Final exam

1. A stimulus is an electrical message from one part of the body to another. An impulse is an
environmental change in an excitable tissue.

A. Both statements are CORRECT

B. The first statement is correct, but the second is NOT

C. The first statement is NOT correct, but the second is correct @

D. NEITHER statement is CORRECT

2. Which fibers are the principle fibers in the transmission of sharp, bright dental pain?

A. Aδ fibers

B. B fibers

C. C fibers

D. Aβ fibers

3. Local anesthetics work by:

A. Penetrating the nerve to inhibit Na + influx

B. Penetrating the nerve to inhibit K+ efflux

C. Penetrating the nerve to inhibit Na + efflux

D. Penetrating the nerve to inhibit K+ influx

4. Local anesthetics mostly have their effect on myelinated nerves in which way?

A. All along the nerve membrane

B. Mostly at the synapse

C. Mostly at the cell bodies

D. 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.

A. True

B. False
6. When energy for conduction is derived from the nerve cell membrane itself and is no longer
dependent on the stimulus for continuance, the conduction is considered to be:

A. Below the minimal threshold level

B. Above the minimal threshold level

C. Self-propagating

D. In the absolute refractory period

7. The absolute refractory period occurs during the fraction of a millisecond when a nerve fiber can be
excited only by a much stronger stimulus than the initial stimulus.

A. True

B. False

8. Saltatory conduction refers to:

A. Rapid transmission of nerve impulses along a myelinated nerve fiber

B. Diffusion of sodium chloride into the nerve cell during impulse conduction

C. Conduction of an impulse along a nonmyelinated nerve at the nodes of Ranvier

D. The movement of continuous waves along a nerve fiber

9. What is the type of glial cell located in the peripheral nervous system?

A. Astrocyte

B. Microglia

C. Ependymal

D. Oligodendrocyte

E. Schwann

10. Myelin (lipoprotein sheath) is composed of:

A. Approximately 75% lipid, 20% protein, and 5% carbohydrate

B. Approximately 60% lipid, 35% protein, and 5% carbohydrate

C. Approximately 65% lipid, 30% protein, and 5% carbohydrate

D. 100% lipid
11. The sympathetic division is involved with the “rest or digest” response. The parasympathetic division
is known as the “fight-or-flight” response.

A. Both statements are CORRECT

B. The first statement is correct, but the second is NOT

C. The first statement is NOT correct, but the second is correct

D. NEITHER statement is CORRECT

12. The afferent division consists of all incoming information traveling along sensory or afferent
pathways. The efferent division consists of all outgoing information along motor or efferent pathways.

A. Both statements are CORRECT

B. The first statement is correct, but the second is NOT

C. The first statement is NOT correct, but the second is correct

D. NEITHER statement is CORRECT

13. What is the outer layer of the myelin sheath that wraps the entire nerve called?

A. Endoneurium

B. Schwann cell

C. Epineurium

D. Node of Ranvier

14. The axon hillock:

A. Is where the majority of input to the neuron occurs

B. Is not involved in impulse transmission

C. Distributes incoming signals to various central nervous system nuclei

D. Decides whether to send the impulse further down the axon

15. In a resting neuron, what positive ion is most abundant outside the plasma membrane?

A. Potassium

B. Sodium

C. Calcium
 D. Chloride

16. In a resting neuron, what positive ion is most abundant inside the plasma membrane?

A. Potassium

B. Sodium

C. Calcium

D. Chloride

17. The electrical potential of nerve axoplasm in the resting state is approximately:

A. -70 mV

B. -30 mV

C. Zero 67

D. +30 mV

18. Mantle bundles will be anesthetized first by a local anesthetic compared with core bundles.

A. True

B. False

19. Chemical synapses use chemical transmitters called:

A. Neurotransmitters

B. Chemical transmitters

C. Synaptic transmitters

D. Endogenous transmitters

20. The “all-or-none” principle occurs:

A. With a spike of positive and negative ionic discharge

B. In the interval during which a second action potential absolutely cannot be initiated

C. Once a nerve is excited by the minimal threshold level

D. Once a nerve is excited by a stimulus greater than the first stimulus

21. Infection and inflammation cause the following effects when administering a local anesthetic:
 A. Make the local anesthetic more effective

