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Final Questions DH 163 1. Predisposing factors for local anesthetic overdose include age, weight, other drugs, sex, genetics mental attitude, environment and presence of disease. All the following are true except: A. Disease may affect the ability of the body to biotransform a drug. B. Genetic deficiencies may alter a patient’s response to certain drugs. C. Men have been shown to have a greater predisposition to local anesthetic overdose. D. A patient’s psychological attitude influences the effect of a drug. E. The old and the young are more likely to be effected by anesthetic overdose. 2. Which of the following is not a cause of anesthetic overdose? A. B. C. D. Rapid IV injection Excessive amount Rapid absorption Fast biotransformation 3. No drug ever exerts a single action. With specific drugs the ideal clinical situation is attained with most patients. A. B. C. D. The first statement is false. The second statement is false The first statement is true. The second statement is true. The first statement is true. The second statement is false. The first statement is false. The second statement is true. 4. If the needle breaks during an injection you should…. A. B. C. D. Remove your hand from the patient’s mouth. Don’t chart the incident because if it’s not charted then it didn’t happen. Remove visible fragment with the hemostat. None of the above 5. True or False The rate at which you inject the drug isn’t that important except for patient comfort. 6. Signs of a severe allergic reaction include: a. rhinitis b. bronchospasms c. urticaria d. tearing of the eyes 7. What are the predisposing patient factors for local anesthetic overdose? 8. What is the function of the vasoconstrictor in the anesthetic solution? A. Antioxidant B. Conduction blockade C. Isotonicity of solution D. Preserve and increase shelf life E. Decrease absorption of local anesthetic into the blood 9. T/F Allergy to epinephrine cannot occur in a living person. 10. Nerve block in the presence of tissue inflammation can be obtained by: A. B. C. D. Administration of the local anesthetic away from the inflammation. Delaying treatment until inflammation subsides. Deposit a larger volume of anesthetic into the region. Changing to a stronger anesthetic. 11. Which of the following statements is incorrect: In Washington State, Dental Hygienist’s A. must have direct supervision from a dentist. B. have general supervision from a dentist. C. are allowed to administer block injections. D. are allowed to administer infiltration injection 12. Primary indications for the PDL injection include: 1. 2. 3. 4. 5. 6. The need for anesthesia of but one or two mandibular teeth in a quadrant Treatment of isolated teeth in both mandibular quadrants Treatment of children Treatment in which nerve block anesthesia is contraindicated Its use as a possible aid in the diagnosis To produce extensive soft tissue anesthesia A. B. C. D. E. 1, 2, and 4 1, 2, 4, 5, and 6 1, 2, 3,4, and 5 All of the above 2, 3, 4, and 5 13. Which injection is not recommended for use on the primary teeth of children because of the possibility of the development of enamel hypoplasia in the developing permanent tooth? A. B. C. D. E. Posterior superior alveolar nerve block Gow-Gates mandibular nerve block Greater palatine nerve block Incisive nerve block PDL injection 14. What complications may arise from the rapid administration of local anesthetic? A. Pain during the injection B. A serious overdose reaction C. Clinical manifestations of toxicity. D. Postanesthetic pain caused by tissue trauma during the injection E. All of the above. 15. What duration of pulpal anesthesia may be expected with a vasoconstrictor-containing local anesthetic? A. 15 min B. 30 min C. 45 min D. 60 min 16. Which nerve block is not necessary in children? a. ASA b. MSA c. PSA d. GP 17. What are the two primary methods of obtaining adequate nerve block anesthesia in the presence of tissue inflammation? 18. An advantage to the Gow Gates injection is the patient is able to immediately close their mouth, relaxing their jaw because this injection has a rapid onset. a. b. c. d. First statement is true but second statement is incorrect and not related. First statement is false but second statement is true and not related First and second statements are false and not related Both statements are true. 19. 1. True or False: Local anesthetics are more toxic in children than in adults. 20. Your pat. claims an allergy to anesthetic. Their last encounter with an anesthetic was about 20 years ago, and they can’t recall what was used. Should You: A) Assume they are allergic to esters, since it was likely used then and proceed using the amides, since it is unlikely to cause an allergic reaction? B) Postpone Tx until they find out C) Continue MHx questioning, consult with their physician and possibly postpone tx w/ anesthetic. 21. Which of the following are predisposing factors for drug overdose. A. Age B. Weight C. Other Meds D. Sex E. All of the above 22. Causes of anesthetic overdose include all of the following except: A. excessive amount of anesthetic B. No vasoconstrictor C. Slow biotransformation D. Administering I cart of anesthetic in 1 min E. Administering 1 cart of anesthetic in 1.5 – 2min. 23. All of the following are contraindications intraligamentary EXCEPT: A. Longer Duration B. Periodontal Involvement C. Super erupted teeth D. Infection E. Baby Teeth 24. True or False: Overdose reactions are the most common of all try adverse drug reactions, accounting for up to 99% in some estimates. 25. The Gow-Gates (GGMB) anesthetizes the Buccal, Mental, and Mylohyoid nerves, BECAUSE it innervates the entire V3. a) Both statements are true b) Both statements are false c) The first statement is true and second statement is false d) The first statement is false and the second statement is true 26. True or False It is necessary to make contact with bone in every technique used to anesthetize the IA? Answers: 1. Answer: C page 305-306 2. Answer D, Powerpoint Local anesthesia: systemic reactions. Slide 12 3. Answer: C. Malamed pg. 303 4. Answer: C, page 287 5. Answer: False, some believe that the rate of injection is the single most important factor. Because it is a major factor in determining whether drug administration will prove clinically safe or hazardous. Pg. 307 6. B it was found in the powerpoint for week 5/24 7. Answer: Age Weight Other medications Sex Presence of disease Genetics Mental attitude and environment 8. Answer: E. Decrease absorption of local anesthetic into the blood: Malamed - pg. 320 (Table 18-10) 9. *T (pg. 320) 10. Answer: A & C, page 269 Malamed 11. You will have to look this one up. 12. Answer: C pg. 256 Malamed 13. Answer: E. PDL injection Malamed pg. 274-5 14. Answer: “E” from S. Malamed Ch.16 on pg. 277. 15. Answer: “B” from S. Malamed Ch.15 on pg. 266. 16. p. 274 17. Answer: 1. 2. Administer the local anesthetic away from the area of inflammation. Deposit a larger volume of anesthetic into the region. Malamed page 269 18. Answer: C page 4 of Supplemental Injection Techniques PPT, under disadvantages of the GOW GATES 19. False pg. 272 20. C 21. E 22. D. pg 2 powerpoint “local anesthesia: systemic reaction” and pg 3 of “techniques/cardinal rules” Don’t administer anesthetic too fast! 23. C page 1 power point “supplemental injection techniquest” 24. B) True Malamed page 305 25. A) Jill’s powerpoint for 5-31-07 slide 11 26. False: The AMB does not require contact with bone.