Download 1 - WordPress.com

Junior Pain Control Midterm
September 1, 2004
Name: Luminita, Dragana, Sejal & Lee
1.
Box#:
Which of the following symptoms or signs may indicate that the patient is in the proper level of sedation when using the L.L.U.
I.V. technique?
1. The needle in his arm bothers him very much
2. Stationary objects can appear to be moving or be blurred
3. The patient will not open his mouth when asked to do so
4. The patient states his worries have disappeared
A.
B.
C.
D.
E.
1, 2, 3
1 and 3
2 and 4
4 only
All the above
2.
Of the following, the most important purpose of I.V. sedation as we use it is to
A. Raise the pain perception threshold
B. Control motor disturbances
C. Counteract the toxic effects of local anesthetics
D. Allay apprehension and fear
3.
A topical agent often sprayed on the skin prior to venipuncture is:
A. Tetracaine
B. Chlorobutanol
C. Ethyl Chloride
- alternate is lidocaine
D. Lidocaine
E. Carbon tetrachloride
4.
Advil (over-the-counter ibuprofen) CAN be used to supplement the analgesia of most prescription analgesics that contain
acetaminophen and an opioid.
A. True
B. False
5.
What are the active metabolite(s) of diazepam (Valium)?
A. desmethyldiazepam and triazolam
B. desmethyldiazepam and triazodiazepam
C. desmethyldiazepam and oxazepam
D. oxazepam and triazolam
E. oxazepam and triazodiazepam
6.
A patient that is allergic to pencillin and needs antibiotic prophylaxis is BEST treated with:
1. Amoxicillin
2. Cephalexin
3. Doxycycline
4. Clindamycin
A.
B.
C.
D.
E.
7.
1 and 3
1, 2, 3
2 and 4
4 only
All the above
Aspirin is CONTRAINDICATED with which of the following drugs?
A. Coumarin (Coumadin)
B. Triazolam (Halcion)
C. Phenobarbital
D. Pentobarbital (Nembutal)
E. Methylprednisolone (Medrol)
8.
During intravenous conscious sedation you observe an upper eyelid ptosis that partially covers the pupil of the eye. This is
called:
A. Anderson’s sign
B. Leyman’s sign
C. Oversedation
D. Verrill’s sign
E. It has no name or designation
9.
A tablespoon contains how many ml?
A. 5
B. 10
C. 15
D. 20
E. 30
10. A teaspoon contains how many ml?
A. 5
B. 10
C. 15
D. 20
E. 30
11. What would you use to treat a benzodiazepine (either Valiumor Versed) overdose during IV sedation?
A. Naloxone (Narcan)
B. Promethazine (Phenergan)
C. Flumazenil (Romazicon)
D. Diphenhydramine (Benadryl)
E. Fentanyl (Sublimaze)
12. What would you use to treat respiratory depression following administration of meperidine (Demerol) during IV sedation?
