Dental Decks in Oral Surgery (anesthesia) _ Dental MCQs

Dental Decks in Oral Surgery (anesthesia) _ Dental MCQs

1. Which of the following teeth could be removed without pain after administration of an inferior alveolar and lingual nerve block?
A. All anterior teeth on the side of the injection
B. Canine and first premolar on the side of the injection
C. All teeth in that quadrant on the side of the injection
D. both premolars and first molar on the side of the injection

2. The maxillary first molar is innervated by which of the following nerves?
Select all that apply.
A. Anterior superior alveolar
B. Middle superior alveolar
C. Posterior superior alveolar
D. Greater palatine
E. Ascending pharyngeal
F. B, C

3. Which of the following characterize shock?
Select all that apply.
A. Increased vascular resistance: cool mottled skin, oliguria
B. Tachycardia
C. Myocardial ischemia
D.Mmental status changes
E. Adrenergic response: diaphoresis, anxiety, vomiting, diarrhea
F. All of the above

4. A full E cylinder of oxygen contains approximately:
A. 150 L at a pressure of 2000 psi
B. 300 L at a pressure of 2000 psi
C. 600 L at a pressure of 2000 psi
D. 750 L at a pressure of 2000 psi

5. According to Guedel’s stages of anesthesia, the proper use of nitrous oxide achieves which level of anesthesia?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV

6. Which of the following are drugs that help to reduce salivary flow during treatment?
Select all that apply.
A. Scopolamine
B. Atropine
C. Local anesthesia
D. Benztropine
E. All of the above

7. Epinephrine and levonordefrin are added to local anesthetics because of their:
A. Ability to increase the potency of the local anesthetic
B. Ability to decrease the pain (burning) caused by the injection of the local anesthetic
C. Vasoconstrictive properties
D. Ability to decrease the possibility of an allergic reaction to the local anesthetic
E. Increasing the duration of the anesthetic and dimin­ishing systemic effects (reducing systemic toxicity)
F. C, E

8. Which of the following are reasons that vasoconstrictors are included in local anesthetics?
Select all that apply.
A. They prolong the duration of action of the local anesthetic
B. They reduce the chance of an allergic reaction to the local anesthetic
C. They reduce the toxicity because less local anesthetic is necessary
D. They reduce the rate of vascular absorption by causing vasoconstriction
E. They help to make the anesthesia more profound by increasing the concentrations of the local anesthetic at the nerve membrane
F. A, C, D, E

9. 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?
A. Acute toxicity
B. Allergic response
C. Syncope
D. Hyperventilation syndrome

10. Which tooth has a root that is NOT consistently innervated by the PSA nerve?
A. Maxillary first molar
B. Maxillary second molar
C. Maxillary third molar
D. All of the above

11. 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:
A. Nitrous oxide
B. Oxygen
C. Epinephrine
D. Enflurane

12. Which of the following correctly describe barbiturates?
A. Not lipid soluble
B. Moderately lipid soluble
C. Very lipid soluble
D. Delayed onset of action
E. Rapid onset of action
F. C, E

13. Which of the following are appropriate treatments for an impending vasovagal syncopal episode?
Select all that apply.
A. Place patient in supine position
B. Monitor vitals
C. Oxygen administration
D. Loosen tight clothing
E. Place a cold compress on patients forehead
F. All of the Above

14. For local anesthetics, for every 1 % solution there is:
A. 0.10 mg/mL of anesthetic
B. 1 mg/mL of anesthetic
C. 10 mg/mL of anesthetic
D. 100 mg/mL of anesthetic

15. Which of the following are needed in combination to produce neuroleptanesthesia?
Select all that apply.
A. narcotic analgesic
B. neuroleptic agent
C. nitrous oxide
D. All of the above

16. The most common cause of loss of consciousness in the dental office is:
A. Anaphylaxis
B. Syncope _ Fainting
C. Heart attack
D. Seizure

