Surgery2 Flashcards
Which of the following local anesthetics are available in North America? Select all that apply. • prilocaine • bupivacaine • procaine • lidocaine • tetracaine • articaine
• prilocaine
• bupivacaine
• lidocaine
• articaine these are Amide group not a Ester
(to remember that the drug name contains an i plus Caine (lidocaine, bupivacaine, and bupivacaine). Esters such as procaine, benzocaine, and tetracaine contain no i.) (Most topical local anesthetic ointments and gels contain benzocaine )
? is most commonly used. Allergic reactions are far more common with ?
- Tetracaine
* esters not amides
The drug of choice in management of an acute allergic reaction involving bronchospasm and hypotension is ?
epinephrine
Allergic reactions to local anesthetic are usually caused by ?
an antigen-antibody reaction
Which of the following are appropriate treatments for an impending vasovagal syncopal episode? Select all that apply.
• sit patient in upright position
• place patient in supine position
• monitor vitals
• oxygen administration
• loosen tight clothing
• place a cold compress on patients forehead
- place patient in supine position
- monitor vitals
- oxygen administration
- loosen tight clothing
- place a cold compress on patients forehead
For local anesthetics, for every 1% solution there is: • 0.10 mg/mL of anesthetic • 1 mg/mL of anesthetic • 10 mg/mL of anesthetic • 100 mg/mL of anesthetic
10 mg/mL of anesthetic (For vasoconstrictor, 1;100,000 means 1 gram per 100,000 mL. This equates to 0.01 mg/mL)
each lidocaine capsule 2%, 1;100,000 contains how much of anesthetic or vasoconstrictor ?
- anesthetic = 34mg lido
* vasoconstrictor = .017 mg epi
Which of the following are needed in combination to produce neuroleptanesthesia? Select all that apply.
• narcotic analgesic
• neuroleptic agent
• nitrous oxide
- narcotic analgesic (administration)
- neuroleptic agent (administration)
- nitrous oxide (inhalation)
Neuroleptanesthesia is a state of ?
neuroleptanalgesia (by narcotic analgesic + neuroleptic agent) and unconsciousness (by nitrous oxide)
The most common cause of loss of consciousness in the dental office is: • anaphylaxis • syncope • heart attack • seizure
syncope (never occur when lying)- fainting
Once the blood pressure drops below levels necessary to sustain consciousness, ? occurs
syncope (by stress-induced release of catecholamines that cause the following: a decrease in peripheral vascular resistance, tachycardia, and sweating)
The single most important drug to use in any medical emergency, including chronic obstructive pulmonary disease, is ?
oxygen
The primary airway hazard for an unconscious dental patient in a supine position is ?. Remember ?
- tongue obstruction
* Head tilt/chin lift
Trauma to muscles or blood vessels in the ? is the most common etiological factor in trismus associated with dental injections of local anesthetics. • pterygoid fossa • temporal fossa • submandibular fossa • infratemporal fossa
infratemporal fossa (The medial pterygoid muscle is most often affected)
Management of trismus?
- Apply hot, moist towels to the site for approximately 20 minutes every hour
- Warm saline rinses
- Use analgesics as required
- Benzodiazepine (e.g., diazepam) for muscle relaxation if deemed necessary
- The patient should gradually open and close mouth as a means of physiotherapy
The most common cause of paresthesia of the lower lip is ?
the removal of mandibular third molar (especially horizontally impacted ones).
There are no contraindications for the use of nitrous oxide sedation in asthmatic patients.
Because anxiety is a stimulus for an asthmatic attack, nitrous oxide sedation is actually beneficial for these patients.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true
both statements are true
The most common complication associated with nitrous oxide sedation is ?
a behavioral problem (laughing, giddy)
A normal platelet count is: • 15,000 - 45,000/mm3 • 75,000 - 100,000/mm3 • 150,000 - 450,000/mm3 • 450,000 - 600,000/mm3
150,000 - 450,000/mm3
Which of the following pairings are correct regarding the amount of epinephrine in 1.7cc of solution? Select all that apply.
