Pathway of pain

C- fiber ( chronic) 04-18-22

Skin mid-summer
EPIDERMIS
"""
⑨

÷!÷÷*y ☒*÷÷:÷
the 1st neuron will always bring the info into
Nociceptors : the spinal cord thru the Dorsal horn
order neuron
( sensory info)
Free nerve
endings electrical

inter -

rendition '

T
.

A- delta ( acute)
chemical

i.io#--.-y--saimYosta-
①
#6 To processing pain
THALAMUS Where pain is generated
electrical 10 / 1st
-

↳ pain center
order neuron

presynaptic
synaptic # 3

Water soluble IOA channels ( Nat channels

) cortex -
pain localization center

µ
* *
block / expansion
2 ACCEPTED
membrane expansion
MECHANISM OF
theory / receptor
dependent MOA
ACTION
I

1. membrane expansion theory

aka receptor independent MOA

2. specific receptor theory

LA =
lipid soluble in basic environment aka receptor mediated MOA

-
can dissolve / enter lipid soluble channels
 Membrane Semi permeable 's
Mode of action of
-

IA
-

↳ has the ability to keep

→
polar certain ions in or out 1 .
decrease rate of Depolarization main
Rest - -70mV
Receptor mediated MOA
N
+

+ + + + +
2-
prolong -1ktpolarization
NIKE) aka
++ membrane potential
3. alter
resting
chlorine / proteins
f. Specific Receptor
4. alter firing threshold theory
ion channels :

via mechanical
step by step
displace cat receptor 4
J
1. Mechanically opener -
close 1. on

forces binds w/ receptor w/ a Nat channel

2. LA
gated -

stretching of neuron
3. to in rate of Nat conductants
2. Voltage gated voltage across in
change in mem tr depolarization
-

4. ,

3. Li and -

presence / absence of
*
lack of action potential generation
when your nerve is 1st stimulus ✓ 5. Conduction blockage
molecules
-

be stimulus X
busy nerve cannot
, 2nd G: Local Anes
Mere stimulated
Refractory period
, ,

* Saltatory conduction
+40mV.• •••
potassium channels open

•y•£epo,aµ-
depolarize
-

jump from one Node of Ranvier

to the next

polar Effective LA on myelinated nerve

#7 5 • # 14

anesthetize 8- 10mm

y-Éting
2-3
-

, , ,n ,
pm y,
↳ Nodes of Ranvier
• a •• -85 hyperpolarized state
depolarization 2 phases
-

# 8
• sodium channels open 1. Slow ,
Initial

2. Fast , Secondary
* Encephalines -
produced by Inter medullary neuron

4g morphine like substances

overload synaptic region ✗ pain
theories of Pain

1. Specific theory
2. Pattern Theory :
any stimulus w/ T intensity can
produce pain

3. Gate Control Theory ① : thickness of neuron ② Absence of myelin esh ath

4.
Hydrodynamic theory :
dentinal tubules ( free nerve endings)
↳ / other
nociceptor long , pain lang mafeel , no cold sensation .
 midbrain
- I
Brainstem - Pons
I. cranial FOSSA/ # INFRAORBITAL II
-

Medulla ptepygo PALATINE CANAL

CANID SPHENO PALATINE FOSSA TERMINAL BRANCHES
midbrain middle

¥f÷:÷:÷÷÷÷f*¥¥÷÷÷
-

mesencephalic meningeal nerve

£1m
(-•µT¥÷¥É ÷÷÷
proprioception
↳ state of muscle

•É
-

MAXILLARY
. V2
chief nucleus §

§
'

Branca

\V3%Ñ¥o?Y¥R
↳ Motor nuclei
•
medulla MSAN ASAN

,temµ
SPINAL
-

pain Trigeminal ganglion

- Pressure Gaserian ganglion /
Semilunar ganglion

÷÷IÉ¥÷:÷÷:÷÷ :
Bl MAXILLARY Anes
-

* man .
-
msm rn or

Naso Palatine nerve

• Valentine ganglion of nerves
•
only unpaired nerve in
* MSAN 1- MAN
the oral
cavity
Boch daleks
•

ganglion
alveolar nerve loop
or

i÷¥ ÷÷÷¥i:÷:÷ ÷÷ ÷÷ :÷
of nerves

)
(
MOTOR
⑥

☐
Innervates Buccal
mucosa of Mand molars
.

Motor branches

④ nerve for medial pterygoid mm

② nerve to very PALAMM

tensor TYMPANI
③ nerve to
④ nerve to Lateral PTERYGOID
MM

massetekic mm
⑤ nerve to
( HORIZONTAL FIBERS

⑥ Deep tempo RAIN .

