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MCQs on Local and General

Anesthetic Agents - Oral and
Maxillofacial Surgery

# Which of the following local anesthetic agent

would be preferred in prolonged surgical
procedure?
A. Bupivacaine
B. Cocaine
C. Lignocaine
D. Prilocaine

# Which of the following is not a theory for local

anesthetic action?
A. Membrane expansion theory
B. Calcium displacement theory
C. Electrical potential theory
D. Specific receptor theory
E. None of the above

# In the extraoral technique for mandibular nerve

block, the needle after contacting the pterygoid
plate is directed:
A. anteriorly
B. posteriorly
C. superiorly
D. inferiorly

# Which of the following is the preferred local

anesthetic technique for hemophilics?
A. Nerve block
B. Supraperiosteal
C. Intraligamentary
D. Field block

# Of the following local anesthetics, which has

intrinsic vasoconstrictive action?
A. Cocaine
B. Procaine
C. Xylocaine
D. Bupivacaine

# It is difficult to obtain local infiltration anesthesia

in the presence of inflammation because of:
A. a decreased pH
B. increased vascularity
C. odedma
D. pain

# Which of the following symptoms is seen in a

patient administered with 20-40% nitrous oxide ?
A. Paraesthesia
B. Floating sensation
C. Sweating
D. None of the above

# Alpha adrenergic agonists are used in

combination with local anesthetics to:
A. increase the rate of liver metabolism of local
anesthetic

B. increase the concentration of LA at receptor site

C. stimulate myocardial contraction
D. increases vascular absorption of LA

# Action of toxic doses of local anesthetic on CNS

can be described as:
A. first stimulating the CNS followed by
depression
B. first depressing it followed by stimulation
C. only depression of the CNS
D. only stimulation of the CNS

# To give field block, the LA should be deposited

near:
A. main trunk
B. large branch of peripheral nerve
C. small nerve endings
D. periodontal ligament

# Most accepted theory for conduction of pain is:

A. Gate control theory
B. Specificity theory
C. Membrane stabilization theory
D. None of the above

# In anesthetizing lower anteriors, all of the

following are indicated except:
A. Fischer 123 technique
B. Classical inferior alveolar nerve block
C. Mental nerve block
D. Incisive block

# Action of lignocaine is affected by all except:

A. pH at the site of injection
B. blood flow at the site of injection
C. vasoconstrictor in the LA solution
D. action of cholinesterase at the site of injection

# Which of the following about syncope is false ?

A. another term for fainting
B. is transient reversible loss of consciousness
C. caused by altered circulation
D. none of the above

# The addition of hyaluronidase to a local

anesthetic solution might:
A. increase the duration of anesthesia
B. limit the area of anesthesia
C. reduce bleeding
D. enhance diffusion of local anesthetic

# The effect of local anesthesia can be increased by

the addition of:
A. Adrenaline
B. Isoprenaline
C. Dopamine
D. Felypressin (synthetic vasopressin)

# Amide type of local anesthetic agents undergo

biotransformation primarily in the:
A. kidney
B. liver
C. plasma
D. excreted in the unaltered form

# The maximum dose of lignocaine without

adrenaline that can be admitted to a patient is:
A. 4 mg/kg body weight
B. 5 mg/kg body weight
C. 7 mg/kg body weight
D. 9 mg/kg body weight

# Surgery is carried out in which stage of general

anesthesia?
A. Plane I
B. Plane II
C. Plane III
D. Plane IV

# The amount of vasoconstrictor in 1 ml of 2 %

lignocaine solution with 1:200000 adrenaline is:
A. 0.5 mg
B. 0.05 mg
C. 0.005 mg
D. 0.0005 mg

# Inferior alveolar nerve block alone can be used in:

A. pulpotomy of third molar
B. apicoectomy of of third molar
C. extraction of first molar
D. root resection of first molar

# Which of the following muscles is pierced by the

needle while giving an inferior alveolar nerve
block?
A. Medial pterygoid
B. Superior constrictor
C. Temporalis
D. Buccinator

