Anesthesia Final

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Anesthesia Final
2013-07-30 09:16:37
Anesthesia review questions

all chapters
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  1. A stimulus is an electrical message from one part of the body to another, and an impulse is an environmental change in an excitable tissue.
    Both statements are false
  2. Which fibers are the principle fibers in the transmission of sharp, bright dental pain?
    A δ(delta) Fibers
  3. Local anesthetics work by:
    Penetrating the nerve to inhibit Na+ influx
  4. Local anesthetics have their effect of myelinated nerves in which way?
    Mostly at the Node of Ranvier
  5. The minimal threshold stimulus required to excite a "C" fiber will also be sufficient to stimulate an "A" fiber.
  6. When energy for conduction is derived from the nerve cell membrane itself and is no longer dependent of the stimulus for continuance the conduction is considered to be...?
  7. The absolute refractory period occurs during the fraction of a millisecond when a nerve fiber can be excited by a much stronger stimulus than the initial stimulus.
  8. Saltatory conduction refers to what?
    Rapid transmission of nerve impulses along a myelinated nerve fiber
  9. What is the type of glial cell located in the peripheral nervous system?
    Schwann Cells
  10. Myelin (lipoprotein sheath) is composed of what?
    Approximately 75% lipid, 20% protein, and 5% carbohydrate
  11. The sympathetic division is involved with the "rest or digest" response. The parasympathetic  division is the "fight or flight" response.
    Both statements are false.
  12. The afferent division consist of all incoming information traveling along sensory or afferent pathways. The efferent division consist of all outgoing information traveling along motor or efferent pathways.
    Both statements are true
  13. The outer layer of the myelin sheath that wraps the entire nerve is called what?
    Schwann Cell
  14. The axon hillock:
    Is where neurotransmitter chemicals are released for possible reception by a nearby neuron.
  15. In a resting neuron, what positive ion is most abundant outside the plasma membrane?
    Sodium ions
  16. In a resting neuron, what is the most abundant positive ion inside the plasma membrane?
    Potassium ions
  17. The electrical potential of nerve axoplasm in the resting state is approximately what?
    -70 mV
  18. Mantle bundles will be anesthetized first by a local anesthetic compared to core bundles.
  19. Chemical synapses use chemical mediators called what?
  20. The "all or none principle" occurs:
    Once a nerve is excited by the minimal threshold level.
  21. Infection and Inflammation cause the following effects when administering a local anesthetic:
    Increases tissue vascularity, which can inactivate the local anesthetic more rapidly.
  22. Which of the following are desirable properties of local anesthetics?
    All of the above (Rapid onset, Reversible, Stability in solution, Potent)
  23. Which characteristic enhances the onset and effectiveness of local anesthetics?
    High lipid solubility
  24. Where is the action site of local anesthetics?
    The protein receptors
  25. Which part of the chemical structure of a local anesthetic determines if it classified as an amide or an ester?
    Intermediate chain
  26. Local anesthetics have their effect on the myelinated nerves mostly in which way?
    Mostly at the nodes of Ranvier
  27. The quaternary form of local anesthetic:
    Is the ionized form in the cartridge and is responsible for binding to the receptor site.
  28. Ester type local anesthetics are no longer manufactured in injectable form for dentistry because why?
    Of there high degree of hypersensitivity
  29. During manufacturing of local anesthetics are something as which of the following to render them water soluble?
    Hydrochloride salt
  30. Which of following anesthetics will provide the most rapid onset based on it's pKa?
  31. Which of following local anesthetics is the most lipid soluble?
  32. The mantle bundles of the inferior alveolar nerve innervate which teeth?
    The molar area
  33. When the local anesthetic is administered the solution reaches the core bundle first.
  34. What is tachyphylaxis?
    Increased tolerance to a drug that is administered repeatedly.
  35. Recovery of local anesthetics following the inferior alveolar block begins in the posterior teeth.
  36. Which of the following are true for local anesthetics:
    1. Are potent vasodialtors
    2. Exhibit antimicrobial properties
    3. Cause hemostasis
    4. Cause hypotension
    5. Have a pH of 7.5
    1, 2, 4
  37. Which of the following is responsible for the allergic reaction in ester anesthetics?
    Para-amino benzoic acid
  38. Most amide local anesthetics are biotransformed in the what?
  39. Local anesthetic, overdose has an effect on system?
    Central nervous system
  40. Topical anesthetics are available in both esters and amides.
  41. The most important advantage of amide over ester LA is:
    Less allergency
  42. Which LA is the longest acting?
    Bupivacaine with epi
  43. Which LA has the least vasodilatory effect when used without epi?
  44. Which LA has the greatest vasodilatory effect
    when used without epi?
  45. One cartridge of anesthetic contains how much
    1.8 mL
  46. Factors in selection of LA for a patient include
    all of the following except:
    Vitamin intake
  47. Which of the following is false:
    Topical Benzocaine is an amide
  48. Which of the following LA is metabolized in the
    plasma and liver?
