Updated 2020

Pain Control

1. LA with epinephrine can be given to a patient with

A. Stroke
B. MI
C. Rheumatic fever

2. the most difficult teeth to anesthetize with irreversible pulpitis:

A. Mandibular premolars
B. Maxillary premolars
C. Maxillary molars
D. Mandibular molars
With irreversible pulpitis, the teeth most difficult to anesthetize are (in order)
the mandibular molars followed by mandibular premolars, maxillary
molars, maxillary premolars ,mandibular anterior teeth, least is maxillary anterior teeth.

3. The allodynia phenomenon:

A. Increased threshold of pain
B. Decreased threshold of pain
C. Less sensitive to a mild stimulus
D. Responds mildly to a stimulus that would otherwise be very painful

4. An important consideration of the intrapulpal injection (IP):

A. The injection should be given with back-pressure
B. It will take several minutes for the injection to take effect
C. A long-acting anesthetic should be used
D. Another supplemental injection should not be attempted first

5. We can give L.A with epinephrine for patients with:

A. Mitral valve
B. Poorly controlled hypertension
C. Arrythmias
D. MI or coronary artery stent within 3 months

6. Patient allergic to penicillin what is the best alternative:

A. Penicillin K 1g
B. Amoxiclin 500mg
C. Augmentin 1g
D. Clindamycin 150mg

7. Maximum dose of acetaminophen:

A. 4 mg
B. 4 g
C. 3.2 mg
D. 3.2 g
historically was 4g but since 2014 3g per day

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8. Methemoglobinemia most occur with:

A. Articain (prilocaine,benzocaine,)
B. Lidocain (can occurs in lesser amount)
C. Mepivacain

9. For incision and drainage, in the initial appointment, best way to give anesthesia:
A. Infiltration between the lesions
B. Nerve block
C. Intraosseous
D. Interligamentary

10. Diagram showing Mepivacain and lidocain what do u

understands?
A. Both are the same

11. Giving bupivacaine in max ant teeth:

A. Long acting LA
B. Short acting LA comparing to lidocaine but for Max 1st molar the same
C. The same time as lidocaine
D. Moderate acting L.A.

12. LA cause Tachycardia to the Pt. Due to:

A. Pt. is anxious and stressed
B. Pharmacological effect
C. Give large amount or IV injection

13. The Ideal pain reliever combination is to alternate between:

A. Ibuprofen and aspirin
B. Ibuprofen and acetaminophen
C. Ibuprofen and opioids

14. Maximal dose of ibuprofen per day is:

A. 2 grams
B. 3.2 grams
C. 6 grams

15. The time is taken by mandibular nerve block for complete anesthesia is:
A. 15 min
B. 10 min
C. 5 min

16. Premedication with NSAIDs in symptomatic irreversible pulpitis is done to:

A. Relieve pain!
B. Raise the pain threshold
C. Decrease postoperative pain
D.

Endodontic management reduce peripheral mechanism of hyperalgesia

Pharmacotherapy often is required to reduce continued nociceptor input (e.g., NSAIDs, local anesthetics) and
suppress central hyperalgesia (e.g., NSAIDs, opioids).

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17. All statements about Intrapulpal injection are wrong, Except one:
A. Work in open pulp canal.
B. Must give under back pressure.

18. Regarding the IL anesthesia all are true except

A. It is essentially type of intraosseous anesthesia.
B. It used when regional anesthesia failed.
C. Bevel should be toward the tooth.
D. It is not effective when interdental papilla has severe gingival inflammation. Can be used with mild periodontitis
and up to moderate gingivitis

19. According to pH of inflamed tissue proper LA used is?

A. lidocaine.
B. bupivacaine.
C. mepivacaine.
D. acidified LA
Decreasing order of pKa being bupivacaine > prilocaine ≥ lidocaine ≥ articaine > mepivacaine, Local anesthetics
with smaller pKa values like mepivacaine are expected to be more effective at relatively low pH than ones with
larger pKa values

20. Most effective anesthesia for patients with irreversible pulpitis

A. Lidocaine
B. Bupivacaine
C. Mepivacaine
D. Articaine

21. Which of the following is true regarding the periodontal ligament injection when treating a tooth with
a pulpal diagnosis of reversible pulpitis?
A. There will be a decrease in pulpal blood flow when anesthetic agents with a vasoconstrictor are used.
B. Damage to the supporting structures can cause continued symptoms.
C. The periodontal-ligament injection is contraindicated when block or infiltration injections are not
effective.
D. The periodontal ligament injection can be used as primary anesthesia in teeth that exhibit single roots,
regardless of the number of canals.

