Initial Certification In Anesthesiology
ABA The American Board ofAnesthesiologyInitialCertificationin AnesthesiologyThe Content Outline for Initial Certification in Anesthesiology reflects the subject matter within the specialtyof anesthesiology and provides the framework for the assessment of knowledge. It is the basis for thewritten examinations (BASIC, ADVANCED, Part 1, and In-Training) of the core specialty. The content outlinewill serve as a resource in the preparation for the written components of initial board certification as boardcertified anesthesiologists are expected to have knowledge within each of the topics.This content outline covers theIn-Training, Part 1, BASIC, and ADVANCED ExamsRevised – October 2019
TABLE OF CONTENTSI. Basic Topics in AnesthesiologyA. BASIC SCIENCES . 4I.A.1Anatomy . 4I.A.2Physics, Monitoring, and Anesthesia Delivery Devices . 4I.A.3Mathematics . 6I.A.4Pharmacology . 7B. CLINICAL SCIENCES: Anesthesia Procedures, Methods, and Techniques . 10I.B.1Evaluation of the Patient and Preoperative Preparation . 10I.B.2Regional Anesthesia . 11I.B.3General Anesthesia . 11I.B.4Monitored Anesthesia Care and Sedation . 12I.B.5Intravenous Fluid Therapy during Anesthesia . 12I.B.6Common Complications (Etiology, Prevention, Treatment) . 12I.B.7Postoperative Care . 13C. ORGAN-BASED BASIC AND CLINICAL SCIENCES. 13I.C.1Central and Peripheral Nervous Systems . 13I.C.2Respiratory System . 15I.C.3Cardiovascular System . 17I.C.4Gastrointestinal / Hepatic Systems . 19I.C.5Renal and Urinary Systems/ Electrolyte Balance . 19I.C.6Hematologic System . 19I.C.7Endocrine and Metabolic Systems . 20I.C.8Neuromuscular Diseases and Disorders . 21D. SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY . 21I.D.1Physician Impairment or Disability: Substance Abuse, Fatigue, Aging,Visual and Auditory Impairment, American Disabilities Act . 21I.D.2Ethics, Practice Management, and Medicolegal Issues. 211
II. Advanced Topics in AnesthesiologyA. BASIC SCIENCES . 22II.A.1Physics, Monitoring, and Anesthesia Delivery Devices . 22II.A.2Pharmacology . 23B. CLINICAL SCIENCES: Anesthesia Procedures, Methods, and Techniques . 23II.B.1Regional Anesthesia . 23II.B.2Special Techniques . 23C. ORGAN-BASED BASIC AND CLINICAL SCIENCES. 23II.C.1Central and Peripheral Nervous Systems . 23II.C.2Respiratory System . 26II.C.3Cardiovascular System . 28II.C.4Gastrointestinal / Hepatic Systems . 30II.C.5Renal and Urinary Systems / Electrolyte Balance: Clinical Science . 31II.C.6Hematologic System . 32II.C.7Endocrine and Metabolic Systems: Clinical Science . 32II.C.8Neuromuscular Diseases and Disorders: Clinical Science . 34D. CLINICAL SUBSPECIALTIES. 34II.D.1Painful Disease States . 34II.D.2Pediatric Anesthesia . 35II.D.3Obstetric Anesthesia . 38II.D.4Otorhinolaryngology (ENT) Anesthesia: Airway Endoscopy; Microlaryngeal Surgery;Laser Surgery, Hazards, Complications (Airway Fires, Etc.) . 40II.D.5Anesthesia for Plastic Surgery, Liposuction . 40II.D.6Anesthesia for Laparoscopic Surgery; Cholecystectomy; Gynecologic Surgery;Gastric Stapling; Hiatus Hernia Repair; Anesthetic Management; Complications. 40II.D.7Ophthalmologic Anesthesia, Retrobulbar and Peribulbar Blocks; Open Eye Injuries. 40II.D.8Orthopedic Anesthesia; Tourniquet Management, Complications,Regional vs. General Anesthesia . 40II.D.9Trauma Anesthesia. 40II.D.10 Anesthesia for Ambulatory Surgery. 41II.D.11 Geriatric Anesthesia/Aging . 41II.D.12 Critical Care . 41E. SPECIAL PROBLEMS OR ISSUES IN ANESTHESIOLOGY . 42II.E.1Electroconvulsive Therapy . 42II.E.2Organ Donors: Pathophysiology and Clinical Management . 422