• 2% lidocaine 1:200,000 / .0085 mg epinephrine
• 2% lidocaine 1:200,000 / .017 mg epinephrine
• 2% lidocaine 1:50,000 / .034 mg epinephrine
• 2% lidocaine 1:50,000 /.017 mg epinephrine
- 2% lidocaine 1:200,000 / .0085 mg epinephrine
* 2% lidocaine 1:50,000 / .034 mg epinephrine
The primary site of biotransformation of amide drugs is the: • plasma • lung • kidney • liver
liver (not for ester local anesthetics which are hydrolyzed in the plasma)
Allergic reactions to amide-type local anesthetics are rare but may occur as a result of hypersensitivity to the local anesthetic agent itself or due to an allergy to ?
methylparaben or other preservatives used in many solutions
For those patients allergic to both ester and amide-type local anesthetics, ? is a safe and effective alternative.
diphenhydramine
The initial clinical signs and symptoms of CNS toxicity for local anesthetics are usually excitatory in nature. However, it is also possible that the excitatory phase of the reaction may be extremely brief or may not occur at all. This is true especially with which local aneshetics? Select all that apply. • lidocaine • tetracaine • etidocaine • procaine • bupivacaine
- lidocaine
* procaine
The pH of normal tissue is ?; the pH of an inflamed area is ? • 9.0; 3 to 4 • 7.4; 5 to 6 • 3.6; 8 to 9 • 8.0; 2 to 3
7.4; 5 to 6
Nitrous oxide works on the:
• peripheral nervous system (PNS)
• central nervous system (CNS)
• autonomic nervous system (ANS)
central nervous system (CNS) (main effects on the reticular activating system and the limbic system)
The maximum limitation dose is ? nitrous oxide and 40% oxygen
60%
- The first symptom of nitrous oxide analgesia is ?
* ? is the most common side effect of nitrous oxide analgesia
- tingling of the hands
* Nausea
The primary action of local anesthetics in producing a conduction block is to decrease the permeability of the ion channels to: • calcium ions • chloride ions • potassium ions • sodium ions
sodium ions
Nerve block produced by local anesthetics is called a ? nerve block.
nondepolarizing
? nerve fibers that conduct pain and temperature sensations are affected first, followed by touch, proprioception, and skeletal muscle tone.
Smallest, unmyelinated
Emergence from a local anesthetic nerve block follows the same diffusion patterns as induction; however, it does so in ? order
reverse
Which of the following is the phase of anesthesia that begins with the administration of anesthetic and continues until the desired level of patient unresponsiveness is reached?
• induction
• maintenance
• recovery
induction
The behavior of patients under general anesthesia suggests that the most resistant part of the CNS is the ?
medulla oblongata (cardiac, vasomotor and respiratory centers of the brain).
Volatile liquids require a vaporizer for inhalational administration. Which one additionally requires a heating component to allow delivery at room temperature? • enflurane • halothane • sevoflurane • desflurane • isoflurane
desflurane
inhalation anesthetics means volatile anesthetics
All the potent inhalation agents are capable of triggering ?, a rare inherited disorder that is potentially fatal
malignant hyperthermia (MH)
The optimum site for IV sedation for an outpatient is the: • median basilic vein • median cephalic vein • median antebrachial vein • axillary vein
median cephalic vein
popular drug for IV sedation for an outpatient is ? but is contraindicated for use in a patient with a history of ?
- Valium (diazepam)
* narrow-angle glaucoma
Dissociative anesthesia is a unique method of pain control that reduces anxiety and produces a trancelike state in which the person is not asleep, but rather feels separated from his or her body. The primary medication used is: • demerol • ketamine • pentobarbital • promethazine hydrochloride
ketamine (used for short procedures that are painful, such as changing bandages. This method is safe and lasts only a short time. Because a person does not usually recall the procedure, this method is useful in children)
ketamine used for dissociative anesthesia increases BP, heart rate, and cardiac output , but not ?
respirations
Malignant hyperthermia (MH) is a pharmacogenetic disorder in which a genetic variant in the individual alters that person's response to certain drugs. Which of the following describe the major clinical characteristics of MH? Select all that apply. • rigidity • fever • hypermetabolism • myoglobinuria • alkalosis
- rigidity
- fever
- hypermetabolism
- myoglobinuria
The following signs: nausea, pallor, cold perspiration, widely dilated pupils, eyes rolled up, and brief convulsions are indicative of a patient having a ? reaction. • somatogenic • psychogenic • either of the above • none of the above
psychogenic (caused by psychological factors rather than physical factors such as Vasovagal syncope which clinical signs closely resemble those of shock and readily respond to placing the patient in a supine position)
Postoperative hypotension is usually due to the effect of:
• transfusion reactions
• a fat embolism
• the anesthetic or analgesics on the myocardium
• liver failure
the anesthetic or analgesics on the myocardium (leading to myocardial depression)
Postoperative hypertension is most often due to ?