22. Which of the following best describes the neural innervation of the dental pulp?
A. A-delta fibers transmit pain to the trigeminal nucleus.
B. C fibers transmit pain to the superior cervical ganglion.
C. Sympathetic fibers are not blocked with application of local anesthetic agents.
D. A-delta fibers play the predominant role in encoding inflammatory pain.

23. Regarding etodolac (i.e., Lodine), which of the following statements is correct?
A. The drug exhibits minimal gastrointestinal irritation when compared to ibuprofen.
B. When compared with ibuprofen, etodolac has a more profound analgesic action.
C. Studies indicate etodolac is unique, because the drug does not have a peripheral analgesic mechanism of
action.
D. This drug can be prescribed for adult patients with aspirin hypersensitivity.

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24. Which of the following statements regarding activation of the opiate receptor is accurate?
A. It blocks nociceptive signals from the trigeminal nucleus to higher brain centers.
B. It blocks transmission of signals from the thalamus to the cerebral cortex.
C. It induces the release of endorphins.
D. It blocks the release of dynorphins.

25. Opioids are frequently used in combination with other drugs because which of the following?
A. The nonsteroidal, anti-inflammatory drugs in combination with the opioid act synergistically on the opiate
receptor.
B. The combination permits a lower dose of the opioid, which can reduce side effects.
C. Opioids do not act peripherally.
D. Opioids are not antipyretic.

26. Which of the following is true for the use of codeine as an analgesic agent?
A. Codeine prescribed in 60-mg doses is more effective than 650 mg of aspirin. less
B. Codeine prescribed in 30-mg doses is more effective than 600 mg of acetaminophen. less
C. Codeine prescribed in 30-mg doses is more effective than a placebo. Same as Placebo
D. Codeine prescribed in 60-mg doses is more effective than a placebo.

27. Management of pain of endodontic origin should focus on which of the following?
A. Removing the peripheral mechanism of hyperalgesia
B. Providing an adequate level of nonsteroidal, anti-inflammatory analgesic agent
C. Prescribing an appropriate antibiotic in cases where pain is the result of infection
D. Using long-acting, local anesthetic agents to break the pain cycle

28. Which of the following best describes a "flexible plan" for prescribing analgesic agents?
A. A maximal dose of an opioid is administered. If pain persists, the opioid is supplemented with a non-steroidal,
antiinflammatory agent or acetaminophen. Doses are then alternated.
B. A maximal dose of a nonsteroidal, antiinflammatory agent or acetaminophen is administered. If pain persists,
the drug is supplemented with an opioid. Doses are then alternated.
C. Patients are advised to take the maximal dose of a nonsteroidal, anti-inflammatory agent a day before the
appointment and then as necessary for postoperative pain.
D. Patients are advised to take an opioid agent a day before the appointment and then as necessary for
postoperative pain.

29. Nonsteroidal, ant-inflammatory agents administered in combination with cyclosporine may result in
which of the following?
A. They increase the risk of nephrotoxicity.
B. They induce bone marrow suppression.
C. They decrease the activity of the cyclosporine.
D. They result in increased concentrations of the nonsteroidal agent in the blood plasma.
Cyclosporine is steroid used for rheumatoid arthritis and to prevent kidney and liver transplant rejection

30. Nonsteroidal, anti-inflammatory agents administered in combination with anticoagulants may result in
which of the following?
A. Increase the prothrombin time
B. Result in a decreased bleeding time
C. Increase the bioavailability of the anticoagulant
D. Produce no adverse effect

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31. Indomethacin (NSAID) administered in combination with sympathomimetic agents results in which of
the following?
A. Decreased blood pressure.
B. Increased blood pressure.
C. Decreased water retention
D. Decreased absorption of indomethacin, requiring a higher dose

32. Peripheral afferent nerve fibers in an inflamed pulp may respond to mediators by which of the
following?
A. Reducing the concentration of those mediators
B. Decreasing responsiveness to nociceptive stimuli
C. Decreasing the number of anesthetic molecule receptors
D. Decreasing numbers of ion channels
E. Sprouting of terminal fibers

