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Junior Pain Control Midterm Exam (8/18/06) Name:

Box#:

1. What is the maximum daily dose of acetaminophen for a chronic alcoholic?

A. 2000 mgB. 2400 mgC. 3200 mg

D. 4000 mgE. 6000 mg

2. Which of the following conditions would be an absolute contraindication for the use of N2O - - with OR

without further information (or questioning and consent) from the patient:

1. History of drug use

2. Bilateral nasal obstruction3. Claustrophobia

4. Active middle ear infectionA. 1, 2, 3

B. 1 and 3C. 2 and 4D. 4 onlyE. All

3. A 6-year-old child undergoes several pulpotomies and SSC crowns, and also extraction of #D,E,F,and G.Using Clarks Rule, how much codeine in milligrams would you give this child every 6 hours? The child

weighs 25 pounds and you would like to give the equivalent amount of codeine contained in TWO Tylenol

#3 tablets.

A. 10 mg

B. 15 mgC. 20 mg

D. 30 mgE. 40 mg

4. A 6-year-old child undergoes several pulpotomies and SSC crowns, and also extraction of #D,E,F,and G.

Using Clarks Rule, how much codeine in milligrams would you give this child every 6 hours? The child

weighs 100 pounds and you would like to give the equivalent amount of codeine contained in ONE Tylenol

#3 tablet.

A. 10 mg

B. 15 mgC. 20 mg

D. 30 mgE. 40 mg

5. How many mg/cc is in 50% Dextrose?

A. 0.5 mg/ccB. 5 mg/ccC. 50 mg/ccD. 500 mg/cc

6. Insulin shock can occur when a patient's blood sugar is lowered to abnormal levels (less than 60 mg/dl) by

an insulin overdose or skipping a meal after taking insulin.

A. True

B. False

7. Novocaine is:

1. The lay persons generic name for a local anesthetic.

2. No longer available as a commercial dental cartridge local anesthetic.3. Is relatively allergenic compared to lidocaine.

4. Is an ester-linkage local anesthetic.A. 1, 2, 3

B. 1 and 3C. 2 and 4

D. 4 onlyE. All the above

8. What is the maximum recommended dose of 2% lidocaine with 1:100,000 epinephrine that can be

administered to a 10-kg child?

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A. 40 mgB. 45 mgC. 50 mg

D. 60 mgE. 70 mg

9. Which of the following inhibit platelet aggregation IRREVERSIBLY?

A. Aspirin

B. IbuprofenC. TramadolD. Acetaminophen

10. Which CYP liver enzyme is responsible for converting acetaminophen to the toxic metabolite NAPQI?

A. 2A6B. 2D6C. 2E1

D. 3E1

11. Which CYP liver enzyme is responsible for converting codeine and tramadol to their respective active

forms?

A. 2A6B. 2D6

C. 2E1D. 3E1

12. Which of the following is NOT a sign of extraordinary dental fear (as exhibited by the patient)?

A. Low oral pain thresholdB. Falling asleep during treatment

C. Inability to complete treatment

D. Frequent cancellations

13. What is the advantage to using intravenous midazolam (Versed) over diazepam (Valium)?

A. Cheaper cost

B. More potentC. SaferD. Water soluble

14. The therapeutic index of a drug is:

A. Lethal dose (50) divided by the average dose (50)

B. Average dose (50) divided by effective dose (50)C. Effective dose (50) divided by lethal dose (50)

D. Lethal dose (50) divided by effective dose (50)

15. A pulse oximeter is required to be used during IV conscious sedation. The most important function of the

pulse oximeter is to measure:

A. Heart rateB. Respiratory rate

C. Blood pressureD. Oxygen saturation

16. Where are amide local anesthetics primarily broken down by the body?

A. Liver

B. KidneysC. LungsD. Plasma

17. Where are ester local anesthetics primarily broken down by the body?A. LiverB. Kidneys

C. LungsD. Plasma

18. What are the benefits of adding vasoconstrictors to local anesthetics (LA)?

A. Decreases LA uptakeB. Increases LA duration

C. Decreases amount of LA necessary to useD. Decreases LA toxicityE. All the above

19. Which of the following results in the largest amount of epinephrine being given to a patient?

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A. 5 cartridges of 1:200,000 epinephrineB. 3 cartridges of 1:100,000 epinephrineC. 2 cartridges of 1:50,000 epinephrineD. 9 cartridges of 1:200,000 epinephrine

20. As far as maximal doses of epinephrine for an at risk cardiac patient, the advantage of using Polocaine

(mepivacaine) with neocobefrin is that you can use an unlimited amount because this vasoconstrictor has no

negative cardiac effects (remember that for epinephrine the dose must be reduced).