A. Naloxone (Narcan)
B. Promethazine (Phenergan)
C. Flumazenil (Romazicon)
D. Diphenhydramine (Benadryl)
E. Fentanyl (Sublimaze)
13. Which of the following is definitely NOT a contraindication to the use of aspirin?
A. Use in children
B. Peptic ulcer
C. Prior MI (myocardial infarction)
D. Asthma
E. Bleeding disorder
14. What is the maximum dose of epinephrine that can be used in a HEALTHY patient?
A. 0.02 mg
B. 0.04 mg
C. 0.1 mg
D. 0.2 mg
E. 0.4 mg
15. What is the maximum dose of epinephrine that can be used in a patient with angina?
A. 0.02 mg
B. 0.04 mg
C. 0.1 mg
D. 0.2 mg
E. 0.4 mg
16. Histamine release following IV sedation is usually attributed to which of the following drugs?
A. Demerol
B. Pentobarbital (Nembutal)
C. Scopolamine
D. Valium
E. Versed
17. What is the maximum daily dose for acetaminophen?
A. 2000 mg
B. 2400 mg
C. 3200 mg
D. 4000 mg
E. 6000 mg
18. What is the maximum daily dose of ibuprofen?
A. 2000 mg
B. 2400 mg
C. 3200 mg
D. 4000 mg
E. 6000 mg
19. Both of the current COX-2 inhibitor (Celebrex and Vioxx) analgesics are indicated for acute pain.
A. True
B. False
20. Meperidine has a possible fatal interaction with which of the following medication classes?
A. Selective serotonin reuptake inhibitors
B. Monoamine oxidase inhibitors
C. Beta blockers
D. Macrolide antibiotics
21. It requires more analgesic medication to overcome pain than to maintain pain relief once it has been established
A. True
B. False
22. Which pair of anesthetics is most likely to show cross-allergy?
A. Lidocaine-mepivacaine
B. Prilocaine-tetracaine
C. Procaine-mepivacaine
D. Procaine-lidocaine
E. Lidocaine-benzocaine
NONE OF THE ABOVE
23. Of the following local anesthetics, which has intrinsic vasoconstrictive actions?
A. Cocaine
B. Procaine
C. Xylocaine
D. Bupivacaine
24. How many mg/cc is in epinephrine 1:10,000?
A. .001 mg/cc
B. .01 mg/cc
C. .1 mg/cc
D. 1 mg/cc
E. 10 mg/cc
25. Caution should be used in giving chronic alcoholics which analgesic?
A. Darvon
-Propoxyphene
B. Darvon compound
-Propoxyphene + caffeine + aspirin
C. Darvocet N-100
- Propoxyphene + Aceta
D. All of the above
E. None of the above
26. Which analgesic is an aniline derivative and is related to phenacetin?
A. Acetaminophen
B. Aspirin
C. Ibuprofen
D. Rofecoxib
27. Your patient is allergic to aspirin. Which of the following medications can be taken for pain?
1. Percodan
- aspirin + oxydone
2. Darvon
3. Darvon Compound
4. Vicodin
A.
B.
C.
D.
- Aceta + Hydrocodone
1, 2, and 3
1 and 3
2 and 4
4 only
28. The usual adult dosage of codeine administered orally is
A. 500-1000mg.
B. 250-500mg.
C. 30-60mg.
D. 2-5mg.
E. None of the above.
29. Hyperventilation in an anxious dental patient leads to
A. amnesia
B. acidosis
C. cyanosis
D. elevated pCO2
E. carpopedal spasm
( This is Lumi’s groups answer)
30. In which way can a patient be best protected from the toxic aspects of a local anesthetic?
A. have oxygen available
B. use an aspirating syringe and technique and inject slowly
C. take a thorough medical history
D. pre-treat with a barbiturate PO or IM
E. use a solution with an epinephrine concentration greater than 1:50,000 to delay absorption
31. A patient has a pulse rate of 72, a respiratory rate of 15, a BP of 120/80, warm pink extremities and pupils that constrict during
near accommodation. What is the most likely diagnosis?
A. Myopia
B. Diabetes
C. Normal patient
D. Acute anxiety syndrome
E. Coronary artery disease
32. The patient reports to you uncontrollable nausea and vomiting the next day. Every time he drinks anything (including water) he
is stricken with severe retching and vomiting immediately. He has been up most of the night with this recurrent problem, and
now is in severe pain because of inability to take his pain medications. What is your plan?
A. Suppository Valium
B. Suppository Phenergan
C. Suppository Versed
D. Suppository acetaminophen
E. Suppository fentanyl (Sublimaze)
33. Under equal conditions (of operator experience), both the Akinosi and Gow-Gates injections are more effective than the
traditional inferior alveolar block.
A. True
B. False
34. The external landmarks of the Gow-Gates injection are the
1. Pinna of the ear
2. External auditory meatus
3. Corner of the mouth
4. Canthus
5. Height of the maxilla
A.
B.
C.
D.
E.
1 and 3
2 and 3
2 and 4
2 and 5
1 and 5
35. Which of the following is not a neurotransmitter substance released by nerve cells at the time of impulse transmission?
A. GABA
B. Dopamine
C. Acetylcholine
D. Norepinephrine
E. Succinylcholine
36. Which of the following local anesthetics are examples of ESTER-type linkages? (Hint: These are generic names)
1. Procaine
2. 3-chlorprocaine
3. Benzocaine
4. Pontocaine
A.
B.