OF TEMPORAL mm)

⑦
⑧
MYLOHYOID

ANT . BELLY OF DIGASTRIC MM

:*
?⃝
 •

it-a.IE?-u---=----wv---w--vv--JULu-ut)randr
÷ ÷ ÷¥.÷ ÷
ophthalmic wÉññe-

-
:*
THICKEST
.me "
-
f-hm-n-nmn-M-n~n.TT
renren.in#-w-.
BRANCH

www.vk#-s-w--J
needle-cartridgT-ydrin.ge
adaption

diaphragm plunger

Anes .
solution -
Acidic

Basic
Anes . agent -

Base form - ☐ Add Hot

problem
:

1.
lipid soluble i. Non -

injectible
tissue penetration
-

2. Unstable
Basic drug that goes
into an acidic environment 2- Non -
ionized * Water soluble
Note : IONIZATION •
tissue penetration -
Ionized
tends to shift towards
.

Basic → Acidic 3. White powder

* opposite = Ionization salt form
how basic / PH
pKa
•

Duration of action
- •

* same ionization
__ non - >

Ionized acidic drugs the

↳ Protein binding capacity
.

i.
8.1 lidocaine Examples of Acidic
Water
-
•

environments 2. absorption of the drug

injectable
:
soluble →
Focal drugs ✗ good systemic drugs V. 6 !¥iAs
Infection →
__ __
1-
-

•
stable ↳
longer it stays in the
Basic drug → BASIC 2. Inflammation
inj.si/-e,1ongertheeffectenvi.--shifttonon-
Binds to Receptor
of absorption to duration :{
•

3. Alcoholic patients toxicity

.

__

Ionization
50% Salt 50% base V. 6 ! ! ! * shift to ionization
-

vascularity of the tissue

[
__
injection INTO NORMAL ,

TISSUE , LEADS TO SHIFT TO ✓ Balance bet 10h12'cd& non .

-
10h .

* Anes is less effective

• Rich Blood supply -

NON IONIZATION ideal tissue 8.1 F absorb to duration

ph of
-

.
=

Less Blood
supply
-
•

least vasodilation is Primary use of ADENERG " DRUGS

add vasoconstrictors to absorb arduration
epinephrine in a. EPINEPHRINE ✗ -

adrenergic 7
meptvacame -

Medicine : sympqttottiinfmpticf receptors affected by blood supply

b. LEVONODEPHRINE diameter of B. V
* A / lanes agents =
of cardiac output
↳DRUGS
mimics sympathetic •

big diameter __ more blood

vasodilators # B. Receptors response
Beta blockers EPINEPHRINE
REVERSAL tfvascularity tfabsorb
except cocaine
,
-_

hvasoconst .
tyduration
☐ Vaso
constrict
small diameter
-
•

NERVOUS SYSTEM CNS

fvascularity.to absorb
-

I 1st line of defense for ones

-

PNS -
SENSORY
-
Visceral •
Amide + vasoconstrictor
7 duration
I
VOLUNTA -
Mtotor somatic
•
2% Lido w/ I :/ 00,000 EPI
physiologic antagonist
Rt
1 2nd line -
EPINEPHRINE & HISTAMINES
skeletal
Autonomic / Amide
sympathetic only
•
-
mm
INVOLUNTARY nervous sys .
•
3% Mepivacaine 2% Lido

| !!!!.ME?j
,
"
-

d. STOMACH
•

fightffflight Cholinesterase enzyme Adrenergic

fright enzyme that breaks
,

&
•

allergic Sympathetic
'

to amides
-

3rd linen truly down acetylcholine

parasymp nervous •
Anti histamine
- -
weak ones @
g
.

syst .
high enough dosage " +9 " Primary neuro trans
•
Rester digester •

Injectable Diphenhydramine antihis -

Mitter in the Para -

urinate * Esters non injectable

= local ones
-

sympathetic nervous
system → cholinergic
-

Difference of Amide & Easterlies in drugs

Syringe types
the intermediate chain
Non disposable
.

1.
-

•
Breech-loading -
metallic cartridge aspirating , Ester Amide
•
Breech-loading
-
metallic cartridge Aromatic ✓
✓
,

( lipophilic)
self -
aspirating group
•
periodontal ligament syringe Amine
✓ ✓
( hydrophilic)
•
Jet injectors topical - ones only group
↳ NP nerve & GP nerve Ester Amide t.LA agent + HCL
Intermediate
2. Disposable chain chain Water
2.
chain
safety syringes
•

3. vasoconstrictor
Anes Delivery Sys
Computer Controlled Local
.

