CDCA LOCAL ANESTHESIA EXAM REVIEW |
LATEST UPDATE 2025/2026 | QUESTIONS AND
CORRECT ANSWERS
which has thicker cortical plate, maxillary or mandibular? - SOLUTION -mandibular (this decreased
the amount of the local anesthesia molecules that can penetrate to nerves during infiltration
injections)
due to the thickness of cortical bone, which is a good option for local anesthetic in the mandibular
arch during infiltrations? - SOLUTION -Articaine (Septocaine) is sometimes effective for mand.
infiltrations (4% vs. 2% for lidocaine) due to the increased number of molecules
hematomas are most common with which type of injection, and why? - SOLUTION -PSA due to
nicking a vessel in the pterygoid plexus of veins
what is the TX for a hematoma? - SOLUTION -pressure, cold compresses on/off, NSAIDS, and time.
a positive aspiration when administering a PSA is due to what? - SOLUTION -aspirating hemorrhage
caused by injection
what are the three most common locations for hematomas to occur? - SOLUTION -1. PSA
2. IA
3. mental
blanching of the tissue following/during an injection is caused by what? - SOLUTION -
vasospasm/vasoconstriction caused by epinephrine or brushing against autonomic nerves
stimulation vasospasm
the pterygomandibular space/triangle is bordered by what anatomical structures? - SOLUTION -
ramus, lateral pterygoid muscle, and medial pterygoid muscle
the pterygomandibular space/triangle is identified intra-orally by what? - SOLUTION -pterygoid
hamulus (palpation), coronoid notch (palpation), and pterygomandibular raphe (visual)
the mandibular foramen lies approx. __________________________ of the distance from the
anterior border of the ramus to the posterior border - SOLUTION -1/2 to 2/3
Antero-posteriorly, the greater palatine foramen is located between the
___________________________. - SOLUTION -middle oft he maxillary second molar and the middle
of the third molar in about 80-90% of patients.
all arteries leading to the oral cavity receive blood from what? - SOLUTION -external carotid (most
are direct or indirect branches from the maxillary artery with the exception of the lingula -- this is a
direct branch from the external carotid)
veins from the oral cavity will drain into what? - SOLUTION -internal jugular (both internal and
external drain into the brachiocephalic veins which drain to the superior vena cava
, do myelinated or un-myelinated nerves create faster impulse? - SOLUTION -myelinated (impulses
jump from node to node -- node of ranvier)
what is saltatory conduction? - SOLUTION -the process of nerve impulses jumping from nodes of
ranvier along a myelinated nerve
what is the resting potential charges of a nerve? - SOLUTION -inside is negative and outside is
positive
what molecules are predominately outside/inside at resting potential? - SOLUTION -Na+ outside and
K+ inside
what is depolarization? - SOLUTION -Na+ channels open , Na+ flows in reversing polarity; K+ flows
out to restore neutrality; the Na+ and K+ pumps restore polarity (resting potential)
what is the mechanism of action for local anesthetics? - SOLUTION -blocks the Na+ channels
preventing depolarization
what is the basic structure of anesthetics? - SOLUTION -aromatic ring (lipid soluble), intermediate
chain (amide or ester configuration), and terminal amine (able to ionize and become water soluble)
lipophilic vs. hydrophyllic - SOLUTION -lipophilic is lipid soluble and hydrophyllic is water soluble
what makes the terminal amine so important to the structure of local anesthetic? - SOLUTION -this
allows the local anesthetic to the both lipid soluble and water soluble at the apporpriate times (ex:
hydrophyllic for dilution and pH control; lipophyllic in order to penetrate neuron cell membrane;
hydrophyllic to block Na+ channels)
what is pKa and what does it do? - SOLUTION -the dissociation constant - this identifies the pH at
which the anesthetic exists in a 50/50 ratio of the ionized to non-ionized (hydrophyllic to lipophyllic)
molecules
lipid solubility of local anesthetics - SOLUTION -the different structure of the various anesthetics
confers varying degrees of lipid solubility (the greater the lipid solubility of the basic molecule the
more potent it is)
protein binding of local anesthetics - SOLUTION -the greater degree of protein binding, the more
molecules you have waiting in reserve for later action (the more proteins bound, the longer the
duration)
vasodilation and the local anesthetics - SOLUTION -with the exception of cocaine, all anesthetics are
vasodilators (undesirable as this promotes quicker vascular uptake/metabolism and therefore less
anesthetic action)
what is biotransformation? - SOLUTION -metabolism
where are amides metabolized and where are esters metabolized? - SOLUTION -amides: liver (in
order to be rendered water soluble so that they can be excreted in the kidneys)
esters: plasma by cholinesterase (more rapid than hepatic leading to shorter duration)
what is the only amide anesthetic that also contains an ester group, and how is it metabolized? -
SOLUTION -Articaine (septocaine) this agent is metabolized both hepatically and by plasma
cholinesterase
LATEST UPDATE 2025/2026 | QUESTIONS AND
CORRECT ANSWERS
which has thicker cortical plate, maxillary or mandibular? - SOLUTION -mandibular (this decreased
the amount of the local anesthesia molecules that can penetrate to nerves during infiltration
injections)
due to the thickness of cortical bone, which is a good option for local anesthetic in the mandibular
arch during infiltrations? - SOLUTION -Articaine (Septocaine) is sometimes effective for mand.