B. Increase tissue vascularity, which can inactivate the local anesthetic more rapidly

C. Increase the duration of action of the local anesthetic

D. Cause the inflamed tissue to have a high pH

22. All of the following are desirable properties of local anesthetics EXCEPT one. Which one is the
EXCEPTION?

A. Reversible

B. Rapid onset

C. Stability in solution

D. Potent

E. Slow biotransformation

23. Which characteristic enhances the effectiveness of local anesthetics?

A. High lipid solubility

B. High pKa

C. Low pH

D. High concentration of cation molecules

24. Where is the action site for local anesthetics?

A. The protein receptors

B. The nerve membrane

C. The central nervous system

D. The calcium receptors

25. Which part of the chemical structure of a local anesthetic determines if the local anesthetic agent is
classified as an ester or an amide?

A. Intermediate chain

B. Aromatic ring

C. Terminal amine
 D. Quaternary amine

26. Local anesthetics have their effect on myelinated nerves mostly in which way?

A. All along the nerve membrane

B. Mostly at the synapse

C. Mostly at the cell bodies

D. Mostly at the nodes of Ranvier

27. The quaternary form of the local anesthetic molecule:

A. Is the ionized form in the cartridge and is responsible for binding to the receptor site

B. Is the unionized form in the cartridge and is responsible for binding to the receptor site

C. Is the ionized form of the molecule that penetrates the nerve membrane

D. Is the unionized form of the molecule that penetrates the nerve membrane

28. Ester type local anesthetics are no longer manufactured in injectable form for dentistry because:

A. Of their difficulty penetrating the nerve

B. Of their high degree of hypersensitivity

C. They increase the potential for systemic overdose

D. They have significant vasodilatory properties

29. During manufacturing, local anesthetics are formulated as which of the following to render them
water-soluble?

A. Muriatic acid

B. Sodium bisulfite

C. Hydrochloride salt

D. Sodium bicarbonate

30. Which of the following anesthetics will provide the most rapid onset based on its pKa?

A. Mepivacaine

B. Lidocaine

C. Bupivacaine
 D. Benzocaine

31. The activity of the sympathetic autonomic nervous system neurotransmitters is terminated mainly
by:

A. Hydrolysis by acetylcholinesterase

B. Metabolism by monoamine oxidase (MAO)

C. Metabolism by catecholamine-O-methyl transferase (COMT)

D. Reuptake by adrenergic nerve

32. Which of the following is a sign of an epinephrine toxicity?

A. Fatigue

B. Tachycardia

C. Miosis

D. Hypotension

E. Sleepiness

33. What is the maximum recommended dose of epinephrine per appointment for a patient with
significant cardiovascular disease?

A. 0.02 mg

B. 0.04 mg

C. 0.2 mg

D. 0.4 mg

E. 2.0 mg

34. Epinephrine should be avoided in patients with:

A. Untreated hyperthyroidism

B. Hypotension

C. Controlled diabetes

D. Myocardial infarction or stroke within the prior 6 months and untreated hyperthyroidism

35. What is epinephrine used for?

 A. Seizures

B. Angina pectoris

C. Anaphylactic reactions

D. Syncope

36. An effect of epinephrine used in dentistry is to:

A. Increase vasoconstriction and slow bleeding

B. Decrease duration of anesthetic

C. Calm down a nervous patient

D. Increase dissociation of cation

37. Which of the following is a systemic effect of vasoconstrictors used with local anesthetics?

A. Increased diastolic blood pressure

B. Decreased systolic blood pressure

C. Increased systolic blood pressure

D. Decreased heart rate

E. A and b

38. Vasoconstrictors are added to local anesthetics for what reason(s)?

A. Reduce bleeding

B. Counteract the vasodilatory effects of local anesthetics

C. Decrease possibility of an anesthetic overdose

D. A, B, C

39. Which of the following is the preservative added to local anesthetic solutions containing epinephrine
to prevent its oxidation?

