
Hyperventilation in an anxious dental patient leads to ?
carpopedal spasm (a spasm of the hand, thumbs, foot, or toes)
87
```
Which tooth has a root that is NOT consistently innervated by the PSA nerve?
• the maxillary first molar
• the maxillary second molar
• the maxillary third molar
• all of the above
```
the maxillary first molar (In approximately 28% of patients, the middle superior alveolar nerve provides sensory innervation to the mesiobuccal root of the maxillary first molar)
88
Positive aspiration is directly correlated to ?
needle gauge
89
A 30-gauge needle has a ? internal diameter than a 25-gauge needle!
smaller
90
Larger-gauge needles (i.e., 25-gauge) have distinct advantages over smaller ones?
* Less deflection as the needle passes through the tissues
* This leads to greater accuracy in needle insertion and, hopefully, to increased succes rates
* Larger-gauge needles do not break as often
91
The 25-gauge needle is the preferred needle for all injections presenting a ? aspiration
high risk of positive
92
Which of the following are reasons that vasoconstrictors are included in local anesthetics? Select all that apply.
• they prolong the duration of action of the local anesthetic
• they reduce the chance of an allergic reaction to the local anesthetic
• they reduce the toxicity because less local anesthetic is necessary
• they reduce the rate of vascular absorption by causing vasoconstriction
• they help to make the anesthesia more profound by increasing the concentrations of the local anesthetic at the nerve membrane
* they prolong the duration of action of the local anesthetic
* they reduce the toxicity because less local anesthetic is necessary
* they reduce the rate of vascular absorption by causing vasoconstriction
* they help to make the anesthesia more profound by increasing the concentrations of the local anesthetic at the nerve membrane
93
```
Laryngospasm is an uncontrolled/involuntary muscular contraction (spasm) of the laryngeal cords. It is a well known, infrequent but serious postsurgical complication. In the operating room, it is treated by administering:
• nitrous oxide
• oxygen
• epinephrine
• enflurane
```
oxygen (and administering succinylcholine which is a skeletal muscle relaxant)
94
```
Following a local anesthetic injection, anesthetic effects will disappear and reappear in a definite order. Arrange the following sensations in increasing order of resistance to conduction.
• touch
• warm
• deep pressure
• pain
• cold
• motor
```
```
• pain
• cold
• warm
• touch
• deep pressure
• motor
(This phenomenon is called differential blockade)
```
95
Differential blockade may be due to ?
• Size of nerve (small fibers first)
• Presence or absence of myelin (Myelinated fibers first)
• Firing frequency (sensory fibers, especially pain fibers, have a high firing rate so first, Motor fibers fire at a slower rate)
Note: Nerves regain function in reverse order.
96
How will a larger than normal functional residual capacity affect nitrous oxide sedation?
• nitrous oxide sedation will happen much quicker
• nitrous oxide sedation will take longer
• functional residual capacity does not affect nitrous oxide sedation
nitrous oxide sedation will take longer (The functional residual capacity is the amount of air remaining in the lungs at the end of the normal expiration)
97
Pulmonary volumes and capacity are greater in ?
in males and in large and athletic individuals. Nitrous oxide sedation will vary accordingly.
98
Tidal Volume (TV)?
amount of air breathed in and out during quiet breathing
99
Expiratory/Inspiratory Reserve Volume (ERV/IRV) amount of air ?
forced out of/inhaled in the lungs in a maximal expiration/inspiration, over and above that expired/inhaled in normal breathing
100
Vital Capacity (VC)=?
Tidal Volume + Expiratory/Inspiratory Reserve Volume(TV + ERV or IRV)
101
Residual Volume (RV):
volume of air that remains in the lungs at all times (can't be measured by spirometry)
102
Total Lung Capacity (TLC):
Vital Capacity + Residual Volume (VC + RV)
103
```
Which of the following correctly describe barbiturates?
Select all that apply.
• not lipid soluble
• moderately lipid soluble
• very lipid soluble
• delayed onset of action
• rapid onset of action
```
• very lipid soluble
• rapid onset of action
(produce unconsciousness in less than 30 seconds)
104
A primary advantage of IV sedation is the ability to ?
titrate individualized dosage.
