The BASIC exam is typically taken at the end of the CA-1 year and focuses on the scientific basis of clinical anesthetic practice, including pharmacology, physiology, anatomy, anesthesia equipment, and monitoring.

The ADVANCED exam is taken after completion of residency and passing the BASIC exam. It focuses on clinical anesthetic practice, including subspecialty-based practice and advanced clinical issues. Browse or search the combined content outline below.

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BASIC

1. A. Basic Sciences

   1. 1. Anatomy

      1. a. Topographical Anatomy as Landmarks

         1. 1) Neck: Cricothyroid Membrane, Internal and External Jugular Veins, Thoracic Duct, Carotid and Vertebral Arteries, Stellate Ganglion, Cervical Spine Landmarks (Vertebra Prominens, Chassaignac’s Tubercle), Hyoid Bone, Superficial Cervical Plexus
         2. 2) Chest: Pulmonary Lobes, Cardiac Landmarks, Subclavian Vein
         3. 3) Pelvis and Back: Vertebral Level of Topographical Landmarks, Caudal Space
         4. 4) Extremities: Relationship of Bones, Nerves, and Arteries
         5. 5) Dermatome Anatomy: Sensory and Motor
      2. b. Radiological and Ultrasound Anatomy

         1. 1) Chest (Including CT and MRI)
         2. 2) Brain and Skull (Including CT and MRI)
         3. 3) Spine (Cervical, Thoracic, Lumbar), Including CT and MRI
         4. 4) Neck (Including Doppler Ultrasound for Central Venous Access)
         5. 5) Abdominal wall
         6. 6) Extremities
      3. c. Clinical Anatomy

         1. 1) Upper Extremity
            1. a) Bones
            2. b) Vasculature
            3. c) Innervation
         2. 2) Lower Extremity
            1. a) Bones
            2. b) Vasculature
            3. c) Innervation
         3. 3) Trunk
            1. a) Intercostal
            2. b) Abdominal Wall
   2. 2. Physics, Monitoring, and Anesthesia Delivery Devices

      1. a. Mechanics

         1. 1) Pressure Measurement of Gases, Liquids
         2. 2) Transducers, Regulators, Medical Gas Cylinders
         3. 3) Principles of Ultrasound: Obtaining an Image, Resolution, Depth, Frequency, Resonance
      2. b. Flow Velocity

         1. 1) Viscosity-Density, Laminar-Turbulent Flow
         2. 2) Flowmeters: Rotameter
         3. 3) Principles of Doppler Ultrasound
      3. c. Properties of Liquids, Gases, and Vapors

         1. 1) Diffusion of Gases
         2. 2) Solubility Coefficients
         3. 3) Critical Temperature, Critical Pressure
      4. d. Gas Laws
      5. e. Vaporizers

         1. 1) Vapor Pressure and Calculation of Anesthetic Concentrations
         2. 2) Vaporizer Types and Safety Features
      6. f. Uptake and Distribution of Inhalation Agents

         1. 1) Uptake and Elimination Curves; Effect of Ventilation, Circulation, Anesthetic Systems
         2. 2) Concentration Effect
         3. 3) Second Gas Effect
         4. 4) Nitrous Oxide and Closed Spaces
      7. g. Physics of Anesthesia Machine/Breathing System

         1. 1) Principles: Resistance, Turbulent Flow, Mechanical Dead Space, Rebreathing, Dilution, Leaks, Gas Mixtures, Humidity, Heat
         2. 2) Components: Connectors, Adaptors, Mask, Endotracheal Tube, Reservoir Bag Unidirectional Valves, Corrugated Breathing Tubes, Laryngeal Mask Airways, Airway Pressure Relief Valve
         3. 3) Characteristics
            1. a) Circle Systems: Closed and Semi-Closed
            2. b) Non-Circle Systems: Insufflation, Open, Semi-Open
            3. c) Portable Ventilation Devices (Self-Reinflating, Non-Self-Reinflating), Non-Rebreathing Valves
            4. d) CO2 Absorption: Principles, Canisters, Efficiency
            5. e) Toxicity: Compound A, Carbon Monoxide
         4. 4) Oxygen Supply Systems: FiO2
         5. 5) Waste Gas Evacuation Systems
         6. 6) Safety Features (Proportioning Devices, Rotameter Configuration, Pressure Fail-Safe)
      8. h. Monitoring Methods

         1. 1) Neuromuscular Function: Nerve Stimulators, Electromyography (EMG)
         2. 2) Ventilation: Respirometers, Inspiratory Force, Spirometry, Flow-Volume Loops
         3. 3) Gas Concentrations: O2, CO2, Nitrogen, Anesthetic Gases and Vapors
         4. 4) Temperature
         5. 5) Oxygen: Oximetry, Co-Oximetry, Pulse Oximetry
         6. 6) Blood Pressure: Noninvasive, Invasive Doppler, Oscillometry, Korotkoff Sounds, Palpation
         7. 7) Heart Function: Heart Tones, Electrocardiogram, Echocardiogram
      9. i. Instrumentation

         1. 1) Arterial and Venous Blood Gases: Electrodes for pH, PO2, PCO2, Calibration, Temperature Corrections, Errors
         2. 2) Gas Concentrations: Infrared Absorption, Mass Spectrometry, Raman Scatter Analysis
         3. 3) Pressure Transducers: Resonance, Damping
         4. 4) Neurologic Function Monitors
         5. 5) Fluid Warmers, Autotransfusion Devices
         6. 6) Body Warming Devices: Forced Air, Heating Lamps, Insulation on Devices, Warming Blankets, Water-Flow “Second Skin” Devices
      10. j. Ventilators

          1. 1) Classifications: Flow Generation vs. Pressure Generation
          2. 2) Principles of Action: Assistors, Controllers, Assist-Control; Pressure-Limited, Volume-Limited; FiO2 Control; Periodic Sigh, Inverse Ratio, High Frequency Ventilation, Intermittent Mandatory Ventilation (IMV), Synchronized IMV, Pressure Support, Airway Pressure Release Ventilation (APRV), Non-Invasive Techniques: Biphasic Positive Airway Pressure (BIPAP), Continuous Positive Airway Pressure (CPAP), Others
          3. 3) Monitors; Pressure (Plateau, Peak), Oxygen, Apnea, Inspiratory/Expiratory Ratio, Dynamic Compliance, Static Compliance
      11. k. Alarms and Safety Features: Operating Room, Electrical, Anesthesia Machine, Ventilators, Capnometer, Oxygen, Hemodynamic Monitors
      12. l. Defibrillators: Automatic Internal, External, Implantable; Energy, Cardioversion, Types of Waveforms (Monophasic, Biphasic); Paddle Size and Position; Automated External Defibrillators (AEDs)
      13. m. Electrical; Fire and Explosion Hazards; Basic Electronics

          1. 1) Source of Ignition; Static
          2. 2) Prevention: Grounding, Isolation Transformers
          3. 3) Macro and Micro Current Hazards
          4. 4) Safety Regulations; National Fire Protection Association (NFPA) Standards
          5. 5) Risk Factors for Intraoperative Fire
      14. n. IV Pumps and Infusers
   3. 3. Mathematics

      1. a. Simple Math: Logarithms, Logarithmic Transformation; Graph of Simple Equations; Exponential Function, Analysis of Biologic Curves
      2. b. Statistics: Sample and Population; Probability; Mean, Median, and Mode; Standard Deviation and Error; T-Test; Chi-Square; Regression Analysis/Correlation; Analysis of Variance, Power Analysis, Meta-Analysis, Confidence Intervals, Odds Ratio, Risk Ratio, Bland-Altman Plot Evaluation, Poisson Distribution
   4. 4. Pharmacology

      1. a. General Concepts

         1. 1) Pharmacokinetics and Pharmacodynamics, Protein Binding; Partition Coefficients; PKA; Ionization; Tissue Uptake; Compartmentalization and Exponential Models
            1. a) Pharmacokinetics of Neuraxial Drug Administration: Epidural and Subarachnoid
            2. b) Tolerance and Tachyphylaxis
         2. 2) Termination of Action
            1. a) Elimination; Biotransformation; Context-Sensitive Half-Time
            2. b) Impact of Renal Disease
            3. c) Impact of Hepatic Disease
         3. 3) Drug Interactions
            1. a) Enzyme Induction and Inhibition
            2. b) Hepatic Blood Flow
            3. c) Drug-Drug Binding
            4. d) Alternative and Herbal Medicines: Perioperative Implications
         4. 4) Drug Reactions (Anaphylaxis, Idiosyncratic)
      2. b. Anesthetics-Gases and Vapors

         1. 1) Physical Properties
         2. 2) Mechanism of Action
         3. 3) Effects on CNS
         4. 4) Effects on Cardiovascular System
         5. 5) Effects on Respiration
         6. 6) Effects on Neuromuscular Function
         7. 7) Effects on Renal Function
         8. 8) Effects on Hepatic Function
         9. 9) Effects on Hematologic and Immune Systems
         10. 10) Biotransformation and Toxicity
         11. 11) Minimum Alveolar Concentration (MAC), Factors Affecting MAC
         12. 12) Trace Concentrations, OR Pollution, Personnel Hazards
         13. 13) Comparative Pharmacodynamics
         14. 14) Environmental implications of anesthetic gases
      3. c. Anesthetics-IV (Opioid and Non-Opioid Induction and Anesthetic Agents)

         1. 1) Opioids
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
               1. (1) IV
               2. (2) Epidural and Intrathecal
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
            9. i) Antagonism
         2. 2) Barbiturates
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
         3. 3) Propofol
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
         4. 4) Etomidate
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
         5. 5) Benzodiazepines
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
            9. i) Antagonism
         6. 6) Ketamine
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
         7. 7) Dexmedetomidine
            1. a) Mechanism of Action
            2. b) Pharmacokinetics and Pharmacodynamics
            3. c) Metabolism and Excretion
            4. d) Effect on Circulation
            5. e) Effect on Respiration
            6. f) Effect on Other Organs
            7. g) Side Effects and Toxicity
            8. h) Indications and Contraindications
      4. d. Anesthetics: Local

         1. 1) Uptake, Mechanism of Action
         2. 2) Biotransformation and Excretion
         3. 3) Comparison of Drugs and Chemical Groups
         4. 4) Prolongation of Action
         5. 5) Local Anesthetic Side Effects
            1. a) CNS: Seizures, Cauda Equina Syndrome, Transient Neurological Symptom
            2. b) Cardiac
            3. c) Allergy
            4. d) Preservatives/Additives
            5. e) Methemoglobinemia
            6. f) LAST
               1. (i) American Society for Regional Anesthesia Checklist for LAST
               2. (ii) IV Lipid Emulsion for LAST
      5. e. Muscle Relaxants (Depolarizing, Non-Depolarizing)

         1. 1) Mechanism of Action
         2. 2) Pharmacokinetics and Pharmacodynamics, Abnormal Responses
         3. 3) Prolongation of Action; Synergism
         4. 4) Metabolism and Excretion
         5. 5) Side Effects and Toxicity
         6. 6) Indications and Contraindications
         7. 7) Antagonism of Blockade
         8. 8) Drug Interactions (Antibiotics, Antiepileptics, Lithium, Magnesium, Inhalational Anesthetics)
2. B. Clinical Sciences: Anesthesia Procedures, Methods, and Techniques

   1. 1. Evaluation of the Patient and Preoperative Preparation

      1. a. Physical Examination Including Airway Evaluation
      2. b. Laboratory Evaluation

         1. 1) American Society of Anesthesiologists (ASA) Preoperative Testing Guidelines
         2. 2) American College of Cardiology/American Heart Association Guidelines for Perioperative Cardiovascular Evaluation
      3. c. ASA Physical Status Classification
      4. d. Preparation for Anesthesia/Premedication

