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DH102 Midterm

A dental student studying local anesthetics, surrounded by textbooks, notes, and a computer screen displaying an online quiz interface

DH102 Midterm Quiz

Test your knowledge with the DH102 Midterm Quiz! This quiz is designed to assess your understanding of local anesthetics, nerve physiology, and pharmacology in a dental context.

Prepare for your midterms with engaging multiple-choice questions covering key concepts, including:

Amide anesthetic agents
Adrenergic receptors
Nerve fiber types
Local anesthetic mechanisms

124 Questions31 MinutesCreated by ApplyingAnatomy123

Which amide anesthetic agent is metabolized by the lungs before it reaches the liver?

Lidocaine

Mepivacaine

Prilocaine

Articaine

Prilocaine is biotransformed in the liver only

True

False

The two types of adrenergic receptors are called:

Alpha and beta

Splanchnic and terminal

Muscarinic and splanchnic

Muscarinic and terminal

Which nerve fiber type is responsible for pain related to temperature?

A alpha

A delta

Which receptors are the most sensitive to epinephrine?

Alpha receptors

Beta receptors

Alpha and beta receptors are equal

Adrenergic receptors

Beta 1 receptors primarily affect the lung. Beta 2 receptors primarily affect the heart.

Both statements are true

Both statements are false

The first statement is true, the second is false

The first is false, the second is true

Which receptors relax bronchial smooth muscles, causing the bronchi of the lungs to dilate?

Alpha 1 receptors

Beta 1 receptors

Beta 2 receptors

Alpha and beta receptors are equal

Since the syringe was introduced in 1921, what has been the single most important improvement in the dental local anesthetic syringe?

The disposable needle

The single-dose anesthetic cartridge

The disposable syringe

The addition of the aspirating haspoon

Which of the following describes an action potential in a neuron?

The voltage across the membrane

Traveling down an axon toward the synapse

A electrical current inside a neuron

myosin binding

Which nerve supplies innervation to the second and third maxillary molars?

ASA

MSA

PSA

Lingual Nerve

At the synaptic knobs of neuron cells, what type of action is required to have the electrical impulse cross the synapse of one cell to another cell?

The action of electrical synapses

The action of either electrical or chemical synapses

The action of chemical synapses

Repolarization

The body's response to fear provokes symptoms that could include

Irritability

Muscular tension

Increased blood pressure

All option listed

Anxiety and hyperventilation

What is the most common topical preparation for lidocaine?

Patch

Spray

5% Gel/Ointment

Solution

The most commonly found form of lidocaine is in base form because it is water soluble and can easily penetrate and be absorbed into the tissues.

True

False

Which structures of the body are most likely to experience the loss of sensation after the administration of an anesthetic agent to the lingual nerve?

Floor of the mouth

Body of the tongue

Lingual gingival tissue of the mandibular teeth

All option listed

Which nerve is anesthetized through localized diffusion of the local anesthetic agent through the tissue when administering an inferior alveolar block?

PSA nerve

ASA nerve

Lingual nerve

Mandibular nerve

What is the available concentration of Oraqix?

5% lidocaine and 5% prilocaine

2.5% lidocaine and 2.5% prilocaine

14% benzocaine, 2% butamben, and 2% tetracaine hydrochloride

20% benzocaine and 5% lidocaine

What is the maximum recommended dose of Oraqix at one dental treatment session?

Two cartridges

Four cartridges

Five cartridges

Eleven cartridges

The higher the pK of an anesthetic, the faster the onset of action.

True

False

Which is the primary factor that determines the onset of action?

PH level

PKa of the anesthetic agent

Sodium leve

All the options listed

The lower the pKa number, the faster the onset of action of a local anesthetic

True

False

The lower pH of inflamed tissues (5-6) will more likely produce a very comfortable and faster onset when anesthetized with a local anesthetic

True

False

Which component of the local anesthetic molecule improves the lipid solubility, facilitating the penetration of the anesthetic through the lipid-rich membrane where the receptor sites are located?