A. Sodium bisulfite

B. Sodium chloride

C. Sodium bicarbonate

D. None of the above

40. Epinephrine causes direct stimulation of which of the following adrenergic receptors resulting in
cardiac stimulation?

A. α

B. β1

C. β2

D. None of the above; epinephrine does not stimulate the cardiovascular system

41. What is the most important advantage of amide over ester local anesthetics?

A. Quicker onset

B. Longer duration

C. Less allergenicity

D. Cheaper cost

42. Which local anesthetic is the longest acting?

A. Lidocaine

B. Procaine

C. Bupivacaine with epinephrine

D. Prilocaine with epinephrine

43. Which local anesthetic has the least vasodilatory effect when used without epinephrine?

A. Mepivacaine

B. Lidocaine

C. Cocaine

D. Procaine

44. Which local anesthetic has the greatest vasodilatory effect when used without epinephrine?

A. Mepivacaine

B. Lidocaine

C. Articaine

D. Procaine
45. One cartridge of anesthetic contains how much solution?

A. 1.8 mL

B. 1.8 g

C. 1.8 mg

D. 1.8 L

46. Factors in selection of local anesthetic for a patient include all of the following EXCEPT one. Which
one is the EXCEPTION?

A. Length of time pain control is necessary

B. Presence of any contraindication (absolute or relative) to the local anesthetic solution

selection for administration

C. Requirement for hemostasis

D. Vitamin intake

47. Which of the following is FALSE?

A. Injectable esters of para-aminobenzoic acid are not commercially available for use in
dentistry

B. Procaine is an ester

C. Topical benzocaine is an amide

D. Prilocaine is an amide

48. Which of the following local anesthetics is metabolized in the plasma and liver?

A. Lidocaine

B. Bupivacaine

C. Prilocaine

D. Articaine

49. Which of the following is an advantage of having a local anesthetic metabolized in the plasma and
liver?

A. Increased duration of action of drug

B. Shorter half-life of drug

 C. Decreased vasoactivity of drug

D. Easy excretion of metabolites

50. Which of the following local anesthetics is metabolized in the lungs and liver?

A. Mepivacaine

B. Bupivacaine

C. Prilocaine

D. Articaine

51. Which drug is most likely to exhibit a drug interaction with epinephrine?

A. Sulfonamides

B. Monoamine oxidase inhibitors

C. Tricyclic antidepressants

D. Serotonin specific reuptake inhibitors

52. Before injecting a patient with a local anesthetic with or without a vasoconstrictor, the dental
hygienist should perform all of the following EXCEPT one. Which one is the EXCEPTION?

A. Review the patient’s health history

B. Take the patient’s blood pressure

C. Determine if the patient has a history of allergies

D. Administer nitrous oxide

53. Patients with bleeding disorders will most likely be susceptible to:

A. Technique of anesthetic administration

B. Vasoconstrictors

C. Ester anesthetics

D. Amide anesthetics

54. Following the administration of a local anesthetic with a vasoconstrictor, the patient experiences
mild itching and a slight rash. This is most likely caused by:

A. The amide anesthetic

 B. Methylparaben

C. Sodium bisulfite

D. The epinephrine

55. Patients with an artificial heart valve need premedication before a local anesthetic injection.

A. True

B. False

56. Which of the following is an absolute contraindication to the use of vasoconstrictors?

A. Blood pressure 175/95 mm Hg

B. Heart attack 5 months ago

C. Use of tricyclic antidepressants

D. Controlled diabetes

57. Which of the following drugs is the best choice to administer when a patient has a history of
hepatitis B?

A. Mepivacaine

B. Lidocaine

C. Bupivacaine

D. Nonselective

58. Which of the following anesthetics should be avoided if a patient has methemoglobinemia?

A. Bupivacaine

B. Prilocaine

C. Lidocaine

D. Procaine

59. Which anesthetic falls under the pregnancy risk category B?

A. Lidocaine

B. Bupivacaine

C. Articaine
 D. Mepivacaine

60. It is recommended to monitor a patient’s blood pressure throughout treatment for symptoms of
altered (increased) blood pressure when a patient is taking which of the following medications?