II.E.3Radiologic Procedures; CT Scan; MRI-Anesthetic Implications/Management,Anesthesia in Locations Outside the Operating Rooms . 42II.E.4Ethics, Practice Management, and Medicolegal Issues. 423
I. Basic Topics in AnesthesiologyA. Basic Sciences1. Anatomya. Topographical Anatomy as Landmarks1) Neck: Cricothyroid Membrane, Internal and External Jugular Veins, Thoracic Duct, Carotidand Vertebral Arteries, Stellate Ganglion, Cervical Spine Landmarks (Vertebra Prominens,Chassaignac’s Tubercle), Hyoid Bone, Superficial Cervical Plexus2) Chest: Pulmonary Lobes, Cardiac Landmarks, Subclavian Vein3) Pelvis and Back: Vertebral Level of Topographical Landmarks, Caudal Space4) Extremities: Relationship of Bones, Nerves, and Arteries5) Dermatome Anatomy: Sensory and Motorb. Radiological and Ultrasound Anatomy1) Chest (Including CT and MRI)2) Brain and Skull (Including CT and MRI)3) Spine (Cervical, Thoracic, Lumbar), Including CT and MRI4) Neck (Including Doppler Ultrasound for Central Venous Access)5) Abdominal wall6) Extremitiesc. Clinical Anatomy1) Upper Extremitya) Bonesb) Vasculaturec) Innervation2) Lower Extremitya) Bonesb) Vasculaturec) Innervation3) Trunka) Intercostalb) Abdominal Wall2. Physics, Monitoring, and Anesthesia Delivery Devicesa. Mechanics1) Pressure Measurement of Gases, Liquids2) Transducers, Regulators, Medical Gas Cylinders3) Principles of Ultrasound: Obtaining an Image, Resolution, Depth, Frequency, Resonance4
I.A.2.a.3b. Flow Velocity1) Viscosity-Density, Laminar-Turbulent Flow2) Flowmeters: Rotameter3) Principles of Doppler Ultrasoundc. Properties of Liquids, Gases, and Vapors1) Diffusion of Gases2) Solubility Coefficients3) Critical Temperature, Critical Pressured. Gas Lawse. Vaporizers1) Vapor Pressure and Calculation of Anesthetic Concentrations2) Vaporizer Types and Safety Featuresf. Uptake and Distribution of Inhalation Agents1) Uptake and Elimination Curves; Effect of Ventilation, Circulation, Anesthetic Systems2) Concentration Effect3) Second Gas Effect4) Nitrous Oxide and Closed Spacesg. Physics of Anesthesia Machine/Breathing System1) Principles: Resistance, Turbulent Flow, Mechanical Dead Space, Rebreathing, Dilution,Leaks, Gas Mixtures, Humidity, Heat2) Components: Connectors, Adaptors, Mask, Endotracheal Tube, Reservoir Bag UnidirectionalValves, Corrugated Breathing Tubes, Laryngeal Mask Airways, Airway Pressure ReliefValve3) Characteristicsa) Circle Systems: Closed and Semi-Closed, Adult, Pediatricb) Non-Circle Systems: Insufflation, Open, Semi-Openc) Portable Ventilation Devices (Self-Reinflating, Non-Self-Reinflating), Non-RebreathingValvesd) CO2 Absorption: Principles, Canisters, Efficiencye) Toxicity: Compound A, Carbon Monoxide4) Oxygen Supply Systems: FiO25) Waste Gas Evacuation Systems6) Safety Features (Proportioning Devices, Rotameter Configuration, Pressure Fail-Safe)h. Monitoring Methods1) Neuromuscular Function: Nerve Stimulators, Electromyography (EMG)2) Ventilation: Respirometers, Inspiratory Force, Spirometry, Flow-Volume Loops5