Hydrophilic amino group

Intermediate hydrocarbon ester or amide chain

Lipophilic aromatic ring

All options listed

What is the layer of connective tissue that surrounds each axon within a nerve called?

Epineurium

Endoneurium

Perineurium

Fascicle

Among local anesthetics procaine has the highest percentage of protein binding and is the most lipid soluble.

True

False

The most potent local anesthetic is bupivacaine, which has the greatest degree of lipid solubility

True

False

What factor/factors influence(s) the duration of the effects of local anesthetics?

Degree of protein binding

Vascularity of injection site

Addition or absence of a vasoconstrictor

All of the above

The rate of systemic absorption of local anesthetics depends on the total dose, concentration, route of administration, vascularity of tissues, and presence or absence of a vasoconstrictor.

True

False

The nerve cell stage in which nerve cell (membrane) is at rest -70mv.

Repolarization

Refractory

Depolarization

Polarization

The primary effects of local anesthetics occur during what phase?

Depolarization phase

Repolarization phase

Refractory phase

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

Potassium

Sodium

Calcium

Chloride

Which of the following concentrations of epinephine is the most diluted?

1:50,000

1:100,000

1:200,000

What should the clinician do while waiting for the local anesthetic to take effect on the patient (besides assembling the syringe)?

Clean the other operatory

Bag instruments in the sterilization area

Take a much-needed break

Observe the patient for possible signs of an adverse reaction

What is another name for axons?

Core bundles

Mantle bundles

Nerve fibers

All options listed

Core bundles are fasciculi located near the center of the nerve and are responsible for anterior teeth

True

False

Mantle bundles are fasciculi located near the outside rim of the nerve

True

False

There are two main classifications of local anesthetic agents: esters and amides. Esters are metabolized in the liver, and most amides are metabolized in the plasma

Both statements are true.

Both statements are false.

The first statement is true; the second statement is false.

The first statement is false; the second statement is true.

Topical anesthetics are available in both esters and amides

True

False

All topical anesthetics should be placed for 1-2 minutes; they absorb into all tissues at a different rates.

True. False

True. True

False. False

False. True

Topical anesthetics are available in concentrations ranging from 0.2% to 20%. Products available over the counter can have concentrations just as high as those used professional in the dental office.

Both statements are true.

Both statements are false.

The first statement is true; the second statement is false.

The first statement is false; the second statement is true.

What is the name of a common ester topical anesthetic?

Lidocaine

Dyclonine hydrochloride

Prilocaine 2.5%

Benzocaine

What is the name of the only topical amide anesthetic currently on the dental market in the United States?

Levonordefrin

Lidocaine

Benzocaine

Butacaine

What is the reason that concentrations of topical anesthetic agents are higher than those of their injectable counterparts?

Topical agents are not natural vasoconstrictors like injectable anesthetic agents.

They facilitate high plasma concentrations of topical anesthetic agents.

They facilitate diffusion of the topical anesthetic agent through the mucous membranes.

With topical anesthetic agents, systemic absorption decreases.

All of the following are considered advantages for the use of topical anesthetic agents EXCEPT one. Which one is the EXCEPTION?

Can be purchased over the counter

Minimize pain associated with needle insertion

Useful in treatment of minor oral injuries

Reduce gag reflex during radiographic procedures

Which of the following characteristics could contribute to the properties of an ideal intraoral topical anesthetic?

Allergenic

Allow pain-free applicatio

Dissolves readily at the site of application

Produces some systemic toxicity

Which anesthetic agent is more concentrated?

Topical

Local anesthetic

Why does the local and systemic absorption of topical anesthetics increase the risk of toxicity?

Topical anesthetics do not contain vasoconstrictors.

Topical anesthetics are formulated in high concentrations.

Topical anesthetics are absorbed quickly into the tissue and blood stream due to vasodilation of the area.

All options listed.

What factor/factors determine the severity of an overdose reaction to local anesthetic?