C.
D.
E.
1 and 3
1, 2, 3
2 and 4
4 only
All the above
37. A absolute contraindication to nitrous oxide may be:
1. History of drug use
2. Complete bilateral nasal obstruction
3. Claustrophobia
4. Active (painful) middle ear infection
A.
B.
C.
D.
E.
1, 2, 3
1 and 3
2 and 4
4 only
All the above
- Claustrophobia & history of drug use is not an absolute contraindication LR
38. You are asked to sedate a patient for your classmate who is going to perform full mouth extractions and insertion of an
immediate denture. The patient is a 42-year-old male with a history of hypertension controlled with a diuretics and a betablocker. What is the most common potential complication from sedation that might arise in this patient?
A. Allergic reaction
B. Hypotension
C. Hypertension
D. Tachycardia
E. Trismus
39. A patient that is allergic to pencillin and needs antibiotic prophylaxis is BEST treated with:
1. Amoxicillin
2. Cephalexin
3. Doxycycline
4. Clindamycin
A.
B.
C.
D.
E.
1 and 3
1, 2, 3
2 and 4
4 only
All the above
40. A 6-year-old child undergoes several pulpotomies and SSC crowns. How much Tylenol with codeine elixir (120 mg
acetaminophen and 12 mg codeine per teaspoon) would you give every 6 hours? The child weighs 50 pounds and you would like
to give the equivalent of two Tylenol #3 tablets every 6 hours. You will have to choose the amount that is CLOSEST to the
calculated amount.
A. ½ teaspoon
B. 1 teaspoon
C. 1 ½ teaspoons
D. 2 teaspoons
E. 2 ½ teaspoons
41. A 10-year-old child undergoes several extractions and pulpotomies with SSC crowns. How much Tylenol with codeine elixir
(120 mg acetaminophen and 12 mg codeine per teaspoon) would you give every 6 hours? The child weighs 75 pounds and you
would like to give the equivalent of two Tylenol #3 tablets every 6 hours. You will have to choose the amount that is CLOSEST
to the calculated amount.
A. ½ teaspoon
B. 1 teaspoon
C. 1 ½ teaspoons
D. 2 teaspoons
E. 2 ½ teaspoons
42. Each of the following drugs has a significant anti-inflammatory property EXCEPT
A. Aspirin
B. Cortisol
C. Acetaminophen
D. Ibuprofen (Motrin)
E. Indomethacin (Indocin)
43. Nitrous oxide exerts its deleterious chronic effect by altering
A. Steroid metabolism
B. Glucose synthetase
C. Methionine synthetase WILL NOT BE ON EXAM
D. Gate control of pain
E. Release of acetylcholine
44. Which of the following drugs has anti-pyretic properties (lowers elevated temperature)?
A. Acetaminophen
B. Aspirin
C. Ibuprofen (Motrin)
D. All of the above
45. A dentist administers 5.4 ml of a 2% solution of lidocaine. How many mg of lidocaine did the patient receive?
A. 36
B. 54
C. 72
D. 108
E. 144
46. Diazepam (Valium) and midazolam (Versed) are both examples of what class of drugs?
A. Ultrashort barbiturate
B. Intermediate barbiturate
C. Benzodiazepine
D. Neuroleptic
E. Inhalational
47. An unusual property of nitrous oxide is that it consistently will make an uncooperative patient cooperative at typical levels (3350%).
A. True WILL NOT BE ON EXAM
B. False
48. One example of airway complications during general anesthesia is a laryngospasm, which is a reflex spasm of the vocal cords.
A. True
B. False
49. You are doing the Jorgensen technique (conscious sedation) for your patient before removing an impacted molar. You use 50
mg of pentobarbital (Nembutal). How much Demerol is used?
A. 5 mg
B. 10 mg
C. 12.5 mg
WILL NOT BE ON EXAM
D. 18.75 mg
E. 25 mg
50. You are doing the Jorgensen technique (conscious sedation) for your patient before removing an impacted molar. You use 200
mg of pentobarbital (Nembutal). How much Demerol is used?
A.
B.
C.
D.
E.