A. Phenothiazines

B. Monoamine oxidase inhibitors

C. Nonspecific beta blockers

D. Insulin

61. When a patient is taking a tricyclic antidepressant and is also given levonordefrin, blood pressure
enhancement is fivefold greater than with levonordefrin alone.

A. True

B. False

62. Select the local anesthetic that is most likely to inhibit the antibacterial activity of sulfonamides.

A. Lidocaine

B. Prilocaine

C. Articaine

D. Procaine

63. Patients with atypical plasma cholinesterase should not receive which classification of drugs?

A. All amides

B. All esters

C. Vasoconstrictors

D. Sulfonamides

64. Methemoglobinemia is caused by the metabolite:

A. Orthotoluidine

B. Benzene

C. Para-amino benzoic acid

D. Xylidine
65. Which of the following treatment modifications are important for patients with alcoholism?

A. Avoid amide local anesthetics

B. Administer the minimal effective dose of articaine

C. Administer the minimal effective dose of lidocaine, mepivacaine, or bupivacaine

D. Administer the minimal effective dose of epinephrine

66. Patients taking Elavil should:

A. Not receive amide local anesthetics

B. Receive amide local anesthetic when administered in the minimal effective dose

C. Not receive ester local anesthetics

D. Receive lowest effective dose of epinephrine similar to that recommended for a

cardiovascularly involved patient

67. ASA II describes a patient:

A. With a mild systemic disease that does not interfere with daily activity

B. With a mild systemic disease that interferes with daily activity

C. With a moderate to severe systemic disease that limits activity but is not incapacitating D.
Who is healthy

68. Which of the following can cause a false high blood pressure reading?

A. Blood pressure cuff is too narrow

B. Bladder or cuff is too wide

C. Cuff is deflated too quickly

D. Arm is above heart level

69. Which of the following is a relative contraindication to the use of an amide local anesthetic?

A. Patient is taking tricyclic antidepressants

B. Patient is taking Tagamet

C. Patient is taking monoamine oxidase inhibitors

D. Patient has diabetes and is taking antidiabetic medication

70. A patient is considered to have tachycardia if beats per minute are greater than 80.

A. True

B. False

71. What is the cardiac dose of epinephrine?

A. 0.02 mg

B. 0.04 mg

C. 0.2 mg

D. 0.4 mg

72. A 2% local anesthetic solution means all of the following EXCEPT one. Which one is the EXCEPTION?

A. 2 g per 100 mL

B. 2000 mg per 100 mL

C. 20 mg per 1 mL

D. 2000 mg per 10 mL

73. What is the MRD dose of 2% lidocaine for a 120-lb patient?

A. 290 mg

B. 320 mg

C. 381 mg

D. 400 mg

74. How many cartridges of 2% lidocaine 1:100,000 epinephrine can be safely administered to a 120-lb
patient taking tricyclic antidepressants?

A. 1.1

B. 2.2

C. 3.3

D. 4.4

75. What is the maximum recommended dose for lidocaine?

A. 420 mg
 B. 445 mg

C. 485 mg

D. 500 mg

76. Which of the following BEST describes the reason for greater incidence of clinically effective local
anesthesia for the maxillary teeth when the local anesthetic agent is administered as a supraperiosteal
injection than would occur with similar teeth on the mandibular arch?