Degree of drop in blood pressure

Time lapse between the administering of the local anesthetic to the overdose

Number of symptoms patient experiences

All of the above

Although topical anesthetics are generally regarded as safe, if used improperly they can produce adverse reactions that are fatal

True

False

Which of the following is/are true regarding topical anesthetics?

Allergic reactions can occur up to 2 days after the anesthetic is given.

Benzocaine and tetracaine are both amides, which increases their potential for causing an allergic reaction.

If there were an allergic reaction, it is likely to present immediately at the time of anesthesia.

All options listed.

Local anesthetic agents with vasoconstrictors are generally more acidic than plain formations. The reason local anesthetics with vasoconstrictors are more acidic is because of the presence of sodium bisulfite

Both statements are true

Both statements are false

The first statement is true, the second statement is false

The first statement is false, the second statement is true

What is the solution that is added to the cartridge of local anesthetic that can trigger bronchospasms?

Sodium bisulfite

Sodium hydroxide

Sodium chloride

Methylparaben

To obtain the most benefit from the use of topical anesthetics, a fairly substantial amount of topical should be placed on the cotton tip applicator. This amount mixes with the saliva and may numb the tongue, soft palate, or pharynx.

Both statements are true.

Both statements are false.

The first statement is true; the second statement is false.

The first statement is false; the second statement is true.

A patient exhibits signs of an allergic reaction after receiving one cartridge of 2% lidocaine with 1:100,000 epinephrine. Which content of the cartridge is most likely responsible?

Sodium chloride

Sodium bisulfite

Sodium hydroxide

Methylparaben

Which of the following are best practices to follow when administering local anesthesia of any kind in the dental office?

Review the patient's health and dental history at all appointments.

Use the lowest concentration of anesthesia to satisfy clinical requirements

Limit the area of application

Know the concentration of the drug being used

All options listed

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

It is located so far distally

It is a highly vascular area

It has major nerve innervations

All options listed

Local anesthetic agents with vasoconstrictors are generally more acidic than plain formations because of the presence of sodium bisulfite

Both the statement and reason are correct and related.

Both the statement and reason are correct but NOT related.

The statement is correct, but the reason is NOT.

The statement is NOT correct, but the reason is correct.

NEITHER the statement NOR the reason is correct.

Larger-gauge needles provide less tissue deflection during significant needle penetration because of the greater rigidity of larger gauge needles

True

False

Which of the following may cause an endogenous release of epinephrine?

An injection of epinephrine

Anxiety related to a divorce

Apprehension about a dental appointment

All options listed

Inflamed tissue experiences an increase in vascularity, slowing the onset of anesthetic action; however, in healthy tissues the onset of action and the duration of action is more predictable

True

False

Drawing the blood into the anesthetic cartridge is called

Normal aspiration

Positive aspiration

Negative aspiraton

Which is the number of times a clinician should aspirate before administering a local anesthetic solution

Once

Twice

Three times

Aspiration is not necessary

All of the following describe why aspiration is a necessary part of administering local anesthesia EXCEPT one. Which one is the EXCEPTION?

To ensure that the needle has not entered a blood vessel

To dramatically decrease the incidence of an intravascular injection

Patient comfort

To decrease the risk of a toxic overdose

If the blood of a positive aspiration does not completely fill the cartridge, the clinician can slightly reposition the needle and attempt a second aspiration.

True

False

Which part of the maxilla articulates with the zygomatic bone laterally, thus completing the infraorbital rim?

Zygomatic process

Frontal process

Palatine process

Alveolar processes

The main difference between motor neurons and sensory neurons is the location of which body part?

Dendritic zone

Axon

Terminal arborization

Cell body

What are the nerves that conduct signals away from the brain or spinal cord called?

Neurotransmitters

Electrical synapses

Afferent nerves

Efferent nerves

Name the most commonly used vasoconstrictor, the most potent, and 'benchmark' of all vasoconstrictors.

Epinephrine

Levonordefrin

Felypressin

All options listed

A comparison of levonordefrin and epinephrine reveals that hemostasis is less effective with the vasoconstrictor epinephrine.