17. Trauma to muscles or blood vessels in the is the most common etiological factor in trismus associated with dental injections of local anesthetics.
A. Pterygoid fossa
B. Temporal fossa
C. Submandibular fossa
D. Infratemporal fossa

18. * 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.
A. Both statements are true
B. Both statements are false
C. The first statement is true, the second is false
D. The first statement is false, the second is true

19. Which of the following pairings are correct regarding the amount of epinephrine in 1.7cc of solution?
Select all that apply.
A. 2% lidocaine 1:200,000 / .0085 mg epinephrine
B. 2% lidocaine 1:200,000 / .017 mg epinephrine
C. 2% lidocaine 1:50,000 / .034 mg epinephrine
D. 2% lidocaine 1:50,000 / .017 mg epinephrine
E. A, C

20. The primary site of biotransformation (Metabolism) of amide drugs is the:
A. Plasma
B. Lung
C. Kidney
D. Liver

21. 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 anesthetics?
Select all that apply.
A. Lidocaine
B. Tetracaine
C. Etidocaine
D. Procaine
E. Bupivacaine
F. A, D

22. The pH of normal tissue is ; the pH of an inflamed area is:
A. 9.0; 3 to 4
B. 7.4; 5 to 6
C. 3.6; 8 to 9
D. 8.0; 2 to 3

23. Nitrous oxide works on the:
A. Peripheral nervous system (PNS)
B. Central nervous system (CNS)
C. Autonomic nervous system (ANS)

24. The primary action of local anesthetics in producing a conduction block is to decrease the permeability of the ion channels to:
A. Calcium ions
B. Chloride ions
C. Potassium ions
D. Sodium ions

25. 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?
A. Induction
B. Maintenance
C. Recovery

26. Volatile liquids require a vaporizer for inhalational administration. Which one additionally requires a heating component to allow delivery at room temperature?
A. Enflurane
B. Halothane
C. Sevoflurane
D. Desflurane
E. Isoflurane

27. The optimum site for IV sedation for an outpatient is the:
A. Median basilic vein
B. Median cephalic vein
C. Median antebrachial vein
D. Axillary vein

28. 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:
A. Demerol
B. Ketamine
C. Pentobarbital
D. Promethazine hydrochloride

29. The following signs: nausea, pallor, cold perspiration, widely dilated pupils, eyes rolled up, and brief convulsions are indicative of a patient having a reaction.
A. Somatogenic
B. Psychogenic
C. Either of the above
D. None of the above

30. Postoperative hypotension is usually due to the effect of:
A. Transfusion reactions
B. Fat embolism
C. The anesthetic or analgesics on the myocardium
D. Liver failure

31. 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?
A. Analgesia
B. Excitement
C. Surgical anesthesia
D. Medullary paralysis

32. The recommended gas combination dose for conscious sedation is:
A. 50% oxygen; 50% nitrous oxide
B. 60% oxygen; 40% nitrous oxide
C. 40% oxygen; 60% nitrous oxide
D. 30% oxygen; 70% nitrous oxide
E. Varies according to the patient response

33. The propylene glycol in IV valium can cause:
A. Cellulitis
B. A unilateral facial paralysis
C. Phlebitis
D. Syncope

34. Local anesthetic containing epinephrine is CONTRAINDICATED for a patient with
A. Addison’s disease.
B. congenital methemoglobinemia.
C. diabetes mellitus.
D. pseudocholinesterase deficiency.
E. sulfite sensitivity.

35. Which of the following local anesthetics is classified as an ester?
A. Articaine.
B. Bupivacaine.
C. Lidocaine.
D. Mepivacaine.
E. Procaine.

36. During general anesthesia, all of the following should be monitored EXCEPT:
A. pupil diameter.
B. blood pressure.
C. heart rate.
D. oxygen saturation.
E. respiratory rate.