A. More porous alveolar process

B. Denser alveolar process

C. Presence of adjacent nerve canals

D. Increased pulpal lymphatic channels

77. Which foramen carries branches of BOTH the right and left nasopalatine nerves?

A. Greater palatine foramen

B. Lesser palatine foramen

C. Incisive foramen

D. Infraorbital foramen

78. Which foramen carries branches of BOTH the right and left nasopalatine nerves?

A. Greater palatine foramen

B. Lesser palatine foramen

C. Incisive foramen

D. Infraorbital foramen

79. Which of the following skull bones is the ONLY freely movable bone of the skull?

A. Maxilla

B. Zygomatic bone

C. Palatal bone

D. Mandible

80. The mental foramen is USUALLY located inferior to the apices of the mandibular
 A. first and second premolars.

B. first and second molars.

C. first premolar and canine.

D. central and lateral incisors.

81. Which of the following is a landmark for the administration of the inferior alveolar local anesthetic
block?

A. Mental foramen

B. Coronoid notch

C. Mandibular notch

D. Incisive foramen

82. Which of the following statements BEST describes the (long) buccal nerve?

A. Efferent nerve for the facial gingiva of the mandibular anterior teeth

B. Afferent nerve for the facial gingiva of the mandibular anterior teeth

C. Efferent nerve for the buccal gingiva of the mandibular molars

D. Afferent nerve for the buccal gingiva of the mandibular molars

83. Which of the following is the nerve division of the trigeminal nerve that does NOT innervate the
teeth?

A. Ophthalmic

B. Maxillary

C. Mandibular

D. Facial

84. Which nerve when anesthetized also anesthetizes BOTH the anterior and middle superior alveolar
nerves?

A. Posterior superior alveolar

B. Inferior alveolar

C. Incisive

D. Infraorbital
85. Which of the following is considered the largest nerve division of the trigeminal nerve?

A. Ophthalmic

B. Maxillary

C. Mandibular

D. Facial

86. Anesthesia of the maxillary teeth is MORE clinically effective than the mandibular teeth BECAUSE the
bone of the maxillae overlying the teeth is denser and less porous.

A. Both the statement and the reason are correct and related.

B. Both the statement and the reason are correct but NOT related.

C. The statement is correct, but the reason is NOT.

D. The statement is NOT correct, but the reason is correct.

87. Which block is MOST appropriate to administer so as to allow for clinically effective anesthesia of the
associated buccal periodontium and gingiva of the maxillary premolars?

A. Greater palatine block

B. Nasopalatine block

C. Anterior superior alveolar block

D. Middle superior alveolar block

88. Which of the following structures does the infraorbital local anesthetic block USUALLY anesthetize?

A. Teeth and associated periodontium and gingiva within one maxillary quadrant

B. Teeth and associated periodontium and gingiva within the maxillary arch

C. Anterior and middle superior alveolar nerves within one maxillary quadrant

D. Anterior and middle superior alveolar nerves within the maxillary arch

89. Which local anesthetic block listed below requires the recommended injection site or needle
insertion point to be at the height of the maxillary mucobuccal fold superior to the apex of the maxillary
second molar?

A. Infraorbital block

B. Anterior superior alveolar block

 C. Middle superior alveolar block

D. Posterior superior alveolar block

90. Where is the recommended injection site or needle insertion point for the middle superior alveolar
local anesthetic block?

A. Apex of the maxillary canine

B. Apex of the maxillary first premolar

C. Apex of the maxillary second premolar

D. Mesiobuccal root of the maxillary first molar

91. Where is the recommended injection site or needle insertion point for the anterior superior alveolar
local anesthetic block?

A. Maxillary mucobuccal fold superior to the apex of the maxillary canine

B. Maxillary mucobuccal fold at the apex of the maxillary first premolar

C. Maxillary mucobuccal fold superior to the apex of the maxillary second premolar

D. Maxillary mucobuccal fold at the apex of the maxillary first molar

92. Where is the greater palatine foramen usually located?

A. Approximately 10 millimeters medial to the mandibular lingual gingival margin

B. Approximately 10 millimeters medial and directly superior to the palatal gingival margin

C. Lateral to the incisive papilla and palatal to the maxillary central incisors

D. Lateral to the lesser palatine foramen and posterior to the hard plate

93. What is the approximate needle insertion depth into soft tissue in MOST cases for the inferior
alveolar local anesthetic block?

