AFK Quiz – Surgery LA

1. A 49-year-old patient with type 2 diabetes arrives for a simple extraction of tooth 3.5. Shortly after the first carpule of 2% lidocaine with 1/100,000 epinephrine is administered, he reports dizziness and feeling unwell. All the following symptoms could be associated with a possible local anesthesia toxicity diagnosis, except:

2. A 69-year-old patient with a history of angina presents for a surgical tooth extraction. During the procedure, the patient suddenly complains of a deep ache in his chest. Your assistant informs you that there is a nitroglycerin bottle in the refrigerator which was opened for another patient last month. What is the right course of action?

3. A 17-year-old patient with a history of asthma attends the office for a planned restoration under local anesthesia. Rubber dam is used. Shortly after beginning the procedure, the patient complains that she feels unwell, hot and breathless. Her face is itchy. What is the most appropriate initial management?

4. Which one is not among the clinical manifestations of hypoglycemia?

5. Which of the following local anesthetics can be administered to a child with a medical history of congenital methemoglobinemia and a dental history of traumatic lip injury after previous dental procedures?

6. Which of the following sutures is least likely to cause inflammation and scar formation?

7. A 65-year-old patient with chronic renal failure presents with severe pain on tooth 4.8. Tooth is diagnosed as hopeless and requires extraction. The patient routinely requires hemodialysis and took heparin IV 4 hours ago for his last dialysis. What is the most appropriate patient management?

8. The expected duration of pulpal anesthesia of tooth 3.6 following an inferior alveolar nerve block injection of 2 carpules of prilocaine plain is

9. A 61-year-old patient with a history of deep vein thrombosis is scheduled for extraction of carious tooth 4.6. The patient is taking warfarin, and his latest INR is 3.0. Prior to the surgery, this patient’s warfarin therapy

10. When epinephrine is administered subcutaneously for the management of anaphylaxis in an adult, the most appropriate concentration and volume for an initial dose is

11. Infections arising from the periapical region of the mandibular first premolars perforate through the lingual cortex to the

12. A 15-year old patient presents for extraction of an upper premolar. Few minutes after the injection of 1 carpule of prilocaine 4%, epinephrine 1/100,000 patient develops cyanosis in mucous membrane and nail beds. Administration of 100% oxygen does not lead to significant improvement. The most appropriate management is

13. A 59-year-old patient with a history of Addison disease presents for surgical extraction of hopeless tooth 4.7 under moderate sedation. She has been taking prednisone 10 mg for the past 5 years. What is the most appropriate recommendation?

14. A patient presents with atypical facial pain. The most appropriate available therapy is prescription of

15. A 65-year-old patient presents 2 days after extraction of several mandibular teeth. She complains from a wide bruise of right side of face and neck. What is the most appropriate management of this case?

16. After the removal of tooth 1.6 the surgeon noticed that a section of bone is adherent to the ends of the tooth. What is the appropriate next step?

17. What is the average duration of soft tissue numbness following local infiltration on buccal of tooth 2.5 with 1 carpule of prilocaine 4% plain?

18. For a healthy 44‑year‑old patient undergoing scaling and root planing on the maxillary anterior sextant, the most appropriate anesthesia options are

19. In which of the following condition it is more difficult to achieve successful anesthesia?

20. Which of the following in not indicated in the emergency management of a hyperventilating patient?

21. What is the maximum recommended number of 1.8 ml cartridges of 2% lidocaine with 1:100,000 epinephrine that may be safely administered for a 50-year old patient with a history of myocardial infarction?

22. A 30-year-old patient in her third trimester of pregnancy presents with fever and an acute pain due to a deep cavity on tooth 4.8. She has a type 1 allergic reaction to penicillin. Which of the following is not recommended for the appropriate management of this patient?

23. What is the most common immediate disadvantage of bilateral sagittal split osteotomy for correction of mandibular excess?

24. Healing by secondary intention results in

25. Which of the following radiographs is more appropriate to locate the buccolingual position of the mandibular canal?

26. What is the initial phase of alveolar fracture healing by periosteal cells?

27. Which of the following sutures is often used for interproximal areas of diastema to adapt the interproximal papilla against the bone?

28. A 78-year-old patient with history of myocardial infarction 3 years ago presents for surgical extraction of his remaining teeth in the upper jaw and placement of an immediate denture. What is the best way to achieve the best adaptation of the new denture with the residual ridge?

29. A 15-year-old boy (weight: 50 kg) with a history of Tetralogy of Fallot presents for extraction of a hopeless primary tooth. He has a history of anaphylactic reaction to penicillin. What is the appropriate dosage of doxycycline for antibiotic prophylaxis here?