37. Which of the following should NOT be administered to a patient with chest pain consistent with a myocardial infarction?
A. Epinephrine.
B. Nitroglycerin.
C. Oxygen.
D. Morphine.
E. Acetylsalicylic acid.

38. The first drug used for the management of anaphylaxis isA. Atropine.
B. Diphenhydramine.
C. Epinephrine.
D. Hydrocortisone.
E. Nitroglycerin.

39. A patient has an acute apical abscess on tooth 1.3. The tooth must be extracted. In addition to a palatine injection, the most appropriate local anesthetic technique is a/an:
A. buccal infiltration.
B. infraorbital block.
C. middle superior alveolar block.
D. intraligamentary injection.

40. What is the correct position of the needle tip for the administration of local anesthetic for an inferior alveolar nerve block?
A. Anterior to the buccinator muscle.
B. Medial to the medial pterygoid muscle.
C. Lateral to the ramus of the mandible.
D. Superior to the mandibular foramen
E. Inferior to the pterygomandibular raphe.

41. Which of the following is NOT an early clinical manifestation of local anesthetic overdose?
A. Nystagmus.
B. Slurred speech.
C. Decreased heart rate.
D. Increased respiratory rate.

42. The use of conscious sedation for a restorative procedure in an office environment:
A. requires the services of an anesthesiologist.
B. is contraindicated in children.
C. precludes the use of local anesthesia.
D. requires effective local anesthesia.
E. may be used in conjunction with narcotics.

43. A healthy, 23 year old patient experiences a warm sensation, diaphoresis, nausea, light headedness and then loses consciousness approximately 30 seconds following the injection of 1.8ml of 2% lidocaine with 1:100,000 epinephrine for an inferior alveolar nerve block. What is the most likely diagnosis for his situation?
A. Allergic reaction.
B. Overdose of local anesthetic.
C. Syncope.
D. Intravascular injection.

44. An immediate toxic reaction to a local anesthetic administration is caused by a/an:
A. Deterioration of the anesthetic agent.
B. Hypersensitivity to the vasoconstrictor.
C. Hypersensitivity to the anesthetic agent.
D. Excessive blood level of the anesthetic agent.

45. The primary use of nitrous oxide and oxygen is as a(n):
A. Substitute agent for local anesthesia.
B. General anesthetic agent.
C. Agent for conscious sedation.
D. Agent for the management of chronic obstructive pulmonary disease.

46. A 3 year old, 16kg child is given 2 cartridges of 4% prilocaine with 1:200,000 epinephrine for extraction of primary teeth. After a few minutes the child becomes lethargic, disorientated and eventually begins to convulse. The most probable cause of this reaction is:
A. Epinephrine.
B. Allergic reaction to the local anesthetic.
C. Overdose of local anesthetic.
D. Epilepsy precipitated by epinephrine.

47. The management of syncope following local anesthetic administration does NOT include:
A. Elevating the legs.
B. Placing in a supine position.
C. Administering oxygen.
D. Ensuring the airway is open.
E. Administering epinephrine.

48. Shortly after the administration of a local anesthetic for the removal of tooth 2.8, the patient complains of a tenseness in the left cheek and left cheek swelling is observed. What is the most likely diagnosis?
A. Surgical emphysema.
B. Immediate allergic reaction.
C. Herniation of buccal fat pad.
D. Hematoma.

49. What is the most probable complication of a local anesthetic injection into the parotid gland?
A. Infection.
B. Trismus.
C. Diplopia.
D. Facial paralysis.

50. Which of the following is NOT a property of Lidocaine (Xylocaine®):
A. Local anesthetic.
B. Topical anesthetic.
C. Anticonvulsant.
D. Antiarrhythmic agent.

51. Which of the following cause sedation?
1.Triazolam.
2.Codeine.
3.Meperidine.
4.Ibuprofen.
A. (1) (2) (3)
B. (1) and (3)
C. (2) and (4)
D. (4) only
E. All of the above.