         1. 1) Interaction with Chronic Drug Therapy; Interaction with Anesthetic Agents
         2. 2) Adverse Reactions to Premedications; Patient Variability, Dose Response Curves, Side Effects
         3. 3) Specific Problems in Disease States: Hyperthyroidism and Hypothyroidism, Drug Abuse, Glaucoma, Uremia, Increased CSF Pressure, Chronic Steroid Ingestion, Obesity, Obstructive Sleep Apnea, Depression, COPD, Hypertension, Cardiovascular disease, malignancy
         4. 4) Geriatric Doses
         5. 5) Role in Patients with Allergies
         6. 6) NPO and Full Stomach Status; Implications for Airway Management, Choice of Anesthesia Technique and Induction of Anesthesia; Gastric Emptying Time; Preoperative; Full Stomach and Induction of Anesthesia; Practice Guidelines for Preoperative Fasting
            1. a) Alteration of Gastric Fluid Volume and pH, Sphincter Tone
         7. 7) Continuation vs. Discontinuation of Chronic Medications: Antihypertensives, Anti-Anginal, Antihyperglycemics, Antidepressants, Platelet Inhibitors, etc.
         8. 8) Prophylactic Cardiac Risk Reduction: Beta-Adrenergic Blockers, etc.
         9. 9) Prophylactic Antibiotics
            1. a) Indications
            2. b) Risks of Administration
            3. c) Drug Interactions
         10. 10) Oral Anticoagulants, Anti-platelet Agents, and Reversal Agents
   2. 2. Regional Anesthesia

      1. a. General Topics: Premedication, Patient Position, Equipment, Monitoring and Sedation
      2. b. Spinal, Epidural, Caudal, Combined Spinal/Epidural

         1. 1) Indications, Contraindications
         2. 2) Sites of Actions
         3. 3) Factors Influencing Onset, Duration, and Termination of Action
         4. 4) Systemic Toxicity, Test Dose
         5. 5) Complications; Precipitating Factors, Prevention, Therapy, Implications of Anticoagulants and Platelet Inhibitors: American Society of Regional Anesthesia and Pain Medicine (ASRA) Guidelines
         6. 6) Physiologic Effects (GI, Pulmonary, Cardiac, Renal)
      3. c. IV Regional: Mechanism, Agents, Indications, Contraindications, Techniques, Complications
      4. d. Transversus Abdominis Plane Blocks: Indications, Risks, Side Effects
   3. 3. General Anesthesia

      1. a. Stages and Signs of Anesthesia; Awareness under Anesthesia
      2. b. Techniques: Inhalational, Total IV, Combined Inhalational/IV
      3. c. Airway Management

         1. 1) Assessment/Identification of Difficult Airway: Anatomic Correlates, Mallampati Classification, Range of Motion
         2. 2) Techniques for Managing Airway: Awake vs. Asleep, Use vs. Avoidance of Muscle Relaxants, Drug Selection, Retrograde Intubation Techniques, ASA Difficult Airway Algorithm
         3. 3) Devices: Flexible Fiberoptic, Rigid Fiberoptic, Transillumination, Laryngoscope Blades, Alternative Intubating Devices, Video Laryngoscopes
         4. 4) Alternatives and Adjuncts: Laryngeal Mask Airway (Traditional and Modified), Esophageal Obturator Airways, Occlusive Pharyngeal Airways
         5. 5) Transcutaneous or Surgical Airway: Tracheostomy, Cricothyroidotomy, Translaryngeal or Transtracheal Jet Ventilation
         6. 6) Endobronchial Intubation: Double-Lumen Endobronchial Tubes; Bronchial Blockers, Placement and Positioning Considerations, Postoperative Considerations
         7. 7) Intubation and Tube Change Adjuncts: Bougies, Jet Stylettes, Soft and Rigid Tube Change Devices; Complications
         8. 8) Endotracheal Tube Types: Tube Material (Polyvinyl Chloride, Silicone, Laser-Resistant, Silver Impregnated, Other), Tube Tip Design (Murphy Eyes, Flexible Tip, Moveable Tip, Short-Bevel), Cuff Design (High vs. Low Volume/Pressure, Cuffed vs. Uncuffed, Cuff Shape), Cuff Pressure Management (Lanz Valves, Active Management, Pilot Balloon, Inflation Valve), Specific Tube Types (Wire-Reinforced, Nasal and Oral Rae®, Microlaryngeal, Supraglottic Secretion Suctioning, Other), Microlaryngoscopy; Laser Safe
      4. d. ASA Monitoring Standards
   4. 4. Monitored Anesthesia Care and Sedation

      1. a. Techniques
      2. b. Risks and Complications
      3. c. ASA Guidelines for Sedation, Sedation Guidelines for Non-Anesthesiologists
      4. d. Indications/Contraindications
   5. 5. IV Fluid Therapy during Anesthesia

      1. a. Water, Electrolyte, Glucose Requirements and Disposition
      2. b. Crystalloid vs. Colloid
      3. c. Fluid Requirements and Fluid Deficit Calculations
      4. d. Normal Saline vs. Lactated Ringer’s vs. Plasma-Lyte vs. D5W
      5. e. Fluid Management and Patient Outcomes
   6. 6. Common Complications

      1. a. Trauma

         1. 1) Upper Airway, Epistaxis
         2. 2) Larynx, Trachea, and Esophagus
         3. 3) Eyes: Corneal Abrasions, Blindness, Postoperative Visual Loss
         4. 4) Vascular; Arterial and Venous Thrombosis; Thrombophlebitis; Sheared Catheter, Intra-Arterial Injections, Air Embolism, Cardiac/Vascular Perforations, Pulmonary Artery Rupture
         5. 5) Neurological: Pressure Injuries of Mask, Tourniquet, Body Position, Intraneural Injections, Retractors, Peripheral Neuropathies
         6. 6) Burns
      2. b. Chronic Environmental Exposure and Scavenging
      3. c. Temperature

         1. 1) Hypothermia: Etiology, Prevention, Treatment, Complications (Shivering, O2 Consumption), Prognosis
         2. 2) Nonmalignant Hyperthermia; Complications, Treatment
      4. d. Bronchospasm
      5. e. Latex Allergy
      6. f. Laryngospasm
      7. g. Postobstructive Pulmonary Edema
      8. h. Aspiration of Gastric Contents
      9. i. Malignant Hyperthermia

         1. 1) Genetics
         2. 2) Pathophysiology
   7. 7. Postoperative Care

      1. a. Pain Relief

         1. 1) Pharmacologic
            1. a) Drugs: Opioids, Agonist-Antagonists, Local Anesthetics, Alpha-2 Agonists, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), N-Methyl-D-Aspartate (NMDA) Receptor Blockers, Tricyclic Antidepressants (TCA), Selective Serotonin Reuptake Inhibitor (SSRI)
            2. b) Routes: Oral, Subcutaneous (SC), Transcutaneous, Transmucosal, Intramuscular (IM), IV, Including Patient-Controlled Analgesia (PCA), Epidural, Spinal, Interpleural, Other Regional Techniques
         2. 2) Other Techniques; Transcutaneous Electrical Nerve Stimulation (TENS); Cryotherapy; Acupuncture, Hypnosis
      2. b. Respiratory Consequences of Anesthesia and of Surgical Incisions
      3. c. Cardiovascular Consequences of General and Regional Anesthesia: Differential Diagnosis and Treatment of Postoperative Hypertension and Hypotension
      4. d. Nausea and Vomiting

         1. 1) Physiology; Etiology; Risk Factors, Preventive Strategies
         2. 2) Pharmacology and Use of Antacids, Histamine-2 (H2) Blockers, Metoclopramide, Transdermal Scopolamine, Droperidol, Serotonin Antagonists, Proton Pump Inhibitors, Dexamethasone, Multimodal Therapy, Acupressure/Acupuncture
      5. e. Neuromuscular Consequences: Residual Paralysis, Muscle Soreness, Recovery of Airway Reflexes
      6. f. Neurologic Consequences of Anesthesia: Confusion, Delirium, Cognitive Dysfunction, Failure to Emerge from Anesthesia
3. C. Organ-Based Basic and Clinical Sciences

   1. 1. Central and Peripheral Nervous Systems

      1. a. Physiology

         1. 1) Brain
            1. a) Cerebral Cortex; Functional Organization
            2. b) Subcortical Areas: Basal Ganglia, Hippocampus, Internal Capsule, Cerebellum, Brain Stem, Reticular Activating System
            3. c) Cerebral Blood Flow
               1. (1) Effect of Perfusion Pressure, Ph, PaCO2, PaO2, and Cerebral Metabolic Rate for O2 (CMRO2); Inverse Steal; Gray vs. White Matter
               2. (2) Autoregulation: Normal, Altered, and Abolished
               3. (3) Pathophysiology of Ischemia/Hypoxia: Global vs. Focal, Glucose Effects, Effects of Brain Trauma or Tumors
            4. d) Cerebrospinal Fluid
               1. (1) Formation, Volume, Composition, Flow and Pressure
               2. (2) Blood-Brain Barrier, Active and Passive Molecular Transport Across, Causes of Disruption
               3. (3) Relation to Blood Chemistry and Acid-Base Balance
         2. 2) Spinal Cord
            1. a) General Organization
            2. b) Spinal Reflexes
            3. c) Spinal Cord Tracts
            4. d) Evoked Potentials
         3. 3) Neuromuscular and Synaptic Transmission
            1. a) Morphology; Receptors, Receptor Density
            2. b) Membrane Potential; Mechanism
            3. c) Action Potential; Characteristics, Ion Flux
            4. d) Synapse; Transmitters, Precursors, Ions, Termination of Action, Transmission Characteristics, Presynaptic and Postsynaptic Functions
         4. 4) Skeletal Muscle Contractions; Depolarization, Role of Calcium, Actin/Myosin; Energy Source and Release
         5. 5) Pain Mechanisms and Pathways
            1. a) Nociceptors and Nociceptive Afferent Neurons, Wind-Up Phenomenon
            2. b) Dorsal Horn Transmission and Modulation
            3. c) Spinal and Supraspinal Neurotransmission and Modulation; Opioid Receptors
            4. d) Autonomic Contributions to Pain; Visceral Pain Perception and Transmission
            5. e) Social, Vocational and Psychological Influences on Pain Perception
            6. f) Gender and Age Differences in Pain Perception
         6. 6) Autonomic Nervous System
            1. a) Sympathetic: Receptors; Transmitters, Synthesis; Storage; Release; Responses; Termination of Action
            2. b) Parasympathetic: Receptors; Transmitters; Synthesis; Release; Responses; Termination of Action
            3. c) Ganglionic Transmission
            4. d) Reflexes: Afferent and Efferent Limbs
         7. 7) Temperature Regulation
            1. a) Temperature Sensing; Central, Peripheral
            2. b) Temperature Regulating Centers; Concept of Set Point
            3. c) Heat Production and Conservation
            4. d) Heat Loss; Mechanisms
            5. e) Body Temperature Measurement; Sites; Gradients
            6. f) Effect of Drugs/Anesthetic Technique on Temperature Regulation
      2. b. Anatomy

         1. 1) Brain
            1. a) Cerebral Cortex
               1. (1) Cerebellum, Basal Ganglia, Major Nuclei and Pathways
               2. (2) Brain Stem
                  1. (a) Respiratory Centers
                  2. (b) Reticular Activating System
               3. (3) Cerebral Circulation; Circle of Willis, Venous Sinuses and Drainage
         2. 2) Spinal Cord and Spine
            1. a) Variations in Vertebral Configuration
            2. b) Spinal Nerves (Level of Exit, Covering, Sensory Distribution)
            3. c) Blood Supply
            4. d) Sacral Nerves: Innervation of Pelvic Structures
         3. 3) Meninges: Epidural, Subdural and Subarachnoid Spaces
         4. 4) Parasympathetic Nervous System: Location of Ganglia, Vagal Reflex Pathways
         5. 5) Sympathetic Nervous System: Ganglia, Rami Communicantes, Sympathetic Chain
            1. a) Cranial Nerves
            2. b) Carotid and Aortic Bodies, Carotid Sinus
            3. c) Ganglia, Rami Communicantes, Sympathetic Chain
            4. d) Nociception
               1. (1) Peripheral Nociceptors: Transduction
               2. (2) Afferent Pathways: Neurons, Dorsal Horn, CNS Pathways
   2. 2. Respiratory System