infiltrations (4% vs. 2% for lidocaine) due to the increased number of molecules
hematomas are most common with which type of injection, and why? - SOLUTION -PSA due to
nicking a vessel in the pterygoid plexus of veins
what is the TX for a hematoma? - SOLUTION -pressure, cold compresses on/off, NSAIDS, and time.
a positive aspiration when administering a PSA is due to what? - SOLUTION -aspirating hemorrhage
caused by injection
what are the three most common locations for hematomas to occur? - SOLUTION -1. PSA
2. IA
3. mental
blanching of the tissue following/during an injection is caused by what? - SOLUTION -
vasospasm/vasoconstriction caused by epinephrine or brushing against autonomic nerves
stimulation vasospasm
the pterygomandibular space/triangle is bordered by what anatomical structures? - SOLUTION -
ramus, lateral pterygoid muscle, and medial pterygoid muscle
the pterygomandibular space/triangle is identified intra-orally by what? - SOLUTION -pterygoid
hamulus (palpation), coronoid notch (palpation), and pterygomandibular raphe (visual)
the mandibular foramen lies approx. __________________________ of the distance from the
anterior border of the ramus to the posterior border - SOLUTION -1/2 to 2/3
Antero-posteriorly, the greater palatine foramen is located between the
___________________________. - SOLUTION -middle oft he maxillary second molar and the middle
of the third molar in about 80-90% of patients.
all arteries leading to the oral cavity receive blood from what? - SOLUTION -external carotid (most
are direct or indirect branches from the maxillary artery with the exception of the lingula -- this is a
direct branch from the external carotid)
veins from the oral cavity will drain into what? - SOLUTION -internal jugular (both internal and
external drain into the brachiocephalic veins which drain to the superior vena cava
, do myelinated or un-myelinated nerves create faster impulse? - SOLUTION -myelinated (impulses
jump from node to node -- node of ranvier)
what is saltatory conduction? - SOLUTION -the process of nerve impulses jumping from nodes of
ranvier along a myelinated nerve
what is the resting potential charges of a nerve? - SOLUTION -inside is negative and outside is
positive
what molecules are predominately outside/inside at resting potential? - SOLUTION -Na+ outside and
K+ inside
what is depolarization? - SOLUTION -Na+ channels open , Na+ flows in reversing polarity; K+ flows
out to restore neutrality; the Na+ and K+ pumps restore polarity (resting potential)
what is the mechanism of action for local anesthetics? - SOLUTION -blocks the Na+ channels
preventing depolarization
what is the basic structure of anesthetics? - SOLUTION -aromatic ring (lipid soluble), intermediate
chain (amide or ester configuration), and terminal amine (able to ionize and become water soluble)
lipophilic vs. hydrophyllic - SOLUTION -lipophilic is lipid soluble and hydrophyllic is water soluble
what makes the terminal amine so important to the structure of local anesthetic? - SOLUTION -this
allows the local anesthetic to the both lipid soluble and water soluble at the apporpriate times (ex:
hydrophyllic for dilution and pH control; lipophyllic in order to penetrate neuron cell membrane;
hydrophyllic to block Na+ channels)
what is pKa and what does it do? - SOLUTION -the dissociation constant - this identifies the pH at
which the anesthetic exists in a 50/50 ratio of the ionized to non-ionized (hydrophyllic to lipophyllic)
molecules
lipid solubility of local anesthetics - SOLUTION -the different structure of the various anesthetics
confers varying degrees of lipid solubility (the greater the lipid solubility of the basic molecule the
more potent it is)
protein binding of local anesthetics - SOLUTION -the greater degree of protein binding, the more
molecules you have waiting in reserve for later action (the more proteins bound, the longer the
duration)
vasodilation and the local anesthetics - SOLUTION -with the exception of cocaine, all anesthetics are
vasodilators (undesirable as this promotes quicker vascular uptake/metabolism and therefore less
anesthetic action)
what is biotransformation? - SOLUTION -metabolism
where are amides metabolized and where are esters metabolized? - SOLUTION -amides: liver (in
order to be rendered water soluble so that they can be excreted in the kidneys)
esters: plasma by cholinesterase (more rapid than hepatic leading to shorter duration)
what is the only amide anesthetic that also contains an ester group, and how is it metabolized? -
SOLUTION -Articaine (septocaine) this agent is metabolized both hepatically and by plasma
cholinesterase
