Department of Oral and Maxillofacial Surgery: Goverment Dental College & Hospital, Ahmedabad

DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY
GOVERMENT DENTAL COLLEGE &
HOSPITAL, AHMEDABAD.
LOCAL ANESTHESIA
Presented by :Aayushi Thayani

Falguni Thakkar
Que -1. In peripheral nerve block, which of the following local anesthetics
has the longest duration of action ?
A. Bupivacaine
B. Cocaine
C. Lignocaine
D. Prilocaine
Ans :- A
Exp :- Bupivacaine and Etidocaine are long acting anesthetics with a

duration of action of about 180 minutes or even longer and this
is due to their increased protein binding property.
(Ref. :- Textbook of Oral & Maxillofacial Surg ery, Monheims 7th
edition Page No.132, 157 )
Que :-2. Which of the following is not a theory for local

anesthetics action ?
A.
B.
C.
D.
E.
Membrane expansion theory

Calcium displacement theory
Electrical potential theory
Specific receptor theory
None of the above
Ans :- E
Exp :- Refer synopsis
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Malameds 5th
edition Page No.12, 13 )
Que :-3. In the extraoral technique for mandibular nerve block

the needle after contacting the pterygoid plate is directed ?
A. Anteriorly
B. B. Posteriorly
C. Superiorly
D. Inferiorly
Ans :- B
Exp :- In extra oral technique for mandibular nerve block , the needle
is inserted from below the zygomatic arch and is directed
posterior to the lateal pterygoid plate below the foramen
ovale.
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th
edition Page No.119, 120 , Vinod Kapoors 2nd edition Page
No. 486)
Que :- 4. Which of the following is the preferred local anesthetic
technique for hemophilics ?
A.
B.
C.
D.
Nerve Block
Supraperiosteal
Intraligamentary
Field block
Ans :- C
Exp :- In hemophilics to avoid complications INTRALIGAMENTARY
method of local infiltration technique is preferred. In this technique, the
solution is deposited in depth of gingival sulcus. The needle should be
inserted apically into the bone until resistance is met.
3
edition Page No. 256 )
Que :- 5. Of the following local anesthetics, which has intrinsic

vasoconstrictive action ?
A.
B.
C.
D.
Cocaine
Procaine
Xylocaine
Bupivacaine
Ans :- A
Exp :- All local anaesthetics except cocaine are synthetic compounds and they
are vasodilating in nature. Cocaine is a natural anaesthetic agent and
causes local vasoconstriction.
edition Page No. 36)
Que :- 6. It is difficult to obtain local infiltration anesthesia in the
presence of inflammation because of ?
A.
B.
C.
D.
a decreased PH
Increased vascularity
Oedema
Pain
Ans :- A
Exp :- The reaction occurring in the submucosa at normal tissue pH is
RNH+
RN + H+
edition Page No. 130 , Vinod Kapoors 2nd edition Page
No. 458)
Que :- 7. Which of the following symptoms is seen in a patient

administered with 20 40 % nitrous oxide ?
A.
B.
C.
D.
Paresthesia
Floating sensation
Sweating
None of the above
Ans :- B
Exp :5 25 % N2O causes
25 45% N2O causes
45 65% N2O
Moderate sedation .
Diminution of fear and anxiety.
Marked relaxation .
Dissociation sedation and analgesia.
Floating sensation .
Reducing blink rate .
Euphoric state ( Laughing gas )
Total anaesthesia .
Analgesia is complete .
Marked amnesia .
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Shobha Tandons 1st

Que :- 8. Alpha adrenergic agonists are used in combination with local
anesthetics to ?
A.
B.
C.
D.
Increase the rate of liver metabolism of local anesthetic

Increase the concentration of L.A. at receptor site
Stimulate myocardial contraction
Increases vascular absorption of L.A.
Ans :- B
Exp :- Adrenaline is the most potent and commonly used alpha adrenergic
5
agonist or vasoconstrictor. In small doses it causes vasoconstriction of

arterioles in the immediate area of injection.
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th edition
Page No.172, Vinod Kapoors 2nd edition Page No. 462)
Que :- 9. Action of toxic doses of Local anesthesia on CNS can be
described as ?
A.
B.
C.
D.
First stimulating the CNS followed by depression

First depressing it followed by CNS stimulation
Only depression of the CNS
Only stimulation of the CNS
Ans :- A
edition Page No. 215, Vinod Kapoors 2nd edition Page
No. 462)
Que :- 10. To give field block the LA should be deposited near ?
A.
B.
C.
D.
Main trunk
Large branch of peripheral nerve
Small nerve endings
Periodontal ligament
Ans :- B
Exp :Nerve block
Field block
Infiltration
L.A. is deposited near main trunk

L.A. is deposited near large branch of peripheral nerve
L.A. is deposited near small nerve endings.