      1. a. Physiology: Lung Functions and Cellular Processes

         1. 1) Lung Volumes
            1. a) Definitions; Methods of Measurement; Normal Values; Time Constants
            2. b) Spirometry; Static and Dynamic Volumes; Dead Space; Nitrogen Washout, O2 Uptake, CO2 Production, Exercise Testing
         2. 2) Lung Mechanics
            1. a) Static and Dynamic Compliance, Pleural Pressure Gradient, Flow-Volume Loops and Hysteresis, Surfactant, Laplace Law
            2. b) Resistances; Principles of Gas Flow Measurement
            3. c) Methods of Measurement
            4. d) Work of Breathing
            5. e) Regulation of Airway Caliber
         3. 3) Ventilation: Perfusion
            1. a) Distribution of Ventilation
            2. b) Distribution of Perfusion, Zones, Hypoxic Pulmonary Vasoconstriction
            3. c) Alveolar Gas Equation
         4. 4) Diffusion
            1. a) Definition, Pulmonary Diffusion Capacity
            2. b) Apneic Oxygenation, Diffusion Hypoxia
         5. 5) Blood Gas
            1. a) O2 Transport; O2 Physical Solubility; Oxyhemoglobin (Hb-O2) Saturation, Hb-O2 Dissociation Curve; 2,3-Diphosphoglycerate (2,3-DPG), P50, Respiratory Enzymes; Hemoglobin (Hb) as a Buffer
            2. b) CO2 Transport; Blood CO2 Content; Carbonic Anhydrase; CO2 Dissociation Curve; Bohr Effect, Haldane Effect
            3. c) Systemic Effects of Hypercarbia and Hypocarbia
            4. d) Systemic Effects of Hyperoxia and Hypoxemia
            5. e) Basic Interpretation of Arterial Blood Gas
         6. 6) Control of Ventilation
            1. a) Respiratory Center
            2. b) Central and Peripheral Chemoreceptors; Proprioceptive Receptors; Respiratory Muscles and Reflexes; Innervation
            3. c) CO2 and O2 Response Curves
         7. 7) Non-Respiratory Functions of Lungs: Metabolic, Immune
         8. 8) Perioperative Smoking
            1. a) Physiologic Effects
            2. b) Cessation of Smoking
      2. b. Anatomy

         1. 1) Nose
         2. 2) Pharynx: Subdivisions; Innervation
         3. 3) Larynx
            1. a) Innervation; Muscles; Blood Supply; Cartilages
            2. b) Vocal Cords, Positions with Paralysis
         4. 4) Tracheobronchial Tree
            1. a) Structure and Relationships in Neck and Chest
         5. 5) Muscles of Respiration, Accessory Muscles
      3. c. Pharmacology

         1. 1) Bronchodilators
            1. a) β-Agonists
            2. b) Anticholinergics
         2. 2) Anti-Inflammatory Medications
            1. a) Steroids
            2. b) Leukotriene Modifier Drugs
            3. c) Mast Cell Stabilizers
            4. d) Immunoglobulin E (IgE) Blockers
   3. 3. Cardiovascular System

      1. a. Physiology

         1. 1) Cardiac Cycle
            1. a) Control of Heart Rate
            2. b) Synchronicity of Pressure, Flow, ECG, Sounds, Valve Action
            3. c) Impulse Propagation
            4. d) Normal ECG
            5. e) Electrophysiology; Ion Channels and Currents
         2. 2) Ventricular Function
            1. a) Frank-Starling Law; Preload and Afterload, Intracardiac Pressures
            2. b) Force, Velocity, Length, Rate of Shortening
            3. c) Myocardial Contractility, Measurement Limitations
            4. d) Cardiac Output: Determinants and Regulation
            5. e) Myocardial Oxygen Utilization
            6. f) Systolic and Diastolic Function
            7. g) Cardiac Output: Fick Principle
         3. 3) Venous Return
            1. a) Vascular Compliance/Venous Capacitance; Controlling Factors
            2. b) Muscle Action; Intrathoracic Pressure; Body Position
            3. c) Blood Volume and Distribution
         4. 4) Blood Pressure
            1. a) Systolic, Diastolic, Mean, and Perfusion Pressures
            2. b) Intracardiac, Pulmonary, Venous
            3. c) Systemic and Pulmonary Vascular Resistance, Viscosity
            4. d) Baroreceptor Function
         5. 5) Microcirculation
            1. a) Capillary Diffusion; Osmotic Pressure, Starling’s Law
            2. b) Pre-Post Capillary Sphincter Control
            3. c) Viscosity; Rheology
         6. 6) Regional Blood Flow and Its Regulation
            1. a) Cerebral and Spinal Cord
            2. b) Coronary
            3. c) Pulmonary
            4. d) Renal
            5. e) Splanchnic:Hepatic
            6. f) Muscle and Skin
            7. g) Uterine and Placental
         7. 7) Regulation of Circulation and Blood Volume
            1. a) Central: Vasomotor Center, Hypothalamic-Pituitary-Adrenal Axis
            2. b) Peripheral: Receptors and Reflexes
            3. c) Hormonal Control
            4. d) Mixed Venous Oxygen Tension and Saturation
         8. 8) Basics of Cardiopulmonary Resuscitation; Medications, Defibrillators, Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) Algorithms
      2. b. Anatomy

         1. 1) Normal Anatomy of Heart and Major Vessels
            1. a) Coronary Circulation
            2. b) Heart Conduction System
      3. c. Pharmacology

         1. 1) Digitalis; Actions and Toxicity
         2. 2) Inotropes
         3. 3) Phosphodiesterase III Inhibitors (Inodilators): Milrinone, Others
         4. 4) Antiarrhythmics
         5. 5) Antianginal Drugs
         6. 6) Vasodilators: Nitroprusside, Nitroglycerin, Hydralazine, Nesiritide, Calcium Channel Blockers, Others
         7. 7) Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
         8. 8) Electrolytes (Potassium, Magnesium, Phosphorus, Calcium): Cardiovascular Effects
         9. 9) Non-Adrenergic Vasoconstrictors: Vasopressin and Congeners
   4. 4. Gastrointestinal/Hepatic Systems

      1. a. Physiology: Hepatic Function

         1. 1) Dual Blood Supply and Its Regulation
         2. 2) Metabolic and Synthetic Functions
         3. 3) Excretory Functions
         4. 4) Mechanisms of Drug Metabolism and Excretion, Cytochrome P450
      2. b. Enhanced Recovery after Surgery for Colorectal Surgery
   5. 5. Renal and Urinary Systems/Electrolyte Balance

      1. a. Physiology

         1. 1) Blood Flow, Glomerular Filtration, Tubular Reabsorption and Secretion
         2. 2) Renal Function Tests
         3. 3) Hormonal Regulation of Extracellular Fluid
         4. 4) Hormonal Regulation of Osmolality
         5. 5) Regulation of Acid-Base Balance
         6. 6) Drug Excretion
         7. 7) Water and Electrolytes: Distribution and Balance; Compartments
         8. 8) Renin-Angiotensin-Aldosterone System
      2. b. Pharmacology

         1. 1) Diuretics
            1. a) Mechanism of Action
            2. b) Comparison of Drugs
            3. c) Effect on Electrolytes and Acid-Base Balance
            4. d) Adverse Effects
         2. 2) Dopaminergic Drugs
   6. 6. Hematologic System

      1. a. Pharmacology

         1. 1) Anticoagulants, Antithrombotics, and Anti-Platelet Drugs
            1. a) Mechanism of Action
            2. b) Comparison of Drugs
            3. c) Drug Interaction
            4. d) Monitoring of Effects
            5. e) Side Effects and Toxicity
            6. f) Alternatives to Transfusion: Hemodilution, Sequestration, Autotransfusion, Blood Substitutes, Erythropoietin
         2. 2) Immunosuppressive and Anti-Rejection Drugs
      2. b. Transfusions

         1. 1) Indications
         2. 2) Blood Preservation, Storage
         3. 3) Blood Filters and Pumps
         4. 4) Effects of Cooling and Heating; Blood Warmers
         5. 5) Blood Components, Volume Expanders
         6. 6) Preparation for Transfusion: Type and Cross, Type and Screen, Uncrossmatched Blood, Autologous Blood, Designated Donors
      3. c. Reactions to Transfusions

         1. 1) Febrile
         2. 2) Allergic
         3. 3) Hemolytic: Acute and Delayed
      4. d. Complications of Transfusions

         1. 1) Infections: Hepatitis, Human Immunodeficiency Virus (HIV), Cytomegalovirus (CMV), Others
         2. 2) Citrate Intoxication
         3. 3) Electrolyte and Acid Base Abnormalities
         4. 4) Massive Transfusion: Coagulopathies, Hypothermia
         5. 5) Pulmonary
            1. a) Transfusion-Related Acute Lung Injury
            2. b) Transfusion-Related Circulatory Overload
         6. 6) Immunosuppression
   7. 7. Endocrine and Metabolic Systems

      1. a. Physiology

         1. 1) Hypothalamus, Pituitary; Thyroid; Parathyroid, Adrenal Medulla, Adrenal Cortex and Pancreas
      2. b. Biochemistry of Normal Body Metabolism

         1. 1) Carbohydrates
            1. a) Aerobic and Anaerobic Utilization; Chemical Processes, Enzymes
            2. b) Relationship to Hormones; Insulin; Human Growth Hormone, Glucocorticoids; Glucagon, Epinephrine
            3. c) Effect of Stress
            4. d) Perioperative Management of Insulin
         2. 2) Proteins
            1. a) Functions, Hormones, Antibodies
            2. b) Cyclic Adenosine Monophosphate (CAMP); Cyclic Guanosine Monophosphate (CGMP)
            3. c) Lipids: Triglycerides, Lipoproteins, Cholesterol
               1. (1) Specific Organ Metabolism (Brain, Heart, Liver, Muscle)
   8. 8. Anatomy and Physiology of Neuromuscular Junction

      1. a. Physiology of Neuromuscular Transmission

         1. 1) Prejunctional Events: Acetylcholine Synthesis and Release, Modulation by Nicotinic and Muscarinic Prejunctional Receptors
         2. 2) Postjunctional Events: Acetylcholine Binding to Acetylcholine Receptors, Ion Flow through Acetylcholine Receptor
      2. b. Anatomy of the Neuromuscular Junction

         1. 1) Prejunctional Components: Motor Neurons, Neuronal Transport System, Synaptic Vesicles
         2. 2) Postjunctional Components: Muscle Cell, Acetylcholine Receptor
         3. 3) Perijunctional Voltage-Gated Channels
4. D. Special Problems or Issues in Anesthesiology

   1. 1. Physician Impairment or Disability: Substance Abuse, Fatigue, Aging, Visual and Auditory Impairment, American Disabilities Act, Clinician Well-Being
   2. 2. Ethics, Practice Management, and Medicolegal Issues

      1. a. Professionalism
      2. b. Ethics, Advance Directives/Do Not Resuscitate (DNR) Orders; Suspended DNR, Patient Privacy Issues, e.g., Health Insurance Portability and Accountability Act (HIPAA)
      3. c. Informed Consent (Principles, Components)

         1. 1) Shared Patient Decision-Making
      4. d. Patient Safety

         1. 1) Medication Errors: Assessment and Prevention
         2. 2) Disclosure of Errors to Patients
      5. e. Core Competencies

