WREB anesthesia board review UPDATED
ACTUAL Exam Questions and CORRECT
Answers
duration of action of 2% lidocaine 1:50,000 epi - CORRECT ANSWER - pulp: 60 min /
soft:180-300 min
intermediate
duration of action of 2% lidocaine 1:100,000 epi - CORRECT ANSWER - pulp: 60 min /
soft:180-300 min
intermediate
duration of action of 4% prilocaine plain - CORRECT ANSWER - infiltration: pulp: 10-15
min / soft: 90-120 min
block: pulp: 40-60 min / soft: 120-240 min
short
duration of action of 4% prilocaine 1:200,000 epi - CORRECT ANSWER - pulp: 60-90
min/ soft: 180-480 min
intermediate
duration of action of 3% mepivacaine plain - CORRECT ANSWER - Plain - pulp 20-40
minutes
short
duration of action of 2% mepivacaine 1:20,000 levo - CORRECT ANSWER - pulp 60
minutes / soft: 180 - 300 min
intermediate
,duration of action of 4% articaine 1:100,000 epi - CORRECT ANSWER - pulp 60-75
minutes / soft 180 -360 min
intermediate
duration of action of 4% articaine 1:200,000 epi - CORRECT ANSWER - pulp 45-60
minutes / soft 120-300 min
intermediate
duration of action of 0.5% bupivacaine 1:200,000epi - CORRECT ANSWER - pulp 90-
180 minutes / soft 240-540 minutes
which anesthetics would be safest for a patient with cardiovascular disease - CORRECT
ANSWER - - any plain anesthetic
- 1:200,000 epi = 4% articaine or 4% prilocaine (no more than 0.04mg total)
- 1:20,000 levo = 2% mepivacaine (no more than 0.2mg total)
desirable characteristics of local anesthetic drugs - CORRECT ANSWER -
Biocompatibility
- Non-irritable
- Nontoxic
- Non-allergenic
- Biotransformable & easily eliminated
- Completely reversible effects
Safety & Efficacy
- Effective in tissues and mucous membranes
- Short onset of action and no residual effects
- Reasonable duration of action
- Adequate potency
- Sterilizable
,- Patients remain conscious
Which nerve is anesthetized with the ASA injection? - CORRECT ANSWER - Anterior
superior alveolar nerve. And some terminal branch nerves of the facial nerve. The ASA nerve is
the internal terminal branch of the maxillary division of the trigeminal nerve.
There is a branching off from the infra orbital nerve in the infraorbital canal 6-10mm before the
infraorbital foramen.
ASA needle path - CORRECT ANSWER - Local anesthetic solution diffuses easily
through the bone and anesthetizes the ASA nerve.
ASA avoids multiple needle penetrations when anesthesia is needed for more than one maxillary
anterior tooth in the same quad.
Which structures are anesthetized by the ASA injection? - CORRECT ANSWER - It
anesthetizes the canine lateral and central teeth, pulp along with the facial tissues of affected
teeth.
All upper lip cheek and lower nose.
ASA site of penetration - CORRECT ANSWER - Height of mucobuccal fold: The
depression between canine and lateral (canine fossa)
What is the optimum depth of penetration for the ASA injection? - CORRECT
ANSWER - 3-6mm
ASA needle selection - CORRECT ANSWER - 27 or 25 gauge short
ASA volume of anesthetic - CORRECT ANSWER - .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
ASA % of positive aspirations - CORRECT ANSWER - 1%
, ASA common reasons for incomplete anesthesia - CORRECT ANSWER - Deposition too
far from the target and inadequate volume of solution are the most common reasons. Others
cause inflammation or injection in the area of deposition and inadequate diffusion of solution.
Cross innervation is also likely!!!
MSA anatomical considerations - CORRECT ANSWER - The MSA nerve separates at
varying points from the infraorbital branch of the maxillary nerve within the infraorbital canal. It
supplies sensation to the dental plexus of the first and second premolars and, in some individuals,
the mesiobuccal root of the maxillary first molar. Studies have reported the absence of an MSA
nerve branch in somewhere between 50% and 72% of individuals. An anatomical variation that
can complicate MSA nerve blocks is the presence of a large zygomaticoalveolar crest. These
excessive bony processes may obstruct access to the apices of the maxillary second premolars.
MSA field of anesthesia - CORRECT ANSWER - Teeth anesthetized:
Maxillary premolars and mesiobuccal root of first molar
Periodontium/Soft tissues:
Facial to affected teeth
MSA needle pathway - CORRECT ANSWER - The needle advances parallel to the long
axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose
connective tissue, microvasculature, and nerve endings.
MSA site of penetration - CORRECT ANSWER - The optimum site of penetration is at
the height of the mucobuccal fold over the maxillary second premolar. The deposition site is well
above the apex of the second premolar.