post-op pain
Anesthesia performed with general anesthetics occurs in four stages which may or may not be observable because they can occur very rapidly. Which stage is the one in which skeletal muscles relax and the patient's breathing becomes regular? • analgesia • excitement • surgical anesthesia • medullary paralysis
surgical anesthesia
the most reliable sign of “oxygen want” while monitoring a patient during general anesthesia is ?. Cyanosis may also be present
an increased pulse rate
the emergency most frequently experienced during outpatient general anesthesia is ?
respiratory obstruction
the best anesthetic technique used in oral surgery to avoid aspiration of blood or other debris when a patient is under general anesthesia is ?
endotracheal intubation with pharyngeal packs
The propylene glycol in IV valium can cause: • cellulitis • a unilateral facial paralysis • phlebitis • syncope
phlebitis (irritation or inflammation of a vein that is sometimes seen after IV administration of valium)
The most frequent respiratory complications following oral and maxillofacial surgery are:
pulmonary atelectasis (most often in smokers), aspiration pneumonia (most likely to manifest initially in the patient’s right lung), and pulmonary embolus (most originate in the deep venous systems of the lower extremities, especially in nonambulatory patients)
When a biopsy is being performed, it is important to:
• incise perpendicular to the long axis of any muscle fibers beneath the lesion
• incise parallel to the long axis of any muscle fibers beneath the lesion
• incise as deep as possible into muscle fibers beneath the lesion
• incise at a 45-degree angle to the long axis of any muscle fibers beneath the lesion
incise perpendicular to the long axis of any muscle fibers beneath the lesion
Biopsy incisions on the face should be oriented to follow ?
Langer’s lines
How long should one wait before obtaining a biopsy of an oral ulcer? • 4 days • 7 days • 14 days • 30 days
14 days (almost all oral ulcers caused by trauma will heal within 14 days) it is mandatory!
after tissue removal for biopsy, the tissue should be immediately placed in ? solution that is at least 20 times the volume of the surgical specimen
10% formalin
A negative incisional biopsy report of a highly suspicious oral lesion suggests that another biopsy specimen is necessary in view of the clinical impressions. The key is ? oral lesion
a highly suspicious
An incisional biopsy is indicated for which of the following lesions?
• a 0.5-cm papillary fibroma of the gingiva
• a 2.0-cm exostosis of the hard palate
• a 2.0-cm area of Fordyce disease of the cheek
• a 3.0-cm hemangiorna of the tongue
• a 3.0-cm area of leukoplakia of the soft palate
a 3.0-cm area of leukoplakia of the soft palate (Leukoplakia is a premalignant lesion)
Which of the following symptoms that suggest that your patient is dehydrated? Select all that apply. • pale or gray skin color • dry mouth • decreased skin turgor (fullness) • modified state of consciousness • high blood pressure • rapid pulse • reduced urine output
- pale or gray skin color
- dry mouth
- decreased skin turgor
- modified state of consciousness
- rapid pulse
- reduced urine output
More severe degrees of fluid loss are accompanied by a shift of water from ? to ?, a process that causes severe cell dysfunction, particularly in the brain.
- the intracellular space
* the extracellular space
Patients with a fasting plasma glucose level higher than ? or a random plasma glucose of greater than ? have diabetes mellitus. • 50 mg/dL, 125 mg/dL • 75 mg/dL, 150 mg/dL • 100 mg/dL, 175 mg/dL • 126 mg/dL, 200 mg/dL
126 mg/dL, 200 mg/dL
The major concern for the dentist treating a patient who has diabetes mellitus is ?
hypoglycemia
Symptoms of hypoglycemia:
weakness, nervousness, excessive sweating, tremulousness (shaking due to become nervous), and palpitations (if you have palpitations, your heart beats quickly in an irregular way )
people with well-controlled diabetes are no more susceptible to infections than people without diabetes, but they have more difficulty ? infections
containing (this is caused by altered leukocyte function).
patients who take insulin daily and check their urine regularly for sugar and ketones (controlled diabetics), do they need medication before dental surgery?
can be treated in the normal manner without additional drugs of diet alterations
Your 60-year-old patient presents with congestive heart failure. They note cardiac symptoms with mild activity but are asymptomatic at rest. What is the functional classification of heart failure in your patient? • class i • class II • class III • class IV
class III
• Class I congestive heart failure is defined as no cardiac symptoms with activity,
• Class II is symptoms with marked activity,
• Class III is symptoms with mild activity,
• Class IV is symptoms at rest
aspirin, NSAIDs, and calcium channel blockers in congestive heart failure?
