- Category: Oral and Maxillofacial Surgery and Anesthesiology
- Aim: Revising for NBDE Part II
- Questions: 25
- Hint: No
- Mutiple Opportunites: No
- Time Limit: No
- Answer Explaining: Yes
Oral and Maxillofacial Surgery/ Pain Control
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The following are those properties deemed most desirable for a local anesthetic, except ____.
It should not be irritating to the tissue to which it is applied
It should cause a permanent alteration of nerve structure
Its systemic toxicity should be low
It must be effective regardless of whether it is injected into the tissue or applied locally to mucous membranes
Question 1 Explanation:
B. A local anesthetic should not be irritating to the tissue to which it is applied, nor should it cause permanent alteration of nerve structure. Its systemic toxicity should be low. Finally, it must be effective regardless of whether it is injected into the tissue or applied locally to mucous membranes. If an agent causes permanent alteration of nerve structure, it would not be of benefit.
Systemic effects of obstructive sleep apnea syndrome (OSAS) include all of the following except ____.
Question 2 Explanation:
C. Systemic sequelae of OSAS include hypertension, Cor Pulmonale, and cardiac arrhythmia.
The majority of injectable local anesthetics used today are .
Question 3 Explanation:
A. Most local anesthetics packaged in dental cartridges are tertiary amines. Currently, the only local anesthetic packaged in dental cartridges that has an ester bond is articaine but the bond in the connecting chain in the drug molecule is an amide.
The __ is recommended for palatal soft-tissue management from canine to canine bilaterally in the maxilla.
Posterior superior alveolar
Question 4 Explanation:
D. Nasopalatine (NP). The palatal tissue from canine to canine bilaterally is the premaxilla. The NP injection anesthetizes this area.
All of the following are possible reasons why some local anesthetics have a longer duration of action than others, except
The addition of a vasoconstrictor
Percent protein binding
Degree of lipid solubility
pKa of the drug
Question 5 Explanation:
D. The addition of vasoconstrictors will prolong the duration of action of a local anesthetic. The percent protein binding also affects duration of action. Lipid solubility also affects the duration of action of injected local anesthetics. The pKa has an effect on onset of action but not on duration of action.
Which of the following local anesthetics has the highest pKa?
Question 6 Explanation:
D. The pKa for lidocaine or prilocaine is 7.8, mepivacaine is 7.7, and bupivacaine is 8.1.
If your patient has a history of liver disease, which of the following would be the safest local anesthetic?
Question 7 Explanation:
A. All amide local anesthetics are biotransformed in the liver. One available local anesthetic also has an ester side chain, which means it has some degree of extrahepatic biotransformation (out-side the liver). This drug is articaine and is there-fore the most appropriate drug for patients with liver disease.
Upon evaluation of an immediate postoperative panoramic film of a dental implant replacing tooth #30, you measure a distance of 1.5 mm from the apex of the implant to the inferior alveolar nerve canal. This is a titanium implant in an otherwise healthy patient. Which of the following actions is indicated?
You may proceed with immediate loading of the implant.
You should continue but only perform a two-stage procedure.
Back the implant out approximately 0.5 mm to ensure a safe distance from the nerve.
Remove the implant and plan a repeat surgery after 4 months of healing.
Question 8 Explanation:
C. Implants should be placed a minimum of 2 mm from the inferior alveolar canal.
A 21-year-old man is referred to your oral and maxillofacial surgery practice for an orthognathic surgery consult After your routine exam and review of radiographs, you note the following problem list: Class III skeletal facial deformity with a negative overjet of 6 mm and significant maxillary crowding; missing left mandibular first molar due to dental decay with multiple other early carious lesions; and calculus on the lingual surfaces of teeth #22 through #27 with gingival inflammation. Which of the following is the most appropriate order in which this patient's oral health needs should be sequenced?
Definitive crown and bridge therapy, orthodontics to relieve crowding and to coordinate arches, caries management, surgery to correct the skeletal discrepancy, and periodontal therapy to control gingival inflammation.
Caries management, orthodontics to relieve crowd¬ing and to coordinate arches, definitive crown and bridge therapy, periodontal therapy to control gingival inflammation, and surgery to correct the skeletal discrepancy.
Periodontal therapy to control gingival inflammation, definitive crown and bridge therapy, orthodontics to relieve crowding and to coordinate arches, surgery to correct the skeletal discrepancy, and caries management.
Periodontal therapy to control gingival inflammation, caries management, orthodontics to relieve crowding and to coordinate arches, surgery to correct the skeletal discrepancy, and definitive crown and bridge therapy.
Question 9 Explanation:
D. Periodontal management is the first step in the management of this patient. If the patient is unwill¬ing to, or unable to maintain adequate hygiene prior to placement of orthodontic appliances, their subsequent placement will only make the peri¬odontal situation more difficult. For the same rea¬sons, dental decay should be treated prior to orthodontic treatment. The final prosthetic man¬agement should not be completed before the underlying skeletal anomaly is addressed because the occlusion will then be constructed to the best—and final—anatomical location.
_____ has a shorter half-life than other amides because a portion of its biotransformation occurs in the blood by the enzyme plasma cholinesterase.
Question 10 Explanation:
D. Bupivacaine, mepivacaine, and lidocaine are ail pure amides. Articaine has an ester bond and an amide bond. Since esters are biotransformed much more rapidly than amides, articaine has a much shorter half-life than the others.
Which of the following is not a vital part of the physical exam for patients with TMJ complaints?