I.A.2.h3) Gas Concentrations: O2, CO2, Nitrogen, Anesthetic Gases and Vapors4) Temperature5) Oxygen: Oximetry, Co-Oximetry, Pulse Oximetry6) Blood Pressure: Noninvasive, Invasive Doppler, Oscillometry, Korotkoff Sounds, Palpation7) Heart Function: Heart Tones, Electrocardiogram, Echocardiogrami. Instrumentation1) Arterial and Venous Blood Gases: Electrodes for pH, PO2, PCO2, Calibration, TemperatureCorrections, Errors2) Gas Concentrations: Infrared Absorption, Mass Spectrometry, Raman Scatter Analysis3) Pressure Transducers: Resonance, Damping4) Neurologic Function Monitors5) Fluid Warmers, Autotransfusion Devices6) Body Warming Devices: Forced Air, Heating Lamps, Insulation on Devices, WarmingBlankets, Water-Flow “Second Skin” Devicesj. Ventilators1) Classifications: Flow Generation vs. Pressure Generation2) Principles of Action: Assistors, Controllers, Assist-Control; Pressure-Limited, Volume-Limited;FiO2 Control; Periodic Sigh, Inverse Ratio, High Frequency Ventilation, IntermittentMandatory Ventilation (IMV), Synchronized IMV, Pressure Support, Airway PressureRelease Ventilation (APRV), Pediatric Adaptation, Non-Invasive Techniques: BiphasicPositive Airway Pressure (BIPAP), Others3) Monitors; Pressure (Plateau, Peak), Oxygen, Apnea, Inspiratory/Expiratory Ratio, DynamicCompliance, Static Compliancek. Alarms and Safety Features: Operating Room, Electrical, Anesthesia Machine, Ventilators,Capnometer, Oxygen, Hemodynamic Monitorsl. Defibrillators: Automatic Internal, External, Implantable; Energy, Cardioversion, Types ofWaveforms (Monophasic, Biphasic); Paddle Size and Position; Automated ExternalDefibrillators (AEDs)m. Electrical; Fire and Explosion Hazards; Basic Electronics1) Source of Ignition; Static2) Prevention: Grounding, Isolation Transformers3) Macro and Micro Current Hazards4) Safety Regulations; National Fire Protection Association (NFPA) Standards5) Risk Factors for Intraoperative Firen. IV Pumps and Infusers3. Mathematicsa. Simple Math: Logarithms; Graph of Simple Equations; Exponential Function, Analysis of BiologicCurves6
I.A.3.bb. Statistics: Sample and Population; Probability; Mean, Median, and Mode; Standard Deviation andError; T-Test; Chi-Square; Regression Analysis/Correlation; Analysis of Variance, PowerAnalysis, Meta-Analysis, Confidence Intervals, Odds Ratio, Risk Ratio, Bland-Altman PlotEvaluation4. Pharmacologya. General Concepts1) Pharmacokinetics and Pharmacodynamics, Protein Binding; Partition Coefficients; PKA;Ionization; Tissue Uptake; Compartmentalization and Exponential Modelsa) Pharmacokinetics of Neuraxial Drug Administration: Epidural and Subarachnoidb) Tolerance and Tachyphylaxis2) Termination of Actiona) Elimination; Biotransformation; Context-Sensitive Half-Timeb) Impact of Renal Diseasec) Impact of Hepatic Disease3) Drug Interactionsa) Enzyme Induction and Inhibitionb) Hepatic Blood Flowc) Drug-Drug Bindingd) Alternative and Herbal Medicines: Perioperative Implications4) Drug Reactions (Anaphylactoid, Anaphylaxis, Idiosyncratic)b. Anesthetics-Gases and Vapors1) Physical Properties2) Mechanism of Action3) Effects on Central Nervous System (CNS)4) Effects on Cardiovascular System5) Effects on Respiration6) Effects on Neuromuscular Function7) Effects on Renal Function8) Effects on Hepatic Function9) Effects on Hematologic and Immune Systems10) Biotransformation and Toxicity11) Minimum Alveolar Concentration (MAC), Factors Affecting Mac12) Trace Concentrations, OR Pollution, Personnel Hazards13) Comparative Pharmacodynamicsc. Anesthetics-Intravenous (Opioid and Non-Opioid Induction and Anesthetic Agents)1) Opioids7