A. TrueB. False

21. What is the clinical concern about using 4% articaine (Septocaine)?A. Rapid toxicity to the patientB. Limited effectivenessC. Inferior alveolar paresthesias

D. Prolonged numbness after infiltration

22. Which dental local anesthetic has both an ester and amide chemical linkage?

A. Mepivacaine (Polocaine)

B. Bupivacaine (Marcaine)C. Prilocaine (Citanest)D. Articaine (Septodont/Septocaine)

E. Lidocaine (Xylocaine/Octocaine)

23. What is generally the first indication of a local anesthetic overdose?

A. Unconsciousness (as in sudden loss of consciousness)

B. CNS stimulation (slurred speech, muscle twitches, shivering)C. Chest pain (substernal)D. Numbness over large areas of the body

24. Which dental local anesthetic has the longest half-life?

A. Mepivacaine (Polocaine)B. Bupivacaine (Marcaine)

C. Prilocaine (Citanest)D. Articaine (Septodont/Septocaine)E. Lidocaine (Xylocaine/Octocaine)

25. Which of the following antibiotics is NOT used for SBE antibiotic prophylaxis?

A. Azithromycin

B. ClarithromycinC. Clidamicin

D. Erythromycin

26. Which of the following statements about aspirin is NOT true?

A. The typical dose is 325-650 mg q4h.B. An early sign of toxicity tinnitus.C. The maximum daily dose is 3,200 mg.

D. A massive overdose can lead to uncoupling of oxidative phosphorylation.

27. Which of the following statement(s) about ibuprofen is/are NOT true?

1. Preliminary stidies have indiated that ibuprofen may block the beneficial effects of aspirin.

2. The amount of ibuprofen in a Vicoprofen tablet is 400 mg.3. Ibuprofen is one of the most effective NSAID analgesics.4. Ibuprofen irreversibly blocks platelet aggregation.

A. 1, 2, 3

B. 1 and 3C. 2 and 4

D. 4 only

E. All of the above

28. Which of the following statement(s) about opioids is/are not true?

1. Most opioids cause pupillary dilation.

2. There are no opioids combination drugs with aspirin.3. Most of the analgesia is due to activity at the kappa receptor.

4. A side effect of opioids is nausea and vomiting.

A. 1, 2, 3

B. 1 and 3

C. 2 and 4

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D. 4 onlyE. All of the above

29. Which of the following is not indicated for the acute pain of multiple tooth extractions?

1. Rofecoxib (Vioxx)2. Dexamethasone (Decadron)3. Tramadol (Ultram)

4. Celecoxib (Celebrex)

A. 1, 2, 3B. 1 and 3

C. 2 and 4D. 4 onlyE. All of the above

30. Which are significant risk factors for perioperative MI?

1. History of angina pectoris

2. Ischemic changes on the EKG (ECG)3. Previous MI

4. Age over 70

A. 1, 2, 3B. 1 and 3C. 2 and 4D. 4 onlyE. All of the above

31. What percent of all patients are successfully sedated by nitrous oxide at levels of 50% and below? (Hint:

How often would you expect to be successful by increasing the percentage to between 50-70% if the patient

is not satisfactorily sedated at 50%?).

A. 85%B. 90%

C. 95% WILL NOT BE ON EXAMD. 99.9%

32. Which cardiac valve is most commonly affected by rheumatic heart disease?

A. AorticB. PulmonaryC. TricuspidD. Mitral

33. Unconsciousness in syncope results from:A. Electrolyte imbalance

B. Neurogenic shockC. Cerebral hyperemiaD. Cerebral hypoxia

34. In the treatment of an acute anaphylactic reaction, the first drug that should be administered is:

A. HydroxyzineB. Epinephrine

C. HydrocortisoneD. Diphenhydramine

35. The selection of a vasoconstrictor for a local anesthetic depends upon

A. the duration of the procedure.B. the need for hemostasis.

C. the medical status of the patient.D. all the above.

36. A patient that is allergic to pencillin and needs antibiotic prophylaxis is BEST treated with:

1. Amoxicillin

2. Cephalexin3. Doxycycline

4. Clindamycin

A. 1 and 3B. 1, 2, 3

C. 2 and 4D. 4 only

E. All the above

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37. Meperidine has a possible fatal interaction with which of the following medication classes?

A. Selective serotonin reuptake inhibitorsB. Monoamine oxidase inhibitors

C. Beta blockersD. Macrolide antibiotics

38. Which pair of anesthetics is most likely to show cross-allergy?

A. Lidocaine-mepivacaine

B. Prilocaine-tetracaineC. Procaine-mepivacaine

D. Procaine-lidocaineE. Lidocaine-benzocaine

39. The usual adult dosage of codeine administered orally is

A. 500-1000mg.B. 250-500mg.C. 30-60mg.

D. 2-5mg.

E. None of the above.

40. In general, what is the amount of the SBE prophylaxis dose that is taken six hours after the first dose?

A. Double the initial dose.B. The same as the initial dose.C. of the initial dose

D. of the initial dose

E. None of the above

41. The patient reports to you uncontrollable nausea and vomiting the next day. Every time he drinks anything

(including water) he is stricken with severe retching and vomiting immediately. He has been up most of the

night with this recurrent problem, and now is in severe pain because of inability to take his pain

medications. What is your plan?