# A bilateral mandibular block:

A. is dangerous because patient may swallow
tongue
B. will lead to space infection
C. is not contraindicated
D. should rarely be performed

# Which of the following general anesthetic

techniques should be used for anesthesia in oral
surgery?
A. Open drop method
B. Anesthesia with nasopharyngeal airway
C. Nasoendotracheal tube with throat pack
D. IV anesthesia with nitrous oxide and oxygen

# The longest acting, most potent and most toxic LA

is:
A. Lidocaine
B. Dibucaine
C. Bupivacaine
D. Tetracaine

# Which of the following is used to prevent

laryngospasm due to GA?
A. Atropine
B. Epinephrine
C. Diazepam
D. Succinylcholine

# For extraction of mandibular molar, anesthesia is

given to act on:
A. Inferior alveolar nerve
B. Buccal nerve
C. Lingual nerve
D. Masseteric nerve

# Among the following, which condition is a

contraindication to the use of local anesthetic
agent?
A. Parkinson's disease
B. Liver damage
C. Pregnancy (third trimester)
D. hypersensitivity to the drug

# Inferior alveolar nerve block is absolutely

contraindicated in patients suffering from the
following disease:
A. Thrombocytopenia
B. Hemophilia
C. Hypoprothrombinemia
D. von Willebrand's disease

# Myelinated nerve fibers have all of the following

properties except:
A. conduction is slower in myelinated than in non
myelinated fibers
B. current discharges at nodes of Ranvier
C. outer layer is of lipids
D. depolarisation occurs only at nodes of Ranvier

# Each of the following side efffects can occur as a

result of systemic absorption of lidocaine except
one. Which is the exception?
A. Increased gastric motility
B. Tonic clonic convulsions
C. Decreased cardiac output
D. Repiratory depression

# Lidocaine is used more commonly in dentistry

because lidocaine:
A. causes less depression of the CNS
B. causes less cardiovascular collapse
C. causes lesser incidence of allergic reactions
D. is 50 times more potent than procaine

# Of the following, in which condition local

anesthesia is ineffective?
A. Edema
B. Localized infection
C. Hematoma
D. Anemia

# LA with adrenaline is absolutely contraindicated

in:
A. First trimester of pregnancy
B. Hyperthyroidism
C. Hemophilia
D. Hypertension

# In systemic LA toxicity, there is:

A. post depression convulsion
B. post convulsion depression
C. convulsions
D. depression

# Which of the following local anesthetic will be

suitable for a hypertensive patient suffering from a
heart disease?
A. Lignocaine without adrenaline
B. Prilocaine
C. Lignocaine with adrenaline 1:1000
D. Prilocaine with Felypressin

# Maximum dose of xylocaine without adrenaline

that can be given in a 60 kg adult is:
A. 500 mg
B. 300 mg
C. 400 mg
D. 600 mg

# When blocking a nerve containing both motor

and sensory fibers, the last functional property lost
is:
A. Temperature
B. Pain
C. Proprioception
D. Touch

# Which of the following statements regarding the

action of local anesthetics is true?
A. More the pH in area less effective is the action
of anesthetic agent
B. Less the pH in an area, less effective is the
action of an anesthetic agent
C. There is little relation between H ion
concentration and anesthetic activity
D. There is no correlation between H ion
concentration and anesthetic activity

# Which of the following is true regarding local

anesthesia?
A. they are basic salts of weak acids
B. not effective in alkaline pH
C. form salts with acids
D. they are acidic salts of weak bases
# Most difficult maxillary tooth to anesthetize by
infiltration is:
A. First molar
B. First premolar
C. Canine
D. Third molar

# In case of Gow-Gates technique , the target area

is:
A. Neck of condyle
B. Head of the condyle
C. Medial side of the ramus
D. Lateral side of the condyle

# Improper direction of the needle insertion during

inferior alveolar nerve block results in:
A. facial nerve paralysis
B. paraesthesia
C. hematoma
D. trismus