ADVANCED

1. A. Basic Sciences

   1. 1. Physics, Monitoring, and Anesthesia Delivery Devices

      1. a. Monitoring Methods

         1. 1) Vascular Pressures: Arterial (Invasive/Noninvasive Differences), Central Venous (CVP), Pulmonary Arterial (PAP), Pulmonary Artery Occlusion (PAOP), Left Atrial (LAP), Left Ventricular End-Diastolic (LVEDP)
         2. 2) Heart Function: Clinical Methods and Uses of Heart Tones, Electrocardiogram (ECG), Echocardiography, Doppler, Cardiac Output
         3. 3) Brain and Spinal Cord Function: Electroencephalogram (EEG) (Raw and Processed), Depth of Anesthesia Monitors (Bispectral, Other), Evoked Potentials, Wake-Up Test, Intracranial Pressure (ICP), Jugular Venous Oxygen Saturation, Near Infrared Spectroscopy (Cerebral Oximetry), Transcranial Doppler
         4. 4) Mixed Venous Oxygen Saturation (SvO2)
      2. b. Instrumentation

         1. 1) Cardiac Output: Fick, Dye Dilution, Thermodilution, Doppler, Impedance, Pulse Wave Analysis, Stroke Volume Assessment
         2. 2) Echocardiography: Technical Aspects, Complications
         3. 3) Coagulation Monitors
         4. 4) Ultrasound-Guided Placement of Vascular Catheters (Arterial, Central Venous) and Nerve Blocks
         5. 5) Point-of-Care Ultrasound (POCUS): Lung, IVC, Bladder, Gastric
      3. c. Ventilators

         1. 1) Continuous Positive Airway Pressure (CPAP) and Positive End-Expiratory Pressure (PEEP), Nasal CPAP
         2. 2) Nebulizers, Humidifiers, Drug Delivery Systems (Nitric Oxide, Others)
      4. d. Pacemakers: Design and Function

         1. 1) Temporary Transvenous; Permanent (Epicardial, Endocardial), Transcutaneous
         2. 2) Types: Fixed Rate, Biventricular Synchronized, Ventricular, Atrial, Atrio-Ventricular (A-V) Sequential
         3. 3) Standard Nomenclature
         4. 4) Reasons for Failure or Malfunction
      5. e. Electrical, Fire, and Explosion Hazards

         1. 1) Causes of Intraoperative Fires
         2. 2) Treatment of Intraoperative Fires
         3. 3) Lasers and Laser Safety
      6. f. Drug Delivery Devices: Patient-Controlled IV and Epidural Analgesia, Epidural and Subarachnoid Continuous Drug Delivery Devices
   2. 2. Pharmacology

      1. a. General Concepts

         1. 1) Pharmacogenetics
            1. a) Malignant Hyperthermia (Including Diagnosis and Therapy)
            2. b) Butyrylcholinesterase (Pseudocholinesterase) Deficiency
            3. c) Prolonged Qt Syndrome
            4. d) Genetic Factors in Drug Dose-Response Relationships
            5. e) Rapid Metabolizers
            6. 2) Addiction
               1. a) Physiology and Pharmacology
               2. b) Patient Addiction: Anesthetic Implications
               3. c) Addiction vs. Tolerance
   3. 3. Interpreting Data

      1. a. Simple Math: Logarithms, Logarithmic Transformation; Graph of Simple Equations; Exponential Function, Analysis of Biologic Curves
      2. b. Visual Display of Data: Dissociation Curves; Scatter Plot; Line Graph; Histograms; Error Bars; Bar and Whisker Plots; Survival Curves
      3. c. Summarizing and Comparing Data

         1. 1) Types of Data: Binary, Categorical, Ordinal, Continuous Normal, Continuous Non-Normal
         2. 2) Summary Measures: Proportions, Measures of Centricity (Mean, Median, Mode), Measures of Dispersion (Standard Deviation, Interquartile Range), Standardized Difference
         3. 3) Statistical Inference: Sample vs. Population; Standard Error of the Mean; Statistical Power; p-Value; Type I Error; Type II Error; Correction for Multiple Comparisons
         4. 4) Statistical Tests: T-Test, Chi-Square, ANOVA
         5. 5) Regression: Linear, Logistic, Univariable, Multivariable, Cox
         6. 6) Effect Sizes: Odds Ratio, Relative Risk, Absolute Risk Reduction, Number Needed to Treat, Hazard Ratio, Confidence Interval
         7. 7) Survival Analysis and Time-to-Event Data
         8. 8) Heterogeneity Among Populations or Studies
      4. d. Validity and Precision; Types of Bias, Inter-Rater Reliability
      5. e. Causal Inference: Confounder; Propensity Weighting/Matching
      6. f. Diagnosis and Prediction: AUROC/Discrimination, Calibration, Sensitivity, Specificity, Positive and Negative Predictive Value, Prevalence
      7. g. Study Design

         1. 1) Observational Studies: Cross-Sectional, Case-Control, Cohort, Natural Experiments
         2. 2) Interventional Studies: Randomization, Blinding
         3. 3) Summary of Evidence: Meta-Analysis; Systematic Review; Narrative Review; Practice Guidelines
2. B. Clinical Sciences: Anesthesia Procedures, Methods, and Techniques

   1. 1. Regional Anesthesia

      1. a. Peripheral Nerve Blocks: Indications, Contraindications, Techniques and Comparisons of Techniques, Complications

         1. 1) Head and Neck Including Retrobulbar/Peribulbar, Facial, Trigeminal Nerve and Branches, Cervical Plexus, Glossopharyngeal, Superior Laryngeal, Transtracheal, Occipital
         2. 2) Extremities Including Brachial Plexus (Interscalene, Supraclavicular, Infraclavicular, Axillary), Ulnar, Radial, Median, Musculocutaneous, Sciatic, Femoral, Fascia Iliaca, Lateral Femoral Cutaneous, Genito-Femoral, Obturator, Lumbar Plexus (PSOAS Block), Adductor Canal/Saphenous, Popliteal Fossa, Ankle Block, IV Regional Anesthesia
         3. 3) Trunk Including Intercostal, Serratus Anterior Plane blocks, Parasternal Intercostal Plane blocks, Paravertebral Somatic, Ilio-Inguinal, Erector Spinae Plane, Retrolaminar, Rectus Sheath, Ilioinguinal Iliohypogastric, Transversus Abdominis Plane blocks, Quadratus Lumborum Blocks, Transversalis Fascia Plane
      2. b. Neuraxial Blocks Including Epidural (Cervical, Thoracic, Lumbar, Caudal, Transforaminal), Spinal (Subarachnoid), Combined Spinal-Epidural
      3. c. Regional Anesthesia for ERAS
      4. d. Factors affecting Onset and Duration, and Termination of Action
      5. e. Use and Clinical Implications of Nerve Stimulators, Ultrasound, and Catheters
      6. f. Implications and Management of Anticoagulants and Platelet Inhibitors

         1. 1) American Society of Regional Anesthesia and Pain Medicine (ASRA) Guidelines for Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy
      7. g. Diagnosis and Management of LAST

         1. 1) Prevention
         2. 2) Treatment
   2. 2. Special Techniques

      1. a. Controlled Hypotension; Choice of Drugs, Use of Posture, Ventilation
      2. b. Targeted Temperature Management; Techniques, Systemic Effects, Shivering, Rewarming, Complications
      3. c. Hyperbaric Oxygen and Anesthesia Care
      4. d. High Altitude Anesthesia
      5. e. Extracorporeal Support
3. C. Organ-Based Advanced Clinical Sciences

   1. 1. Central and Peripheral Nervous Systems

      1. a. Physiology

         1. 1) Metabolism: Substrates, Aerobic and Anaerobic
         2. 2) Intracranial Pressure
            1. a) Brain Volume, Elastance and Compliance
            2. b) Increased ICP, Herniation
         3. 3) Electroencephalography (EEG)
            1. a) Wave Patterns, Frequency and Amplitude, Raw and Processed, Spectral Edge
            2. b) Sleep, Convulsions; O2 and CO2; Hypothermia; Brain Death
            3. c) Depth of Anesthesia; Burst Suppression, Electrical Silence, Specific Anesthetic and Drug Effects
         4. 4) Evoked Responses
            1. a) Morphology, Effects of Ischemia and Anesthetics
            2. b) Sensory: Somatosensory, Visual, Brainstem Auditory
            3. c) Motor
      2. b. Anatomy

         1. 1) Functional Anatomy or the Peripheral Nervous System: Sensory and Motor Distributions of Peripheral Nerves
            1. a) Somatic
            2. b) Autonomic
      3. c. Pharmacology

         1. 1) CNS Drugs for Non-Anesthetic Use (Major Actions, Comparison of Drugs; Effect on Respiration; Circulation, Adverse Effects)
            1. a) Pre- and Postanesthetic Medications
               1. (1) Opioids
               2. (2) Opioid Antagonists, Agonist-Antagonists
            2. b) Alpha-2 Agonists: Clonidine, Dexmedetomidine
            3. c) Tranquilizers: Butyrophenones; Benzodiazepines
            4. d) Anticonvulsants: Phenytoin, Carbamazepine, Gabapentin, Barbiturates, Others
            5. e) Antidepressants, Anti-Parkinson Drugs
            6. f) Arousal Agents: Physostigmine, Benzodiazepine Antagonists
            7. g) Substance Abuse and Addiction; Dependence
               1. (1) Chronic Opioid Dependence and Therapy
               2. (2) Pharmacologically-Assisted Opioid Withdrawal
         2. 2) Autonomic Drugs
            1. a) Sympathetic
               1. (1) Transmitters and Types of Receptors
               2. (2) Target Organ Effects; Metabolic Effects
               3. (3) Agonists: Peripheral and Central Actions, Direct and Indirect Actions, Alpha vs. Beta vs. Mixed Agonists, Alpha and Beta-Receptor Subtype-Selective Agonists
               4. (4) Antagonists: Alpha and Beta Blockers, Selective Blockers, Ganglionic Blockers
            2. b) Parasympathetic
               1. (1) Transmitters
               2. (2) Muscarinic Effects
               3. (3) Nicotinic Effects
               4. (4) Agonists: Cholinergic and Anticholinesterases
               5. (5) Antagonists
      4. d. Clinical Science

         1. 1) CNS
            1. a) Seizures
            2. b) Coma: Traumatic, Infectious, Toxic-Metabolic, Cerebrovascular Accident (CVA), Cerebral Hypoxia
               1. (1) Glasgow Coma Scale, Management of Traumatic Brain Injury
               2. (2) Therapeutic Barbiturate Coma
            3. c) Drug Intoxication (CNS Drugs, Carbon Monoxide, Insecticides, Nerve Gases)
            4. d) Paraplegia, Quadriplegia, Spinal Shock, Autonomic Hyperreflexia
               1. (1) Airway Management in the Patient with Cervical Spine Disease
            5. e) Tetanus
            6. f) Special Problems of Anesthesia for Neurosurgery
               1. (1) Increased Intracranial Pressure: Tumors, Hematomas, Hydrocephalus
               2. (2) Positioning: Prone, Sitting, Other, Head Stabilization in Tongs
               3. (3) Air Embolism
               4. (4) Cerebral Protection from Hypoxia, Ischemia, Glucose Effects
               5. (5) Aneurysms and A-V Malformations, Cerebral Vasospasm
               6. (6) Interventional Neuroradiology; Coils and Embolization
               7. (7) Pituitary Adenomas, Trans-Sphenoidal Hypophysectomy
               8. (8) Anesthetic and Ventilatory Effects on Cerebral Blood Flow and Metabolism
               9. (9) Fluid Management: Hypertonic vs. Isotonic Saline vs. Balanced Salt Solutions
               10. (10) Spinal Fluid Drainage
               11. (11) Stereotactic and Gamma-Knife Techniques, Deep Brain Stimulator Placement, Intraoperative Wake-Up Techniques
               12. (12) Ventriculostomy
               13. (13) Awake Craniotomy
               14. (14) Postoperative Visual Loss
               15. (15) Cerebral Protection
                   1. (a) Hypothermia
                   2. (b) Anesthetic and Adjuvant Drugs
   2. 2. Respiratory System

