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Local Anesthesia Board Exam.
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- IB GLOBAL POLITICS - CASE STUDIES
Local Anesthesia Board Exam.
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Local Anesthesia Board ExamWhat injection numbs the lower lip? - ANS-Mental
*Foramens & Nerves that enter and exit foramen rotundum, ovale, mandibular, incisive
and mental - ANS-Foramen rotundum - maxillary division of trigeminal nerve - V5
Foramen ovale - mandibular division of trigeminal nerve - V5
Mandibular - inferior alveolar nerve
Incisive - nasopalatine nerve
Mental - mental nerve
*Incisive papilla & nasopalatine injection - ANS-Nerves anesthestized - bilateral
nasopalatine
Area anesthestized - anterior portion of hard palate from M of right first premolar to M of
leftpremolar.
No hemostasis except in injection sight.
Technique - 27 gauge short needle inserted into palatal mucosa just lateral to incisive
papilla, target area is incisive foramen beneath the incisive papilla.
Landmarks - incisive papilla and central incisors
Approach - 45 degree angle toward incisive papilla
Topical Anesthesia - ANS-*Benzocaine - ester, not absorbed systemically, penetrates
2-3mm, 6 - 20 %,
Lidocaine- amide
Other info on topicals - no vasoconstrictors, concentration greater than locals,
benzocaine and lidocaine are not soluble in water.
*What cause would you expect if a patient had a lesion on lower lip the next day?? -
ANS-Soft tissue injury - self inflicted trauma to lips and tongue from biting it while
anesthetized.
*Question on IA injection technique on how far to insert the needle and outcome of a
certain scenario? - ANS-What would happen if needle inserted to hub
Insert 25 gauge long needle 20 -25 mm (3/4 of needle) till you contact bone. If you don't
contact bone, you need to retract slightly, reposition angle of syringe more posteriorly
and reinsert.
, *What happens during depolarization? - ANS-reverse polarity = *sodium in and
potassium out*
Local anesthetic ability to decrease the depolarization phase of the action potential
What is a free nerve ending? - ANS-a receptor nerve ending that is not enclosed in a
capsule. A typical free nerve ending consists of a bare axon that may be myelinated or
unmyelinated. It is often found in fibrous capsules, ligaments, synovial spaces, may be
sensitive to mechanical or biochemical stimuli.
*Which of the following best describes Myelinated nerves? - ANS-transmits impulses
faster
*Understand safety precautions for recapping needles? - ANS-scoop method is
recommended; **never use two hands to recap
*How is bevel of needle oriented upon insertion? - ANS-Toward bone
*Amide vs. Ester biotransformation specifically? - ANS-Esters are hydrolyzed in the
**plasma by the enzyme psuedocholinesterase. 1 in every 2800 people has an inability
to hydrolyze esters this is called atypical plasma cholinesterase.
Amides biotransformation takes place in the **liver. People with cirrhosis or hypotension
/ congestive heart failure cannot biotransform amides.
*When do you aspirate? - ANS-Aspirate prior to depositing anesthesia to ensure
negative aspiration.
Beta Blockers decrease blood pressure, but in the presence of vasopressors, what
changes occur? - ANS-blood pressure will increase.
What part of the syringe indicates whether it is an aspirating syringe? - ANS-Harpoon
*What tissue is topical least effective? - ANS-Keratinized or palatal
*What local anesthetic is metabolized by enzyme psuedocholinesterase? - ANS-Esters
What antiseptic you should not use? - ANS-Alcohol
Landmark for IA injection? - ANS-Coronoid notch
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