33. Two nonsteroidal antiinflammatory drugs (NSAIDs) that have minimal adverse gastrointestinal side
effects are which of the following?
A. Etodolac and ibuprofen
B. Etodolac and rofecoxib
C. Ibuprofen and ketoprofen
D. Ketoprofen and etodolac
E. Ibuprofen and rofecoxib

34. To minimize posttreatment pain, when are analgesics most effective when administered?
A. As a pretreatment
B. Immediately after treatment
C. When the anesthetic begins to wear off
D. When the patient first perceives pain
E. When the pain is the most intense

35. Prophylactic administration of antibiotics to control adverse post treatment symptoms in prospective,
controlled, clinical trials on asymptomatic patients has been shown to be which of the following?
A. Ineffective
B. Effective if given in high doses
C. Effective only if given pretreatment
D. Effective if given in conjunction with intracanal antibiotics

36. Marshal and Walton 1984, The effect of intra-muscular injection of Dexamethasone 4 mg on post-
treatment endodontic pain:
A. significantly reduced both the incidence and severity of pain at 4 hours posttreatment and reduced pain
at 24 hours posttreatment
B. preoperative pain associated with postoperative pain
C. significantly reduced both the incidence and severity of pain at 4 hours posttreatment and no significant
at 24hrs & 48hrs posttreatment p119

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37. Rogers et al. 1999, Ketorolac tromethamine is:

A. NSAID is member of the pyrrolo-pyrrole group
B. Steroid
C. Antimicrobial
D. Anaesthesia

38. The majority of life-threatening systemic complications arise in which of the following?
A. During or immediately after injection of local anesthetics
B. In conjunction with surgical procedures, such as tooth extraction
C. During the pulp extirpation phase of root canal treatment
D. As a result of bleeding from patients with known bleeding disorders

39. Which of the following is not a factor affecting the onset of local anesthesia?
a. Diffusion of the local anesthetic through the lipid-rich nerve sheath
b. The pKa for the anesthetic agent
c. The pH of the tissue
d. The protein-binding ability of the local anesthetic Effect duration not onset

40. A decrease in the tissue pH causes which of the following?

a. It increases the free base of the local anesthetic agents. Dec uncharged basic to cross cell membrane
b. It results in fewer anesthetic molecules entering the nerve sheath.
c. It changes the pKa value for a given local anesthetic.
d. It decreases the protein-binding of the local anesthetic.

41. Failure to obtain adequate anesthesia after an appropriately administered nerve block is most likely
the result in which of the following?
a. pH changes in the pulp tissue caused by inflammations
b. Morphologic neurodegenerative changes and inflammatory mediators
c. Insufficient volume of local anesthetic injected
d. Tolerance to the anesthetic agent

42. When comparing amide and ester local anesthetic agents, which of the following is true?
A. Esters are more likely to produce systemic toxicity when compared to amides.
B. Amides are more allergenic when compared to esters.
C. Amides are more effective than esters.
D. Esters and amides are equally effective.

43. A patient is anesthetized using a posterior superior alveolar (PSA) nerve block to perform endodontic
treatment on the maxillary, first molar. Adequate anesthesia
is not obtained. In this situation the clinician should consider
which of the following?
A. Anesthetizing the anterior, superior nerve
B. Anesthetizing the middle, superior nerve
C. Performing a palatal infiltration
D. Repeating the PSA

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44. An infiltration injection is given for a maxillary, second premolar. Adequate anesthesia is not
obtained. Which injection should be considered?
a. Anterior superior alveolar (ASA) block
b. PSA block
c. Palatal infiltration
d. Maxillary (division II) block
e. Greater palatine nerve block

45. Infiltration in the mandible may be ineffective technique in treating which of the following?
A. Central incisor
B. Canine
C. First premolar
D. Second molar

46. The Stabident local anesthesia system is used for which one of the following reasons?
a. As a true intraosseous injection
b. As a modified periodontal ligament injection
c. To limit the adverse reactions to vasopressor components of local anesthetic cartridges
d. As a method to administer intrapulpal injections painlessly

47. Prescriptions for analgesic agents should provide which of the following?
A. Instructions for administration at regular intervals
B. Instructions for taking the medication when patients experience pain
C. Administration instructions for patients in pain the day before initiating root canal treatment to ensure
adequate blood levels
D. Immediate preoperative administration of opiates when pulpal pain is present.