      1. a. Physiology: Lung Functions and Cellular Processes

         1. 1) Ventilation: Perfusion
            1. a) Measurement of Ventilation/Perfusion (V/Q) Ratio, Implications of Alveolar-Arterial O2 Gradient (A-aDO2), Arterial-Alveolar CO2 Gradient (A-aDCO2), Dead Space to Tidal Volume Ratio (Vd/Vt), Shunt Fraction (Qs/Qt), Lung Scan
      2. b. Anatomy

         1. 1) Lungs
            1. a) Divisions and Bronchoscopic Anatomy
            2. b) Bronchial and Pulmonary Circulations
            3. c) Microscopic Anatomy
      3. c. Biochemistry

         1. 1) Normal Acid-Base Regulation: Buffer Systems; Compensatory Mechanisms
         2. 2) Effects of Imbalance on Electrolytes and Organ Perfusion
         3. 3) Strong Ionic Difference (SID)
         4. 4) ABG Interpretation
            1. a) Anion Gap
            2. b) Temperature Effect on Blood Gases: Alpha-Stat vs. pH-Stat
      4. d. Clinical Science

         1. 1) Respiratory System
            1. a) Obstructive Disease
               1. (1) Upper Airway: Congenital, Infectious, Neoplastic, Traumatic, Foreign Body, Obstructive Sleep Apnea
               2. (2) Tracheobronchial: Congenital, Infectious, Neoplastic, Traumatic, Foreign Body
               3. (3) Parenchymal: Asthma, Bronchitis, Emphysema, COPD, Lung Abscess, Bronchiectasis, Cystic Fibrosis, Mediastinal Masses
            2. b) Restrictive Disease
               1. (1) Neurologic: CNS Depression, Spinal Cord Dysfunction, Peripheral Nervous System
               2. (2) Musculoskeletal: Muscular, Skeletal, Obesity, Chest Trauma
               3. (3) Parenchymal: Atelectasis, Pneumonia, Interstitial Pneumonitis, Pulmonary Fibrosis, Respiratory Distress Syndrome (ARDS), Bronchopulmonary Dysplasia
               4. (4) Pleural and Mediastinal: Pneumo-, Hemo-, and Chylothorax, Pleural Effusion, Empyema, Bronchopleural Fistula
               5. (5) Other: Pain, Abdominal Distention
            3. c) Management of the Patient with Respiratory Disease
               1. (1) Evaluation: History and Physical Examination, Chest X-Ray, Arterial Blood Gases (ABGs), Pulmonary Function Tests (PFTs), Flow Volume Loops, Assessment of Perioperative Risk for Thoracic and Non-Thoracic Surgery
               2. (2) Anesthetic Management
                  1. (a) Preoperative Preparation: Respiratory Therapy, Drug Therapy (Antibiotics, Bronchodilators, Mucolytics, Steroids), Tobacco Smoking Cessation (Techniques to Assist Patients, Benefits)
                  2. (b) Intraoperative Management
                     1. (1) Monitoring
                     2. (2) Choice of Anesthesia
                     3. (3) Anesthetic Techniques:
                     4. (a) Nonpulmonary Surgery, Including Mediastinoscopy
                     5. (b) Thoracic and Pulmonary Surgery
                     6. (c) One-Lung Ventilation
                     7. (d) Thoracoscopy
                  3. (c) Postoperative Care: Pain Management, Respiratory Therapy, Ventilator Support, Extubation Criteria
               3. (3) Management of Respiratory Failure
                  1. (a) Nonventilatory Respiratory Management: O2 Therapy and Toxicity, Tracheobronchial Toilet, Positive Airway Pressure, Respiratory Drugs
                  2. (b) Ventilatory Management
                     1. (1) Criteria for Ventilatory Commitment and Weaning
                     2. (2) Mode of Ventilation: Conventional Mechanical Ventilation, PEEP, CPAP, IMV, SIMV, Pressure Support, Pressure Control, High Frequency Ventilation (Positive Pressure, Jet, Oscillation), Prone Ventilation, BIPAP, Airway Pressure-Release Ventilation
                     3. (3) Complications and Side Effects of Mechanical Ventilation: Volutrauma, Barotrauma, Biotrauma
                     4. (4) Management of Bronchospasm: Bronchodilator Drugs, Anti-Inflammatory Drugs, Acute and Chronic Management, Perioperative Management
                  3. (c) Other Management Adjuncts: Nitric Oxide, Steroids, Heliox
                  4. (d) Lung Transplantation: Anesthetic Implications
         2. 2) Sleep Apnea
            1. a) Diagnosis: Sleep Study, STOP-BANG
            2. b) Anesthetic Implications
   3. 3. Cardiovascular System

      1. a. Normal Anatomy of Heart and Major Vessels

         1. 1) Echocardiographic Heart Anatomy: Chambers, Valves, Great Vessels, Pericardium, Basic Transesophageal Echocardiography (TEE) Views
         2. 2) Radiographic: Roentgenograms, CT, MRI
         3. 3) Other: Cardiac Catheterization
      2. b. Clinical Sciences

         1. 1) Ischemic Heart Disease
            1. a) Risk Factors; Predictors of Perioperative Risk, Modification of Perioperative Risk (e.g., Prophylactic Beta-Blockers)
            2. b) Manifestations
            3. c) Diagnosis of Myocardial Infarction and Acute Coronary Syndrome; Clinical, ECG, Enzymes, Echocardiography, Nuclear Techniques
            4. d) Classification of types of MI (STEMI vs. demand)
            5. e) Pharmacological Treatment of Angina, Thoracic Epidural for Angina, Interventional Cardiologic Techniques
            6. f) Determinants of Myocardial Oxygen Requirements and Delivery, Silent Ischemia, Postoperative Ischemia
            7. g) Perioperative Diagnosis and Treatment of Ischemia; ECG, TEE
            8. h) Coronary Artery Bypass Procedures; Cardiopulmonary Bypass; Protamine Reactions
         2. 2) Valvular Heart Disease
            1. a) Classification
            2. b) Diagnosis (Including Echocardiography), Natural History, Surgical Management
            3. c) Anesthetic Considerations
            4. d) Subacute Bacterial Endocarditis Prophylaxis
         3. 3) Rhythm Disorders and Conduction Defects
            1. a) Chronic Abnormalities: Etiology, Diagnosis, Therapy
               1. (1) Automated Implantable Cardioverter/Defibrillator (AICD) Implantation
               2. (2) Pacemakers: Permanent, Temporary, Transvenous, Transcutaneous; Ventricular Synchronization
               3. (3) Ablations, Cryotherapy, Maze Procedure
            2. b) Perioperative Dysrhythmia: Etiology, Diagnosis, Therapy
            3. c) Perioperative Implications of Pacemaker and AICD
         4. 4) Heart Failure and Cardiomyopathy (Ischemic, Viral, Hypertrophic)
            1. a) Definition and Functional Classification, Perioperative Diagnosis and Treatment
            2. b) Compensatory Responses
            3. c) Right or Left Ventricular Dysfunction
               1. (1) Etiology
               2. (2) Signs and Symptoms
               3. (3) Diagnostic Tests
               4. (4) Systolic vs. Diastolic Dysfunction
            4. d) Treatment
               1. (1) Pulmonary Edema
               2. (2) Pulmonary Hypertension
               3. (3) Cardiogenic Shock
            5. e) Cardiac Transplantation
         5. 5) Cardiac Tamponade and Constrictive Pericarditis
            1. a) Etiology
            2. b) Diagnosis; TEE, PA Catheter
            3. c) Anesthetic Management
         6. 6) Circulatory Assist
            1. a) Cardiopulmonary Bypass
               1. (1) Components (Pump, Oxygenator, Heat Exchanger, Filters)
               2. (2) Cardiopulmonary Bypass Techniques
               3. (3) Mechanisms of Gas Exchange
               4. (4) Priming Solutions, Hemodilution
               5. (5) Anticoagulation and Antagonism; Activated Clotting Time (ACT) and Other Clotting Times, Heparin Assays, Antithrombin III, Protamine Reactions, Heparin and Protamine Alternatives
               6. (6) Prophylaxis with Aminocaproic Acid, Tranexamic Acid
               7. (7) Anesthetic Considerations during Bypass
               8. (8) Cooling and Warming, Deep Hypothermic Circulatory Arrest
               9. (9) Monitoring, Blood Pressure Management
               10. (10) Minimally Invasive Bypass Techniques
               11. (11) Myocardial Preservation: Physiology, Techniques, Complications
               12. (12) Preconditioning
            2. b) Minimal Invasive Cardiac Surgery
               1. (1) Off-Pump Coronary Artery Bypass (OPCAB)
               2. (2) Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
               3. (3) Percutaneous Valve Repair/Replacement
            3. c) Intraaortic Balloon: Rationale, Indications, Limitations
            4. d) Extracorporeal Membrane Oxygenation (ECMO)
               1. 1) Indications. Anesthetic Management
            5. e) Ventricular Assist Devices
         7. 7) Pulmonary Embolism
            1. a) Etiology: Blood, Air, Fat, Amniotic Fluid
            2. b) Diagnosis, TEE Findings
            3. c) Treatment; Acute, Preventive
         8. 8) Hypertension
            1. a) Etiology, Pathophysiology, Course of Disease
            2. b) Drug Treatment, Interactions with Anesthetics, Risk of Anesthesia
            3. c) Intra- or Postoperative Hypertension; Differential Diagnosis and Treatment
         9. 9) Shock States: Anesthetic Management of Patient in Shock
         10. 10) Vascular Diseases
             1. a) Cerebral Circulation; Luxury Perfusion, Steals, Infarcts, Intracranial Hemorrhage
             2. b) Carotid Endarterectomy: Anesthetic Management, Monitoring of Cerebral Perfusion, Complications
             3. c) Abdominal Aneurysm Resection: Anesthetic Management
             4. d) Peripheral Arteriosclerotic Disease
             5. e) Aneurysms of Ascending, Descending and Arch of Aorta, Thoracoabdominal Aneurysms, Including Endovascular Repair Techniques
         11. 11) Advanced Cardiopulmonary Resuscitation
             1. a) Recognition
             2. b) Adult Management: Drugs, Defibrillators, Monitors, Advanced Cardiac Life Support (ACLS) Algorithms
             3. c) Complications and Outcomes of Therapy
             4. d) Pediatric Management: Drugs, Defibrillators, Monitors, Advanced Cardiac Life Support (ACLS) Algorithms
   4. 4. Gastrointestinal/Hepatic Systems

      1. a. Biochemistry: Nutrition

         1. 1) Parenteral: Peripheral or Central Vein, Hyperalimentation, Solutions Used and Complications, Anesthetic Implications
         2. 2) Enteral: GI Elemental Diets, Routes of Delivery, Complications, Anesthetic Implications
      2. b. Clinical Science

         1. 1) Morbid Obesity/Anesthesia for Bariatric Surgery
            1. a) Pre-Anesthetic Evaluation and Management
            2. b) Pharmacologic Considerations
            3. c) Anesthetic Management (Airway, Ventilation, Monitoring, Venous Access)
            4. d) Postoperative Management (Ventilation, Analgesia)
         2. 2) Hepatic Disease
            1. a) Preoperative Laboratory Assessment
            2. b) Anesthesia Choice (Hepatocellular Disease, Ascites, Portal Hypertension)
            3. c) Postoperative Hepatic Dysfunction, Hepatic Failure, Hepatorenal Syndrome
            4. d) Hepatic Transplantation
         3. 3) Intestinal Obstruction
            1. a) Causes; Paralytic Ileus; Mechanical; Vascular
            2. b) Physiological Changes; Fluid and Electrolyte; Respiratory
            3. c) Anesthesia Management: Full Stomach; Fluid Therapy; Nitrous Oxide
         4. 4) Anesthesia for Upper and Lower GI Endoscopy
         5. 5) Antiemetics and Aspiration Prophylaxis: Phenothiazines; Butyrophenones; Metoclopramide; Anticholinergics; Serotonin Antagonists, Antihistamines (H1 Blockers, H2 Blockers, Mixed Blockers), Antacids, Proton Pump Inhibitors
   5. 5. Renal and Urinary Systems/Electrolyte Balance: Clinical Science