52. Five minutes after injecting a local anesthetic, a patient experiences a generalized warmth of the face, mouth and upper chest. What is the most likely cause?
A. Increased blood pressure.
B. Anaphylactic reaction.
C. Nervousness.
D. Vagal shock.

53. Procaine (Novocaine®) is an example of a local anesthetic which is chemically classified as an:
A. Amide.
B. Ester.
C. Aldehyde.
D. Ethamine.
E. Aminide.

54. Lidocaine (Xylocaine®) is an example of a local anesthetic which is chemically classified as an:
A. amide.
B. ester.
C. aldehyde.
D. ethamine.
E. aminide.

55. The local anesthetic technique requiring the needle to contact the neck of the condyle is the:
A. posterior superior alveolar nerve block.
B. Gow-Gates block.
C. Vazirani-Akinosi block.
D. inferior alveolar nerve block.

56. What is the most effective local anesthetic technique for a patient with trismus who requires a pulpectomy on a mandibular molar?
A. Mental nerve block.
B. Gow-Gates block.
C. Vazirani-Akinosi block.
D. Inferior alveolar nerve block.
E. Buccal nerve block.

57. During the administration of local anesthesia, an intravascular injection will occur most often in a/an:
A. incisive block.
B. Posterior superior alveolar block.
C. Inferior alveolar block.
D. Anterior superior alveolar block.
E. Long buccal block.

58. Aspiration prior to a local anesthetic injection reduces the:
A. toxicity of local anesthetic.
B. toxicity of vasoconstrictor.
C. possibility of intravascular administration.
D. possibility of paresthesia.

59. There is an acute periradiuclar abscess on tooth 1.3. The tooth must be extracted. In addition to a palatal injection, the most appropriate local anesthetic technique would be:
A. Vestibular infiltration.
B. Infraorbital.
C. Middle superior alveolar.
D. Intraligamentary.

60. Local anesthetics are less effective in inflamed tissue because they are:
A. Diluted by the edematous fluid.
B. Rapidly redistributed by the increased blood flow.
C. Ionized by the acidic pH.
D. Rapidly degraded by released enzymes.

61. Local anesthetics block nerve conduction by interfering with ionic movement of:
A. Calcium.
B. Potassium.
C. Sodium.
D. Chloride.

62. Which one of the following describes the position of the needle tip during administration of local anesthetic for the inferior alveolar nerve block?
A. Anterior to the pterygomandibular raphe.
B. Medial to the medial pterygoid muscle.
C. Superior to the lateral pterygoid muscle.
D. Lateral to the sphenomandibular ligament.

63. Which of the following constituents of a local anesthetic cartridge is most likely to be allergenic?
A. Lidocaine.
B. Epinephrine.
C. Metabisulfite.
D. Hydrochloric acid.

64. The use of aspirating syringes for the administration of local anesthetics is recommended because
1.The effectiveness of local anesthesia is increased.
2. Aspiration of blood is proof that the needle is in an intravascular location.
3. Their use removes the hazard of rapid injection and provides a distinct saving of time.
4. Their use reduces the frequency of accidental intravenous injection.
A. (1) (2) (3)
B. (1) and (3)
C. (2) and (4)
D. (4) only
E. All of the above.

65. The penetration of a local anesthetic into nerve tissue is a function of the:
A. Length of the central alkyl chain.
B. Lipid solubility of the un-ionized form.
C. Ester linkage between the aromatic nucleus and the alkyl chain.
D. Amide linkage between the aromatic nucleus and the alkyl chain.

66. Facial nerve paresthesia is most likely to occur from which of the following injections?
A. Posterior superior alveolar block.
B. Inferior alveolar block.
C. Posterior palatine block.
D. Extraoral maxillary division block.

67. Epinephrine in a local anesthetic solution will
1.Decrease absorption of the anesthetic.
2.Assist hemostasis at the site of injection.
3.Prolong the action of the anesthetic agent.
4.Assist in post-operative healing.
A. (1) (2) (3)
B. (1) and (3)
C. (2) and (4)
D. (4) only
E. All of the above.