A. Suppository ValiumB. Suppository Phenergan

C. Suppository Versed

D. Suppository acetaminophen

E. Suppository fentanyl (Sublimaze)

42. Which of the following local anesthetics are examples of ESTER-type linkages? (Hint: These are generic

names)

1. Procaine2. 3-chlorprocaine3. Benzocaine

4. Pontocaine

A. 1 and 3

B. 1, 2, 3

C. 2 and 4D. 4 only

E. All the above

43. How many mg/cc is in 0.5% bupivacaine?

A. 0.5 mg/ccB. 5 mg/cc

C. 50 mg/cc

D. 500 mg/cc

44. Which of the following drugs does NOT contain Acetaminophen?

A. FioricetB. PercocetC. Darvocet N-100D. Fiorinal

45. After receiving an inferior alveolar block using a long 25 gauge needle the patient develops paralysis of

some of the facial muscles. This is most probably related to diffusion of the anesthetic solution into the:

A. Otic ganglionB. Medial and/or lateral pterygoid musclesC. Motor branches of the mandibular nerve supplying the masticatory musclesD. Parotid gland

E. Submandibular parasympathetic ganglion

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46. What is the injectable local anesthetic that can cause methemoglobinemia?

A. Lidocaine

B. MepivacaineC. ArticaineD. Prilocaine

47. Caution should be used in giving chronic alcoholics which analgesic?

A. DarvonB. Darvon compoundC. Darvocet N-100

D. All of the aboveE. None of the above

48. Advil (over-the-counter ibuprofen) CAN be used to supplement the analgesia of most prescriptionanalgesics that contain acetaminophen and an opioid.

A. True

B. False

49. What are the active metabolite(s) of diazepam (Valium)?A. Desmethyldiazepam and triazolamB. Desmethyldiazepam and triazodiazepamC. Desmethyldiazepam and oxazepam

D. Oxazepam and triazolamE. Oxazepam and triazodiazepam

50. Aspirin is CONTRAINDICATED with which of the following drugs?A. Coumarin (Coumadin)B. Triazolam (Halcion)

C. Phenobarbital

D. Pentobarbital (Nembutal)

E. Methylprednisolone (Medrol)

51. A tablespoon contains how many ml?

A. 5B. 10C. 15

D. 20E. 30

52. A teaspoon contains how many ml?A. 5

B. 10

C. 15D. 20

E. 30

53. What would you use to treat a benzodiazepine (either Valium, Versed) overdose during IV sedation?A. Naloxone (Narcan)

B. Promethazine (Phenergan)

C. Flumazenil (Romazicon)D. Diphenhydramine (Benadryl)

E. Fentanyl (Sublimaze)

54. What would you use to treat respiratory depression following administration of meperidine (Demerol)during IV sedation?

A. Naloxone (Narcan)B. Promethazine (Phenergan)

C. Flumazenil (Romazicon)

D. Diphenhydramine (Benadryl)

E. Fentanyl (Sublimaze)

55. Which of the following is definitely NOT a contraindication to the use of aspirin?

A. Use in childrenB. Peptic ulcerC. Prior MI (myocardial infarction)

D. Asthma

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E. Bleeding disorder

56. What is the maximum dose of epinephrine that can be used in a HEALTHY patient?

A. 0.02 mgB. 0.04 mgC. 0.1 mgD. 0.2 mg

E. 0.4 mg

57. What is the maximum dose of epinephrine that can be used in a patient with angina?

A. 0.02 mg

B. 0.04 mgC. 0.1 mgD. 0.2 mgE. 0.4 mg

58. What is the maximum daily dose for acetaminophen?

A. 2000 mgB. 2400 mg

C. 3200 mgD. 4000 mg

E. 6000 mg

59. What is the maximum daily dose of ibuprofen?

A. 2000 mg

B. 2400 mg

C. 3200 mgD. 4000 mgE. 6000 mg

60. It requires more analgesic medication to overcome pain than to maintain pain relief once it has been

established

A. True

B. False

61. Which pair of anesthetics is most likely to show cross-allergy?

A. Lidocaine-mepivacaine

B. Prilocaine-tetracaineC. Procaine-mepivacaine

D. Procaine-lidocaineE. Lidocaine-benzocaine

62. How many mg/cc is in epinephrine 1:1000?

A. 0.01 mg/ccB. 0.1 mg/ccC. 1 mg/cc

D. 10 mg/cc

63. Which analgesic is an aniline derivative and is related to phenacetin?

A. Acetaminophen

B. AspirinC. IbuprofenD. Rofecoxib

64. Your patient is allergic to aspirin. Which of the following medications can be taken for pain?

1. Percodan2. Darvon3. Darvon Compound

4. Vicodin

A. 1, 2, and 3B. 1 and 3C. 2 and 4

D. 4 only