      1. a. Renal Disease

         1. 1) Pathophysiology of Renal Disease; Risk Factors for Acute Renal Failure
         2. 2) Anesthetic Choice in Reduced Renal Function
         3. 3) Anesthetic Management in Renal Failure, Arteriovenous (A-V) Shunts
         4. 4) Anesthetic Management in Renal Transplantation
         5. 5) Perioperative Oliguria and Anuria
         6. 6) Dialysis and Hemofiltration: Hemodialysis, Peritoneal Dialysis, Continuous Hemofiltration (Arteriovenous, Venovenous)
         7. 7) Pharmacologic Prevention and Treatment of Renal Failure
      2. b. Urologic Surgery: Lithotripsy, Transurethral Resection of Prostate (TURP)/Irrigating Fluids/Hyponatremia
      3. c. Perioperative Electrolyte Abnormalities
      4. d. Fluid Therapy and Fluid Homeostasis

         1. 1) Fluid Balance during Surgery; Role of the Endothelial Glycocalyx
         2. 2) Assessment of Fluid Responsiveness and Goal-Directed Therapies
            1. a) Esophageal Doppler, Pulse Pressure Variation, Pulse Contour Analysis
            2. b) Fluid Replacement Strategies and Controversies
   6. 6. Hematologic System

      1. a. Clinical Science

         1. 1) Hematologic Disorders
            1. a) Diseases of Blood
               1. (1) Anemias; Compensatory Mechanisms
               2. (2) Polycythemias; Primary vs. Secondary
               3. (3) Clotting Disorders
                  1. (a) Thrombocytopenia and Thrombocytopathy
                  2. (b) Congenital and Acquired Factor Deficiencies
                  3. (c) Disseminated Intravascular Coagulation
                  4. (d) Fibrinolysis
                  5. (e) Pharmacologic: Anticoagulants and Antagonists
               4. (4) Hemoglobinopathies, Porphyrias
      2. b) Advanced Transfusion Therapy: Indications, Reactions

         1. 1) Febrile
         2. 2) Allergic
         3. 3) Hemolytic: Acute and Delayed
      3. c) Complications of Transfusions

         1. 1) Infections: Hepatitis, Human Immunodeficiency Virus (HIV), Cytomegalovirus (CMV), Others
         2. 2) Citrate Intoxication
         3. 3) Electrolyte and Acid Base Abnormalities
         4. 4) Pulmonary
            1. a) Transfusion-Related Acute Lung Injury
            2. b) Transfusion-Related Circulatory Overload
         5. 5) Immunosuppression, Graft vs. Host Disease
      4. d) Transfusion Therapy for Massive Hemorrhage

         1. 1) Massive Transfusion Protocol
            1. a) Ratios of RBC and Plasma
            2. b) Use of Uncrossmatched Products
            3. c) Adjuvant Therapies: Antifibrinolytics, Calcium, etc.
         2. 2) Coagulopathy of Hemorrhagic Shock
   7. 7. Endocrine and Metabolic Systems: Clinical Science

      1. a. Pituitary Disease

         1. 1) Hypopituitarism, Pituitary Removal: Substitution Therapy
            1. a) Panhypopituitarism
            2. b) Diabetes Insipidus
         2. 2) Hyperpituitarism
            1. a) Acromegaly, Including Airway Management
            2. b) Inappropriate ADH Secretion
      2. b. Thyroid Disease

         1. 1) Hyperthyroidism
            1. a) Metabolic and Circulatory Effects
            2. b) Anesthetic Management
            3. c) Thyroid Storm
         2. 2) Hypothyroidism
            1. a) Metabolic and Circulatory Effects, Myxedema Coma
            2. b) Substitution Therapy
            3. c) Anesthetic Implications
         3. 3) Complications of Surgery: Hypocalcemia, Recurrent Laryngeal Nerve Injury, Diagnosis and Treatment
      3. c. Parathyroid Disease

         1. 1) Hyperparathyroidism; Physiological Effects
         2. 2) Hypoparathyroidism; Postoperative Manifestations and Treatment
      4. d. Adrenal Disease

         1. 1) Cushing Syndrome
         2. 2) Primary Aldosteronism
         3. 3) Addison Disease
         4. 4) Pheochromocytoma
            1. a) Circulatory and Metabolic Manifestations
            2. b) Diagnosis
            3. c) Anesthetic Management
      5. e. Carcinoid Syndrome
      6. f. Diabetes Mellitus

         1. 1) Pathophysiology
         2. 2) Control of Blood Glucose - Hypoglycemia; Hyperglycemia and Ketoacidosis
         3. 3) Elective Anesthesia - Perioperative Management
         4. 4) Emergency Anesthesia
         5. 5) Hyperosmolar Coma
         6. 6) Pancreas Transplantation
   8. 8. Neuromuscular Diseases and Disorders: Clinical Science

      1. a. Demyelinating Diseases

         1. 1) Multiple Sclerosis
         2. 2) Motor Neuron Diseases: Amyotrophic Lateral Sclerosis, Spinobulbar Muscular Atrophy, Hereditary Spastic Paraplegia
         3. 3) Guillain-Barre Syndrome
         4. 4) Charcot-Marie-Tooth Disease
      2. b. Primary Muscle Diseases

         1. 1) Muscular Dystrophies: Duchenne’s, Becker’s, Limb-Girdle
         2. 2) Mitochondrial Myopathies
      3. c. Myasthenic Syndromes

         1. 1) Myasthenia Gravis
         2. 2) Lambert-Eaton Myasthenic Syndrome
         3. 3) Congenital Myasthenic Syndromes
      4. d. Ion Channel Myotonias

         1. 1) Dystrophic: Congenital Myotonic Dystrophy
         2. 2) Nondystrophic: Myotonia Congenita, Becker Disease, Hyperkalemic Periodic Paralysis, Paramyotonia Congenita, Hypokalemic Periodic Paralysis
4. D. Clinical Subspecialties

   1. 1. Painful Disease States

      1. a. Pathophysiology

         1. 1) Acute Pain
         2. 2) Cancer-Related Pain
         3. 3) Chronic Pain States
            1. a) Acute and Chronic Neck and Low Back Pain
            2. b) Neuropathic Pain States
               1. (1) Complex Regional Pain Syndrome, Types I and II
               2. (2) Postherpetic Neuralgia
               3. (3) Phantom Limb, Post-Stroke
               4. (4) Peripheral Neuropathies (e.g., Diabetic Neuropathy)
            3. c) Somatic Pain Conditions: Myofascial Pain, Facet Arthropathy, etc.
            4. d) Sickle Cell Anemia
      2. b. Treatment

         1. 1) Acute Postoperative and Posttraumatic Pain
            1. a) Postoperative Epidural Analgesia
            2. b) Neuraxial Opioids
            3. c) Peripheral Nerve Blockade and Catheters to Treat Postoperative and Posttraumatic Pain
            4. d) Patient-Controlled Analgesia
            5. e) Other Modalities, Multimodal Analgesia (Nonsteroidal Analgesics, Electrical Stimulation, Acupuncture, Ketamine, etc.)
         2. 2) Cancer-Related Pain
            1. a) Systemic Medications
            2. b) Continuous Spinal and Epidural Analgesia
            3. c) Neurolytic and Non-Neurolytic Blocks to Treat Cancer Pain
            4. d) World Health Organization Analgesic Ladder
         3. 3) Chronic Pain (Non-Cancer-Related)
            1. a) Systemic Medications: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Opioid Analgesics, Anti-Epileptics, Antidepressants
            2. b) Spinal and Epidural Analgesia
            3. c) Use of Peripheral Nerve Blocks to Treat Chronic Pain
            4. d) Use of Sympathetic Nerve Blocks to Treat Chronic Pain
            5. e) Other Techniques: TENS, Spinal Cord Stimulation, Neuroablation (Surgical and Chemical Neurolysis)
   2. 2. Pediatric Anesthesia

      1. a. Apparatus: Breathing Circuits (Advantages/Disadvantages, Dead Space, etc.), Humidity, Thermal Control

         1. 1) Endotracheal Tube Selection (Cuffed vs. Uncuffed) and Sizing
         2. 2) Warming Devices: Types, Efficacy, Complications
      2. b. Premedication: Drugs; Dosage; Routes; Vehicles, Including Topical Anesthetics; Parental Presence
      3. c. Agents and Techniques

         1. 1) Induction Techniques
         2. 2) Anesthetics: Actions Different From Adults
            1. a) Drug Toxicities Preferentially Occurring in Children (e.g., Propofol)
            2. b) Opioid Dosing and Sensitivity
            3. c) Neuromuscular Blockers (Sensitivity, Congenital Diseases, Complications of Succinylcholine, Age-Related and Drug-Related Pharmacodynamics and Pharmacokinetics)
            4. d) Regional Anesthesia
      4. d. Fluid Therapy and Blood Replacement, Physiologic Anemia, Glucose Requirements

         1. 1) NPO Guidelines for Pediatric Patients
      5. e. Problems in Intubation and Extubation (Full Stomach, Diaphragmatic Hernia, Tracheoesophageal (TEF) Fistula, Pierre-Robin, Treacher-Collins, Crouzon, Goldenhar, Hurler, Awake/Fiberoptic Intubation, Dentition, Laryngospasm, Stridor)
      6. f. Neonatal Physiology

         1. 1) Respiratory
            1. a) Development, Anatomy, Surfactant
            2. b) Pulmonary Oxygen Toxicity
            3. c) Pulmonary Function
            4. d) Lung Volumes vs. Adult
            5. e) Airway Differences, Infant vs. Adult
         2. 2) Cardiovascular
            1. a) Transition, Fetal to Adult
            2. b) Persistent Fetal Circulation
         3. 3) Retinopathy of Prematurity: Anesthetic Implications
         4. 4) Metabolism, Fluid Distribution and Renal Function
         5. 5) Thermal Regulation (Neutral Temperature, Nonshivering Thermogenesis)
         6. 6) Fetal Hemoglobin
         7. 7) Prematurity, Apnea of Prematurity
         8. 8) Bronchopulmonary Dysplasia
      7. g. Congenital Heart and Major Vascular Disease

         1. 1) Cyanotic Defects
         2. 2) Acyanotic Defects
         3. 3) Primary Pulmonary Hypertension
         4. 4) Major Vascular Malformations: Coarctation, Persistent Patent Ductus Arteriosus, Vascular Rings
         5. 5) Altered Uptake/Distribution of IV and Inhalation Anesthetics
         6. 6) Anesthetic Considerations
            1. a) Cardiac Surgery; Corrective and Palliative
            2. b) Noncardiac Surgery
            3. c) Chronic Congenital Heart Disease, Corrected, Uncorrected, and Palliated
               1. (1) In Childhood Beyond the Newborn and Infant Periods
               2. (2) In Adulthood
      8. h. Emergencies in the Newborn

         1. 1) Diaphragmatic Hernia
         2. 2) Tracheoesophageal Fistula and Esophageal Atresia
         3. 3) Neonatal Lobar Emphysema
         4. 4) Pyloric Stenosis
         5. 5) Necrotizing Enterocolitis
         6. 6) Omphalocele/Gastroschisis
         7. 7) Respiratory Distress Syndrome: Etiology, Management, Ventilation Techniques
         8. 8) Myelomeningocele
      9. i. Pediatric Medical Problems with Anesthetic Implications

         1. 1) Respiratory: Upper Respiratory Infections (Colds, Epiglottitis, Laryngotracheobronchitis), Bronchopulmonary Dysplasia, Cystic Fibrosis
         2. 2) Musculoskeletal: Muscular Dystrophies, Myotonias, etc.
         3. 3) Developmental Delay, Cerebral Palsy, Autism
         4. 4) Childhood Obesity
         5. 5) Endocrine Diseases: Childhood Diabetes, Congenital Adrenal Hyperplasia, etc.
         6. 6) Skeletal Abnormalities with or without Systemic Implications: Klippel-Feil, Achondroplasia, Marfan, Morquio, Osteogenesis Imperfecta
         7. 7) Trisomy 21 and Other Chromosomal Abnormalities
         8. 8) Juvenile Rheumatoid Arthritis
         9. 9) Anemias: Congenital and Acquired: Iron Deficiency, Physiologic Anemia, Sickle Cell, Thalassemia, etc.
         10. 10) Malignant Hyperthermia in Children; Susceptibility, Associated Diseases, Anesthetic Management of MH Susceptibility, Intraoperative Diagnosis, Treatment
      10. j. Anesthetic Implications for Common Non-Neonatal Pediatric Subspecialty Surgery