Joint tenderness and sounds
Range of motion of the mandible
Question 11 Explanation:
C. Tissue symmetry, tenderness, joint noises dental health and occlusion and range of motion are all critical components of the physical exam in the TMJ patient. Although the length of the soft palate is important in the evaluation of patients with sleep apnea, snoring, patients being sedated, or patients needing complete denture construction, it does not contribute directly to TMJ dysfunction.
Which of the following is the longest-acting local anesthetic?
Question 12 Explanation:
D. The degree of hydrophobicity and protein binding are the most important factors in determining dura¬tion of action of a local anesthetic. Bupivacaine is highly hydrophobic (therefore lipophilic) and is 95% bound to protein. The other listed agents are less hydrophobic and are between 55% and 75% bound to protein.
Which of the following does not represent a fasciaI space for the spread of infection?
Superficial temporal space
Question 13 Explanation:
D. The superficial temporal, pterygomandibular, masseteric, and submental spaces are potentially involved in the of odontogenic infection. There is no rhinosoteric space.
Which of the following does not represent a possible finding of severe infection?
Difficult or painful swallowing
Swelling and induration with elevation of the tongue
A temperature of 99° F
Question 14 Explanation:
E. A patient with severe infection and systemic involvement unless immunocompromised are expected to present in a febrile state, or a tem-perature of greater than 100°F. All the other items refer to symptoms that indicate potential airway emergency.
Myofascial pain dysfunction may be described as ____.
Masticatory pain and limited function
Clicking and popping of the joint
An infectious process
Dislocation of the disc
Question 15 Explanation:
A. In myofascial pain dysfunction the source of the pain and dysfunction is muscular. Here dysfunc-tion is associated with decreased opening or inability to chew.
Which of the following local anesthetics is marketed for dentistry in the United States in more than one concentration?
Question 16 Explanation:
B. Bupivacaine is only packaged in dental cartridges as a 0.5% solution. Likewise, lidocaine is always a 2% solution (in the United States) and articaine is always a 4% solution. Mepivacaine Is packaged In both 2% and 3% solutions (In the United States).
Which injection anesthetizes the distobuccal aspect of the mandibular first molar?
Posterior superior alveolar (PSA)
Middle superior alveolar (MSA)
Anterior superior alveolar (ASA)
Inferior alveolar (IA)
Question 17 Explanation:
D. All mandibular molars are anesthetized by the inferior alveolar nerve block. The other three answers in the question are maxillary injections.
Which of the following is not a relative contraindication, for routine, elective oral surgery?
Unstable cardiac angina
History of head and neck radiation
Question 18 Explanation:
C. Chronic sinusitis is not a relative contraindication to most elective oral surgical procedures. Unstable chest pain should be evaluated by an internist or cardiologist prior to any dental treatment. Radiation to the jaws or a history of clotting disorders would both need further investigation of the health history and likely alter the patient’s treatment plan to lessen the likelihood of osteo-radionecrosis or of bleeding complications.
Which of the following is considered the highest and most severe classification of maxillary fracture?
Question 19 Explanation:
C. Maxillary fractures may be classified as LeFort I, or III. The LeFort III is the highest and most severe.
From the list of classifications of impacted teeth below, which one(s) must always involve both bone removal and sectioning during the surgical procedure?
A and B only
A, B, and C
Question 20 Explanation:
B. Depending on the ramus relationship the mesioangular and vertical impactions may not require removal of bone or sectioning of the tooth. The horizontal impaction will always require removal of bone and sectioning.
The major factor determining whether aspiration can be reliably performed is .
The needle gauge
The needle length
The injection performed
Question 21 Explanation:
A. The larger the lumen of the needle, the easier it will be to determine whether the needle is actually in a vessel. The needle length is irrelevant, as is the patient. The injection performed is relevant as to the frequency of obtaining a positive aspiration but not the reliability of the aspiration per se.
Three cartridges of 2% lidocaine with 1:100,000 epinephrine contain ____ lidocaine.
Question 22 Explanation:
D. A 2% solution of any drug contains 20 mg/mL, by definition. A dental cartridge of local anesthesia has a fluid volume of 1.8 mL. 20 mg x 1.8 = 36 mg of lidocaine per cartridge. Three cartridges of 2% lidocaine with 1:100,000 epinephrine therefore contain 108 mg.
You are performing a 5-year follow-up on a 43-year-old implant patient When comparing radiographs you estimate that there has been almost 0.1 mm loss of bone height around the implant since it was placed. Which of the following is indicated?
Removal of the implant and replacement with a larger size implant.
Removal of the implant to allow healing before another one can be placed 4 months later.
Remaking the prosthetic crown because of tangential forces on the implant.
The implant is doing well; this amount of bone loss is considered acceptable.
Question 23 Explanation:
D. Criteria for implant success include mean vertical bone loss of less than 0.02 mm annually after the first year of service. In this question, no further treatment is necessary at this time.
Which of the following injections has the highest degree of failure?
Posterior superior alveolar
Question 24 Explanation:
D. The inferior alveolar nerve block has a stated success rate of 85%, the lowest of any intraoral injection. Lingual and nasopalatine injections are close to 100% successful, and the PSA nerve block is also much more than 85% effective.
Which of the following is true regarding temporomandibular disorders?
The primary treatment for the majority of patients with facial pain is TMJ surgery.
Disc displacement without reduction can cause a decrease in interincisal opening.
Myofascial pain is commonly related to parafunctional habits, but not commonly related to stress.
Systemic arthritic conditions do not affect the TMI because it is not a weight-bearing joint.
Question 25 Explanation:
B. Disc displacement without reduction can result in decreased range of motion because the condyle becomes restricted by the anteriorly displaced disc, limiting translation.
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