Oral Sedation--nitrous/Local Pre-test Indicate your answer by highlighting, bold, or underlining. Review Test – Summer 2012 Please complete and email to



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Oral Sedation--Nitrous/Local Pre-test Indicate your answer by highlighting, bold, or underlining.
Review Test – Summer 2012 Please complete and email to
info@lsucde.org, or you
Benjamin Record, DDS can fax a printed copy to 504-941-8403.


Name & contact (ph or email): .

1. The most common form of local anesthetics used today are of the

a. Ester based compounds

b. Combination of esters & amides

c. Amide salts dissolved in sterile water

d. Neither


2. Local anesthetics, a CNS depressant, are injected locally at site of desired anesthesia, but they will

never cause CNS depression if given above the MRD (in most patients).

a. Both statements are TRUE

b. Both statements are FALSE

c. First statement is TRUE; Second Statement is False

d. First Statement is FALSE; Second Statement is TRUE

3. Tertiary amine local anesthetics (lidocaine, articaine, etc) interact with specific receptors

a. On the outside of the Na+(sodium channels)

b. On the inside of the Na+(sodium channels)

c. By “activation of the Na+ channels causing them to “close”

d. By “deactivation” of the Na+ channels causing them to “close”

e. Only on the K+ (potassium) channels

4. Local anesthetics stop the action potential by increasing the permeability of Na+ through the channels.

a. True

b. False

5. Which of the following properties of local anesthetics increase onset of action (faster anesthesia)?

a. Lipid insolubility

b. Lipid solubility

c. Higher pKa of LA salt compared to physiological pH

d. Determined by the David Hasselhoff equation

6. After dissociation, which form of the local anesthetic blocks the sodium channel?

a. Base form

b. Cationic form

c. Salt form

d. Local anesthetics don’t dissociate

7. Aspiration prior to injection of local anesthetic solutions with vasoconstrictor is important to avoid:

a. Overdose of vasoconstrictor because of intravascular injection

b. Overdose of local anesthetic because of intravascular injection

c. Allergic reaction to the local anesthetic because of intravascular injection

d. All of the above

8. An infected tooth with an obvious abscess (i.e. intraoral swelling) is more difficult to anesthetize due to:



  1. Decreased pH in tissues resulting in less cationic (RNH+) form of local anesthetic salt in

extracellular fluid and less of the base (RN) form

  1. Increased pH in tissues resulting in less cationic (RNH+) form of local anesthetic salt in

extracellular fluid and more of the base (RN) form

  1. Decreased pH in tissues resulting in more cationic (RNH+) form of local anesthetic salt in

extracellular fluid and less of the base (RN) form

  1. Increased pH in tissues resulting in more cationic (RNH+) form of local anesthetic salt in

extracellular fluid and more of the base (RN) form

9. A second injection (e.g. inferior alveolar block) into the same area is sometimes unsuccessful if given

2-3 hours after the initial injection due to:

a. Transudation

b. Edema

c. Tachyphylaxis

d. Hyponatremia

e. All the above

f. None of the above

g. A, B, C only

h. A, C, D only

i. A only


10. Administration of local anesthetic above the MRD for a typical patient can result in a mild overdose

and have the one or more following reactions



a. Talkativeness

b. Overall “nervousness” and muscle

twitching

c. Decreased heart rate

d. Increased heart rate

e. Clear speech

f. B, C, E

g. A, B, C

h. A, B, D, E

i. A, B, D



11. A “moderate overdose” of a typical patient may result in one or more of the following

a. Seizures

b. Loss of Consciousness

c. Decreased blood pressure

d. Patient begins to decompensate (“bottom falls out”)

e. All the above

12. Treatment of an local anesthetic overdose includes all the following except

a. Administration of Oxygen (positive pressure)

b. Continue with treatment and tell patient to wait it out

c. Calm patient and allow for recovery due to drug metabolism

d. Call EMS if patient begins to decompensate

13. To avoid an OD during a long sedation appointment it is best to use the following except:

a. Knowing the anatomy of injection site

b. Use the same number of carpules (adult or child) for each patient and hope it works

c. Aspirate during every injection

d. Calculate the proper dosage per drug used per patient (by knowing weight of children too)

14. Proper planning involves the following key rules when determining the maximum amount of local
to be used:

a. Use 150lbs as maximum weight for every adult (and weigh children)

b. Use 2mg/lb as a ‘good rule of thumb’ for your local anesthetics

c. Limit ASA III patients to 2 carpules of local in most cases

d. Communicate with staff the planned maximum amount and only set that amount on tray to begin

e. All the above

15. Which one below is not a reason that we add vasoconstrictors to the local anesthetic?

a. Increase the duration

b. Increase the absorption rate

c. Decrease the toxicity

d. Decrease the bleeding

e. All of the above

16. Non-selective beta-blockers are of concern in regard to local anesthesia with vasoconstrictor because:

a. It will increase dysrhythmias

b. They do not cause a significant problem

c. It may cause the blood pressure to increase greatly

d. It will counteract the vasoconstrictor actions

17. A 1.8 ml cartridge of 3% Mepivacaine has how many milligrams of local anesthetic?

a. 20

b. 72


c. 36

d. 54


18. A 1.8 ml cartridge of 4% articaine has how many milligrams of local anesthetic?

a. 34


b. 54

c. 72


d. 9

19. According to the manufacturer, the MRD for articaine is 3.2mg/lb. For a child weighing 55lbs, what is the

total # of 1.8 ml carpules of articaine you could potentially use? (4% 1:100,000 epi)

a. 1


b. 1.5

c. 2


d. 2.5

e. 3


f. 3.5

20. What is the approximate amount of time that it takes for nitrous oxide to reach the brain?

a. 3-5 minutes

b. 20 seconds

c. 1 minute

d. 10 minutes

21. What is not an advantage of nitrous oxide?

a. Rapid Onset

b. Titration

c. Sedation level easily changed up or down

d. Rapid recovery

e. All of above are advantages of nitrous oxide

22. What is not an indication for nitrous oxide in current times?

a. Analgesia

b. Fear and anxiety

c. Behavior control

d. Gagging

e. All of the above are indications for nitrous oxide

23. What is the most dangerous impurity that can be present in nitrous oxide?

a. Water vapor

b. Nitric acid

c. Nitric oxide

d. Oil and grease

e. Carbon monoxide

24. Which one below is not a physical characteristic of nitrous oxide?

a. Colorless

b. Inorganic

c. Odorless

d. Non Flammable

e. All are physical characteristics of nitrous oxide

25. Nitrous oxide is metabolized in the lung.

a. True


b. False

26. Which one below is not a physical characteristic of oxygen?

a. Colorless

b. Odorless

c. Non Flammable

d. Stored in green cylinders in U.S

e. All above are physical characteristics of oxygen

27. Ambient room air has approximately which percentage of oxygen?

a. 27%

b. 33%


c. 19%

d. 21%


28. You must always wait at least 1 minute after each change in the nitrous oxide level when titrating.

a. True


b. False

29. Which one below is not an early sign or symptom of nitrous oxide administration?

a. Light-headedness

b. Tingling sensation of arms and legs

c. Feeling of warmth and flushing

d. Vivid dreams

e. All of the above are early signs or symptoms of nitrous oxide administration

30. Which one below is not a sign of oversedation of nitrous oxide?

a. Persistent closing of mouth

b. Nausea

c. Excessive laughing or crying

d. Lightheadedness

e. All of the above are signs of oversedation

31. I would prefer more “self-taught” CE like this for review subjects prior to sedation classes, so we

could focus more on new material.

a. Yes


b. No

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