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DH102 Final Study Guide Part 1

Create an educational illustration featuring dental local anesthesia concepts, nerve conduction, and pharmacology, with a clean and professional design suitable for a medical or dental study guide.

DH102 Final Study Guide Quiz

Test your knowledge and preparation for the DH102 final exam with this comprehensive quiz covering essential topics in dental local anesthesia. Each question is designed to challenge your understanding and application of critical concepts in the field.

Features:

120 multiple-choice questions
In-depth coverage of pharmacology and nerve conduction
Immediate feedback on answers

120 Questions30 MinutesCreated by LearningLeaf472

Prilocaine is biotransformed in all of these organs, EXCEPT:

Liver

Kidneys

Lungs

Pancreas

Two types of adrenergic receptors are ______and ______; ________ is the one that predominates.

Alpha 1, beta 2; beta 2

Alpha, beta; beta

Beta, alpha; alpha

Beta 1, beta 2; beta 1

The heart is primarily affected by the ______ receptors. The lungs are primarily affected by the _______ receptors. _

Beta 1; Beta 2

Beta 2; Beta 1

Beta 3; Beta 1

Beta 1; Beta 3

The addition of the aspirating harpoon has been the single most important improvement in dental local anesthetics syringes. *

True

False

Which would be the best description of an action potential in a neuron?

Traveling down an axon in two directions toward the synapse

Traveling upwards in one direction toward the synapse

Traveling down an axon in one direction toward the synapse

Traveling down in multiple directions toward many synapses

What kind of action is required to have electrical impulse cross the synapse of one cell to another cell?

The action of electrical synapses

The action of chemical synapses

The action of either electrical or chemical synapses

None of the above

If a patient is experiencing fear, the patient will show all of the following responses, EXCEPT:

Increased blood pressure

Muscular tension

Anxiety

Hyperventillation

Irritability

Sweating

The pKa is the primary factor that determines the onset of the action.

True

False

The lower the pKa, the faster or shorter the time it takes to start numbing. The higher the pKa, the slower or longer the time it takes to start numbing.

Both true

Both false

First true; second false

First false; second true

Which local anesthetic molecule improves lipid solubility which allows penetration of the nerve membrane.

Lipophilic aromatic ring

Intermediate link

Hydrophilic amino group

All of the above

Each axon is surrounded by which type of connective tissue?

Loose

Adipose

Endoneurium

Elastic

On a resting neuron, what positive ion is most abundant outside the plasma membrane?

Ca+

Na+

K+

All of the above

Axons are also known as:

Mantle bundles

Core bundles

Nerve fibers

All of the above

Local anesthetics with vasoconstrictors are more acidic than plain formulas because of the presence of the preservative sodium bisulfite which is also acidic.

True

False

In ________ neurons the cell body is located off the axon and does not participate in nerve conduction, whereas in _________neurons the cell body is part of the neuron and participates in impulse conduction.

Afferent; sensory

Afferent; efferent

Motor; sensory

Efferent; motor

Elimination half-life is defined as,

How long will take for 50% of the anesthetic to be eliminated from the blood and tissues.

How long will take for 50% of the anesthetic to be digested by the liver

How long will it take the body to digest 15% of the anesthetic

None of the above

What does local anesthetic inhibit in order to prevent nerve cell stimulation? *

Calcium influx

Potasion influx

Sodium influx

Oxygen influx

All of the following statements are true about the Nodes of Ranvier, EXCEPT one,

They are found along myelineated nerve fivers as gaps between adjacent Schwann cells.

They are located where the myelinated axon has direct contact with the extracellular space.

They occur at unevenly spaced intervals

It is where the anesthetic solution diffuses through the nerve membrane and takes it effect.

Where does the excretion of local anesthetics and their metabolites occur?

Kidneys

Pancreas

Lungs

Large intestines

Which part of the chemical structure of local anesthesia determines if a local anesthetic will be an ester or amide.

The intermediate carbon chain

The aromatic ring

The amino group

None of the above

_______ are metabolized in the blood plasma; _________ are metabolized in the liver.

Esters; Amides

Amides; Esters

What type of nerve fibers have the fastest conduction velocity?

Nerve fibers that are smaller and unmyelinated

Nerve fivers that are large and myelinated

Nerve fibers that are large and unmyelinated

Nerve fibers that are smaller and myelinated

The most common topical preparation for Lidocaine is,

10% Gel/ointment

7% soluble liquid

5% Gel/ointment

10% soluble liquid

Administration of anesthesia covering the lingual nerve my cause loss of sensation in which structures of the mouth?