No. 468)
Que :- 11. Most accepted theory for conduction of pain is ?

A.
B.
C.
D.
Gate control theory

Specifity theory
Membrane stabilization theory
None of the above
Ans :- A
Exp :- Gate control theory was proposed by MELZACK and WALL
( AIIMS 2012) in 1965.
No. 457,459)
Que :-12. In anesthetizing lower anteriors all of the following are
indicated Except ?
A.
B.
C.
D.
Fischer 123 technique

Classical inferior alveolar block
Mental nerve block
Incisive block
Ans :- C
Exp :- the mental nerve passes through the mental foramen on the lateral
surface of mandible and is sensory to lower lip and skin of chin. During
mental nerve block, the L.A. solution is developed anterior to apex of
the bicuspsid near mental foramen.
No. 457,483)
Que :-13. Action of lignocaine is affected by all except ?

A.
B.
C.
D.
PH at the site of injection

Blood flow at the site of injection
Vasoconstrictor in the L.A. solution
Action of cholinesterase at the site of injection
Ans :- D
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Vinod Kapoors 2nd edition
Page No. 460, 461)
Que :- 14. Which of the following about syncope is false ?
A.
B.
C.
D.
Another term for fainting

Is transient reversible loss of consciousness
Caused by altered circulation
None of the above
Ans :- D
No. 488)
Que :- 15. The addition of hyaluronidase to a local anesthetic solution
might ?
A.
B.
C.
D.
Increase the duration of anesthesia

Limit the area of anesthesia
Reduce bleeding
Enhance diffusion of local anesthetic
Ans :- D
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Vinod Kapoors 2nd
8
Que :- 16. The effect of local anesthetic can be increased by the addition
of ?
A.
B.
C.
D.
Adrenaline
Isoprenaline
Dopamine
Felypressin ( synthetic vasopressin )
Ans :- A
Exp :- Epinephrine stimulates both a and b receptors. In small doses it causes
vaso constriction and thus it increases the efficiency of local
anaesthetic agent.
No. 463)
Que :- 17. Amide type of local anesthetics agents undergo bio
transformation primarily in the ?
A.
B.
C.
D.
Kidney
Liver
Plasma
Excreted in unaltered form
Ans :- B
Exp :- the amide type of L.A. undergoes biotrans formation primarily in the
liver by microsomal enzymes.
No. 461)
Que :- 18. The maximum dose of lignocaine without adrenaline thet can
be admitted to a patient is ?
A.
B.
C.
D.
4
5
7
9
Mg / Kg body wt
Mg / Kg body wt
Mg / Kg body wt
Mg / Kg body wt
Ans :- A
Exp :- Without vasoconstrictor the maximum acceptable dose is 4.4 mg / kg
body weight and not to exceed 300mg.
Que :- 19. The amount of vasoconstrictor in 1 ml of 2% Lignocaine
solution with 1:2,00,000 adrenaline is :
A.
B.
C.
D.
0.5 mg
0.05 mg
0.005 mg
0.0005 mg
Ans :- C
Exp :- A solution that contain 1: 200000 epinephrine me 1000 mg. In 200000
ml. Of solution.
1: 200000 = 1000mg. / 200000 ml.
= 1 mg. / 200 ml.
= 0.005 mg. / ml.
10
No. 464)
Que :- 20. Inferior alveolar nerve block alone can be used in :

A.
B.
C.
D.
Pulpotomy of 3rd molar

Apicoectomy of 3rd molar
Extraction of 1st molar
Root resection of 1st molar
Ans :- A
Exp :- For options B,C,D, inferior alveolar block should be accompanied
by long buccal nerve to anaesthetize the buccal mucosa of the
mandibular molars.
No. 481)
Que :- 21. Which of the following muscles is pierced by the needle while
giving an inferior alveolar nerve block ?
A. Medical pterygoid
B. Superior constrictor
C. Temporalis
D. Buccinators
Ans :- D
Que :- 22. A bilateral mandibular block :
A.
B.
C.
D.
Is dangerous because patient may swallow tongue

Will lead to space infection
Is not contraindicated
Should rarely be performed
Ans :- C
11
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Malamed s 5th