30. All the following options regarding the management of dental patients with active tuberculosis is true, except

31. A 34-year-old female patient presents with fever and extra-oral swelling on right side for the past 2 days. Two weeks earlier a local dentist prescribed mouth gargles for her complaint of upper right back tooth pressing on lower gums causing her pain and swelling in that area. The dentist could have prevented this with

32. Odontogenic infection can spread directly to cavernous sinus through

33. How many carpules of lidocaine 2%, with epinephrine 1/100,000 can safely be administered to a healthy 10-year-old patient (weight 30kg)?

34. Which one is not among the findings of an isolated zygomatic fracture?

35. During cementation of a PFM crown on tooth 4.6, it suddenly slips into the patient’s throat. The patient begins to have an exaggerated cough which developed into a silent choke. He is still conscious. Which of the following is the most appropriate management?

36. Nasopalatine nerve block is used for anesthetizing

37. In a patient with valvular heart disease, which microorganisms are most likely to cause infective endocarditis during periodontal debridement?

38. In patients with post-radiotherapy severe caries which of the following restorations in not recommended?

39. A healthy patient presents for extraction of tooth 2.2 which has a vestibular abscess. The most appropriate injection technique is palatal infiltration and

40. The most appropriate local anesthetic agent in a patient with a documented history of sulfite allergy is

41. What is the physiologic antagonist of histamine?

42. In a patient with Alzheimer’s disease, the inability to carry out voluntary movements despite intact muscular power is called

43. Which one of the following congenital bleeding disorders is diagnosed by prolonged partial thromboplastin time (PTT)?

44. Which one is a clinical finding associated to anterior disk displacement with reduction?

45. During cementation of a full metal crown on tooth 3.7, the patient accidentally swallows the crown. There is no sign of suffocation. What is the most appropriate next step?

46. To minimize the swelling that is common after the surgical removal of impacted third molars, the most appropriate method is the

47. During the extraction of tooth 1.5, the main forceps movement should be in which direction?

48. Rinsing mouth with chlorhexidine gluconate 0.12% before an oral surgery is recommended mainly to

49. All of the following cases require antibiotic prophylaxis prior to a surgical tooth extraction, except a patient

50. Paresthesia following local anesthesia injection most commonly affects which nerve?

51. Which of the following procedures need antibiotic prophylaxis in a patient susceptible to infective endocarditis?

52. During endodontic treatment on tooth 3.4, the patient still complains from a sharp pain. What is the most appropriate injection technique?

53. What age is the ideal time to close a palatal cleft surgically?

54. A 25-year old patient with a history of type 1 allergic reaction to penicillin presents with severe trismus due to pericoronitis on tooth 4.8. He reports a recent history of pseudomembranous colitis. What is the most appropriate antibiotic for this condition?

55. Which of the following medications is used for management of Von Willebrand disease?

56. Which of the following factor is not related to the breakage of a local anesthetic needle during an inferior alveolar block injection?

57. A few minutes after the injection of second carpule of local anesthetic, a type 2 diabetic patient starts sweating, becomes pale and agitated and has increased heart rate. Soon after she becomes unresponsive. The most appropriate treatment is

58. After giving two cartridges of 2% lidocaine to anesthetize the inferior alveolar nerve, the patient develops facial drooping on the side of the injection. This complication occurred because the needle was directed:

59. A 3-year-old boy (weight: 20kg) with a history asthma complains from pain after a recent simple tooth extraction. The most appropriate pain management is

60. Which area has the lowest rate of fracture in mandible?

61. A 65-year-old patient with a history of myocardial infarction 3 months ago presents for a restoration. Which of the following is not true regarding appropriate management of this patient?

62. A 36-year old patient receives a heavy blow to his chin. On clinical examination, the mandible deviated the to right side on opening. Where is the most likely site of the fracture?

63. Temporomandibular joint dysfunction pain is most likely caused by

64. What is the main reason for Alveoloplasty during the insertion appointment of an immediate complete denture?

65. A 74-year-old patient with severe chronic bronchitis presents for a regular check-up. He takes theophylline. All the following agents should be avoided, except

66. What is the most appropriate initial management of condylar ankylosis?

67. A 55-year-old individual with a background of hypertension and depression comes in for veneer preparation on the upper four incisors. The patient is currently on atenolol, diltiazem, and imipramine. What statement accurately reflects the appropriate approach to managing her care?

68. Which of the following options is not true regarding the use of botulinum toxin as part of the management of temporomandibular dysfunction?

69. All the following are among the manifestation of hyperventilation, except

70. All the following medications/agents can be used in management of temporomandibular dysfunction, except

71. Which one is among the characteristics of the Abscess stage of a dental infection?

72. A 54-year-old patient with a history of prosthetic heart valve placement 3 years ago presents for surgical extraction of tooth 3.8. He has a history of anaphylactic allergic reaction to penicillin. What is the appropriate antibiotic prophylaxis regiment before the procedure?