Floor of the mouth

Half of the tongue

Lingual gingival tissues of the mandibular teeth

All of the above

Gel mixtures such as Oraqix, are used in injectables.

True

False

What are the active ingredients used in Oraqix?

2.5% Lidociane and 2.5% Prilocaine gel mixture

3.5% Lidocaine and 5% Prilocaine gel mixture

1% Lidocaine and 3% Prilocaine gel mixture

5% Benzocaine and 5% Prilocaine gel mixture

Repolarization occurs once the peak of the action potential is reached, and the membrane potential begins to move back toward the resting potential.

Refractory periods puts everything back to normal, potassium returns inside and sodium returns outside.

Both true

Both false

First true, second false

First false, second true

Saltatory conduction is defined as the propagation of action potential along myelinated axons from one node of Ranvier to the next node, located between the Schwann cells.

True

False

_______contains many cable-like bundles of peripheral axons or nerve fibers.

Nerve

Neuron

Neurotransmitter

Synaptic clef

Which local anesthetic is the most potent and has the greatest degree of lipid solubility.

Lidocaine

Prilocaine

Bupivacaine

Benzocaine

All of these factors influence the duration of the effects of the local anesthetics, EXCEPT one.

Vascularity of the injection site

Addition or absence of vasoconstrictor

Degree of protein binding

Patient's medical condition

During polarization the nerve cell is at rest at _____.

-50mv

+70mv

-70 mv

+50 mv

The primary effects of local anesthetics occur during the depolarization phase.

True

False

Which concentration of epinephrine is the most dilute (weakest)?

1: 50,000

1:200,000

1: 100,000

1: 300,000

What is the best thing to do while waiting for the anesthetic to take effect on the patient?

A) continue making notes on the patient's chart while waiting

B) walk around the clinic for a five minute break

C) observe the patient for possible signs of an adverse reaction

D) continue assembling the syringe

C and D

C only

Local anesthesia are divided chemically into two groups;

Esters and amide

Ketones and esters

Alcohol and amide

Aldehydes and carboxylic acid

One clinical significance of esters is the potential for ___________ .

Allergic reactions

Syncope

Shortness of breath

Fainting

All injectable local anesthetics manufactured for dentistry today are in the _____group

Ester

Amine

Alcohol

Hydroxyl

All local anesthetic solutions are acidic prior to injection. Preservative sodium bisulfite found in vasoconstrictors contributes to acidic nature.

Both true

Both false

First true; second false

First false; second true

_______________theory proposes that during depolarization, calcium (Ca+) ions are displaced and are thought to be the most significant factor responsible for the influx of Sodium into the nerve. During depolarization, local anesthetics work by competing with Ca+ ions to bind with these ion channels.

Specific membrane receptor

Membrane expansion

Membrane permeability

Specific protein receptor

Anesthetic recovery is a slower process than induction because the anesthetic binds to the receptor site in the Na+ channel, releasing the anesthetic slowly into the systemic circulation.

Both the statement and the reason are true and related

The statement is true but the reason is not true

Both statements are true but not related

The statement is true but not related to the reason

It is mportant to reinject the anesthetic before the mantel fibers have fully recovered

True

False

PNS is the most sensitive system to high blood levels of local anesthetics

True

False

What are some of the effects of local anesthesia on the Cardiovascular System?

At mild overdose levels, patient may exhibit slight increase in blood pressure, heart rate, or respiration

The time lapse between administration of local anesthetic to the overdose reaction determines its severity.

Symptoms that occur rapidly are more likely to evolve into a more serious reaction.

Intravascular injections significantly increase the possibility of an overdose.

All of the above

_________ is an ester and it is available in a cream, gel ointment, spray and patch.

5% Lidocaine

20% Prilocaine

20% Benzocaine

None of the above

5% Lidocaine is an amide.

True

False

20% Benzocaine topical is _______ concentrated than 5% Lidocaine topical plus all of the amide injectables of 2%, 3% and 4%.

Less

Which are some of the advantages for the use of topical anesthetic agents?

A) useful for minor injuries

B) minimizes pain

C) reduces gag reflex

A and B only

All of the above

Some of the disadvantages for the use of topical anesthetic agents are; miss-use can be fatal and there is a high risk for toxicity when purchased over the counter.

True

False

Which factor(s) determine the severity of an overdose reaction to local anesthetic?

A) time lapse between the administering of the local anesthetic to the overdose.

B) symptoms that occur rapidly (within 5 mins) may evolve into a more serious reaction

C) delayed symptoms are easily resolved and do not develop into a serious reaction.