Que :- 23. The longest acting, most potent and most toxic LA is :
A.
B.
C.
D.
Lidocaine
Dibucaine
Bupivacaine
Tetracaine
Ans :- B
Exp :- Dibucaine is amide type of local anesthetic agent. It is used as a surface
anesthetics on delicate mucous membranes such as anal canal and
occasionally for spinal anesthesia .
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Tripathis 5th
Que :-24. For extraction of mandibular molar, anesthesia is given to act
on :
A.
B.
C.
D.
Inferior alveolar nerve

Buccal nerve
Lingual nerve
Masseteric nerve
Ans :- A
No. 481)
Que :- 25. Among the following, which condition is a contraindication to
the use of local anesthetic agent ?
A. Parkinsons disease
B. Liver damage
C. Pregnancy (3rd trimester )
D. Hypersensitivity to the drug
Ans :- D
12

No. 465)
Que :-26. Inferior alveolar nerve block is absolutely contraindicated in
patients suffering from one of the following diseases :
A.
B.
C.
D.
Thrombocytopenia
Hemophilia
Hypoprothrombinemia
Von willebrands disease
Ans :- B
Exp :- Field Blocks and nerve blocks are contraindicated in haemophilic
patients. Inferior alveolar nerve block and posterior alveolar nerve blocks
should be administered only after replacement therapy of factor VIII,
because of possibility of dissecting hematoma. Intraligamentary
injection technique is the preferred one.
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Neelima Maliks 2nd
Que :- 27. Myelinated nerve fibres have all of the following properties
except :
A.
B.
C.
D.
Conduction is slower in myelinated than in non myelinated fibres

Current discharges at nodes of Ranvier
Outer layer is of lipids
Depolarisation occurs only at nodes of ranvier
Ans :- A
Exp :- Conduction is faster in the myelinated nerves than in unmyelinated
fibres. The effect in myelinated nerves is at the nodes of Ranvier as
the LA do not penetrate the myelin sheath.
No. 462)
13
Que :- 28. Each of the following side effects can occur as a result of
systemic absorption of lidocaine except one. Which one of of
this is exception :
A.
B.
C.
D.
Increased gastric motility

Tonic clonic convulsions
Decreased cardiak output
Respiratory depression
Ans :- A
No. 462, 489)
Que :- 29. Lidocaine is used more commonly in dentistry because
lidocaine :
A.
B.
C.
D.
Causes less depression of CNS

Causes less cardiovascular collapse
Causes lesser incidence of allergic reactions
Is 50 times more potent than procaine
Ans :- C
Page No. 464)
Que :- 30. Of the following in which condition local anesthesia is
ineffective ?
A. Edema
B. Localized infection
C. Hematoma
D. Anemia
Ans :- B
14
Exp :- In infected areas, a low tissue of PH is found. This will interfere with the
development of anaesthesia by preventing liberation of free base ( RN ).
Page No. 131, Vinod Kapoors 2nd edition Page No. 458)
Que :- 31. LA with adrenaline is absolutely contra indicated in :
A.
B.
C.
D.
First trimester of pregnancy

Hyperthyroidism
Hemophilia
Hypertension
Ans :- B
Exp :- 3% mepivacaine, lidocaine or prilocaine without vaso constrictor are
used in hyperthyroid patients.
No. 465)
Que :- 32. In systemic LA toxicity there is :
A.
B.
C.
D.
Post depression convulsion

Post convulsion depression
Convulsions
Depression
Ans :- B
Exp :- Most of the local anaesthetic agents produce stimulation followed by
depression of the CNS system. The signs and symptoms of stimulation
may vary from mild restlessness to severe convulsions. The stimulation
is usually followed by depression.
edition Page No. 129, 214, Vinod Kapoors 2nd edition Page
No. 489)
15
Que :- 33. Which of the following local anaesthetic will be suitable for a
hypertensive patient suffering from a heart disease ?
A.
B.
C.
D.
Lignocaine without adrenalin

Prilocaine
Lignocaine with adrenaline 1 : 1000
Prilocaine and felypressin
Ans :- A
No. 464, 491)
Que :- 34. Maximum dose of xylocaine with out adrenaline that can be
given in 60kg adults is ?
A.
B.
C.
D.
500 mg
300 mg
400 mg
600 mg
Ans :- B
Exp :- The maximum acceptable dose of lidocaine is 4.4 mg/kg. So a
maximum of 300 mg can be given in 60 kg adult.
Que :- 35. When blocking a nerve containing both motor and sensory
fibres, the last functional property lost is ?
A. Temperature
C.Proprioception
Ans :- C
B. Pain
D. Touch
Exp :- In local anaesthetics the loss of function will be in the following order
16
i.e., pain, temparature, touch, proprioception and skeletal muscle tone.