          1. 1) Otolaryngology: Cleft Lip and Palate, Tonsillectomy and Adenoidectomy, Common Ear Procedures, Peritonsillar Abscess, Flexible and Rigid Bronchoscopy, Diagnostic and Therapeutic Laryngoscopy Techniques (Jet Ventilation, Laser Implications), Airway Foreign Bodies
          2. 2) Neurosurgery: Craniotomies for Tumor or Vascular Malformations, Hydrocephalus, Ventriculoperitoneal Shunts, Craniofacial Procedures, Tethered Spinal Cord, Halo Placement Implications
          3. 3) Thoracic Surgery: Anterior Mediastinal Mass, Lung Isolation Techniques, Pectus Excavatum and Carinatum
          4. 4) General and Urologic Surgery: Laparotomy vs. Laparoscopy, Bowel Surgery, Urologic Surgery (Wilms Tumor, Ureteral Reimplantation, Bladder and Urethral Malformations, Neuroblastoma)
          5. 5) Orthopedic Surgery: Fractures and Dislocations, Congenital Hip Dysplasia, Foot and Hand Malformations; Scoliosis Implications and Repair
          6. 6) Ophthalmologic: Strabismus, Cataract, Glaucoma Procedures, etc.
      11. k. Outpatient Pediatric Anesthesia

          1. 1) Indications and Contraindications
          2. 2) Anesthetic Considerations: Premedication, Induction, Maintenance, Monitoring
          3. 3) Postoperative Considerations: Recovery Period, Discharge Criteria, Post-Discharge Monitoring/Follow-Up
      12. l. Postoperative Analgesia

          1. 1) Systemic Medications and Routes of Administration, Multimodal Therapy
          2. 2) Regional Techniques: Caudal, Epidural, Nerve Blocks
      13. m. Postoperative Nausea and Vomiting: Risk Factors, Prophylaxis, Treatment
      14. n. Pediatric Sedation: Guidelines, Pharmacology, Credentialing, Indications, Monitoring, Complications
      15. o. Pediatric Anesthesia Outside the Operating Room: Diagnostic and Interventional Radiologic Procedures, Gastroenterology Laboratory, MRIs, Radiation Therapy
   3. 3. Obstetric Anesthesia

      1. a. Maternal Physiology

         1. 1) Effects of Pregnancy on Uptake and Distribution
         2. 2) Pulmonary (Anatomy, Lung Volumes and Capacities, Oxygen Consumption, Ventilation, Blood Gases, Acid Base)
         3. 3) Cardiovascular (Aorto-Caval Compression, Cardiac Indices)
         4. 4) Renal
         5. 5) Liver (Albumin/Globulin Ratio, Protein Binding of Drugs)
         6. 6) Gastrointestinal (Gastric Acid, Motility, Anatomic Position, Gastroesophageal Sphincter Function)
         7. 7) Hematology (Blood Volume, Plasma Proteins, Coagulation)
         8. 8) Musculoskeletal
         9. 9) Placenta
            1. a) Anatomy
            2. b) Placental Exchange: O2, CO2
            3. c) Placental Blood Flow
            4. d) Barrier Function
         10. 10) Multiple Gestation: Differences Compared with Singleton Gestation
      2. b. Fetal/Perinatal Physiology

         1. 1) Cardiovascular System (Development, Fetal Circulation, Stress Response, Blood Volume)
         2. 2) Pulmonary (Development, Perinatal Changes in Type II Pneumocytes)
         3. 3) Thermoregulation
         4. 4) Neurologic (Development)
         5. 5) Amniotic Fluid (Production, Disposition, Role in Fetal Development)
         6. 6) Fetal to Neonatal Transition
      3. c. Labor Physiology (Stages, Metabolism, Respiration, Cardiovascular, Thermoregulation)
      4. d. Maternal and Fetal Pharmacology

         1. 1) Anesthetic Drugs and Adjuvants
         2. 2) Oxytocic Drugs (Indications, Adverse Effects)
         3. 3) Tocolytic Drugs (Indications, Adverse Effects)
         4. 4) Magnesium Sulfate (Maternal vs. Fetal Indications)
         5. 5) Fetal Pharmacology
            1. a) Mechanisms of Placental Transfer, Placental Transfer of Specific Drugs
            2. b) Fetal Drug Absorption, Distribution, Metabolism, Elimination
            3. c) Drug Effects on the Newborn
      5. e. Fetal Assessment

         1. 1) Amniotic Fluid (Amniocentesis, Oligohydramnios, Polyhydramnios)
         2. 2) Antepartum Fetal Assessment (Ultrasonography, Fetal Heart Rate Monitoring, Nonstress Test, Stress Test, Biophysical Profile, Umbilical Blood Flow, Middle Cerebral Artery Blood Flow)
         3. 3) Intrapartum Fetal Assessment (Fetal Heart Rate Monitoring, National Institute of Child Health and Human Development Criteria)
      6. f. Analgesia for Labor and Vaginal Birth

         1. 1) Systemic Medications: Opioids, Sedatives, Nitrous Oxide
         2. 2) Regional Techniques
            1. a) Epidural, Spinal, Combined Spinal Epidural, Dural-Puncture Epidural, Continuous Spinal
            2. b) Paracervical Block, Lumbar Sympathetic Block, Pudendal Block
         3. 3) Neuraxial Medications (Local Anesthetics, Opioids, Clonidine, Dexmedetomidine, Neostigmine, Epinephrine)
         4. 4) Infusion Methods (Patient-Controlled Epidural Analgesia, Continuous, Programmed Intermittent Bolus)
         5. 5) Complications and Side Effects of Neuraxial Labor Analgesia
            1. a) Side Effects (Hypotension, Pruritus, Epidural Fever, Placental Perfusion)
            2. b) Influence of Anesthetic Technique on Labor
            3. c) Incorrect Catheter Location (Subdural, Intrathecal, Intravascular)
            4. d) Post-Dural Puncture Headache
               1. (1) Prevention (Needle Selection, Dural Puncture Management)
               2. (2) Diagnosis (Evaluation, Differential Diagnosis)
               3. (3) Treatment (Medications, Epidural Blood Patch, Sphenopalatine Ganglion Block)
               4. (4) Complications (Subdural Hematoma, Cerebral Venous Thrombosis, Chronic Headache)
            5. e) Infection (Epidural Abscess, Meningitis)
            6. f) Postpartum Nerve Palsies
            7. g) Epidural Hematoma
         6. 6) Anesthetic Considerations for Complicated Labor and Vaginal Birth
            1. a) Intrauterine Fetal Resuscitation Techniques
            2. b) Preterm Labor
            3. c) Trial of Labor After Cesarean
            4. d) Shoulder Dystocia
            5. e) Instrumental Delivery (Vacuum, Forceps)
            6. f) Vaginal Lacerations (Definitions, Anesthetic for Repair, Postpartum Analgesia)
      7. g. Cesarean Delivery Anesthesia

         1. 1) Indications, Elective/Urgent/Emergent
            1. a) Cord Prolapse
            2. b) Prolonged Labor (Definitions)
            3. c) Malposition and Malpresentation
               1. (1) Breech, Transverse Lie
         2. 2) Neuraxial Anesthesia Considerations
            1. a) Techniques: Advantages/Disadvantages, Block Assessment
            2. b) Neuraxial Hypotension (Mechanism, Prophylaxis, Treatment)
            3. c) Intraoperative Pain
         3. 3) General Anesthesia Considerations
            1. a) Difficult Airway, Aspiration Prophylaxis
            2. b) Pharmacologic Effects on Uterine Tone
         4. 4) Postoperative Considerations
            1. a) Enhanced Recovery After Cesarean
            2. b) Pain Management (Oral Adjuvants, Neuraxial Opioids, TAP Blocks, Erector Spinae Plane Block)
            3. c) PACU Considerations
            4. d) Respiratory Monitoring
      8. h. Perinatology

         1. 1) Resuscitation of Newborn
            1. a) Apgar Scoring
            2. b) Umbilical Cord Blood Gas Measurements
            3. c) Neonatal Resuscitation Program
         2. 2) Anesthetic Considerations in Breast-Feeding
      9. i. Other Surgical Procedures in Pregnant and Postpartum Women

         1. 1) Ectopic Pregnancy
         2. 2) Cerclage Placement and Removal
         3. 3) Dilation and Curettage / Dilation and Evacuation
            1. a) Gestational Trophoblastic Disease (Hydatid Mole)
            2. b) Retained Products of Conception
         4. 4) External Cephalic Version
         5. 5) Cesarean Hysterectomy
         6. 6) Fetal Surgery
            1. a) Maternal and Fetal Considerations, Intrauterine Fetal Resuscitation
            2. b) Percutaneous Fetal Interventions (Periumbilical Blood Sampling, Twin to Twin Transfusion Syndrome, Fetal Laser Surgery
            3. c) Laparoscopic Fetal Interventions (e.g., Myelomeningocele Repair)
            4. d) EXIT Procedures
         7. 7) Non-Obstetric Surgery During Pregnancy
            1. a) Endoscopic Retrograde Cholangiopancreatography and Gastrointestinal Interventions
            2. b) Electroconvulsive Therapy in Pregnancy
      10. j. Pathophysiology and Management of Complicated Pregnancy
      11. k. Maternal Comorbidities

          1. 1) Cardiovascular and Hypertensive Disorders (Valvular, Congenital, Arrhythmias, Cardiomyopathy, Pulmonary Hypertension, Chronic/Gestational Hypertension)
          2. 2) Endocrine and Autoimmune Disorders (Thyroid, Gestational Diabetes, Type 1 and Type 2 Diabetes Mellitus, Lupus, Antiphospholipid Syndrome)
          3. 3) Neurologic and Musculoskeletal Disorders (Seizure Disorder, Myasthenia Gravis, Spinal Cord Injury, Multiple Sclerosis, Intracranial Mass, Benign Intracranial Hypertension, Scoliosis, Spina Bifida)
          4. 4) Respiratory and Infectious Diseases (Asthma, Respiratory Failure, HIV, HSV, COVID-19)
          5. 5) Hematologic and Renal Diseases (Iron Deficiency Anemia, Sickle Cell Anemia, Idiopathic Thrombocytopenic Purpura, Von Willebrand Disease, Nephrolithiasis, Chronic Kidney Disease)
          6. 6) Transplants, Immunosuppression, Cancer
          7. 7) Chronic Pain and Substance Use Disorder (Opioid)
   4. 4. Otorhinolaryngology (ENT) Anesthesia: Airway Endoscopy, Microlaryngeal Surgery, Laser Surgery, Hazards, Complications (Airway Fires, etc.) Laser-Safe Endotracheal Tubes, Maxillofacial Trauma

      1. a. Intraoperative Thyroid and Parathyroid Function Monitoring
      2. b. Nerve Injury Monitoring during ENT Surgery
   5. 5. Anesthesia for Plastic Surgery: Free flaps, Microvascular Surgery, Reconstructive Surgery

      1. a. Liposuction
   6. 6. Anesthesia for Laparoscopic Surgery, Cholecystectomy, Gynecologic Surgery, Gastric Stapling, Hiatus Hernia Repair, Robotic Surgery, Anesthetic Management, Complications
   7. 7. Ophthalmologic Anesthesia, Retrobulbar and Peribulbar Blocks, Open Eye Injuries, Intraocular Pressure
   8. 8. Orthopedic Anesthesia