A and C only

All of the above

Which solution is added to the cartridge of local anesthetic that can trigger broncospasms and allergies?

Sodium bisulfite

Calcium bisulfite

Potassium bisulfite

Chloride bisulfite

Causes of an endogenous release of epinephrine include:

Apprehension about dental appointment

Anxiety over anything

An injection of epinephrine

All of the above

Those who should NOT receive an anesthetic with a vasoconstrictor include:

Patients with recent myocardial infarction, coronary bypass surgery, or cerebrovascular accident within the past 6 months

Patients with uncontrolled hypertension, angina, arrhythmias, diabetes, and hyperthyroidism

Patients with a relative contraindication for vasoconstrictors

All of the above

Most common concentrations of epinephrine combined with local anesthetics are 1:50,000 mg/mL, 1:100,000 mg/mL, and 1:200,000 mg/mL. Which dilution represents the highest concentration of vasoconstrictor and its proven effective for bleeding control?

1:50,000 mg/mL

1:100,000 mg/mL

1:200,000 mg/mL

Action of epinephrine is terminated primarily by the reuptake action of adrenergic nerves.

True

False

Which of the following is NOT true about Levonordefrin (Neo-Cobefrin)?

Synthetic vasoconstrictor

Approximately 1/6 as potent as epinephrine

Manufactured in higher concentrations

Contains sodium bisulfite

Available ONLY with 2% mepivacaine in 1:20,000 mg/mL

All of the above are true

Small-gauge needles provide the least deflection during significant needle penetration because of the smaller rigidity of small-gauge needles.

True

False

There is little predictability of duration of anesthesia when injecting into inflamed tissues due to the increase in vascularity which slows the onset of anesthetic action. In healthy tissues the onset of action and duration is more predictable.

True

False

How many times a clinician should aspirate before administering a local anesthetic?

1-2 times

3 times

4-5 times

5-6 times

Which part of the maxilla articuletes with the zygomatic bone laterally, this completing the infraorbital rim?

Coronoid process

Mandibular process

Zygomatic process

Coronoid notch

Known effects of epinephrine are,

It raises blood pressure

It dilates the bronchioles

It constrict peripheral blood vessels

All of the above

Special consideration should be given to the use of 1:100,000 epi in patients who have uncontrolled hyperthyroid clinical symptoms

True

False

Epinephrine and Norepinephrine are naturally occurring stress hormones and neaurotransmitters.

True

False

How long should it take to deposit one cartridge of anesthetic.

At a rate of 1.8 ml per 2 mins

At a rate of 1.8 ml per 1 min

At a rate if 2 ml per 2 mins

At a rate of 2 ml per 1 min

What is the purpose of the colored band on a cartridge?

Color signifies the strength of the drug

Color signifies the volume of the drug

Color signifies the anesthetic drug inside the cartridge

Color signifies the location where the drug is administered

The solution that USED to be added to the cartridge of local anesthetic to prevent bacterial growth was,

Methylparaben

Sodium influx

Benzocaine

Prilocaine

Local anesthetics are vasodilators

True

False

What is true about Articaine (Septocaine)?

Slightly more toxic than mepivacaine

Highly lipid soluble and binds powerfully to protein receptor sites in the Na channels.

Not recommended for patients who are prone to self-mutilation

Metabolized more easily by liver than lidocaine and mepivacaine

What is true about Bupivacaine?

Highly lipid soluble and binds powerfully to protein receptor sites in the Na channels.

Slightly more toxic than mepivacaine

Much less toxic than lidocaine and articaine

Primary limiting factor for clinical use is methemoglobinemia

Injectable ester anesthetics are no longer used in dentistry

True

False

Articaine has the shortest half-life (27 minutes) and lowest risk for systemic toxicit. Bupivacaine is the only long-lasting local anesthetic in dentistry

Both true

Both false

First true, second false

First false, second true

What happens to the local blood vessels in the area of injection immediately after a plain local injection?

Vasodilation of the blood vessels and increased blood flow to the site of injection

Decreased blood flow to the site of injection

Stopping of blood flow in the are of injection

None of the above

At which temperature should local anesthetic cartridges be stored?

Cold temperature

Room temperature

Hot temperature

How many minutes of pupal anesthesia one gets from 2% Lidocaine w/epi 1:100,000?

30 mins

45 mins

20 mins

60 mins

Another name for vasopressor is vasoconstrictor.