A. 10 millimeters

B. 15 millimeters

C. 16 millimeters

D. 20 millimeters
94. After a few minutes following the administration of a mental local anesthetic block, a patient reports
that some of her contralateral mandibular anterior teeth feel numb. What caused the patient’s
contralateral mandibular anterior teeth to become anesthetized?

A. Diffusion of the anesthetic agent to the incisive nerve

B. Trauma to the nerves within the inferior dental plexus

C. Overlapping of lingual nerve fibers in the inferior dental plexus

D. Rapid constriction of the mental artery in the area

95. When administering the inferior alveolar block, the syringe barrel in MOST cases should usually be
superior to which mandibular tooth?

A. Premolar on the injection side

B. Premolar on the contralateral side

C. First molar on the contralateral side

D. First molar on the injection side

96. Which of the following local anesthetic blocks has the HIGHEST risk of hematoma for the patient
after administration?

A. Posterior superior alveolar block

B. Inferior alveolar block

C. Gow-Gates mandibular block

D. Mental or incisive blocks

97. While administering the inferior alveolar block, the clinician contacts bone at a depth of
approximately 10 millimeters on an average size adult patient. What should the clinician do next?

A. Aspirate correctly and then deposit anesthetic agent at the site.

B. Withdraw the needle and reinsert with the syringe barrel more anteriorly.

C. Withdraw the needle and reinsert with the syringe barrel more posteriorly.

D. Withdraw the needle and reinsert with the syringe barrel more perpendicularly to the
mandibular occlusal plane.

96. The target area for the incisive block is the same as the mental block, but after administering
themental block, the clinician MUST place pressure to the injection site following the injection for
clinically effective local anesthesia.
 A. Both statements are true.

B. Both statements are false.

C. First statement is true and the second is false.

D. First statement is false and the second is true.

97. There is NO need to palpate for the mental foramen prior to administering the mental local
anesthetic block because the mental foramen is USUALLY in the same location on all patients.

A. Both the statement and the reason are correct and related.

B. Both the statement and the reason are correct but NOT related.

C. The statement is correct, but the reason is NOT.

D. The statement is NOT correct, but the reason is correct.

E. Neither the statement nor the reason is correct.

98. Which of the following local anesthetic blocks anesthetizes the mylohyoid, mental, and the
auriculotemporal nerves?

A. Gow-Gates mandibular block

B. Inferior alveolar block

C. Mental block

D. Buccal block

E. Vazirani-Akinosi mandibular block

99. Which mandibular local anesthetic blocks require the clinician to gently contact the mandible with
the anesthetic needle?

A. Inferior alveolar block and infraorbital block

B. Inferior alveolar block and Gow-Gates mandibular block

C. Buccal block and mental block

D. Gow-Gates mandibular block and mental block

100. Which of the following local anesthetic blocks uses BOTH the mandibular occlusal plane and
pterygomandibular raphe as landmarks for administration?

A. Gow-Gates mandibular block

 B. Inferior alveolar block

C. Mental block

D. Incisive block

101. Which of the following supplemental injections is MAINLY used within the mandibular arch?

A. Supraperiosteal injection

B. Intraseptal injection

C. Periodontal ligament injection

D. Both the supraperiosteal and intraseptal injections

102. What is the injection site or needle insertion point for a periodontal ligament injection within the
mandibular arch?

A. Center of the interdental papilla

B. Inferior to the apex of the tooth

C. Depth of the gingival sulcus

D. Depth of the maxillary mucobuccal fold

103. Which of the following supplemental injections increase hemostasis when used with a LESS diluted
vasoconstrictor upon instrumenting within the mandibular arch?