True

False

An anesthetic solution that contains a 1:100,000 epinephrine dilution is twice as effective in controlling pain as a solution that contains a 1:50,000 epinephrine dilution.

True

False

All of the following are absolute contraindications for the use of epinephrine EXCEPT one. Which one is the EXCEPTION?

Unstable angina

Recent knee replacement

Uncontrolled diabetes

Uncontrolled hypertension

What is a 1:1000 dilution of epinephrine used for?

Increase hemostasis

Increase duration

Anaphylaxis

Prevent systemic overdose

Special consideration should be given to the use of 1:100,000 epi in

Patients who have uncontrolled hyperthyroid clinical symptoms

Hyper-responders

ASA 3 or 4 cardiovascularly compromised persons

All the options listed

Epinephrine and Norepinephrine are stress hormones and neurotransmitters

True

False

What is another name for the elimination of the local anesthetic from the blood and tissues?

Concentration grade

Absorption grade

Half-life

What is the maximum recommended dose of epinephrine per appointment for a health patient?

0.1 mg

0.2 mg

0.04 mg

0.5 mg

What is the maximum recommended dose of epinephrine per appointment for a medically compromised patient?

0.1 mg

0.2 mg

0.04 mg

0.5 mg

What is produced when the thumb ring of a syringe is pulled back by the clinician, causing retraction of the rubber stopper?

Positive pressure

Negative pressure

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

At a rate of 1.7 mL per minutes

At a rate of 1.8 mL per minute

At a rate of 1.8 mL per 2 minutes

At the rate that is comfortable for the patient

The colored band on the anesthetic cartridge indicates:

The amount of the anesthetic

The anesthetic inside the cartridge

The location of the bevel

The expiration date

What do local anesthetic drugs inhibit in order to prevent nerve cell stimulation?

Sodium influx

Potassium influx

Chloride excretion

All options listed

What is the solution that was added to the cartridge of local anesthetic to prevent bacterial growth?

Vasoconstrictor preservative

Sodium hydroxide

Sodium chloride

Methylparaben

Benzocaine is available in all of the following preparations EXCEPT one. Which one is the EXCEPTION?

Cream

Gel

Spray

Patch

Injectable

The onset of action for benzocaine is rapid. The duration of action for benzocaine is 5 to 15 minutes.

Both statements are true

Both statements are false

True. False

False. True

Adverse reactions associated with topical anesthetic is:

Tissue discoloration

Sloughing

Burning and stinging

All the options listed

In dentistry, the pressure-type syringe is used for providing anesthetic for periodontal ligament injections. It provides reliable anesthesia for one tooth in the mandible.

Both statements are true

Both statements are false

The first statement is true, second is false

The first statement is false, second is true

The regular gaps that are present between two adjoining Schwann cell cytoplasm and its nucleus are called:

Schmidt-Lanterman Nodes

Nodes of Ranvier

Nodes of Schewann

All of the following are true regarding the nodes of Ranvier EXCEPT one? Which one is the EXCEPTION?

Found along myelinated nerve fibers between adjacent Schwann cells

Occur at uneven spaced intervals

Where action potential conduction occurs

Where myelinated axon has direct contact with the extracellular space

Decreasing the bleeding at the site of injection is an example of Hemostasis

True

False

Studies show effective hemostasis with 1:100,000 epi

True

False

"Relative contraindication" means that a local anesthetic may be administered, but only after careful weighing of the risk versus the benefit to be gained

True

False

Local anesthetics containing a vasoconstrictor are an absolute contraindication for a patient who reports being allergic to wine and dried fruits.

True

False

Few health conditions absolutely contraindicate the administration of vasoconstrictors. Patients with uncontrolled systemic disease are not normally seen for nonsurgical periodontal therapy.

Both statements are true.

Both statements are false.

The first statement is true; the second statement is false.

The first statement is false; the second statement is true.