      1. a. Tourniquet Management
      2. b. Complications of Orthopedic Surgery
      3. c. Regional vs. General Anesthesia
   9. 9. Trauma Anesthesia

      1. a. Massive Trauma

         1. 1) Evaluation of the Trauma Patient
         2. 2) Resuscitation from Hemorrhagic Shock
      2. b. Management of Traumatic Brain Injury
      3. c. Burn Management
      4. d. Mass Casualty, Disaster Management, and Preparedness
      5. e. Chemical and Biological Warfare
   10. 10. Anesthesia for Ambulatory Surgery

       1. a. Patient Selection and Preoperative Management
       2. b. Anesthetic Management
       3. c. Discharge Criteria and Postoperative Follow-Up, Including Continuous Nerve Blocks
       4. d. Office-Based Anesthesia: Equipment, Safety, Organization, Patient Management
   11. 11. Geriatric Anesthesia/Aging

       1. a. Pharmacological Implications, MAC Changes
       2. b. Physiological Implications: CNS, Circulatory, Respiratory, Renal, Hepatic
   12. 12. Critical Care

       1. a. Shock States

          1. 1) Etiology, Classification, Pathophysiology
          2. 2) Septic Shock and Life-Threatening Infection
             1. a) Sequential (Sepsis Related) Organ Failure (SOFA) Assessment Score
          3. 3) Systemic Inflammatory Response Syndrome
          4. 4) Multiple Organ Dysfunction Syndrome
       2. b. Poisoning and Drug Overdose

          1. 1) Prescription Medications
          2. 2) Carbon Monoxide
       3. c. Drowning
       4. d. Infection Control

          1. 1) Standard and Transmission-Based Precautions
          2. 2) Needle Stick Injury
          3. 3) Catheter Sepsis
             1. a) Intravascular
             2. b) Urinary
          4. 4) Nosocomial Infections: Ventilator Associated Pneumonia
          5. 5) Antibiotics: Antibacterial, Antifungal, Antiviral, Antiparasitic; Antimicrobial Resistance
       5. e. Ventilator Management

          1. 1) Volume Controlled; Pressure Controlled; PEEP, Inspired Oxygen Concentration; Tidal Volume
          2. 2) Pressure Support; Weaning
          3. 3) Complications
5. E. Special Problems or Issues in Anesthesiology

   1. 1. Electroconvulsive Therapy
   2. 2. Organ Donors: Pathophysiology and Clinical Management

      1. a. Circulatory
      2. b. Endocrine
      3. c. Fluid and Electrolyte Management
      4. d. Brain Death Criteria
   3. 3. Radiologic Procedures; CT Scan; MRI-Anesthetic Implications/Management, Anesthesia in Locations Outside the Operating Rooms
   4. 4. Ethics and Medico-Legal Issues

      1. a. Professionalism: Definitions and Teaching

         1. 1) Disclosure of Errors or Adverse Events
         2. 2) Professional Behavior: Honesty, Integrity, Compassion, Respect, Altruism, Conflicts of Interest, Response to Marketing
         3. 3) Recognizing Limitations in Expertise and Need to Seek Guidance
         4. 4) Personal Role in Reporting Unsafe Conditions and Fitness for Work
         5. 5) Recognizing and Responding to Unprofessional Behavior
         6. 6) Evidence-Based Practice
      2. b. Patient Autonomy and Decision-Making

         1. 1) Principles of Informed Consent and Shared Decision-Making
         2. 2) Advance Directives, Do Not Resuscitate (DNR) Orders, Medical Orders for Life-Sustaining Treatment
         3. 3) Health Care Proxy Laws and Limitations
         4. 4) Patients Refusing Transfusion and Other Treatments
      3. c. Legal and Regulatory Issues

         1. 1) Elements of Medical Malpractice: Duty, Breach of Duty, Causation, Damages
         2. 2) Legal Actions and Consequences, National Practitioner Data Bank, Closed Claims Findings, Professional Liability Insurance
         3. 3) Understanding Laws Related to Controlled Substances, Including Opioids and Cannabinoids
         4. 4) Patient Privacy Issues: Principles of Confidentiality, Access to Records, Protected Health Information
         5. 5) The Health Insurance Portability and Accountability Act (HIPAA)
      4. d. Primary Certification, Recertification, Maintenance of Certification and Related Issues (Professional Standing, Lifelong Learning, Cognitive Knowledge, Clinical Practice Assessment, Systems-Based Practice)
      5. e. Research Ethics

         1. 1) Principles of Justice, Autonomy, Beneficence, Nonmalfeasance
         2. 2) Ethical Standards in Research Design: Scientific Validity, Fair Subject Selection, Favorable Risk-Benefit Profile
         3. 3) Rigor in Ethical Design, Implementation, and Analysis of Interventional Studies: Roles of the Institutional Review Board, DSMB, clinicaltrials.gov, Publication of Protocols
         4. 4) Statistics: Data Dredging, Selection of Covariates A Priori, Bonferroni Correction
         5. 5) Informed Consent in research
         6. 6) Conflicts of Interest and Financial Disclosure
         7. 7) Academic Integrity, Publication Bias, Fraud
      6. f. Clinician Wellness and Self-Care

         1. 1) Diagnosis and Treatment of Burnout
         2. 2) Sleep Deprivation
         3. 3) Adaptations for Clinical Disability
         4. 4) Substance Use Disorder
   5. 5. Practice Management

      1. a. Costs of Medical/Anesthesia Care

         1. 1) Understanding Principles of Healthcare Funding and Payment
         2. 2) Cost-Conscious Practice
      2. b. Efficient OR Staffing and Scheduling

         1. 1) Subspecialization Issues: Pediatrics, Cardiac, Regional, Obstetric Coverage
         2. 2) Anesthesia Care Team and Scope of Practice
      3. c. Population Health: Perioperative Surgical Home and Enhanced Recovery

         1. 1) Population Based Health Determinants, Resources to Improve Access
         2. 2) Health Care Disparities Between Populations
      4. d. Clinical Informatics

         1. 1) Electronic Medical Record Systems: Costs and Benefits
         2. 2) Artificial Intelligence and Machine Learning
      5. e. Documentation, Coding, and Billing

         1. 1) Compliance with Documentation requirements
         2. 2) Accuracy, Clarity, Specificity of Medical Records
         3. 3) Coding Integrity, Audits, and Insurance Denials
   6. 6. Quality Improvement and Patient Safety

      1. a. Definitions

         1. 1) Medical Error, Adverse Events, Sentinel Events, Misuse of Medications and Technology
         2. 2) Human Factors and Mindfulness
         3. 3) Systems Thinking and Technology Design
      2. b. Medication Errors: Assessment and Prevention

         1. 1) Medication Reconciliation
         2. 2) Information Technology to Reduce Medication Errors
      3. c. Crisis Management and Teamwork

         1. 1) Simulation Training
         2. 2) Crisis Manuals and Other Cognitive Aids
         3. 3) Teamwork Training
         4. 4) Handoff Communication
         5. 5) Preoperative and Procedural Checklists
      4. d. Quality Improvement (QI) Basics

         1. 1) Design, Analysis, and Implementation of QI Projects
         2. 2) Data Collection
         3. 3) QI Metrics
         4. 4) Patient Satisfaction Measurement
         5. 5) Value-Based Care Incentives, Pay-for-Performance
      5. e. Performance Assessment

         1. 1) Individual Benchmarking
         2. 2) Group and Facility Scorecards
         3. 3) Public Reporting
            1. a) Federal Quality Payment Program
            2. b) Anesthesia Registries
      6. f. Change Management Methods

         1. 1) Peer Review and Morbidity and Mortality Conferences
         2. 2) Lean Six Sigma
         3. 3) QI and the 5S Process
         4. 4) Value Stream Mapping
         5. 5) Failure Mode and Effects Analysis
         6. 6) Root Cause Analysis
      7. g. Barriers to QI
   7. 7. Diversity, Equity, and Inclusion (DEI) in Health Care

      1. a. Barriers

         1. 1) Systematic Racism, Colorism/Shadeism, Sexism, Discrimination Against Sexual Orientation, Gender Identity, Language, National Origin, Ethnicity, Religion, Immigration/Citizenship Status, Age, Familial Status, and Disability
         2. 2) Bias; Implicit bias, Microaggression, Stereotype Threat
      2. b. Approaches to Improvement; Interventions at Individual, Inter-Personal, Community, Organizational and Policy Levels; Cultural and Gender Competency, Upstander vs. Bystander, Allyship vs. Performative Action, Tokenism vs. Representation, Assortativity vs. Homophily
      3. c. DEI in the Workplace
      4. d. DEI in Academia

         1. 1) Leadership
         2. 2) Scholarship; Representation of Diversity and Race Related Topics in Research, Importance of Language in Reports Discussing Racial Inequities
   8. 8. Healthcare Disparities

      1. a. Social Determinants of Health Considerations in Assessment and Management of Patients – Race, Language, Education Status, Religion, Housing, Nutrition, Geographic Location, Rural vs. Urban, Access to and Quality of Care, Health Coverage
      2. b. Maternal Healthcare Disparities; Maternal Mortality and Morbidity, Pain Management
      3. c. Child and Adolescent Healthcare Disparities
      4. d. ICU Disparities and Outcomes

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Question Bank

1990–1996 In-Training Examination questions

All examsBASIC & ADVANCED BASIC ADVANCED Uncategorized All topicsCardiac Equipment & Physics General Neuro OB Pediatric Pharmacology & Pharmacokinetics Regional & Pain Respiratory & Critical Care Transfusions & Fluids

10 Random Questions

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Study Resources

2022-24 and 2025 Gaps in Knowledge Reports and keywords explained (2014, 2015, 2016, 2017-8, 2019, 2020) by Randy Schell and (2022, 2023) by Benjamin Landgraf

Open Anesthesia Keywords

Keyword and Lecture Video Library from the University of Kentucky Department of Anesthesiology

Jed Wolpaw's ACCRAC Keywords

Advice from critical care anesthesiologist and blogger Amanda Xi:

• How to Study for the ITE, BASIC, and anesthesia (2017)
• How to Study for the ABA BASIC exam (2019)
• How to Study for the ABA ADVANCED exam (2020)

My anesthesia math review: Problem Set and Solutions

Board review books

Information about the British FRCA examinations

Commercial Board Review Courses

• Board Vitals - BASIC
• Board Vitals - ADVANCED
• Core Concepts Anesthesia Review
• Dr. Jensen Anesthesiology & Pain Board P.R.E.P
• Gas Questions
• M5 Board Review
• Michael Ho: The Essential Written Board Review
• The Pass Machine - BASIC
• The Pass Machine - ADVANCED
• Propofology (FRCA)
• True Learn Anesthesiology

Discussion Threads at Student Doctor Network

BASIC

• ABA Basic 2020 Thread (6/20)
• Basic exam (6/19)
• Anesthesiology Board Preps (3/19)
• PASS MACHINE basic exam materials (12/18)
• Basic exam 2016 (6/16)
• ABA BASIC STUDY TIPS (4/16)
• Basic Exam Stats (2015) (8/15)
• ABA Basic Exam 2015 (4/15)
• How to kill basic science/ite exams? (2/15)
• ABA Basic Exam (11/14)
• How are YOU studying for the ABA Basic Exam? (6/14)

ADVANCED

• ABA Advanced Exam Keywords (7/25)
• ABA Advanced 2023 (7/23)
• ABA Advanced 2022 (7/22)
• How did people sutdy for the Advanced Exam (3/22)
• Advanced 2021 (7/21)
• Advanced exam 2018-2019 (7/19)
• 2018 ABA Advanced Results (9/18)
• AnesthesiaQbank vs. M5 (7/18)
• Advanced exam 2018 study plan (2/18)
• ABA Advanced Exam (7/17)
• Truelearn for the advanced exam (7/17)
• Random topics for ABA Advanced Exam (6/17)
• Advanced Exam (Written Boards) 2017 (3/17)
• Advanced Exam 2016 (8/16)