True

False

The different solutions available for Mepivacaine are,

3% Mepivacaine w/levonordefrin 1:30,000

3% Mepivacaine plain (HCL) and 2% Mepivacaine w/levonordefrin 1:20,000

2% HCL and 2% Levonordefrin 1:500,000

2% HCL and 3% Benzocaine

_______ person who under-respond to LA. They stay numb for a shorter amount of time than expected. ________ person who over-respond to LA and stay numb for a longer amount of time than expected.

Hypo-responder; Hyper-responder

Hyper-responder; Hypo-responder

The "Gauge" refers to the diameter of the lumen (size of opening in the needle).

True

False

Which of the following is true about Methemoglobinemia?

A condition in which a form of hemoglobin called methemoglobin builds up in the blood

Oxygen is unable to be carried effectively to body tissues

Benzocaine spray is used to treat it

All of the above are true

Why is it significant that dyclonine hydrochloride is not an ester or an amide?

It can be used for patients who have sensitivities to the traditional topical anesthetics

Onset of action is fast

It lasts for up to 3 hours

No contraindications exists

Vital signs helps to identify diagnosed or undiagnosed conditions that may require modifications to treatment, drug selection, and/or drug dosage.

If patient has high BP, limit or avoid use of vasoconstrictor

Both true

Both false

First true; second false

First false, second true

What should a dental professional administer to a patient taking tricyclic antidepressants?

Avoid levonordefrin and norepinephrine

Limit epinephrine to lowest effective dose [not to exceed 0.04 mg/appointment]

Levonordefrin is available only with 2% mepivacaine in a 1:20,000 dilution

All of the above

The administration of epinephrine to a patient taking tricyclic antidepressants is considered a relative contraindication.

True

False

________ contraindications – the administration of the offending drug increases the possibility of a life-threatening situation. The drug should not be administered to the individual under any circumstances.

Absolute

Relative

The use of vasoconstrictors are an absolute contraindication for patients with uncontrolled hyperthyroidism. Why?

Patients with hyperthyroidism are sensitive to catecholamines and may precipitate an exaggerated response to vasoconstrictors resulting in cardiac stimulation.

Patients with hyperthyroidism are sensitive to antihistamines and may precipitate a minor response to vasoconstrictors resulting in cardiac stimulation

Bisulfate allergies typically manifest as a severe respiratory allergy, commonly bronchospasm.

True

False

Which family of local anesthetic agents is most likely to be associated with allergic reactions?

Esters

Amine

Amide

Alkene

What is the possibility of an allergic reaction with an amide local anesthetic?

Extremely rare

Extremely likely

Never

Every so often

What does a “positive aspiration” mean?

It means that the tip of the needle is within a blood vessel

It means that the tip of the needle is free of blood

It means that the tip is inside of the tissue

None of the above

The infraorbital nerve is the largest contributor to the maxillary nerve trunk.

The lingual nerve is anesthetized when administering an inferior alveolar block through localized diffusion of the local anesthetic agent through the tissue due to its close proximity to the inferior alveolar nerve

Both true

Both false

First false, second true

First true, second false

The _____________ may in some cases serve as an afferent nerve for the mandibular first molar

Mylohyoid Nerve

Alveolar Nerve

Mental Nerve

Infraorbital Nerve

The lingual nerve is afferent for general sensation of the body of the tongue, floor of the mouth, and lingual gingival tissue of the mandibular teeth

True

False

For safe and comfortable injections, the clinician should consider the following,

Inject the solution slowly

Always cap the needle, contaminated or uncontaminated, utilizing the scoop method

Administer anesthetic solution slowly at a rate of 1.8 mL in 2 minutes

Never leave the patient’s side after the administration of anesthetic

Observe for possible adverse reactions!

All of the above

Which technique should be used when administering MSA injection in the presence of buccal frenum at injection site?

Inject through the frenum

Move injection site so posterior as to lose maxillary premolar coverage

Insert needle more posterior to injection site and retract frenum more anteriorly

None of the above

Will the ASA anesthetize the lingual tissue of the maxillary anterior teeth?

No. Use the nasopalatine injection for the lingual tissue.

Yes, it is possible to numb both buccal and lingual with ASA

Does the NP provide pulpal anesthesia of the maxillary anterior teeth?

No. Additional anesthesia such as the MSA and ASA or the IO block may be needed.

Yes. NP provide pulpal anesthesia of all the maxillary anterior teeth

The angle of the syringe barrel should be parallel to the long axis of the tooth following the contour of the tooth.

True

False

How often should needles be changed?

Every 3-4 penetrations

Every 1-2 penetrations

Every 5-6 penetrations

Never

Short needles are ____ mm long; Long needles are ______mm long.