48. For emergency treatment of patients with pulp pathosis, oral sedation should be considered during
which of the following?
a. When deep sedation of the fearful patient is desired
b. When barbiturates with oral sedation should be considered
c. When oral sedation with midazolam may provide an amnesia effect
d. When a short-acting agent permits the patient to leave without an escort

49. Which of the following statements regarding supra-periosteal injection (infiltration) is accurate?
A. It is effective for most maxillary teeth.
B. It is more effective in the presence of infection
C. It is ineffective for both adults and children in anesthetizing mandibular teeth.
D. It is targeted mesial and distal to the apex of the involved tooth.

50. Which of the following statements regarding regional nerve block is accurate?
A. It achieves anesthesia by blocking efferent nerve impulses.
B. It may be more effective because it is deposited in normal, rather than inflamed, tissue.
C. It is exemplified by the long buccal nerve block.
D. It requires use of an agent without vasoconstrictors.

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51. Which of the following statements regarding the anterior middle superior alveolar (AMSA) nerve
block is accurate?
A. It anesthetizes all branches of the maxillary nerve.
B. It can be delivered by a computer-controlled system or by traditional needle and syringe.
C. It anesthetizes buccal and palatal bone, but not soft tissue. It anesthesia soft tissue and gingiva but not the Upper lip and face
D. It occasionally anesthetizes the orbicularis oris.

52. If the dentist thinks there may be considerable posttreatment pain, the clinician may do which of the
following?
A. Prescribe antibiotics
B. Reanesthetize with a long-acting anesthetic
C. Prescribe antianxiety medications
D. All of the above

53. Which of the following statements regarding oral sedation is accurate?

A. It has a quick onset of action.
B. It has a significant number of adverse reactions.
C. It has a reasonably short duration.
D. It is difficult to titrate to ideal levels.

54. Schellenberg 2015 (A Prospective, Randomized, Double-blind Study), what was the conclusion of the
study:
A. 4% buffered lidocaine formulation with did not result in a statistically significant increase in the
success rate or a decrease in injection pain of the IAN block in patients with symptomatic irreversible
pulpitis.

55. Zarei, comparison of the anesthetic efficacy of heart rate changes after PDL or –
A. IO x-tip

56. Kung et al 2015, In cases of persistent pulpal pain despite successful mandibular block anesthesia,
supplementary infiltration with:
A. articaine
B. mepivicaine
C. prilocaine
D. bupivacaine

57. Dunbar et al 1996, The use of IO supplementary injection with IANB compared to control, in
mandibular teeth with irreversible pulpit, significant finding was:
A. Intraosseous increase heart rate
B. bur

58. Sebastian et al 2016, Patient without a dentist or access to care may present to emergency room with
pain, best management is:
A. Prescribe analgesic ibuprofen + acetaminophen for 5 days
B. Give the patient long acting local anesthesia to relief pain

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59. Zarie 2012 et al, comparing the anaesthetic efficacy and Heart rate changes after PDL or IO
injections in mandibular molars:
A. Both were 100% effective.
B. IO injection was more effective with subjective increase in the heart rate.

60. Rule of 25 by Finder and Moore in 2002:

A. cartilage of LA for every 25 pounds

61. Interaction between Digoxin (digitalis) with vasoconstrictor:

B. Dysrhythmias

62. Block Technique used with limited mouth opening:

C. Vazirani-Akinosi technique

63. Definition of anaesthesia success with IANB:

A. 2 consecutive nonresponsive readings on EPT with 15 min and continuously sustain this lack of
responsiveness for 60 min

64. Maximum dose of acetaminophen?

A. 4g

65. Intraosseous injection with guide sleeve that can be left during the treatment?
A. X-tip

66. Interaction between NSAID, anticoagulant?

A. Increase prothrombin time and bleeding

67. Exception of intraosseous technique for site location?

A. Max and mand 2nd molar
B. Max 1st and 2nd molar
C. Mand 1st and 2nd molar
D. Max and mand 2nd premolar

68. Pt came to ER with irreversible pulpitis, but there is time limitation. What is the best treatment?
A. Pulpotomy and remove pulp from largest canal