Which of the following local anesthetics, without a vasoconstrictor, is/are useful in dentistry when the vasoconstrictor is contraindicated?

Prilocaine

Mepivacaine

All options listed

None of the options listed

After a plain local injection, the local blood vessels in the area of injection will immediately begin to absorb the local anesthetic causing:

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

Vasodilation of the blood vessels & decreased blood flow to the site of injection

Vasoconstriction of the blood vessels & increased blood flow to the site of injection

The part of its chemical structure that determines if a local anesthetic agent will be an ester or amide is the:

Intermediate hydrocarbon chain

Aromatic ring

Terminal amide

Quarternary amine

The BEST way to store local anesthesia cartridges is at

Cold temperature

Hot temperature

Room temperature

2% Lidocaine w/epi 1:100,000 provides 60 minutes pulpal anesthesia.

True

False

The solutions available for Mepivacaine are

3% Mepivacaine plain or HCL

2% Mepivacaine w/ levonordefrin 1:20,000

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

None of the options listed

What duration category best describes mepivacaine 3%?

Short-acting

Intermediate-acting

Long-acting

None of the options listed

Another name for vasopressor is vasoconstrictor

True

False

Persons who remain anesthetized longer than expected are called:

Hypo-responders

Hyper-responders

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

True

False

A 25 gauge needle has a larger internal diameter than a 30 gauge needle

True

False

Which of the following intraoral needle gauges used in dentistry are listed from the smallest to the largest

25, 27, 30

30, 27, 25

The needle should be changed after every injection

True

False

Dull needles can cause pain upon insertion and withdrawal

True

False

Needle fishhook barbs are produced by contacting bone forcefully

True

False

The length of the short needle is ____mm. The length of the long needle is ____mm

20, 30

20, 32

30, 40

30, 32

Patient comfort can be increased by the sharpness of the bevel. The bevel of the needle should be turned toward the bone.

Both statements are true.

Both statements are false.

True. False

False. True

The bevel of the needle should:

Be turned away from the bone

Be turned toward the bone

Be at any direction

Needle breakage most often occurs at the hub.

True

False

A major cause of needle injury is:

Not using the 'scoop' method

Sudden, unexpected patient jerking

Inattentiveness of administrator

None of the options listed

All of the options listed

A small Nitrogen gas bubble of 1-2 mm is normal and found under the cap of cartridges

True

False

Effect(s) of Methemoglobinemia is the clinical observation of

A bluish skin tone

Bluish nail beds

Bluish lips

All of the options listed

Methemoglobinemia is a condition from breakdown of Prilocaine and can be hereditary

True

False

Ester local anesthetics are metabolized in which one of the following pathways?

In the liver

In the blood plasma

In the kidneys

In the brain

What is the name of the most potent ester topical anesthetic?

2.5% Lidocaine and 2.5% Prilocaine cream

Dyclonine hydrochloride

Tetracaine hydrochloride

Benzocaine

Why is severe liver disease (ASA IV) a contraindication for local anesthetic administration?

Because the patient will have prolonged bleeding

Because the chance of overdose increases due to the liver not being able to efficiently biotransform the local anesthetic

There is no contraindication

Because the patient will remain numb for a longer period of time

Patients with uncontrolled hyperthyroid disease should have limited amounts of:

Lidocaine w/epinephrine

Any local anesthetic w/ epinephrine

Benzocaine

Which of the following four types of nerve fibers has the fastest conduction velocity?

Myelinated large fibers, or Type A

Myelinated intermediate fibers, or Type B

Unmyelinated small fibers, or Type C

Which local anesthetic would be the best choice for a patient with known sensitivity to epinephrine and a need for approximately 30 minutes of pulpal anesthesia?

4% Prilocaine

4% Articaine

2% Lidocaine

3% Mepivacaine plain

Four percent Articaine with 1:200,000 epinephrine provides how much time of pulpal anesthesia?

15-30 mins

30-60 mins

60-75 mins

90-120 mins

Local anesthetics cross both the placenta and blood brain barriers

True

False

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