3.
•
palatal approach ASAN Block
4. Sodium Bisulfate -
preservative
5. NaCl lsotonoc.im
ASAN Block ( 1. injection)
-

•
MSAN

bacteriostatic
,

6. Methyl Paraben -
 2% LIDO __ Basic
All membranes →
phospholipid bilayer
meaning ? →
Ltprb SOLUBLE can pass 2%4 DOW / HCl __
Acidic
THRU THE MEMBRANE
All
drugs are either weak acids tweak bases
Lanes

w/ infection acidic environment

=

+
heavy smoker

Anes ( weak based = ionization occurs oral

cavity is

↳ ✗ pass thru BASIC

acid t acid -
NON IONIZED 1st compartment
non ionized
✓ Pass thru
- -

↳
-

base form
pKa =
dissociation constant
=
onset of action
=
50% ionized
= 50% non -

Ionized
2nd compartment
-
ones Solin
non -

IONIZED IONIZED -

injectable
-

Base form "" ""

-

alkaline -

audio
-

pass thru membrane -

cannot pass membrane 3rd compartment
outside membrane
lipid soluble / not water form that bonds w/ receptor
-

shift toward non ionization

-

"" b "
-

not injectable -

Injectable ,
water soluble -

pH :
7.4
unstable stable
-
-

faster exp date .

4th compartment
-

inside nerve mem

Provo Caine -
Esther Chasma)
.

equilibration
✗ give to cholinesterase deficiency pxs

✓ give to Malignant hyperpyrexia px

- Short duration of action

?⃝
 trñaañt.Iñ→→ncTaTI¥Eñ→→h Eñññ#ññ→→h
b- new u -
←
b- new
Lidocaine 2% I :/ 00000 EPI
posterior point
, •

antero
supero inferior point ( height)
-

' -

LIDOCAINE EPINEPHRINE •

midway between •

coronoid notch or

•
wt dependent
•

0.2mg / day Pterygomand raphe . & 1cm above mandibular

^L seen
•
all cardiovascular by naked eye
•

w/ vaso =
70mg / kg occlusal plane
dse EXCEPT anterior boarder of
to exceed
not hypotension can
ramus →
palpate
receive0.04mg / day
600mg / day •

hypotension treat __
objective : reach mand foramen .

w/o normal
•
as
Vaso =
213 from ant .
boarder of ramus

hyperthyroid
•
=
no
4.4mg 1kg to posterior boarder
epi
not exceed not
completely
rmanhid but
400mg / day
partial ones of mandibular molars :
soft-tissue ones w/o pulpal ones

OVERDOSE OF LIDO
1. Bifid IAN 2nd ' AN block
did not apes central fibers
-

Respiratory ARREST
-
=

innervation by 1. deposited little solin

supplementary
:
2.
Local ones Depressors -_

local INFILTRATION
mylohyoid supplemental

g- 2. goin injected too far from

a.
↳ D @ press cortex ☐
0N LINGUAL 1- tooth distal
* capsules
b. lingual the nerve

BASIC DRUG
•

•
survives acidity OF stomach MOST COMMONS :

to Reach small intestine

ASAN :

small ,
lipid soluble ,
non
-
ionized 1 .
Naso palatine nerve block ① ASAN
pass thru nerve block
drug molecules can .
most painful ② External nasal
the membrane in
dentistry .

③ superior labial
2. Local Infiltration
Inter septal ones
-

most common technique

④ Inferior palpebral
900 to soft

)n
needle :

supraperiostealinj
-

tissue
-

aka .

3. IAN BLOCK

fingerling →
-
most common nerve block
6 .
1mL / 30 secs
CFech~Éqe highest failure
-

speed of injection
www.UWJ 4. NISAN BLOCK 7. Hematoma
1. local infiltration -

least common nerve block

-
complication for all inj techniques
-

small terminal nerve 5. Bevel 8. Syncope

-

endings face the bone dental clinic

complication
-

in
site
-

Tx area : same as inj

-
Inter
papillary injection
* IAN ,
Gow -

gates ,
Akinosi & 9 .

Supine
-
ADV . Hemostasis PDL -

away from the bone -

patient position in all inj

2. Field block
technique .

large terminal nerves

Tx area :
away from inj site
-

Lessing ,
less Solin wider ,

area of effect
3. Nerve Block
-
main trunk of nerve
-
TX area : distant from site
of inj .