  49. Which of the following is an advantage of having a LA metabolized in the plasma and liver?
    Shorter half-life of drug
  50. Which of the following LA is metabolized in the
    lungs and liver?
  51. Methylparaben is a:
    Bacterial static agent that is no longer added to dental cartridges due to high incidence of allergic reaction
  52. How is 3% mepivacaine formulated?
    3% Plain
  53. Which of the following is a concern when
    selecting bupivacaine?
    Patient self-mutilation
  54. Which of the following LA is the best option for
    readministration of anesthetic to provide a lessened likelihood of blood concentration buildup?
  55. The lower the pKa of a drug, the more cations
    are present, which decreases the onset of action?
  56. Which of the following is not a factor in the
    duration of a LA?
    Injection technique
  57. Which of the following LA used without a
    vasoconstrictor provides intermediate duration of action when administering a
    block injection?
  58. Which of the following is the best reason for
    choosing a LA that provides a long duration?
    Need for postoperative pain control
  59. When is lidocaine 1:50,000 epi most effective?
    When hemostasis is needed
  60. Where is procaine metabolized?
  61. What best describes a localized complication?
    A complication that occurs in a region of injection and is attributed to the needle or the administered anesthetic
  62. What best describes a secondary complication?
    A complication that is experienced by the patient after the injection
  63. If needle breakage occurs and the clinician can
    easily retrieve the needle, what is the next step?
    Keep hand in patient's mouth and ask him or her to open widely
  64. Anaphylaxis is considered to be what type of
    Systemic and severe
  65. When a blood vessel is punctured or lacerated by the anesthetic needle, an asymmetrical swelling and discoloration may occur. This is possibly a sign of:
  66. What is the first step in managing a hematoma?
    Apply pressure
  67. Soreness in the muscles caused by muscles spasms is called what?
  68. Edema can be caused by which of the following?
    All of the above (trauma during injection, infection, contaminated solutions, allergic rxn)
  69. Paresthesia occurs most commonly during which intraoral injection?
    IA block
  70. How can the dental hygienist decrease the risk
    of infection during injection?
    All of the above (use sterile needles, store cartridges in original containers, use topical anesthetic, carefully sheath and unsheathe the needle before and after injections)
  71. Why should topical anesthetics only be applied
    for 1-2 minutes?
    To prevent tissue sloughing
  72. Systemic complications usually occur more
    frequently than local complications and are usually caused by high plasma concentrations of the LA drug.
    First statement is False, second is True.
  73. All of the following can increase the risk of LA
    overdose EXCEPT:
    Fast biotransformation
  74. What are signs of central nervous system overdose?
  75. Convulsions, resp. distress, cardio depression,
    and coma are all signs of what?
    Local anesthetic overdose
  76. Which of the following has the lowest concentration of epi?
    1:200,000 epi
  77. Which of the following is the appropriate treatment for a mild cutaneous reaction?
  78. All are signs of angina pectoris EXCEPT:
  79. If the clinician strongly suspects the patient is having a MI, he or she should terminate the procedure and then:
    Activate EMS
  80. If a patient starts to experience involuntary  muscle contractions and altered breathing, what should the clinician suspect?
  81. Before administering LA the dental hygienist should describe the risk and benefits to the patient. What type of terms should be used?
    Term appropriate for the patient's education level
  82. Practicing within the legal scope of practice means?
    Practicing only within the limits set fourth by your license and state's rules and regulations
  83. Which of the following statements is false regarding the administration of LA?
    Never inform the patient of any unanticipated occurences during or after the administration of LA
  84. In most stated the hygienist is not required to have malpractice insurance, bc the hygienist will be covered under the dentist’s insurance:
    Both are False
  85. Hygienists are accountable for their own actions and practice: however, the dentist is always liable for any legal actions taken against the hygienist:
    First statement is true, second is false
  86. Hygienist who hold a current anesthesia license are always able to administer LA without the physical presence of a dentist, but only if the dentist authorizes the procedure:
    First statement is false, second is true
  87. What is the appropriate amount of anesthetic to be administered during a procedure?
    The amount necessary to complete the area that will be treated or finished in a single appt.
  88. Which of the following diseases is contractible if a needlestick occurs to the hygienist?
    All of the above (HBV, HCV, HIV)
  89. Postexposure management protocol for occupational exposures should contain?
    None of the above
  90. Which statement is true regarding the handling of sharps?
    It is acceptable to recap a needle only using the single handed scoop method.
  91. If a needlestick injury occurs, is it not necessary to report the details of what happened, only that you were possibly exposed?