A. Supraperiosteal injection

B. Intraseptal injection

C. Periodontal ligament injection

D. Both the supraperiosteal and intraseptal injections

104. Which of the following supplemental injections within the mandibular arch is palpated to ensure
soft tissue entry before the needle is inserted?

A. Supraperiosteal injection

B. Intraseptal injection

C. Periodontal ligament injection

D. Both the supraperiosteal and intraseptal injections

105. Which of the following BEST describes a localized complication?

 A. A complication that occurs in a region of the injection and is attributed to the needle or the
administered anesthetic

B. A complication that is attributed ONLY to the drug administered

C. A complication that will resolve on its own and requires no treatment

D. A complication that requires a definite plan of treatment.

106. If needle breakage occurs and the clinician can easily retrieve the needle, what is the next step by
the dentist?

A. Inform the patient

B. Have the patient be seen by the dentist

C. Keep one’s hand in the patient’s mouth and ask to open widely

D. Take panoramic radiograph and refer to oral and maxillofacial surgeon

107. Which of the following BEST describes a secondary complication?

A. A complication that occurs in a region of the injection and is attributed to the needle

B. A complication that is experienced by the patient after the injection

C. A complication that will resolve on its own and requires no treatment

D. A complication that requires a definite plan of treatment

108. Anaphylaxis is considered to be what type of complication?

A. Localized and severe

B. Systemic and mild

C. Systemic and severe

D. Localized and mild

109. 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:

A. Hematoma

B. Hemangioma

C. Edema

D. Trismus
110. What is the first step that needs to be completed by the dentist when managing a hematoma?

A. Apply heat

B. Apply cold compress

C. Massage soft tissue

D. Apply pressure

111. What is soreness in the muscles of mastication caused by muscle spasms called?

A. Trismus

B. Nerve paralysis

C. Hematoma

D. Paresthesia

112. An incident of edema in patient after administration of a local anesthetic can be caused by all of the
following EXCEPT one. Which one is the EXCEPTION?

A. Trauma during injections

B. Broken needle

C. Contaminated agents

D. Allergic reaction

113. Paresthesia occurs MOST commonly during which intraoral local anesthetic injection?

A. Middle superior alveolar block

B. Posterior superior alveolar block

C. Inferior alveolar block

D. Gow-Gates mandibular block

114. All of the following can increase the risk of local anesthetic overdose EXCEPT one. Which is the
EXCEPTION?

A. Fast biotransformation

B. Rapid deposit of agent

C. Intravascular injection
 D. Atypical pseudocholinesterase

115. What are signs of central nervous system overdose from moderate to high blood levels that can be
noted in a patient after administration of a local anesthetic?

A. Dizziness

B. Hypertension

C. Excitatory-nervousness

D. Convulsions

116. The patient shows convulsions, respiratory distress, cardiovascular depression, and coma; what is
occurring to the patient?

A. Heart attack

B. Cardiovascular toxicity

C. Epinephrine overdose

D. Local anesthetic overdose

117. Which of the following dilutions of local anesthetic agents has the lowest concentration of
epinephrine?

A. 1:100,000 epinephrine

B. 1:200,000 epinephrine

C. 1:50,000 epinephrine

D. 1:250,000 epinephrine

118. Which of the following is the appropriate treatment for a mild cutaneous reaction?

A. Corticosteroids

B. Diphenhydramine

C. Nitroglycerin

D. Aspirin

119. All of the following are signs of angina pectoris EXCEPT one. Which is the EXCEPTION?

A. Chest pain

B. Pain in left arm

 C. Shortness of breath

D. Dizziness

120. If the clinician strongly suspects the patient is having a myocardial infarction, the procedure is
stopped and then the clinician should:

A. Position the patient upright

B. Administer nitroglycerin

C. Activate emergency medical services

D. Initiate basic life support

121. If a patient starts to experience involuntary muscle contractions and altered breathing, what should
the clinician suspect?

A. Respiratory distress

B. Hypoglycemia

C. Seizures

D. Asthma attack