69. Effect of LA on pulp:

A. Local anesthesia with vasoconstrictors may compromise the inflamed pulp’s ability to recover from
inflammation.

70. Allergy from anesthesia is due to:

A. Rubber Latex stopper

71. TTX-R:
A. Found primarily on nociceptors (NAv1.8, NAv 1.9)

72. Bupivacaine given in maxillary lateral incisors is considered as:

A. Long acting anesthesia
B. Short acting anesthesia

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73. Methemoglobinimea reaction of LA is mostly due to:

A. Articaine

74. Reverse the action of LA on soft tissue:

A. Oraverse (phentolamine mesylate)

75. If IANB failed what to give in order to have profound pulpal anesthesia:
A. Give supplemental IO and IL

76. Effective management of endodontic pain with 3Ds:

A. Diagnosis, Definitive treatment and drugs

77. Tachycardia occurs after local anesthetic injection is due to:

A. pharmacologic effect (primarily)

78. True about levonordefrin ?

A. 75 % alpha activity and 25 % beta activity

79. To increase success of the inferior alveolar nerve block?

A. increasing the volume
B. increasing the epinephrine concentration
C. addition of hyalironidase
D. none of these increase success
• Manittol inc IANB success by 15-20% but doesn’t provide complete pulpal anesthesia
• Recent study showed administration of 30% to 50% nitrous oxide resulted in a statistically
significant increase in the success of the IAN block in patients presenting with symptomatic
irreversible pulpitis
• Preemptive analgesic inc IANB success

80. Patients with Parkinson disease, LA used should be:

A. plain mepivacaine (3% Carbocaine)

81. When giving Local anesthesia near the apical foramen, the needle position should be:
a. Anterior-inferior
b. Anterior- superior
c. Posterior -superior
d. Posterior -inferior

82. Objective measurement of anesthesia is obtained through which of the following :

A. -electrical pulp test
B. -lip numbness subjective
C. -responsiveness to mucosa needle sticks
D. -commencing the treatment

83. According to Reader & Nusstein 2002 when the inferior alveolar nerve block fails which of the
following is most suitable to increase the anesthesia depth ?
A. -incisive nerve block
B. intra osseous injection
C. -itra ligamental injection
D. -mylohyoid injection

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84. According to Hargreaves and Keiser 2002 a possible hypothesis for local anesthesia failure is that
inflammation evokes which of the following:
A. -decrease in sodium channels pores responsible for local anesthesia
B. -an increase in anesthetic resistance subpopulation of sodium channels that exist on pain neurons
C. -marked reduction in the ph at the vicinity of pain receptors
D. -binding of the local anesthesia to the sodium channel in the activation phase

85. Local anesthetic drugs are especially effective in blocking :

A. -slowly firing nerve
B. -non firing nerve
C. -rapidly firing nerve
D. -slowly activating nerve

86. According to Hargreaves and Keiser 2002 If the IAN block fail then the clinician can performed a
second injection via:
A. -gow-gates technique
B. -buccal and lingual infiltration
C. -slow IAN
D. -Akinosi-Vazirani

87. Recent studies on anesthesia blocked have demonstrated that :

a. -complete anesthesia occur when three consecutive nodes of ranvier are blocked
b. complete anesthesia occur when five consecutive nodes of ranvier are blocked
c. -anesthesia can be cumulative along the axon length resulting in a gradual reduction in conduction velocity
d. -conduction blockade occur regardless of the length of the nerve anesthetized

88. According to the local PH hypothesis which of the following anesthetic drugs represents the most
effective local anesthetic for use in patient with irreversible pulpitis:
A. -lidocaine
B. -bupivacaine
C. -mepivacaine
D. -acidized anesthetic solution

89. Hargreaves and keiser 2002 reported benzomorphan is a promising drug that offer particular
advantages in treating pain patient include patient with endodontic pain . this is due to its selective
and potent antagonism to :
A. -TTX resistance class
B. -TTX clss
C. -NaV 1.8 may
D. -NaV 1.9 may

90. The best technique to get mental nerve block advance the needle in :
A. Anterior superior direction
B. anterior and inferior direction
C. Posterior superior direction
D. Posterior Inferior direction