Lessing less Solis ,

'

ADV :
-

.
,

wider area of effect

 * NLE * NCLEX * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY *
MED TECH
BAYANIHAN FINAL COACHING
TEST 6: Anesthesiology
Prepared By: Doc Mostafa Mehrafsha
Philippine Dentistry Licensure Examination

NAME:
1. This is the minimum intensity of a stimulus required to be interpreted as pain
A. Pain Threshold
B. Pain Tolerance maximum intensity tolerable w/o seeking tx
-

C. Pain Pathway
D. Depolarization Threshold

2. Nerve fibers responsible for impulse propagation of acute pain

A. A-delta SHARP -

TYPES OF PAIN
impulse →

any unwanted experience →

slowest

B. A-beta ACUTE -
A -
delta CHRONIC → C fibers

C. C-fibers unmyelinated
myelinated
•
thin •
thin

/ •
30m s / •
0.5 -
2m s

D. A-gamma pain throbbing

glutamate
•

•
1st long lasting
, pain
( neuro -
•

•
substance p
,
dull

✓
transmitter) -

3. Carries electrical impulse from periphery to spinal cord

A. pre-synaptic neuron
B. post-synaptic neuron
C. 3rd order neuro
D. intermediary neuron

4. For an anesthetic agent to be effective it needs to

A. block the sodium channels and prevent entry of Na+ during depolarization
B. Block the Sodium channels and prevent exit of Na+ during depolarization
C. block the potassium channels and prevent entry of K+ during depolarization
D. block the potassium channels and prevent exit of K+ during depolarization

5. Most clinically useful anesthetic agents are classified as

mediated [
A. Class A outside
-
neuron
receptor
B. Class B Inside
-
neuron

C. Class C receptor independent / Benzocaine

-

D. Class D combination of
both
-

6. Part of the brain responsible for processing pain impulses and generate pain
A. Thalamus
B. Cortex
C. Frontal Lobe
D. Limbic System

7. Depolarization threshold or firing threshold

A. -70mv
B. +40mv
TOP RANK REVIEW ACADEMY, INC. Page 1 | 12
 C. -55m
D. -85mv
8. An axolemma in a hyperpolarized state has a membrane potential of
A. -70mv
B. +40mv
C. -55m
D. -85mv

9. At -55 mv potential difference across nerve membrane

A. Na+ channels open and a fast influx of Na+ into the nerve
B. Na+ channels open and a fast exit of Na+ out of the nerve
C. K+ channels open and a fast influx K+ into the nerve
D. K+ channels open and a fast exit of K+ out of the nerve

10. Is comprise of a slow "initial phase" and a fast "secondary phase"

A. Deploarization
B. Repolarization
C. Refractory Period
D. Resting Phase

11. At +40 leads to repolarization

A. Opening of K+ Channels and fast exit of K+ out the nerve
B. Opening of K+ Channels and a fast influx of K+ into the nerve
C. Opening of Na+ channels and gast influx of Na+ into the nerve
D. Opening of Na+ channels and a fast exit of Na+ out of the nerve

12. At -85 mv the following events lead to a return to resting phase

A. Activation of Sodium-potassium pump and exit of 3Na+ for entry of 2 K+
B. Activation of Sodium-potassium pump and exit of 2Na+ for entry of 3 K+
C. Deactivation of Sodium-potassium pump and exit of 3Na+ for entry of 2 K+
D. Deactivation of Sodium-potassium pump and exit of 2Na+ for entry of 3 K+

13. Pre-synaptic A-delta fibers release that leads to the excitation of the post-synaptic neuron.
A. Glutamate
B. Substance P C fibers
-

C. Acetylcholine
D. ATP

14. In a myelinated nerve, this is the minimum required length to achieve anesthesia
A. 8-10mm 2- 3 nodes of
=
Ranvier

B. 10-12mm
C. 12-14mm
D. 6-8mm

15. Describes pain system as a straight through channel from skin to brain
A. Specific Theory
B. Pattern Theory
C. Hydrodynamic Theory
D. Gate Control Theory

16. Claims that information that travel faster have higher priority to reach the brain and thus interpreted
TOP RANK REVIEW ACADEMY, INC. Page 2 | 12
 A. Specific theory
B. Pattern theory
C. Hydrodynamic theory
D. Gate Control theory -

paunahan maka rating sa

gate ( synaptic
region (
17. Gate control theory proposes the existence of a modulatory gate located at of spinal cord
A. Ventral Horn
B. Substantia Gelatinosa nucleus inside neuron
C. Dorsal Nucleus
D. Intermediolateral nucleus

18. Proposes pain as a result of stimulation of nerve endings brought about by increased fluid flow in
dentinal tubules
A. Specific theory
B. Pattern theory
C. Hydrodynamic theory dentinal pain
-