The return of sensation is in the reverse of preceding order.
Que :-36. Which of the following statements regarding the action of local
anesthetics is true ?
A. More the pH in an area less effective is the action of anesthetic agent
B. Less the pH of in an area, less effective is the action of an anesthetic
agent
C. There is little relation between H ion concentration and anesthetic
activity
D. There is no correlation between H ion concentration and anesthetic
activity.
Ans :- B
edition Page No. 130, 131 Vinod Kapoors 2nd edition Page
No. 458, 460)
Que :-37. Which of the following is true regarding local anesthesia ?
A.
B.
C.
D.
They are basic salts of weak acids

Not effective in alkaline pH
From salts with acids
They are acidic salts of weak bases
Ans :- D
No. 457)
Que :-38. Most difficult maxillary tooth to anaesthetize by infiltration is :
A.
B.
C.
D.
1st molar
1st premolar
Canine
3rd molar
17
Ans :- A
Exp :- This is due to thick zygomatic bone over the roots of maxillary first
molar.
Que :- 39. In case of Gow Gates technique the target area is :
A.
B.
C.
D.
Neck of condyle
Head of the condyle
Medial side of the ramus
Lateral side of the condyle
Ans :- A
Exp :- Both Gow gates techniques and akninosis technique are intra oral
techniques of mandibular anaesthesia.
Que :- 40. Improper direction of the needle insertion during inferior
alveolar nerve block results in ?
A.
B.
C.
D.
Facial nerve paralysis

Paraethesia
Hematoma
Trismus
Ans :- A
Exp :- if the needle is penetrated too deeply and too posteriorly, it may
penetrate the parotid capsule and this results in transient facial
paralysis due to facial nerve block .
Page No. 495)
Que :- 41. The closed mouth technique for mandibular nerve block is ?
A.
B.
C.
D.
Clark and Holmes technique

Akinosi. Vazarani technique
Gow gates technique
Angelio sergenti technique
18
Ans :- B
Que :- 42. Hematoma formation is more frequent with ?
A.
B.
C.
D.
Inferior alveolar nerve block

Posterior superior alveolar nerve block
Greater palatine nerve block
Infraorbital nerve block
Ans :- B
Exp :- hematoma is most commonly associated with posterior superior alveolar
and infraorbital nerve blocks. Hematoma formation in posterior superior
alveolar nerve block is due to injury of pterygoid plexusof veins, which
results in immediate swelling of face. To avoid this short needles are
used.
No. 494)
Que :-43.Toxicity of local anaesthesia is reversed by :
A.
B.
C.
D.
IV epinephrine
IV nalorphine
IV Barbiturates
IV sodium bicarbonate
Ans :- C
No. 490)
Que :- 44. How much lignocaine is present in 2.0 ml of 2% lignocaine
solution ?
A.
B.
C.
D.
40 mg
20 mg
30 mg
2 mg
19
Ans :- A
(Ref. :- Synopsis)
Que :- 45. Sensitivity to local anaesthetics is greater in :
A.
B.
C.
D.
Type B fibres
Type C fibres
Type A delta fibres
Fibres supplying the muscle spindles
Ans :- B
edition Page No. 5)
Que :- 46. A patient manifests systemic symptoms of pallor ans
unconsciousness following local anesthesia. The patient is
experiencing :
A.
B.
C.
D.
CNS depression
Syncope
Tonic reaction to local anesthesia
Allergic response
Ans :- B
No. 488)
Que :- 47. Which of the following can be used as local anesthetic agent for
infiltration if a patient is allergic to amide and ester anaesthetics
derivatives ?
A. Nitrous oxide
C.Phenylephrine
B. Bupivacaine
D.Diphenhydramine
Ans :- D
Exp :- when a patient is allergic to both ester and amide types, antihistamines
such as diphenhydramine (Benadryl) in injectable from (KCET-08) can
20
be used.
edition Page No. 152, 159)
Que :- 48. Each of the following statements about local anesthesia is
correct except :
A. Lignocaine causes cardiag dysarrhythmias
B. Prilocaine is more toxic than lignocaine
C. Prilocaine and lignocaine are components of EMLA (eutectic mixture of
local anesthesia)
D. Bupivacaine is given for obstetric epidural anesthesia
Ans :- B
Exp :- Ortho toluidine, is one of the metabolities of prilocaine and it produces
methemoglobin. So it is contraindicated in patients who have respiratory
diseases and in patients with congenital methemoglobinemia.
edition Page No. 152, 159)
Que :- 49. The local anesthetic which has sympathomimetic property is :
A.
B.
C.
D.
Procaine
Lidocaine
Cocaine
Tetracaine
Ans :- C
Que :- 50. Which of the following respiratory conditions is most alarming
during patient sedation in dental clinic ?
A. Apnea
C.Hyperapnea
B. Dyspnea
D. Tachyopnea
Ans :- A
21
Exp :- Apnea or respiratory arrest is the most common cause of death due to
overdose of local anesthetic.
Que :-51. The onest of action of lidocaine is :
A.
B.
C.
D.
1-2 minutes
5-10 minutes
3-5 minutes
7-8 minutes
Ans :- C
Que :-52. In dentistry which sedatives are generally used :
A.
B.
C.
D.
Benzodiazepines
Morphine
NSAID
Pethidine
Ans :- A
edition Page No. 281-283)
Que :- 53. A patient who faints during extraction should be positioned in
the :
A.
B.
C.
D.
Lateral position
Horizontal position
Trendelenburg position
Dorsosacral position
Ans :- C
Exp:CONDITION
Most important patient
POSITION OF THE PATIENT