    Both are false
  92. Secondary prevention is when there is containment of an injury after it occurs. Tertiary prevention involved the return of the patient to a functional state and the prevention of further injuries:
    Both are true
  93. What does PPE stand for?
    Personal protective equiptment
  94. When it comes to occupational exposure risks, a QHCP should be experienced in which of the following?
    All of the above (conducting testing, providing antiretroviral therapy, being familiar with the unique nature of dental injuries)
  95. Risk management occurs when:
    You identify preventative measures to reduce or elimnate the risk of legal actions
  96. Following exposure, if there is not enough time to get tested right away it is okay to use bleach to cleanse the exposure site. However, if you are able to get tested immediately then you should just use soap and water.
    First is false, second is true
  97. Communication, documentation, and risk reduction protocols are all necessary elements when administering a LA. This is because they help to reduce the chance of possible litigation.
    Both are true
  98. The QHCP must take into consideration which of the following factors when determining the need for follow-up of occupational exposures?
    All of the above (infectious state of source, type and amount of tissue/fluid, type of exposure, susceptibility of exposed person)
  99. When handling a contaminated needle it is only important to avoid being exposed to the end that penetrated the tissues or fluids. The cartridge-penetrating end of the needle is not a risk for contamination.
    Both are false
  100. It is the responsibility of the hygienist to report any illegal activities regarding the administration of LA to the proper authorities as well as to educate the dentist about current regulations regarding the hygienist’s scope of practice.
    First true, second false
  101. The activity of the sympathetic autonomic nervous system neurotransmitters are terminated mainly by:
    Re-uptake by adrenergic nerves
  102. Which of following is a sign of epi toxicity?
  103. The maximum recommended dose of epi per appt for a patient with ischemic heart disease is:
    0.04 mg
  104. Epi should be avoided in patients with:
    Both A and D (untreated hyperthyroidism and MI or CVA within prior 6 months)
  105. Epinephrine is used for what?
    Anaphaylatic rxns
  106. An effect of epi used in dentistry is to:
    Increase vasoconstriction and decrease bleeding
  107. Which of the following is a systemic effect of vasoconstrictors used with LA?
    A and C (Increase diastolic BP and Increases systolic BP)
  108. Vasoconstrictors are added to LA to:
    All of the above
  109. Which of the following is a preservative added to LA solutions containing epi to prevent oxidation?
    Sodium bisulfite
  110. There is no difference in pain control when using a 1:50,000 or 1:100,000 concentration of epi.
  111. Epi causes direct stimulation of which of following adrenergic receptors resulting in cardiac stimulation?
  112. Which of the following vasoconstrictor can be safely administered to a patient with uncontrolled hyperthyroidism?
  113. The half-life of epi is approximately:
    1-3 mins
  114. What is a 1:1000 concentration of epi for:
  115. Levinordenfrin is added to what LA?
    2% Mepivacaine
  116. Vasoconstrictor drugs are also known as:
    All of the above
  117. Epinephrine and norepinephrine are endogenous hormones excreted by:
    Adrenal glands
  118. Which adrenergic receptor causes epi to have inhibitory actions that cause vasodilation and bronchodilation?
  119. Which of following concentrations is the most diluted?
  120. Signs and symptoms associated with vasoconstrictor overdose manifest itself as:
    CNS stimulation
  121. Which of following topical anesthetics is classified as an amide?
  122. Benzocaine is available in which of the following preperations
    All of the above (cream, gel, spray, and patch)
  123. Which of the following statements is incorrect:
    The more topical placed at the site of the needle penetration the better
  124. Which of the following topical anesthetics has a FDA pregnancy category of B?
  125. Which of the following would be an indication for use of a topical anesthetic?
    To minamize a patient's gag reflux
  126. Which of the following is true regarding Maximum recommended dosage for topical anesthetics?
    Patches are a good way to monitor exact doses
  127. Concentrations available in over-the-counter products can be as high as those administered professionally in a dental office.
  128. Which of the following topical anesthetics do not require a prescription?
  129. All of the following are considered to be ideal properties of a topical except:
    It should be allergenic
  130. Which method of delivery is recommended to decrease the risk of methemoglobinemia?
    Unmetered spray with disposable knob
  131. Topical anesthetics generally penetrate____ into the tissue.
    2-3 mm
  132. Oraqix is composed of which of the following anesthetics:
    A and B (Lidocaine and Prilocaine)
  133. The concentrations of topical anesthetics are greater than those of their injectable counterparts and they do not contain vasoconstrictors
    Both are True
  134. Which of the following describes an advantage of single-unit dose applications?
    All of the above
  135. EMLA is approved for use on which of the following areas:
    All of the above (intact skin, hard palate, and mucous membranes)
  136. Pulpal anesthesia can be achieved using 2.5% lidocaine and 2.5% prilocaine gel mixture.
  137. Which of the following topical anesthetic agents is considered a ketone?
    Dyclonine Hydrochloride
  138. If plasma concentration in the body become too high, the most prominent systemic effect will occur in which of following systems?
    B and C (Cardiovascular and CNS)
  139. Allergic reactions from topical anesthetics are rare. It is not necessary to review a patient's med history before applying it.
    First true, second false
  140. Which of the following is a possible localized adverse reaction associated with topical anesthesia?
    All of the above