D. Gate Control theory

19. Which of the ff. Branches of the maxillary nerve is given off within the pterygopalatine fossae
A. ASAN
B. MSAN
C. PSAN
D. Nervous Spinosus

20. This is the only branch of trigeminal nerve that receives fibers from the motor nuclei
A. Mandibular nerve
B. Maxillary nerve
7- sensory
C. Opathalmic nerve
D. Frontal nerve

21. Serves as the point of exit for mandibular nerve from the cranial cavity
A. froamen ovale
B. foramen rotundum
C. infraorbital fissure
D. mandibular foramen

22. Branch of mandibular nerve that innervates the temporomandibular joint

A. n. to lateral pterygoid muscle
B. articular nerve
C. ant, auricular nerve
D. internal pterygoid nerve

23. Which of the following is a sensory branch of the anterior trunk of mandibular nerve?
A. long buccal nerve
B. masseteric nerve
C. inferior alveolar nerve
D. deep temporal nerve

24. Which of the following is NOT a sensory branch of the posterior trunk of mandibular nerve?
A. Lingual nerve
B. Inferior Alveolar nerve
TOP RANK REVIEW ACADEMY, INC. Page 3 | 12
 of anterior trunk
C. Long Buccal nerve sensory
-

D. mental nerve
25. Innervates the lower lip
A. inferior labial nerve
B. inferior palpebral nerve
C. superior labial nerve
D. superior palpebral nerve

26. Which of the following nerves need to be anesthetized for successful extraction of # ✗ 45?
A. IAN, Lingual Best answer :

Nerve
IAN Mental
B. Mental, Lingual , ,
PULPAL ROT

45J
, an
-

Lingual -

EXO

C. Incisive, Lingual Exo -

RESTO

D. Incisive, Long buccal MUCOPCRIOSTEAL

- Mental
Exo Branch of IAN → .

-
Deep scauN6 Lingual
27. Which
Q
of the following nerves need to be anesthetized for RCT on tooth #47?
×
A. IAN
B. Long buccal
PULPAL IAN
-

C. Incisive
D. Mental

28. Which of the following nerves need to be anesthetized for deep scaling of tooth #33?
✗
A. Incisive, lingual 2nd choice Best
/ choices
B. Mental, lingual * lfwalasi mental ,&
"
nasa
"

MUCOPCRIOSTCAL IAN Lingual pwede

C. IAN, lingual
si ,
.

si IAN
*
mental & LINGUAL
D. Mental, Long buccal
- .

29. Which of the ff. Branches of the maxillary nerve is given off within the pterygopalatine fossae
A. ASAN
B. Infraorbital
C. Zygomatic
D. External Nasal

30. Which of the ff. Branches of the maxillary nerve is given off within the Infraorbital Canal
A. ASAN & MSAN
B. Inferior Palpebral
C. Superior Labial
D. PSAN

31. Which of the ff is NOT a terminal branch of maxillary nerve

A. External Nasal
B. Inferior Palpebral
C. Superior Labial
D. Inferior Labial

32. Nerve responsible for innervation of pulp of maxillary molars except mesiobuccal root of maxillary first
molar
A. Posterior Superior Alveolar Nerve
B. Middle Superior Alveolar Nerve
C. Anterior Supertor Alveolar Nerve
D. Greater Palatine nerve

TOP RANK REVIEW ACADEMY, INC. Page 4 | 12

 33. Serves as point of exit for nasopalatine nerve
A. infraorbital foramen
B. foramen rotundum
C. incisive foramen
D. mental foramen

34. The following nerves form the outer alveolar nerve loop except
A. ASAN
B. MSAN
C. Infraorbital nerve
D. PSAN

35. The following nerves form the internal plexus of alveolar nerves except
A. anterior palatine nerve
B. greater palatine nerve
C. posterior palatine nerve
D. nasopalatine nerve of scarpa

36. Which of the following nerves need to be anesthetized for extraction of tooth ×
# 16
A. ASAN, MSAN, Greater palatine nerve PSAN
PULPAL MSNN
B. MSAN, PSAN, Nasopalatine nerve Exo 16
-

(
,

C. ASAN, MSAN, Nasopalatine nerve MP-

fp
D. MSAN, PSAN, Greater Palatine nerve

37. Which of the following nerves need to be anesthetized for a successful RCT of #24

:
A. MSAN, Greater palatine nerve
B. MSAN only
C. PSAN only
D. Greater Palatine only