Semireclined and
22
Positions during recovery from

syncope
During CPR, the patient
Should be kept in
Trendelenburg
Positions
Supine position
Que :- 54 . The action of adrenaline is potentiated in the presence of all

except :
A.
B.
C.
D.
Halothane
Ethyl chloride
Cyclopropane
Ether
Ans :- D
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Neelima maliks 2nd
Que :-55. Syncope :
A.
B.
C.
D.
Is associated with bradycardia and loss of consciousness

Never occurs in children
Always associated with hypoglycemia
Best treated in a sitting posture
Ans :- A
No. 488)
Que :- 56. The dose of epinephrine given in anaphylaxis :
A.
B.
C.
D.
0.5 mg in 1 : 1000 IM
0.5 mg in 1 : 10,000 IM
0.5 mg in 1 : 500 IM
1 mg in 1 : 100 IM
Ans :- A
23

No. 608)
Que :- 57. LA acts on nerve membrane by :

A.
B.
C.
D.
Blocking conductance of
Na+ from interior to exterior

Na+ from exterior to interior
K+ from interior to exterior
K+ from exterior to interior
Ans :- B
Exp :- When the nerve is at rest, K+ ions are concentrated inside while Na+
and Cl ions are concentrated outside the nerve membrane. As the
nerve is stimulated, there is passage of Na+ into cell and K+ out of the
cell. This is called depolarization and is responsible for pain
transmission. The primary action of local anesthetic agent is to decrease
the permeability of nerve membrane to sodium and thus prevents
depolarization.
No. 456, 458)
Que :-58. On administration of LA in an area of infection, it is not effective
because of increase in ?
A.
B.
C.
D.
Cations
Free base
Uncharged base
None
Ans :- A
Exp:- In contrast to alkaline conditions, a low tissue pH, as found in infected
areas (pus has pH of 5.5 to 5.6),may interfere with development of
adequate anaesthesia by preventing deprotonisation and liberation of the
free base.
24

edition Page No. 129 131)
Que :-59. The common complication of the local anesthetic prilocaine is :

A.
B.
C.
D.
Agranulocytosis
Hepatic dysfunction
Methemoglobinemia
Loss of taste
Ans :- C
Que :- 60. Rapid onset of action seen by local anesthesia in small nerve
endings is due to ?
A.
B.
C.
D.
Increased threshold of small nerves due to depolarization

Low pH of small nerve fibres.
High ratio of surface area to the volume of small nerve fibres
Increased resting potential of small nerve fibres
Ans :- C
Que :- 61. The cause of sensation of tissue tearing during locl anesthesia
administration is due to :
A.
B.
C.
D.
Passage through a cyst

Passage through a muscle
Passage through an area of infection
Barb on the needle
Ans :- D
Page No. 493)
25
Que :-62. Increased incidence of reaction to L.A. will occur by ?