68. Ionization of local anesthetics is facilitated by a tissue pH:
A. Above 7.4.
B. At 7.4.
C. Below 7.4.

69. Local anesthetics:
A. Do not readily pass the blood-brain barrier.
B. Interfere with the propagation of action potentials in nerve fibers.
C. Selectively interfere with the propagation of action potentials in nociceptive fibers.

70. The selection of a vasoconstrictor for a local anesthetic depends upon the
1.Duration of the procedure.
2.Need for hemostasis.
3.Medical status of the patient.
4.Type of procedure.
A. (1) (2) (3)
B. (1) and (3)
C. (2) and (4)
D. (4) only
E. All of the above.

71. Local anesthetics interfere with the transport of which of the following ions?
A. Sodium.
B. Calcium.
C. Chloride.
D. Potassium.
E. Magnesium.

72. Which local anesthetic should be used to achieve the longest pain relief for a patient requiring the surgical extraction ?
A. Articaine 4%, with epinephrine 1:100,000.
B. Bupivacaine 0.5%, with epinephrine 1:200,000.
C. Lidocaine 2%, with epinephrine 1:100,000.
D. Mepivacaine 3% plain.
E. Prilocaine 4%, with epinephrine 1:200,000.

73. A 3 year old requires the extraction of a deciduous maxillary second molar. The local anesthetic technique of choice is:
A. A posterior superior alveolar block.
B. Buccal and palatal infiltration.
C. A tuberosity block plus subperiosteal infiltration of the mesio-buccal root.
D. An infra-orbital block.

74. A patient has a proven allergy to para-amino benzoic acid derivatives. Which local anesthetic solution can be used safely?A. Procaine.
B. Butethamine hydrochloride.
C. Tetracaine.
D. Lidocaine.

75. What is the maximum number of cartridges (1.8ml) of a 2% local anesthetic solution that can be administered without exceeding a total dose of 300mg?
A. 2.
B. 4.
C. 6.
D. 8.
E. 10.

76. In a standard dental cartridge (carpule) containing 1.8ml 2% lidocaine with epinephrine 1/100,000, the amount of vasoconstrictor is:
A. 18.0 mg.
B. 0.018 mg.
C. 1.8 mg.
D. 0.18 mg.
E. 180.0 mg.

77. The most common complication associated with the use of local anesthetics is:
A. Syncope.
B. Trismus.
C. Toxic reaction.
D. Allergic reaction.
E. Anaphylactic reaction.

78. A patient suddenly becomes pale and sweaty after an injection of 4ml of lidocaine 2% with epinephrine l:l00,000. The radial pulse is slow and steady. The respiration is slow. The blood pressure is 80/60. What is the most probable diagnosis?
A. A toxic reaction to lidocaine.
B. A toxic reaction to epinephrine.
C. An allergic reaction to the local anesthetic.
D. Incipient syncope.
E. An impending adrenal insufficiency.

79. During the administration of local anesthesia, positive aspiration of blood will occur most often in a/an:
A. Mental or incisive block.
B. Posterior superior alveolar block.
C. Inferior alveolar block.
D. Anterior superior alveolar block.
E. Long buccal nerve block.

80. Which of the following statements is true regarding local anesthetic syringes and needles for dental anesthesia?
A. Bending a needle is an acceptable practice for injections when the needle is inserted more than 5mm into soft tissue.
B. To avoid percutaneous injury, needles may be left uncapped away from the working area after use.
C. A new anesthetic needle should be used when the elapsed time between multiple injections is more than 30 minutes.
D. Needles should be recapped after use, using a scoop method or mechanical device.

81. Which of the following is a sign of local anesthetic overdose?
A. Rash.
B. Wheezing.
C. Fainting.
D. Convulsions.
E. Swelling.