should be avoided
hypercapnia hypocapnia respiratory arrest hyperventilation hypoventilation dyspnea hyperpnea apnea
excess CO2 in arterial blood
below normal CO2 in arterial blood
permanent cessation of breathing (unless corrected)
an increase in both rate and depth of respiration
a reduced rate and depth of respiration
the unpleasant sensation of difficulty in breathing
increase in depth of respiration
transient cessation or absence of breathing
Diminished volume affecting all or part of a lung is called: • bronchiectasis • atelectasis • pneumothorax • pneumonia
atelectasis (occurs when mucus or a foreign object obstructs airflow in a main stem bronchus causing collapse of the affected lung tissue into an airless state. It typically occurs 36 hours postoperatively)
Prolonged atelectasis can lead to ?
pneumonia
? are two of the most common causes of fever in a patient who has had general anesthesia
Pneumonitis (inflammation of the lung) and atelectasis
the most common post-op complication of outpatient general anesthesia is ?
nausea
A 55-year-old male presents to your office with a long history of a productive cough. The patient states that the cough has been present for 6 months during each of the last 3 years. The patient is afebrile (fever) and chest x-ray is unremarkable. • viral pneumonia • chronic bronchitis • emphysema • asthma
chronic bronchitis
COPD patients taking theophylline should not be prescribed ?
erythromycin. Erythromycin increases the metabolism of theophylline and may cause toxicity
Which of the following acid-base abnormalities will develop in a patient with recurrent vomiting of gastric contents? • respiratory acidosis • respiratory alkalosis • metabolic acidosis • metabolic alkalosis
metabolic alkalosis
Which statement below is true regarding type 2 diabetes?
• was formally known as insulin-dependent diabetes
• patients have little or no insulin secretion capacity
• symptoms appear abruptly and include polyuria, polydipsia, polyphagia, and weight loss
• accounts for 90% of all cases of clinical diabetes
accounts for 90% of all cases of clinical diabetes
The clinical presentation of acute asthma includes which of the following? Select all that apply. • dyspnea or tachypnea • wheezing • hypoxemia • occasionally hypercapnia • hemoptysis
- dyspnea or tachypnea
- wheezing
- hypoxemia
- occasionally hypercapnia
local anesthesia dosage in asthmatic patients?
up to 2 carpules of 2% lidocaine with 1:100,000 epinephrine may be used (avoid antihistamines!!)
Hemophilia A and B are inherited as ? trait by which males are affected and females are carriers
a sex-linked recessive
- Which coagulation factors is deficient in hemophilia A?
- Which coagulation factors is deficient in hemophilia B (Christmas disease)?
- Which coagulation factors is deficient in hemophilia C (not sex linked)?
- VIII
- IX
- XI
true hemophiliac is characterized by having the following lab test results?
- Prolonged partial thromboplastin time (PTT)
- Normal prothrombin time (PT)
- Normal platelet count
- Normal bleeding time
A history of rheumatic fever, IV drug abuse, or heart murmur should alert the dentist to the possibility of: • diabetes mellitus • AIDS • valvular disease • end-stage renal disease
valvular disease (Patients with valvular heart disease are also at risk for bacterial endocarditis)
A heart murmur may have no pathological significance or may be an important clue to ?
the presence of valvular, congenital, or other structural abnormalities of the heart
A tall, thin patient presents to your office with shortness of breath. On examination, you note the patient is breathing through "pursed" lips, his expiratory phase is prolonged, and lung sounds are distant. Which of the following is the most likely diagnosis? • asthma • bronchiectasis • cystic fibrosis • emphysema
emphysema (also called pink puffer, destructive changes to the alveoli walls and enlargement of air spaces)
Patients with ? may be predisposed to lung cancer
chronic bronchitis
Special considerations must be taken when treating a patient on renal dialysis. Which of the following should be considered? Select all that apply.
• treat the day before dialysis
• treat the day after dialysis
• NSAIDs are the best analgesic to use
• morphine is acceptable for use as an analgesic
• be aware of shunts when taking the patients blood pressure
• consider that the patient may be on steroid therapy
• treat the day after dialysis
• be aware of shunts when taking the patients blood pressure
• consider that the patient may be on steroid therapy
(avoid the following analgesics: aspirin, acetaminophen, NSAlDs, meperidine, and morphine)
Codeine, a widely used analgesic in dentistry:
• is a natural constituent of opium
• may be given only by injection
• has a calming effect on gastric mucosa
• is stronger than morphine, more addictive, and more constipating
is a natural constituent of opium
? is the least lipid soluble of the three main benzodiazepines, resulting in a slow onset of action but a long duration of action.