A.
B.
C.
D.
Rapid rate of injection

Using an aspirating technique
Addition of vaso constrictor to the solution
Premedication with barbiturate
Ans :- A
Exp :- An optimum speed of 1ml./10 sec. Will minimise the tissue distension
and discomfort.
Que :-63. Which of the following local anesthetic is a vasoconstrictor ?
A.
B.
C.
D.
Lidocaine
Procaine
Bupivacaine
Ropivacaine
Ans :- D
Exp :- Ropivacaine causes cutaneous vasoconstriction.
Que :- 64. Excess of plasma level of lignocaine can cause cardiovascular
collapse due to :
A.
B.
C.
D.
Myocardial depression
Vagal stimulation
Syncope
CNS excitability
26
Ans :- A
Page No. 147, Vinod Kapoors 2nd edition Page No. 462, 489)
Que :- 65. Syncope is usually caused by :
A.
B.
C.
D.
Vasoconstriction
Cerebral ischemia
Cerebral hyperaemia
Decrease in the vascular bed
Ans :- B
No. 488, 605)
Que :- 66. First local anaesthesia to be used clinically was ?
A.
B.
C.
D.
Cocaine
Bupivacaine
Procane
Lignocaine
Ans :- A
The first local anaesthetic came the with the discovery of cocaine in 1860
by albert Niemann, but its anaesthetic properties were not realized until
1873 by Alexander Bennet .
(Ref. :- Dental analgesia by Gerald D. Allen)
Que :- 67. Maximum recommended dose of lignocaine with epinephrine :
A.
B.
C.
D.
5 mg/kg. Body weight

Ans :- B
27

Que :- 68. The activity of procaine is terminated by :
A.
B.
C.
D.
Elimination by kidney
Storage in the adipose tissue
Metabolism in the liver only
Metabolism in the liver and by pseudocholinesterase in the plasma
Ans :- D
Exp :- procaine in ester group of local anaesthetic agent. All the ester type of
LA agents are metabolized by plasma cholinesterase in the plasma. Some
hydrolysis also occurs in the liver.
No. 461)
Que :- 69. Xylocaine strength used in dentistry is ?
A. 2%
C.8%
B. 5 %
D. 10 % C
Ans :- A
Exp :- Lidocaine is synthesized by Lofgren in 1943. It is the first none
ester compound used as a LA agent in dentistry.
No. 463)
Que :- 70. The most significant adverse consequences of accidental
intravenous administration of a local anesthetic is ?
A.
B.
C.
D.
Bronchoconstriction
Hepatic damage
Nerve damage
Seizures
28
Ans :- D
Page No. 214, Vinod Kapoors 2nd edition Page No. 462, 489)
Que :- 71. The first sensation to be lost following administration of local
anesthetic is ?
A.
B.
C.
D.
Proprioception
Pain
Touch
temperature
Ans :- B
Que :- 72. Most commonly used local anesthesia
A.
B.
C.
D.
1 : 20,000 xylocaine
Hcl
Hcl
Hcl
Hcl
Ans :- D
Que :- 73. The safe dose of adrenaline in a patient with compromised
cardiac condition is :
A.
B.
C.
D.
0.2 mg
0.02 mg
0.4 mg
0.04mg
Ans :- D
In normal patient 0.2 mg is safe dose.
In compromised patient 0.04mg is safe dose.
29

edition Page No. 174, 175 )
Que :- 74. Cartridges should not be permitted to sock in alcohol because

it ?
A.
B.
C.
D.
Destroys vasoconstrictor
Is less effective
Is warm in sensation
Diffuses though rubber cap causing contamination.
Ans :- D
Exp :- Injection of contaminated solution with alcohol can cause neurolysis and
may result in paresthesia and permanent anaesthesia.
Page No. 467 )
Que :- 75. Sedation by which of the following routes can be reversed most
rapidly :
A.
B.
C.
D.
Oral
Inhalation
Intravenous
Intramuscular
Ans :- B
No. 454 )
Que :- 76. With over dosage of L.A. agent, one would observe ?
A.
B.
C.
D.
Hypertension
Hypotension
No change in BP
Cardiac arrhythmias
Ans :- B
30
Exp :- Hypotension is due to vasodilating properties of LA agent.

Page No. 217, Vinod Kapoors 2nd edition Page No. 489 )
Que :- 77. The role of sodium metabisulfite in Local anesthetic agent is :
A.
B.
C.
D.
Preservative
Fungicide
Reducing agent
Vaso constrictor
Ans :- C
Exp :- Sodium metabisulfite is added as a reducing agent in the LA solution to
prevent the oxidation of vaso constrictor. Sodium metabisulfite
competes with the vasoconstrictor for the available oxygen and is
oxidized to sodium bisulphate.
Page No. 464 )
Que :-78. Symptoms of Epinephrine overdose following a local anesthetic
injection may include all of the following except :
A.
B.
C.
D.
Restlessness
Hypotension
Apprehension
Palpitations
Ans :- B
Page No. 217 )
Que :- 79. Trismus during block anesthesia is a result of ?
A. Massive edema
B. Damage to medial pterygoid
C. Damage to lateral pterygoid
D. Damage to inferior alveolar nerve
Ans :- B
31