# The closed mouth technique for mandibular nerve

block is:
A. Clark and Holmes technique
B. Akinosi, Vazirani technique
C. Gow Gates technique
D. Angello sergenti technique

# Hematoma formation is more frequent with:

A. Inferior alveolar nerve block
B. Posterior superior alveolar nerve block
C. Greater palatine nerve block
D. Infraorbital nerve block

# Toxicity of local anesthesia is reversed by:

A. IV epinephrine
B. IV nalorphine
C. IV barbiturates
D. IV sodium bicarbonate

# How much lignocaine is present in 2.0 ml of 2%

lignocaine solution ?
A. 40 mg
B. 20 mg
C. 30 mg
D. 2 mg

# Sensitivity to local anesthetics is greater in:

A. Type B fibers
B. Type C fibers
C. Type A delta fibers
D. Fibers supplying the muscle spindles

# A patient manifests systemic symptoms of pallor

and unconscious following local anesthesia. The
patient is experiencing:
A. CNS depression
B. Syncope
C. Tonic reaction to local anesthesia
D. Allergic response

# Which of the following can be used as a local

anesthetic agent if a patient is allergic to amide and
ester anesthetic derivatives?
A. Nitrous oxide
B. Bupivacaine
C. Phenylephrine
D. Diphenhydramine

# Each of the following statements about local

anesthesia is correct except:
A. Lignocaine causes cardiac dysarrhythmia
B. Prilocaine is more toxic than lignocaine
C. Prilocaine and lignocaine are the components of
EMLA (eutectic mixture of local anesthetics)
D. Bupivacaine is given for obstetric epidural
anesthesia

# The local anesthetic which has sympathomimetic

property is:
A. Procaine
B. Lidocaine
C. Cocaine
D. Tetracaine

# Which of the following respiratory conditions is

most alarming during patient sedation in dental
clinic?
A. Apnea
B. Dyspnea
C. Hyperapnea
D. Tachypnea

# The onset of action of lidocaine is after:

A. 1-2 minutes
B. 5-10 minutes
C. 3-5 minutes
D. 7-8 minutes

# In dentistry which sedatives are generally used?

A. Benzodiazepines
B. Morphine
C. NSAID
D. Pethidine

# A patient who faints during extraction should be

positioned in the:
A. lateral position
B. horizontal position
C. Trendelenburg position
D. Dorsosacral position

# The action of adrenaline is potentiated in the

presence of all except:
A. Halothane
B. Ethyl chloride
C. Cyclopropane
D. Ether

# Syncope:
A. is associated with bradycardia and loss of
consciousness
B. never occurs in children
C. always associated with hypoglycemia
D. best treated in a sitting posture

# The dose of epinephrine given in anaphylaxis:

A. 0.5 mg in 1:1000 IM
B. 0.5 mg in 1:10000 IM
C. 0.5 mg in 1:500 IM
D. 1 mg in 1:100 IM

# LA acts on nerve membrane by:

A. blocking conductance of Na+ from interior to
exterior
B. blocking conductance of Na+ from exterior to
interior
C. blocking conductance of K+ from exterior to
interior
D. blocking conductance of K+ from interior to
exterior

# On administration of LA in an area of infection, it

is not effective because of the increase in:
A. Cations
B. Free base
C. Uncharged base
D. None

# The common complication of the local anesthetic

prilocaine is:
A. Agranulocytosis
B. Hepatic dysfunction
C. Methemoglobinemia
D. Loss of taste

# The action of long acting muscle relaxants used

during GA may be terminated by:
A. Neostigmine
B. Atropine
C. Ketamine
D. Succinylcholine

# Rapid onset of action seen by local anesthesia in

small nerve endings is due to:
A. Increased threshold of small nerves due to
depolarisation
B. low pH of small nerve fibers
C. high ratio of surface area to the volume of small
nerve fibers
D. increased resting potential of small nerve fibers

# The cause of sensation of tissue tearing during

local anesthesia administration is due to:
A. Passage through a cyst
B. passage through a muscle
C. passage through an area of infection
D. barb on the needle