38. Which of the following nerves need to be anesthetized for extraction of tooth # 12
A. ASAN, MSAN
B. MSAN, Greater palatine
C. ASAN, Greater palatine
D. ASAN, Nasopalatine
ptulpal Imp
39. Which of the following nerves need to be anesthetized for sensitive deep restoration of tooth #
× 25?
A. ASAN to
B. PSAN
C. Nasopalatine
pulpal
0m¥
D. Greaterpalatine
E. None of the above

40. This is the nuclei of trigeminal nerve located within medulla

A. Mesencephalic
B. Spinal
C. Chief
D. Motor

41. Which of the following is a motor branch of trigeminal nerve?

A. ASAN
TOP RANK REVIEW ACADEMY, INC. Page 5 | 12
 B. Inferior Alveolar Nerve
C. Infraorbital Nerve
D. N. to tensor veli palatin
42. This is the thinnest branch of Trigeminal Nerve
A. Ophthalmic
Note thickest branch
B. Maxillary
:

of the Ophthalmic
is

C. Mandibular the frontal Nerve

D. Zygomatic * thickest of the thinnest

branch #

43. Point of exit of Ophthalimc nerve from cranium

A. Foramen Ovale
B. Foramen Rotundum
C. Supraorbital Fissure
D. Infraorbital Fissure

44. This is the part of cartridge that engages the harpoon of the syringe
A. Rubber Plunger
B. Rubber Diaphragm
C. Aluminum cap
D. Shaft

45. Burning during injection can be caused by

A. cold solution
B. too fast injection Pain -

Burning sensation
C. too fast needle penetration abrupt -

bone contact cold -

should be room temp .

D. hooked needle - pain on

insertion acidity -

buffer soin

↳ pain during withdrawal

-
dull needle

46. Anesthetic solutions are ALWAYS

A. Basic AINT
-
ones
].

B. Acidic -

C. can either be acidic or basic

47. Sodium bisulfit in anesthetic solution acts as preservative for

A. Sodium Chloride
B. Epinephrine
C. Local anesthetic agent
D. Methylparaben

48. This number corresponds to the diameter of the lumen of the needle
A. Gauge Larger gauge
↳ Better aspiration
B. Length
→ Doesn't break easily
C. Deflection
D. Elasticity

49. Recommended gauge of the needle for use in dentistry

A. 25
B. 27
C. 30
D. 27 long

50. It is the bending of needle inside the tissue after insertion

TOP RANK REVIEW ACADEMY, INC. Page 6 | 12
 A. Deflection Less deflection → higher accuracy
B. Gauge →
f- gauge needle

C. Elasticity
D. Shifting

51. Length of dental long needle

A. 20mm
between
B. 32mm 30 32mm = -
* No pain diff .

gauge 25 & 30
C. 20cm short needle
-

D. 16mm * Needle is measured from

tip to hub

52. Pain on insertion of the needle is caused by

A. Too fast insertion
B. Too fast deposition
C. Dull needle
D. Hooked needle

53. Hooked needle is caused by

A. Too fast insertion
B. Too fast deposition
C. Dull needle
D. Abrupt bone contact
Matic na self -

aspirating
pp

54. These type of syringes utilizes a projection, that presses on the rubber diaphragm of cartridge and
creation of a negative pressure, to achieve aspiration
A. breech-loading, metallic,cartridge type, aspirating
B. breech-loading, metallic,cartridge type, self-spirating
C. Pressure syringes
D. Safety Syringes

55. In the pen-type dental syringes, how much anesthetic solution is deposited upon each "click"?
ROOT for PDL
A. 0.2ml amt of solution needed PER
-

↳ Rubber plunger thickness

B. 0.1ml
C. 0.5ml
D. 1.0ml

56. Which of the following nerves can be blocked by the use of jet injectors?
A. Nasopalatine nerve
B. Long buccal nerve
C. Lingual nerve
D. Anterior Superior Alveolar Nerve
me fault of practitioner
57. Broken cartridge during injection is caused by
A. Too much force during injection
B. too much force during aspiration
C. improper storage of cartridge
D. off centric penetration of rubber diaphragm by the needle -

leakage during injection

58. Most common cause for disengagement of the Harpoon from the Plunger during Aspiration
A. too much force during injection
B. too much force during aspiration harpoon design
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 C. off centric penetration of rubber diaphragm by the needle
D. bent harpoon