Page No. 240 )
Que :- 80. Allergic reactions in patients who receive amidetype local
anesthetics for dental procedures are most likely caused by
reaction of ?
A.
B.
C.
D.
Methylparaben
Contaminants
Lignocaine hydrochloride
Epinephrine
Ans :- A
Exp :- Methyl paraben is used as germicide or preservative. Cardiac lidocaine,
which is free of methyl paraben, should be used in these cases.
edition Page No. 151, 201, Vinod Kapoors 2nd edition Page
No. 490 )
Que :- 81. The colour of a nitrous oxide cylinder is :
A.
B.
C.
D.
Red
Blue
White
Black
Ans :- B
Exp :GAS
Nitrous oxide
Oxygen
Co2
Nitrogen
Ethylene
COLOUR
Blue
Black cylinder with white shoulder
Brownish grey
Black
Purple

32
Que :-82. Which of the following is not used as a topical LA ?

A.
B.
C.
D.
Procaine
Tetracaine
Lidocaine
Benzocaine
Ans :- A
Exp :- Benzocaine and Lidocaine base are water insoluble topical
anaesthetics.
Que :-83. Local anesthetics is not effective in an inflamed tissue because :
A.
B.
C.
D.
All impulses generated cannot be blocked

Myelin sheath is inflamed so it does not absorb the solution
pH is more acidic, so LA is ineffective
All of the above
Ans :- C
No. 458)
Que :-84. The earliest sign of syncope is ?
A.
B.
C.
D.
Pallor
Constriction of pupil
Dilation of pupil
Bradycardia
Ans :- A
33
Page No. 355 )
Que :- 85. For extra oral maxillary nerve block the target area is ?
A.
B.
C.
D.
Anterior to lateral pterygoid plate

Posterior to lateral pterygoid plate
Pterygomandibular fossa
Pterygomamdibular fissure
Ans :- A
edition Page No. 119, 120 )
Que :- 86. The primary execretory organ for the local anaesthetic and its
metabolites is :
A.
B.
C.
D.
Lungs
Kidneys
Rectum
Skin
Ans :- B
Exp :- The excretion of local anesthetic drug takes place through kidneys. 90%
of the drug is excreted in form of metabolites and the rest is excreted
unchanged in urine.
Page No. 461 )
Que :- 87. Maximum allowable dose of 2% lidocaine with 1 : 100000
epinephrine for a child of 40 lbs is :
A. 60 mg
C.180 mg
B.120 mg
D. 240 mg
Ans :- B
Exp :- The maximum dose of lidocaine with adrenaline is 7mg/kg body weight.
34
So for a child of 40 lbs ( 1lb = 0.453 kg) , the maximum dose is

( 7 mg *40 *0.453) is 126 mg.
Que :- 88. Pterygomandibular space contains all, except :
A.
B.
C.
D.
Nerve to mylohyoid muscle

Long buccal nerve
Loose areolar tissue
Nerve to medial pterygoid muscle
Ans :- B
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Neelima malik 2nd
Que :- 89. Which one of the following local anaesthetics belongs to the ester
to group ?
A. Procaine
C.Lignocaine
B. Buovacaine
D. Mepivacaine
Ans :- A
Exp :- All esters contain a single I in their name and all amides contain
double I in their name.
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Malamed 5th edition
Page No. 28, Box 2 - 10 )
Que :- 90. LA toxicity complication except :
A. Cardiac depression
B. CNS depression
C.Paresthesia
D. Respiratory depression
Ans :- C
Page No. 489 )
35
Que :- 91. Which of the following intravenous induction agents is the most
suitable for day care surgery :
A. Morphine
C.Proplofol
B. Ketamine
D. Diazepam
Ans :- C
Page No. 447 )
Que :-92. An anesthetist orders a new attendant to bring the oxygen
cylinder. He will ask the attendant to identify the correct cylinder
by following color code :
A.
B.
C.
D.
Black cylinder with white shoulder

Black cylinder with grey shoulders
White cylinder with black shoulders
Grey cylinder with white shoulders
Ans :- A
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Neelima malik 2nd
Que :-93. Apainless, fluid retention cyst appearing in the area of recent
dental treatment may be the result of ?
A.
B.
C.
D.
Failure of absorptionof the anaesthetic

Aalergic reaction of agents employed
Infection occurred during treatment .
Injury to salivary gland.
Ans :- D
Exp :- Mucocele results from traumatic severance of salivary duct produced by
pinching the lip by extraction forceps or by biting the lip or cheek
leading to spillage of mucin in to the surrounding tissues.
36
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Shafers 5th edition