20;32

30;40

50;60

27;45

Needle breakage most often occur at the ________.

Hub

Bevel

Plunger

Needle

Which of the following is(are) true about dull needles? Select all that apply

A) after 3 soft tissue insertions, or 2 contacts w/bone needles can dull

B) dull needles do not cause pain upon insertion

C) dull needles can cause pain upon insertion but not on withdrawal

D) dull needles cause pain upon withdrawal

A and C only

All of the above

Contacting bone too forcefully can cause fishhook barbs on the end of needles. Fishhook barbs cause pain upon insertion and withdrawal.

Both true

Both false

First true, second false

First false, second true

The needle should remain sharp for ease of penetration and patient comfort. The bevel should be positioned toward the bone for patient comfort and so that the anesthetic solution pours toward the bone for diffusion not away from it.

Both true

Both false

First true, second false

First false, second true

A major cause of needle injury is from? Select all that apply

A) not using the scoop method

B) inattentiveness of the administrator

C) sudden, unexpected patient jerking

A and B only

All of the above

Which type of gas bubble is found under the cartridge cap?

Nitrogen gas bubble

Oxygen gas bubble

Hydrogen gas bubble

CO2 gas bubble

What are some clinical observations of Methemoglobinemia?

Bluish skin tone, nail beds and lips

Can be hereditary

Condition form breakdown of Prilocaine

Patients needs Methylene Blue IV which can reverse the condition is 15 mins

All of the above

Severe liver disease is a contraindication for local anesthetic because the damaged liver will not be able to metabolize the anesthetic creating a greater chance of an overdose in the system.

True

False

How much time 4% Articane with 1:200,000 epinephrine provides for pulpal anesthesia

1-2 hours

20-30 mins

60-75 mins

90 mins

Local anesthesia is able to cross the placenta and blood brain barriers

True

False

Which anesthetic drugs would have the slowest rate of biotransformation?

Lidocaine

Mepivcaine

Bupivacaine

All of the above

Which local anesthetic drug is the least toxic?

Articaine

Prilocaine

Bupivacaine

Lidocaine

ASA III patients should not receive an anesthetic with a vasoconstrictor until their medical condition is under control. Patients with a relative contraindication for vasoconstrictors can receive epinephrine-containing local anesthetic in the lowest possible dose utilizing the best technique.

Both true

Both false

First true, second false

First false, second true

What happens when the pH of the anesthetic solution is more acidic?

It results on a rapid onset of action of the local anesthesia

Acidity has no effect on the onset of action

It results in a slightly slower onset of action of the local anesthesia

It results in an extremely slower onset of action of the local anesthesia

What does the vasodilating property of local anesthetics cause?

1. An increased rate of anesthetic absorption into the bloodstream by enabling the anesthetic to be carried away from the injection site.

2. A decrease in the duration of the anesthetic’s action by enabling it to diffuse quickly from the injection site.

3. Higher plasma levels of local anesthetics increasing the risk of toxicity.

4. Increased bleeding in the area due to increase in blood flow.

1,2

2,3,4

2,3

1,2,3,4

Which dilution of epi-pen is used for anaplylactic reactions?

0.2% of 1:200,000 epinephrine

0.3% of 1:100,000 epinephrine

0.5% of 1:500,000 epinephrine

1% of 1:50,000 epinephrine

What is homeostasis?

1. The stopping of blood flow or bleeding control.

2. Studies show effective homeostasis with 1:100,000 epi.

3. The strongest homeostasis is with 1:50,000 epi and used in surgery

4. Uncontrollable blood flow may be experienced.

1,2

2,3,4

1,2,3

Which two local anesthetics have the least vasodilatory properties and may be used if patients are allergic to sodium bisulfite?

Prilocaine and Lidociane

Mepivacaine and Prilocaine

Benzocaine and Lidocaine

Benzocaine and Mepivacaine

The ______ the gauge needle number, the ________ the lumen (opening).

Larger; larger

Smaller; smaller

Larger; smaller (viceversa)

Why the pterygoid plexus is an area of concern when giving the PSA?

1) It is a high vascular area

2) There is potential to side effects associated with intravascular injections.

3) These side effects include swelling and hematomas.

4) Adverse reactions include bleeding and facial paralysis.

1, 2

1, 2, 3

2, 3, 4

What anesthetic is used for a patient with a sensibility to Epinephrine and a need for 30 mins of pupal anesthesia?

3% Mepivacaine plain

2% Prilocaine plain

4% Lidocaine

3% Articaine

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