59. Primary determinant of Local Anesthetics' potency is

A. Partition coefficient How lipid soluble ↳ dosage
-
dependent

B. Dissociation Constant drug is a all receptors in our

made up of :
body are

C. Protein- binding capacity Glycoprotein w/ e means

D. Presence or absence of vasoconstrictor theprimary determinant

factor for the duration of
action of LA
=

60. Primary determinant of Local Anesthetics' onset of action is Protein binding

A. Partition coefficient capacity

B. Dissociation Constant
C. Protein- binding capacity
D. Presence or absence of vasoconstrictor

61. Which of the following does not affect the duration of action of local anesthetic solutions?
A. lipid solubility
B. vascularity of site of injection
C. dosage of anesthetic agent
D. amide/ ester configuration

62. Which of the following anesthetic agents can be found naturally?

A. Cocaine only vasoconstrictor 1st discovered
n

,
Bupivacaine longest duration :

Trp post OP pain management

B. Procaine 1st
-
synthetic longest used practice
,
Benchmark
in ,
comparison
for

cardio toxic →

C. Lidocaine Prilocaine Methemoglobin line mia -

of Prilocaine
D. Benzocaine
ortho toluidine
↳ metabolite → -

for pxs
use
Arti Caine both
→ & Ester Amide
W/ hepatic
-

Tetracaine -
most toxic slowest elimination
-
Blood ; 85 90%
-

, dse -
cholinesterase enzyme
63. Which of the following anesthetic agents leads to the constriction of blood vessels?
A. Cocaine
B. Lidocaine
C. Procaine
D. Mepivacaine

64. Which of the following anesthetic agents has the lowest coefficient of vasodilation?
A. Articaine
B. Lidocaine
C. Mepivacaine
D. Bupivacaine

65. This is considered the most cardiotoxic anesthetic agent

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

66. Anesthetic agent of choice for post-operative pain management

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

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 67. Anesthetic agent of choice for patients with hepatic diseases
A. Lidocaine
B. Bupivacaine
C. Articaine metabolized in the blood
-

D. Mepivacaine
68. This is the active ingredient in the anesthetic solution
A. Anesthetic Agent Local
- Anes agent

B. Vasoconstrictor
C. Epinephrine
D. Sodium bisulfite

69. This is the enzyme that breakdown ester anesthetics

A. cholinesterase enzyme
" "

pseudo cholinesterase
t
B. CYP450 breaks down AMIDES
-

C. Lipases
D. Maltases

70. Which of the following anesthetic agents is metabolized in the blood?

A. Bupivacaine
-
ester
B. Lidocaine
C. Articaine
D. Prilocaine

71. Which of the following is a contraindication for use of ester anesthetic agents?
A. cholinesterase deficiency
B. severe hepatic disease
C. hypertension
D. hypotension

72. Methemoglobulinemia is commonly associated with the use of which anesthetic agent?
A. Procaine
B. Lidocaine
C. Prilocaine / Benzocaine
D. Mepivacaine

73. This is the most commonly used anesthetic solution. Anes .

agent sold in 2 diff

concentrations =P RILO CAINE
A. 2% lidocaine HCl with1:100,000 Epinephrine ↳ 3% & 4%
B. 1% lidocaine HCl with1:100,000 Epinephrine
C. 2% lidocaine HCl
D. 2% lidocaine HCl with1:200,000 Epinephrin

74. What is the maximum number of cartridges that can be injected on a healthy adult patient
A. 11.1 cart/day
B. 7.9 cart/day
C. 7.1 cart/day
D. 8 cart/day

75. Local Anesthetic agents pass across membranes thru

A. Passive diffusion
B. Facilitated diffusion
C. Active transport kidneys ( bowman capsule)
-

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 D. Osmosis
76. Which of the following is not a contributing factor to the toxicity of anesthetic agent?
A. rate of absorption - fast abs . 7- toxicity
B. rate of distribution to non-target tissues
7 toxicity
C. rate of elimination -
longer drug stays in the body ,

D. pH of injection site
77. Anesthetic agents when placed in an acidic environment
A. Tend to shift toward ionization
B. Tend to shift toward unionization
C. Tend to retain neutrality H2O
:
& salt

78. Which of following anesthetic agent molecules can pass thru membrane?
A. Lipid soluble, ionized
B. Lipid soluble, non-ionized
C. Water soluble, non-ionized
D. Water soluble, ionized

79. It is not advised to inject on an inflamed tissue because

A. inflamed tissues are acidic therefore there will be a shift toward ionization of anesthetic agent
B. inflamed tissues are acidic therefore there will be a shift toward unionization of anesthetic agent
C. inflamed tissues are basic therefore there will be a shift toward unionization of anesthetic agent
D. inflamed tissues are basic therefore there will be a shift toward ionization of anesthetic agent