Page No. 747 - 48 )
Que :- 94. The agent of choice to reverse status epilepticus inducted by
local anaesthetic overdose is :
A. Oxygen
C.Epinephrine
B. Diazepam
D. Phenobarbital
Ans :- B
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Petersone 4th edition
Page No. 36 )
Que :-95. Toxic effect of local anaesthetic include :
A. Convulsions
C.Methemoglobinemia
B. Asystole
D. All of the above
Ans :- D
edition Page No. 152, 214 - 217 )
Que :- 96. Pick out odd drugs for anaesthetic emergencies are :
A. Aminophylline
C.Atropine sulphate
B. Epinephrine
D. Amoxycillin
Ans :- D
Exp :- Refer synopsis
Page No. 609 ,613 )
Que :- 97. The anatomical landmark used during posterior superior
alveolar nerve block are mucobuccal border of :
A. Ramus
B. Mandible
37
C.Premolar
D. Midline
Ans :- A
Que :-98.The maximum concetration of LIDOCAINE for topical block is :
A. 2%
C. 15 %
B. 4 %
D. 10 %
Ans :- B
Que :-99. The maximum dosage of local anesthetic agent like lidocaine
must be reduced when used in combination with a CNS and
/respirqatory depressant because, it may result in :
A.Seizures
C. Death
B. Coma
D. All of the above
Ans :- D
Page No. 489, 490 )
Que :- 100. Bupivacaine , a local anaesthetic agent used in the dentistry in
the concentration of :
A. 2 %
C.5 %
B. 4 %
D. 0.5 %
Ans :- D
(Ref. :- Textbook of Oral & Maxillofacial Surgery, Malamed 5th edition
Page No. 73 )
Que :- 101. The site of action of local anesthetic is on :
A. Axioplasm
C. Nerve membrane
B. Epineurium
D. perineurium
38
Ans :- C
Page No. 456, 457 .)
39
40

Department of Oral and Maxillofacial Surgery: Goverment Dental College & Hospital, Ahmedabad

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DEPARTMENT OF ORAL AND

Presented by :Aayushi Thayani

Exp :- Bupivacaine and Etidocaine are long acting anesthetics with a

Que :-2. Which of the following is not a theory for local

Membrane expansion theory

Que :-3. In the extraoral technique for mandibular nerve block

edition Page No. 256 )

Que :- 5. Of the following local anesthetics, which has intrinsic

Que :- 7. Which of the following symptoms is seen in a patient

25 45% N2O causes

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Shobha Tandons 1st

Increase the rate of liver metabolism of local anesthetic

agonist or vasoconstrictor. In small doses it causes vasoconstriction of

First stimulating the CNS followed by depression

L.A. is deposited near main trunk

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th

Que :- 11. Most accepted theory for conduction of pain is ?

Gate control theory

Fischer 123 technique

Que :-13. Action of lignocaine is affected by all except ?

PH at the site of injection

Another term for fainting

Increase the duration of anesthesia

Que :- 20. Inferior alveolar nerve block alone can be used in :

Pulpotomy of 3rd molar

Is dangerous because patient may swallow tongue

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Malamed s 5th

Inferior alveolar nerve

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th

Conduction is slower in myelinated than in non myelinated fibres

Increased gastric motility

Causes less depression of CNS

First trimester of pregnancy

Post depression convulsion

Lignocaine without adrenalin

i.e., pain, temparature, touch, proprioception and skeletal muscle tone.

They are basic salts of weak acids

Facial nerve paralysis

Clark and Holmes technique

Inferior alveolar nerve block

POSITION OF THE PATIENT

Positions during recovery from

Que :- 54 . The action of adrenaline is potentiated in the presence of all

Is associated with bradycardia and loss of consciousness

edition Page No. 229, Vinod Kapoors 2nd edition Page

Que :- 57. LA acts on nerve membrane by :

Na+ from interior to exterior

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th

Que :-59. The common complication of the local anesthetic prilocaine is :

Increased threshold of small nerves due to depolarization

Passage through a cyst

Que :-62. Increased incidence of reaction to L.A. will occur by ?

Rapid rate of injection

5 mg/kg. Body weight

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th

Que :- 74. Cartridges should not be permitted to sock in alcohol because

Exp :- Hypotension is due to vasodilating properties of LA agent.

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th edition

(Ref. :- Textbook of Oral & Maxillofacial Surgery, Monheims 7th

Que :-82. Which of the following is not used as a topical LA ?

All impulses generated cannot be blocked