82. With respect to local anesthetic, which of the following will elicit the most rapid response in a patient?
A. Too large a dose.
B. Rapid absorption.
C. Slow elimination.
D. Intravascular injection.
E. Slow biotransformation.

83. The small bubble normally seen in a local anesthetic cartridge is:
A. Nitrogen.
B. Air.
C. Oxygen.
D. A breakdown product.

84. Local anesthetic injected into dental abscesses is rarely effective because:
A. Bacteria can metabolize the local anesthetic.
B. Edema dilutes the local anesthetic.
C. The tissue is too acidic.
D. There is excessive vasoconstriction.

85. The first sign of a toxic reaction to an injected local anesthetic solution would be:
A. Convulsions.
B. Erythematous rash.
C. Asthmatic attack.
D. Excitement.

86. Which of the following may be used as a local anesthetic in a patient allergic to both amide and ester-type local anesthetics?
A. Nitrous oxide.
B. Bupivacaine.
C. Phenylephrine.
D. Diphenhydramine.
E. Ethyl aminobenzoate.

87. Which of the following nerves should be anesthetized for the removal of a maxillary first molar?
1.Greater palatine.
2.Naso palatine.
3.Middle superior alveolar.
4.Anterior superior alveolar.
5.Posterior superior alveolar.
A. (1) (2) (4)
B. (1) (3) (4)
C. (1) (3) (5)
D. (2) (3) (5)
E. (2) (4) (5)

88. With respect to local anaesthetics, which of the following statements is/are correct?
A. Certain nerve fibers are more susceptible.
B. In mixed nerves, sensory fibers are more susceptible.
C. They are marketed as water-soluble acid salts.
D. They are capable of blocking every type of nerve tissue.
E. All of the above.

89. Cardiovascular collapse caused by a high circulating dose of a local anesthetic is due to:
A. Vagal stimulation.
B. Histamine release.
C. Myocardial depression
D. Medullary stimulation.

90. High plasma levels of local anesthetics may cause:
A. Inhibition of peristalsis.
B. Stimulation of the central nervous system.
C. Inhibition of the vagus nerve to the heart.
D. Depression of the central nervous system.

91. Lidocaine
1.Is a local anesthetic agent.
2.has topical anesthetic properties.
3.Is an antiarrhythmic agent.
4.has anticonvulsant properties.
A. (1) (2) (3)
B. (1) and (3)
C. (2) and (4)
D. (4) only
E. All of the above.

92. In a standard inferior alveolar nerve block, which muscle is penetrated by the needle?
A. Buccinator.
B. Mylohyoid.
C. Superior constrictor.
D. Masseter.
E. Medial (internal) pterygoid.

93. Immediate toxic reactions to local anesthetic administration are most commonly due to:
A. deterioration of the anesthetic agent.
B. hypersensitivity to the vasoconstrictor.
C. hypersensitivity to the anesthetic agent.
D. excessive blood level of the anesthetic agent.

94. Which of the following complications might occur after administration of a local anesthetic agent?
1. Convulsions.
2.Nausea.
3.Respiratory depression.
4.Cardiovascular collapse.
A. (1) and (3)
B. (1) (3) (4)
C. (2) and (3)
D. (3) and (4)
E. All of the above.

95. When used alone, which of the following agents will not produce satisfactory anesthesia?
A. Isoflurane.
B. Sevoflurane.
C. Nitrous oxide.
D. Desflurane.

96. Which of the following local anesthetics is subject to inactivation by plasma esterases?
A. Procaine.
B. Lidocaine.
C. Prilocaine.
D. Mepivacaine.
E. Bupivacaine.

97. The first sensation lost after administration of a local anesthetic is:
A. pain.
B. touch.
C. pressure.
D. proprioception.

98. In a safe general anesthetic mixture, the MINIMALLY acceptable percentage of oxygen is:
A. 5%.
B. 10%.
C. 20%.
D. 50%.
E. 80%.