5 mg
10 mg
WILL NOT BE ON EXAM
12.5 mg
18.75 mg
25 mg
51. Localized histamine release following IV sedation is usually attributed to which of the following drugs?
A. Demerol
B. Pentobarbital (Nembutal)
C. Scopolamine
D. Valium
E. Versed
52. If you observe histamine release following IV sedation, the treatment most often necessary is:
A. Call 911 immediately
B. Administer IV epinephrine
C. Administer IV epinephrine and benadryl
WILL NOT BE ON EXAM
D. Observe the patient for further signs and treat only if necessary
53. Barbiturates are the best choice for oral sedation because they can be reversed in the event of an overdosage.
A. True
B. False
54. NIOSH issued nitrous oxide recommendations in 1977 (and reconfirmed them in 1995). What is the maximum allowable dental
office level of nitrous oxide (time-weighted average over 8 hours)?
A. 25 ppm
B. 50 ppm
WILL NOT BE ON EXAM
C. 100 ppm
D. 400 ppm
55. Which of the following is an ominous sign of that a patient may NOT be able to physically tolerate dental treatment?
A. The patient has had stable, daily angina for 5 years.
B. The patient was recently changed from an oral hypoglycemic drug to insulin.
C. The patient is unable to complete physical tasks that he/she could recently perform.
D. The patient has mitral valve prolapse WITH regurgitation.
56. You are doing the Jorgensen technique (conscious sedation) for your patient before removing an impacted molar. You use 100
mg of pentobarbital (Nembutal). How much Demerol is used?
A. 5 mg
B. 10 mg
C. 12.5 mg
WILL NOT BE ON EXAM
D. 25 mg
E. 50 mg
57. What one physical characteristic about a patient is the most important factor when performing a risk assessment for dental
treatment?
A. The patient has to rest during activities that he/she was able to perform (without rest) in the recent past
B. The patient smokes
C. The patient drinks alcohol daily
D. The patient is allergic to “novocaine”
E. The patient has chronic, stable angina pectoris
58. Which of the following patients has the best prognosis for successful dental treatment (based upon their health history)?
A. A patient with blood pressure of 205/125 (treated).
B. A patient that had an MI 5 ½ months ago but now is able to exercise daily, takes no medications, and has no restrictions.
C. A patient that had an MI 7 months ago who now has daily angina and severely limited exercise tolerance.
D. A patient who has to rest once or twice (for 1-2 minutes each time) while climbing a flight of stairs.
E. A patient that has angina at rest.
59. A dentist administers 5.4 ml of a 0.5% solution of local anesthetic. How many mg did the patient receive?
A. 18
B. 27
C. 36
D. 45
E. 54
60. Both of the current COX-2 inhibitor (Celebrex and Vioxx) analgesics are indicated for acute pain. True or False
A. True
B. False
61. Meperidine has a possible fatal interaction with which of the following medication classes?
A. Selective serotonin reuptake inhibitors
B. Monoamine oxidase inhibitors
C. Beta blockers
D. Macrolide antibiotics
62. Vasoconstrictors retard absorption of local anesthetic by
A. Alpha adrenergic stimulation
B. Alpha adrenergic inhibition
C. Beta adrenergic stimulation
D. Beta adrenergic inhibition
63. Bronchodilation is a response to stimulation of which of the following receptors?
A. Alpha 1
B. Alpha 2
C. Beta 1
D. Beta 2
64. Tinnitus is not a sign of toxicity with which of the following analgesics?
A. Aspirin
B. Acetaminophen
C. Ibuprofen
D. Naproxyn
65. Thrombophlebitis, which occurs after intravenous administration of diazepam, is usually attributed to which of the following
substances in the mixture?
A. Benzoic acid
B. Ethyl alcohol
C. Propylene glycol
D. Sodium meta-bisulfite
66. How many mg/cc is in epinephrine 1:1,000?
A. 0.01 mg/cc
B. 0.1 mg/cc
C. 1 mg/cc
D. 10 mg/cc
67. A patient was administered a flow rate of 4 liters of oxygen and 2 liters of nitrous oxide. What percentage of nitrous oxide did
the patient inhale?