MSA needle selection - CORRECT ANSWER - 27 or 25 gauge short
MSA volume of anesthetic - CORRECT ANSWER - .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
MSA depth of penetration - CORRECT ANSWER - 5-8mm
ACTUAL Exam Questions and CORRECT
Answers
duration of action of 2% lidocaine 1:50,000 epi - CORRECT ANSWER - pulp: 60 min /
soft:180-300 min
intermediate
duration of action of 2% lidocaine 1:100,000 epi - CORRECT ANSWER - pulp: 60 min /
soft:180-300 min
intermediate
duration of action of 4% prilocaine plain - CORRECT ANSWER - infiltration: pulp: 10-15
min / soft: 90-120 min
block: pulp: 40-60 min / soft: 120-240 min
short
duration of action of 4% prilocaine 1:200,000 epi - CORRECT ANSWER - pulp: 60-90
min/ soft: 180-480 min
intermediate
duration of action of 3% mepivacaine plain - CORRECT ANSWER - Plain - pulp 20-40
minutes
short
duration of action of 2% mepivacaine 1:20,000 levo - CORRECT ANSWER - pulp 60
minutes / soft: 180 - 300 min
intermediate
,duration of action of 4% articaine 1:100,000 epi - CORRECT ANSWER - pulp 60-75
minutes / soft 180 -360 min
intermediate
duration of action of 4% articaine 1:200,000 epi - CORRECT ANSWER - pulp 45-60
minutes / soft 120-300 min
intermediate
duration of action of 0.5% bupivacaine 1:200,000epi - CORRECT ANSWER - pulp 90-
180 minutes / soft 240-540 minutes
which anesthetics would be safest for a patient with cardiovascular disease - CORRECT
ANSWER - - any plain anesthetic
- 1:200,000 epi = 4% articaine or 4% prilocaine (no more than 0.04mg total)
- 1:20,000 levo = 2% mepivacaine (no more than 0.2mg total)
desirable characteristics of local anesthetic drugs - CORRECT ANSWER -
Biocompatibility
- Non-irritable
- Nontoxic
- Non-allergenic
- Biotransformable & easily eliminated
- Completely reversible effects
Safety & Efficacy
- Effective in tissues and mucous membranes
- Short onset of action and no residual effects
- Reasonable duration of action
- Adequate potency
- Sterilizable
,- Patients remain conscious
Which nerve is anesthetized with the ASA injection? - CORRECT ANSWER - Anterior
superior alveolar nerve. And some terminal branch nerves of the facial nerve. The ASA nerve is
the internal terminal branch of the maxillary division of the trigeminal nerve.
There is a branching off from the infra orbital nerve in the infraorbital canal 6-10mm before the
infraorbital foramen.
ASA needle path - CORRECT ANSWER - Local anesthetic solution diffuses easily
through the bone and anesthetizes the ASA nerve.
ASA avoids multiple needle penetrations when anesthesia is needed for more than one maxillary
anterior tooth in the same quad.
Which structures are anesthetized by the ASA injection? - CORRECT ANSWER - It
anesthetizes the canine lateral and central teeth, pulp along with the facial tissues of affected
teeth.
All upper lip cheek and lower nose.
ASA site of penetration - CORRECT ANSWER - Height of mucobuccal fold: The
depression between canine and lateral (canine fossa)
What is the optimum depth of penetration for the ASA injection? - CORRECT
ANSWER - 3-6mm
ASA needle selection - CORRECT ANSWER - 27 or 25 gauge short
ASA volume of anesthetic - CORRECT ANSWER - .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
ASA % of positive aspirations - CORRECT ANSWER - 1%
, ASA common reasons for incomplete anesthesia - CORRECT ANSWER - Deposition too
far from the target and inadequate volume of solution are the most common reasons. Others
cause inflammation or injection in the area of deposition and inadequate diffusion of solution.
Cross innervation is also likely!!!
MSA anatomical considerations - CORRECT ANSWER - The MSA nerve separates at
varying points from the infraorbital branch of the maxillary nerve within the infraorbital canal. It
supplies sensation to the dental plexus of the first and second premolars and, in some individuals,
the mesiobuccal root of the maxillary first molar. Studies have reported the absence of an MSA
nerve branch in somewhere between 50% and 72% of individuals. An anatomical variation that
can complicate MSA nerve blocks is the presence of a large zygomaticoalveolar crest. These
excessive bony processes may obstruct access to the apices of the maxillary second premolars.
MSA field of anesthesia - CORRECT ANSWER - Teeth anesthetized:
Maxillary premolars and mesiobuccal root of first molar
Periodontium/Soft tissues:
Facial to affected teeth
MSA needle pathway - CORRECT ANSWER - The needle advances parallel to the long
axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose
connective tissue, microvasculature, and nerve endings.
MSA site of penetration - CORRECT ANSWER - The optimum site of penetration is at
the height of the mucobuccal fold over the maxillary second premolar. The deposition site is well
above the apex of the second premolar.
MSA needle selection - CORRECT ANSWER - 27 or 25 gauge short
MSA volume of anesthetic - CORRECT ANSWER - .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
MSA depth of penetration - CORRECT ANSWER - 5-8mm