91. Patient is having moderate pain after root canal treatment; she has liver disease what is the best
treatment?
A. 400 ibuprofens
B. 1000 paracetamol +oxycodone 10 mg
C. 200 ibuprofen and Antibiotic
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92. Patient with severe pain and she is on antidepressant, what medication is contraindicated?
A. Acetaminophen
B. Ibuprofen

93. Patient has severe pain and she has sensitivity of NSAID drug what is the best analgesic for the
patient?
A. 1000mg paracetamol and 10 oxycodone
B. 800 ibuprofens

94. What is the best strategy to prevent post-operative pain?

A. As a pretreatment
B. When the anesthetic begins to wear off
C. When the pt. first perceives pain
D. When pain is the most intense

95. What is the 3 Ds?

A. A. Definitive treatment plane, diagnosis and drugs

96. Pt on anticoagulant therapy coumadin (warfarin) what medication is contraindicated?

A. Amoxicillin
B. Tetracycline
C. Clindamycin
D. Metronidazole

97. Patient came with pain, fever and swelling after 5 days of pulpectomy and intracanal medicament,
patient on Amoxicillin , the patient saying the symptom are not improving what should you do?
A. Patient reassures
B. Shift to Augmentin
C. Add metronidazole

98. Bupivacaine to 2% lidocaine 1:100.000

A. A. Slow onset
B. B. Short duration
C. C. Medium duration
D. D. The same duration

99. Patient has symptomatic irreversible pulpitis with symptomatic apical periodonitis of tooth #46 what
is the best anesthesia?
A. Intraosseous
B. Intraligamanterry
C. Inrapulpal
D. Intrasulcular

100. In classical studies on history of extracted teeth with pain, the hypothesis was:
A. the more sever the pain, the less success
B. the more sever the pain, the more destructive
C. he more sever the pain, the less destructive

101. Apprehensive pt came with severe pain, the best protocol is

A. delay appointment, premedication with Ibuprofen
B. do the procedure under general anesthesia
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102. Maximum dose of acetaminophen:

A. 4 mg
B. 4 g
C. 3.2 mg
D. 3.2 g

103. Methimoglobeniumia most occur with:

A. Articain
B. Lidocain
C. Mepivacain

104. Giving bupivacaine in max ant teeth:

A. Long acting LA
B. Short acting LA comparing to lidocain
C. The same time as lidocain
D. Moderate acting L.A.

105. LA cause Tachycardia to the Pt. Due to:

A. Pt. is anxious and stressed
B. Pharmacological effect
C. Give large amount or IV injection

106. Maximum number of carpules of lidocaine with 1:100 000 epinephrine:

A. 11_
B. 13_
C. 15
D. 17

107. 59- pt. With history of coronary artery bypass graft, what is the maximum # of carpules of
anesthesia with 1:200 000 epinephrine:
A. 2
B. 4
C. 6
D. 8
• 1:50 000 =20 µg /ml epi
• 1:100 000 =10 µg /ml epi 2 cartridges of 1:100 000
• 1:200 000 =5 µg /ml epi 4 cartridges of 1:200 000
• Mx for cardio pt .036 mg
• Exceeding 40 µg epinephrine per appointment cannot be recommended unless the patient’s cardiac status is monitored continuously
during the procedure.

108. pt. With history of cardiac valvular replacement, allergic to penicillin, and can't take Antibiotics
orally, you will give him:
A. 500 mg amoxicillin_
B. 500 mg clindamycin _
C. 600 mg clindamycin phosphate
D. 500 mg Azithromycin

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109. 61- Pt. With history of valvular replacement, defective RCT on #17, PA lesion on MB root. What is
the factor that could impart an effect on the treatment?
A. Septicemia
B. Bacteremia _
C. Inability to isolate the tooth #17
D. Pt. Developing arrhythmias

110. 62- During the treatment, patient complained of pain on chest radiating to left side of jaw and
shoulder, relieved by Nitroglycerin:
A. Angina_
B. MI
C. Cerebrovascular accident
D. Vasovagal syncope

111. 63- During the treatment, patient complained of pain on chest radiating to left side of jaw and
shoulder, not responded to Nitroglycerin:
A. Angina_
B. MI
C. Cerebrovascular accident
D. Vasovagal syncope