# Increased incidence of reaction to LA will occur

by:
A. Rapid rate of injection
B. Using an aspirating technique
C. Addition of vasoconstrictor to the solution
D. Premedication with barbiturate

# Which of the following local anesthetic is a

vasoconstrictor>
A. Lidocaine
B. Procaine
C. Bupivacaine
D. Ropivacaine

# Excess of plasma level of lignocaine can cause

cardiovascular collapse due to:
A. Myocardial depression
B. Vagal stimulation
C. Syncope
D. CNS excitability

# Syncope is usually caused by:

A. Vasoconstriction
B. Cerebral ischemia
C. Cerebral hyperemia
D. Decrease in the vascular bed

# First local anesthetic to be used clinically was:

A. Cocaine
B. Bupivacaine
C. Procaine
D. Lignocaine

# Which of the following inducing agents has

analgesic property?
A. Nitrous oxide
B. Halothane
C. Enflurane
D. Sevoflurane

# Maximum recommended dose of lignocaine with

epinephrine is:
A. 5mg/kg body weight
B. 7 mg/kg body weight
C. 10 mg/kg body weight
D. 15 mg/kg body weight

# The most common anesthetic complication

occuring within first 24 hours after surgery under
general anesthesia is :
A. Hypertension
B. Renal failure
C. Atelectasis
D. Cardiac arrest

# The activity of procaine is terminated by:

A. elimination by kidney
B. storage in the adipose tissue
C. metabolism in the liver only
D. metabolism in the liver and by
pseudocholinesterase in the plasma

# Xylocaine strength used in dentistry is:

A. 2 %
B. 5 %
C. 8 %
D. 10 %

# The most significant adverse consequence of

accidental intravenous administration of local
anesthetic is:
A. Bronchoconstriction
B. Hepatic damage
C. Nerve damage
D. Seizures

# The first sensation to be lost following

administration of local anesthetic is:
A. Proprioception
B. Pain
C. Touch
D. Temperature

# Most commonly used local anesthetic:

A. 1:20000 xylocaine HCl
B. 1:50000 xylocaine HCl
C. 1:10000 xylocaine HCl
D. 1:80000 xylocaine HCl

# The safe dose of adrenaline in a patient with

compromised cardiac condition is:
A. 0.2 mg
B. 0.02 mg
C. 0.4 mg
D. 0.04 mg

# Cartridges shouldn't be permitted to soak in

alcohol because it:
A. destroys vasoconstrictor
B. is less effective
C. is warm in sensation
D. diffuses through rubber cap causing
contamination

# Sedation by which the following routes can be

reversed most rapidly?
A. Oral
B. Inhalation
C. Intravenous
D. Intramuscular

# With over dosage of LA agent, one would observe:

A. Hypertension
B. Hypotension
C. No change in BP
D. Cardiac arrhythmias

# The role of sodium metabisulphite in local

anesthetic agent is:
A. Preservative
B. Fungicide
C. Reducing agent
D. Vasoconstrictor

# Symptoms of epinephrine overdose following a

local anesthetic injection may include all of the
following except:
A. Restlessness
B. Hypotension
C. Apprehension
D. Palpitations

# Trismus during block anesthesia is as a result of:

A. Massive edema
B. Damage to medial pterygoid
C. Damage to lateral pterygoid
D. Damage to inferior alveolar nerve

# Allergic reactions in patients who receive amide

type local anesthetics for dental procedures are
most likely caused by the reaction of:
A. Methylparaben
B. Contaminants
C. Lignocaine hydrochloride
D. Epinephrine

# ECG changes can first be observed when level of

lignocaine is more than:
A. 5-6 mcg/ml
B. 10-12 mcg/ml
C. 2-4 mcg/ml
D. 1.2 mcg/ml

# Inferior alveolar nerve block is given in:

A. Retromolar area
B. Pterygomandibular space
C. Submandibular space
D. Submental space

# The color of a nitrous oxide cylinder is:

A. Red
B. Blue
C. White
D. Black