A. 25%
B. 33%
WILL NOT BE ON EXAM
C. 50%
D. 66%
68. How many mg/cc is in 50% Dextrose?
A. 0.5 mg/cc
B. 5 mg/cc
C. 50 mg/cc
D. 500 mg/cc
69. Which of the following drugs does NOT contain Acetaminophen?
A. Fioricet
B. Percocet
C. Darvocet N-100
D. Fiorinal
70. Insulin shock can occur when a patient's blood sugar is raised to abnormal heights (to more than 360 mg/dl) by an insulin
overdose or skipping a meal after taking insulin.
A. True
B. False
71. In general, what is the amount of the SBE prophylaxis dose that is taken six hours after the first dose?
A. Double the initial dose.
B. The same as the initial dose.
C. ½ of the initial dose
D. ¼ of the initial dose
E. None of the above
72. After receiving an inferior alveolar block using a long 25 gauge needle the patient develops paralysis of some of the facial
muscles. This is most probably related to diffusion of the anesthetic solution into the:
A. Otic ganglion
B. Medial and/or lateral pterygoid muscles
C. Motor branches of the mandibular nerve supplying the masticatory muscles
D. Parotid gland
E. Submandibular parasympathetic ganglion
73. Liver disease least affects the biotransformation of which of the following local anesthetics?
1. Chloroprocaine
2. Bupivacaine
3. Propoxycaine
4. Etidocaine
A.
B.
C.
D.
E.
1 and 3
1, 2, 3
2 and 4
4 only
All the above
74. Novocaine is:
1. The generic name of an ester local anesthetic. (This should say commercial, I spoke with Dr. Leyman about it)
2. No longer available as a commercial dental local anesthetic.
3. Is relatively allergenic compared to lidocaine.
4. Is the proprietary name of an amide local anesthetic.
A.
B.
C.
D.
E.
1, 2, 3
1 and 3
2 and 4
4 only
All the above
75. If the maximum recommended dose of lidocaine is given, how long must the dentist wait before giving another dose that is ½ the
maximum recommended dose?
A. 1 hour
B. 2 hours
C. 3 hours
D. 4 hours
76. What is the injectable local anesthetic that can cause methemoglobinemia?
A. Lidocaine
B. Mepivacaine
C. Articaine
D. Prilocaine
77. The following statement(s) are true regarding articaine (Septocaine):
1. The most recent local anesthetic added in the USA.
2. It is a 4% solution with 1:100,000 epinephrine.
3. It causes double the incidence of mandibular nerve paresthesias compared to lidocaine.
4. It has both an amide and ester chemical linkage.
A. 1, 2, 3
B. 1 and 3
C. 2 and 4
D. 4 only
E. All the above
78. What is the maximum recommended dose of 2% lidocaine (plain) that can be administered to a 10-kg child?
A. 25 mg
B. 30 mg
C. 35 mg
D. 40 mg
E. 45 mg
79. What is the maximum recommended dose of 2% lidocaine with 1:000,000 epinephrine that can be administered to a 10-kg child?
A. 40 mg
B. 45 mg
C. 50 mg
D. 60 mg
E. 70 mg
80. Which of the following NSAID's may be given by IM injection?
A. Aspirin
B. Tylenol
C. Ketorolac
D. Ibuprofen
81. If a patient is allergic to penicillin, which of the following antibiotics could be SAFELY used to premedicate your patient with
mitral valve prolapse?
1. Cleocin (clindamycin)
2. Zithromaz (azithromycin)
3. Biaxin (clarithromycin)
4. Keflex (cephalexin)
A.
B.
C.
D.
E.
1, 2, and 3
1 and 3
2 and 44
4 only
All the above
82. Which of the following inhibit platelet aggregation REVERSIBLY?
A. Aspirin
B. Ibuprofen
C. Codeine
D. Acetaminophen
83. What dose of ibuprofen gives the maximum ANALGESIA for the “average” adult patient? (Hint: You can give more than this
dose, but you do not get any more effect).
A. 200 mg
B. 400 mg
C. 600 mg
D. 800 mg
84. What dose of ibuprofen gives the maximum ANTI-INFLAMMATORY effect for the “average” adult patient? (Hint: You can
give more than this dose, but you do not get any more effect).
A. 200 mg
B. 400 mg
C. 600 mg
D. 800 mg