80. Which of the ff. Is NOT true in regard to an ideal local anesthetic agent?
A. should have long duration of action
B. should be reversible
C. should possess adequate tissue penetration
D. should be strerile

81. HCl acid is added to anesthetic agents to

A. make the anesthetic agent stable
B. make the anesthetic agent unionzed
C. make the anesthetic agent lipophilic
D. make the anesthetic agent lipid soluble

82. In an amide anesthetic agent, the intermediate chain is composed of

A. Aromatic portion
B. Amine group
C. An amide
D. An ester

83. To stabilize local anesthetic agents - ☐ Placed in an

environment
acidic

A. A strong acid (HCl) is added Add HCl ( Hydrochloric

B. Sodium bisulfite is added acid)

C. Sodium chloride is added

D. Methyparaben is added

84. Effective in children where the needle is forced into the cancellous bone and anesthetic solution is
deposited to proximate the pericementum
A. Interseptal injection
B. Intraosseous injection
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 C. PDL injection
D. Infiltration

85. These include injection techniques where small terminal nerve endings are anesthetized
A. Local infiltration
B. Field Block
C. Nerve Block
D. None of the options

86. Which of the following techniques is considered a true mandibular nerve block?
A. Classic mandibular nerve block technique Other for IAN block
#
name

B. Halsted Approach
C. IAN Block
D. Gow-gates Technique

87. Which of the following nerves is NOT anesthetized thru an IAN block?
A. IAN
B.
C.
Incisive
Mental
f- sure na
tip
Kasama sa IAN block
of needle mandibular foramen
:

ht of needle
D. Long Buccal : determined by coronoid notch /
1cm above mand occlusal
.

plane
( 10mm)

88. In IAN block, the tip of the needle is located at

A. Mandibular Foramen
B. Foramen Ovale
C. Mental Foramen
D. Incisive Foramen

89. The height of needle insertion in an IAN block is deter

A. Coronoid Notch
B. Mandibular Notch
C. Mandibular Foramen
D. Pteygomandubular Raphe

90. Partial anesthesia of mandibular molar teeth after an IAN block can be attributed to
A. Accessory Innervation by mylohioid nerve
B. Accessory Innervation by contralateral IAN
C. too little anesthetic Solution deposited
D. Anesthetic solution deposited away form the nerve

91. Soft tissue anesthesia without pulpal anesthesia after an IAN block is due to
A. Accessory Innervation by a bifid IAN
B. Accessory Innervation by contralateral IAN
C. too little anesthetic Solution deposited
D. soft tissue anesthesia always warrant pulpal anesthesia

92. Which of the following is not anesthetized thru mental nerve block?
A. Mandibular premolars on the side of injection
B. lower lip on the side of injection
C. facial mucoperiosteum of mandibular premolars on the side of injection
D. facial mucoperiosteum of mandibular incisors on the side of injection

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 93. This is the only injection technique in dentistry where pressure anesthesia can be achieved,
A. intraligamentary injection
B. intrapulpal injection
C. intraosseous injection
D. local infiltration

94. These include injection techniques where large terminal branches are anesthetized
A. Local Infiltration
B. Field Block
C. Nerve Block
D. None of the options

95. In these injection techniques. The treatment area is slightly away from the site of injection
A. Local Infiltration
B. Field Block
C. Nerve Block
D. None of the options

96. Which of the following is not an area anesthetized by the Posterior Superior alveolar nerve?
A. Facial Pulp of Maxillary molars except the mesiobuccal root of maxillary first molar on the side
of injection
B. Pulp of the palatal root of maxillary roots on the side of injection
C. Facial muoperiosteum at the area of maxillary molars on the side of injection
D. palatal muoperiosteum at the area of maxillary molars on the side of injection

97. Which of the following nerves in not anesthetized thru an ASAN block?
A. Anterior superior alveolar nerve
B. External nasal Nerve
C. Superior Labial nerve
D. Nasopalatine nerve

98. During a routine extraction after a nasopalatine nerve block, the patient still experiences pain on the
palatal mucoperiosteum at the area of canine this can be explained by
A. supplementary innervation by the greater palatine nerve
B. supplementary innervation by anterior superior alveolar nerve
C. supplementary innervation by middle superior alveolar nerve
D. wrong injection technique

99. Depth of needle insertion during a maxillary nerve block

A. 16mm :P SAN short needle
,

B. 30mm
C. 20mm
D. 32mm
( 2nd PM)
100. For a routine extraction of tooth ✗
#15 the following injection techniques provides sufficient
anesthesia.
A. MSAN block+ NP block
B. ASAN Block+ NP Block
C. MSAN block+ GP block
D. PSAN block+ GP block

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