112. 64- pt. Diagnosed with irreversible pulpitis, what is the thing that will affect the efficacy of L.A:
A. Pka
B. Lipid solubility
C. Protein binding

113. pt. has irreversible pulpitis, after giving him 2 IANB, and lip numbness confirmed, you started the
treatment. When the bur first dropped the pulp chamber he felt pain, supplemental anesthesia:
A. IL_
B. IO_
C. Intra pulpal_
D. Another IANB

According to the book when first drop to pulp chamber and there is pain give IO, if still there is pain give IP

114. 66- After giving the patient Prilocaine, patient developed cyanosis, dyspnea, emesis, and headache,
what could be the cause:
A. Methemoglobinemia
B. Vasovagal attach
C. Allergic reaction

115. After giving pt. Multiple carpules of LA with 1:50 000 epinephren, he became dizzy, increase HR
and blood pressure, tachycardia ...
A. Vasovagal syncope
B. Allergic reaction_
C. Overdose of epinephrine

Acute toxicity from an overdose of a local anesthetic -Excitatory phase then depression phase

116. Pregnant patient in 2nd trimester with pain which analgesics to give her:
A. Acetaminophen
B. Ibuprofen _
C. Diclofenac
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117. Pregnant women in 2nd trimester, need RCT, which anesthesia is safe to give her:
A. Lidocain
B. Mepivacain
C. Bupivacaine

118. Pt. Taking SSRI which is anti-depressant drug, and she is on pain, needs analgesics, which is
contraindicated to give her:
A. Ibuprofen
B. Acetaminophen

119. Patient Needs supplemental anesthesia, and you're about to give IO, by which mean:
A. X-tip
B. Gentle wave

120. Patient With history of coronary artery bypass graft, you are planning to do surgery for him, what is
the precaution before starting:
A. No precaution needed
B. 2g Augmentin 1 h before surgery
C. 2g augmenting 1h before surgery and immediately after
D. Give 500mg amoxicillin for 7 days after surgery

121. Patient Was given IANB with multiple needle insertions, he will develop:
A. Trismus
B. Diplopia
C. Hemi-facial paralysis

122. When giving Vazirani-Akinosi injection to the patient, you went too deep to the parotid gland, what
will happen:
A. Trismus
B. Diplopia
C. Hemi-facial paralysis

123. When giving IANB, the solution was diffused back to and .......... reach the ophthalmic artery, what
will happen:
A. Trismus
B. Diplopia
C. Hemi-facial paralysis

124. After doing surgery to the patient, he Felt loss of numbness in his tongue, and loss of taste, which
nerve is most commonly affected:
A. Lingual nerve
B. IAN
C. Glossopharyngeal nerve
D. Facial nerve

125. (During something non surgical) you injured the nerve...._….When you will refer the patient to the
oral maxillofacial? After how many weeks:
A. 4 weeks_
B. 8 weeks_
C. 12 weeks_
D. 16 weeks

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126. Pt. have Addison disease, she’s on cortisone, you are planning do non surgical RCT, what is the
percussion before treatment:
A. No need to give him steroid
B. 25 mg hydrocortisone Minor surgery
C. 50 mg hydrocortisone Moderate surgery
D. 75mg hydrocortisone Moderate surgery

127. what is the maximum dose for Ibuprofen in milligram:

A. 2400
B. 4000
C. 3200
D. 3000

128. 82- what is the maximum dose for Acetaminophen in milligram

A. 2400
B. 4000
C. 3200
D. 3000
Historically was 4g but since 2014 3g per day

129. The author who used multivariate causes of flare up

A. Torabinejad 1988
B. Walton 1992

130. 4. De Oliveira, endodontic flare up, incidence of flare up

A. 1.5%
B. 1.7%
C. 1.9%
D. 2.1%

131. Tesis, flare up after endo trx, average % of flare up

A. 8.4

132. Siqueira, most common cause of endo flare up

A. -Bacteria

133. Rosenberg, occlusal reduction is done in which cases?

A. -Vital & no PA lesions

134. Sebstian, no access to endodontist and best trx in ER

A. Pain killer ….

135. Pashly, dentine permeability. physiologic & pathologic material occludes dentinal tubules:
A. Caries crystals + irritation dentine

136. Wang, comparison of post-obturation pain experience following one-visit & two visits on vital pulps
A. No difference

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