73. What is the recommended labial frenectomy technique when the frenal attachment has a wide base?

74. Which of the following microorganisms is most likely associated with nonodontogenic sinusitis?

75. Shortly after the administration of the first carpule of local anesthesia, a 25-year-old patient develops severe laryngeal edema. No air movement can be felt through the mouth and nose despite exaggerated respiratory movements by the patient. Administration of epinephrine didn’t help with the condition. What is the most appropriate initial management?

76. During the surgical extraction of tooth 2.6 the infected palatal root tip (size: 2 mm) is accidentally displaced into the maxillary sinus. Examination of the socket shows a 5 mm perforation of sinus lining. The most appropriate immediate treatment is

77. An odontogenic infection from which of the following teeth is less likely to cause cavernous sinus thrombosis?

78. A 78-year-old patient with a history of atrial fibrillation and emphysema presents for the extraction of symptomatic tooth 3.5. He takes dabigatran and theophylline. Before the procedure, which of the following is required?

79. A 34-year-old female patient with a history of persistent asthma presents with a chief complaint of bad taste and burning sensation in her mouth. Your clinical examination shows yellow bumps that form in patches on the inner cheeks, tongue, and roof of the mouth, as well as the throat area. Which of the following medications is not likely to be associated with the symptoms?

80. A patient presents with severe headache, shortness of breath, and epistaxis. The most likely cause is

81. Which of the following sutures is preferred for dermal surface closure?

82. A 56-year-old patient returns 3 days following the extraction of tooth 3.8, complaining of a foul smell, worsening pain, and bad taste. There is normal post-operative swelling without any sign of discharge or fluctuance. What is the most likely diagnosis?

83. During dental examination, a 48-year-old patient with a history of Diabetes mellitus (type 2) suddenly becomes unresponsive to verbal command. The radial pulse is 50 times a minute and the blood pressure is 85/61. What is the most probable diagnosis?

84. In a healthy patient, what is the strongest stimulus to respiration?

85. A depressive fracture of the zygomatic arch on the right-side results in

86. Immediately after extraction of tooth 2.6 in a healthy female patient, a 7mm opening in the floor of the maxillary sinus is found. What is the most appropriate initial management?

87. An odontogenic infection that had spread into the lateral pharyngeal space can result in

88. A 67-year-old individual with a medical history including hypertension and liver cirrhosis resulting from prolonged alcohol abuse reports experiencing pain while chewing. The patient is currently prescribed furosemide and amlodipine. Upon clinical examination, heightened sensitivity is observed in tooth 3.5 upon percussion, and a buccal fistula is noted. Radiographic imaging reveals inadequate root canal treatment and an elongated casting post. A tear-drop shaped radiolucency is evident around tooth 3.5. In light of these findings, the decision is made to extract tooth 3.5. The results of a complete blood analysis for this patient with most likely show

89. The periapical infection from tooth 4.8 usually spread into the submandibular spaced because of the

90. Combination of local anesthetics with an opioid or an antihistamine in children can result in

91. A 60-year-old patient with a history of previous infective endocarditis five years ago, presents for periodontal probing and prophylactic teeth cleaning. The patient is unable to take oral medication due to gastric ulcer. What is the appropriate infective endocarditis prophylaxis regimen for this patient?

92. In a favourable mandibular fracture

93. Upon maxillary infiltration, which of the following local anesthetic agents does have a shorter soft tissue anesthesia?

94. Shortly following the administration of first carpule of 4% prilocaine plain in a patient with history of ischemic heart disease, she reports difficulty breathing. Her blood pressure is 78/60. The most appropriate immediate management is to administer

95. A patient with chronic renal failure presents for the extraction of a hopeless tooth. Which of the following options is true regarding the appropriate management of this patient?

96. Use of rotational forces during the extraction of maxillary first premolar

97. Nasopalatine nerve block is used for anesthetizing

98. During the surgical extraction of tooth 4.8, the broken distal root suddenly disappears. It is most likely displaced into

99. What is the major advantage of oxidized regenerated cellulose over absorbable gelatin sponge?

100. All the following medications is used in management a large oroantral communication, except

101. Which of the following options is not true regarding the displaced condylar fracture?

102. 24-year-old patient with a history of intermittent asthma presents for extraction of his right wisdom teeth. During the procedure, he suddenly starts coughing and complains of sense of suffocation and tightness in his chest. His respiratory rate is 30 per minutes and hist blood pressure is 148/99. Immediately, 200 μg of salbutamol was administered but there is no improvement in the symptoms. What is the next step in the management of this emergency?

103. A 66-year-old patient presents with severe pain on tooth 4.8 with deep occlusal caries and asks for tooth extraction. Patient just finished a course of chemotherapy 2 weeks ago. The result of a recent blood work is as follow.
White blood cell count: 2500/mm3 (40% polymorphonuclear leukocytes)
Platelet count: 65000/mm3
What is the appropriate management?