• midazolam (Versed)
• lorazepam (Ativan)
• diazepam (Valium)
lorazepam
? is a sedative and hypnotic that is widely used for pediatric sedation
chloral hydrate
effect of emotional stress on the rate of absorption of a drug when given orally?
decreases the rate of absorption of a drug when given orally
Which of the following drugs would be BEST given to a patient with a history of gastric ulcers? • aspirin • ibuprofen • acetaminophen • naproxen
acetaminophen (Tylenol is the only over-the-counter non-antiinflammatory analgesic commonly available in the USA)
which analgesic should be given in children with viral infections ?
acetaminophen (since are at a risk for Reye syndrome if they take aspirin)
Which of these barbiturates can be classified as an ultra-short-acting compound? • amobarbital • thiopental • phenobarbital • pentobarbital
thiopental
Barbiturates are contraindicated in patients with ?
respiratory disease or those who are pregnant
? should be used cautiously in the elderly. It should never be given to patients on monoamine oxidase inhibitors for psychiatric disease and is generally contraindicated in patients receiving phenytoin (Dilantin) for seizure disorders. • ibuprofen • acetaminophen • meperidine • codeine
meperidine (=Demerol, most widely used narcotic in American hospitals)
? is the most abused drug by health professionals
Meperidine (The onset of action is more rapid, but the duration of action is shorter, than that of morphine)
? is the standard drug to which all analgesic drugs are compared, causes ?
- Morphine
* euphoria and respiratory depression.
Atropine and scopolamine have similar pharmacologic effects. Which of the following actions do they share?
Select all that apply:
• reduction of salivation
• prevention of cardiac slowing during general anesthesia
• cns depression
• mydriasis
• cycloplegia
- mydriasis
- cycloplegia
- reduction of salivation
- prevention of cardiac slowing during general anesthesia
The cholinergic blocking (anticholinergic) drugs (atropine and scopolamine) ? the action of acetylcholine at parasympathetic postganglionic neuroeffector sites
competitively inhibit
Anticholinergic drugs contraindication?
in patients with glaucoma, prostate hypertrophy and intestinal obstruction
A sedative dose of a barbiturate should be expected to produce: • respiratory depression • minor analgesia • decreased BMR • all of the above effects • none of the above effects
none of the above effects (no analgesic effect )
After IV administration of barbiturate, the last tissue to become saturated as a result of redistribution is ?
fat (as compared to liver, brain, and muscle tissue)
All of the following are true statements concerning the principles of suturing technique EXCEPT one. Which one is the EXCEPTION?
• the needle should be perpendicular when it enters the tissue
• sutures should be placed at an equal distance from the wound margin (2-3 mm) and at equal depths
• sutures should be placed from mobile tissue to thick tissue
• sutures should be placed from thin tissue to thick tissue
• sutures should not be overtightened
• tissues should be closed under tension
• sutures should be 2-3 mm apart
tissues should be closed under tension
What areas are impacted maxillary third molars occasionally displaced into? Select all that apply? • canine space • pterygomaxillary space • infratemporal space • pharyngeal space • maxillary sinus
- infratemporal space
* maxillary sinus
The major disadvantage of interrupted suture over continuous pattern is ?
the time required for placement of this pattern of sutures
if an impacted maxillary third molars are displaced into maxillary sinus (antrum), what approach is used to remove it?
Caldwell-Luc approach
if an impacted maxillary third molars are displaced into infratemporal space, what approach is used to remove it?
if the tooth is not retrieved after a short amount of time with a hemostat, the area should be closed and the patient is referred to an oral surgeon
when performing a surgical removal of a mandibular molar, do not section through the entire tooth. The lingual plate is often thin, and complete sectioning may ?
perforate the plate and injure the lingual nerve
position of the inferior alveolar nerve regarding a mandibular third molar?
lies buccal and slightly apical to the root of a mandibular third molar
For maxillary extractions, the upper jaw of the patient should be:
• below the height of the operator’s shoulder
• above the height of the operator’s shoulder
• at the same height of the operator’s shoulder
• it makes no difference where the patient’s upper jaw is in relation to the operator’s shoulder
at the same height of the operator’s shoulder
position of the patient for mandibular extractions?
the occlusal plane of the mandibular arch is parallel to the floor when the mouth is opened
Which of the following are contraindications to tooth extraction. Select all that apply. • acute pericoronitis • acute apical abscess • end-stage renal disease • acute infectious stomatitis
- acute pericoronitis
- end-stage renal disease
- acute infectious stomatitis