a) Mechanism of ActionI.A.4.c.1.bb) Pharmacokinetics and Pharmacodynamics(1) Intravenous(2) Epidural and Intrathecalc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organsg) Side Effects and Toxicityh) Indications and Contraindications2) Barbituratesa) Mechanism of Actionb) Pharmacokinetics and Pharmacodynamicsc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organsg) Side Effects and Toxicityh) Indications and Contraindications3) Propofola) Mechanism of Actionb) Pharmacokinetics and Pharmacodynamicsc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organsg) Side Effects and Toxicityh) Indications and Contraindications4) Etomidatea) Mechanism of Actionb) Pharmacokinetics and Pharmacodynamicsc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organs8
g) Side Effects and ToxicityI.A.4.c.4.hh) Indications and Contraindications5) Benzodiazepinesa) Mechanism of Actionb) Pharmacokinetics and Pharmacodynamicsc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organsg) Side Effects and Toxicityh) Indications and Contraindicationsi) Antagonism6) Ketaminea) Mechanism of Actionb) Pharmacokinetics and Pharmacodynamicsc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organsg) Side Effects and Toxicityh) Indications and Contraindications7) Dexmedetomidinea) Mechanism of Actionb) Pharmacokinetics and Pharmacodynamicsc) Metabolism and Excretiond) Effect on Circulatione) Effect on Respirationf) Effect on Other Organsg) Side Effects and Toxicityh) Indications and Contraindicationsd. Anesthetics: Local1) Uptake, Mechanism of Action2) Biotransformation and Excretion3) Comparison of Drugs and Chemical Groups4) Prolongation of Action9
5) Local Anesthetic Side EffectsI.A.4.d.5.aa) CNS: Seizures, Cauda Equina Syndrome, Transient Neurological Symptomb) Cardiacc) Allergyd) Preservatives/Additivese) Methemoglobinemiaf) Local Anesthetic Systemic Toxicity(i) American Society for Regional Anesthesia Checklist for Local AnestheticSystemic Toxicity(ii) Intravenous Lipid Emulsion for Local Anesthetic Systemic Toxicitye. Muscle Relaxants (Depolarizing, Non-Depolarizing)1) Mechanism of Action2) Pharmacokinetics and Pharmacodynamics, Abnormal Responses3) Prolongation of Action; Synergism4) Metabolism and Excretion5) Side Effects and Toxicity6) Indications and Contraindications7) Antagonism of Blockade8) Drug Interactions (Antibiotics, Antiepileptics, Lithium, Magnesium, Inhalational Anesthetics)B. Clinical Sciences: Anesthesia Procedures, Methods, and Techniques1. Evaluation of the Patient and Preoperative Preparationa. Physical Examination Including Airway Evaluationb. Laboratory Evaluation1) American Society of Anesthesiologists (ASA) Preoperative Testing Guidelines2) American College of Cardiology/American Heart Association Guidelines for PerioperativeCardiovascular Evaluationc. ASA Physical Status Classificationd. Preparation for Anesthesia/Premedication1) Interaction with Chronic Drug Therapy; Interaction with Anesthetic Agents2) Adverse Reactions to Premedications; Patient Variability, Dose Response Curves, SideEffects3) 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,malignancy4) Pediatric and Geriatric Doses, Routes of Administration5) Role in Patients with Allergies10
I.B.1.d.56) NPO and Full Stomach Status; Implications for Airway Management, Choice of AnesthesiaTechnique and Induction of Anesthesia; Gastric Emptying Time; Preoperative; FullStomach and Induction of Anesthesia; Practice Guidelines for Preoperative Fastinga) Alteration of Gastric Fluid Volume and pH, Sphincter Tone7) Continuation vs. Discontinuation of Chronic Medications: Antihypertensives, Anti-Anginal,Antihyperglycemics, Antidepressants, Platelet Inhibitors, Etc.8) Prophylactic Cardiac Risk Reduction: Beta-Adrenergic Blockers, Etc.9) Prophylactic Antibioticsa) Indicationsb) Risks of Administrationc) Drug Interactions10) Oral Anticoagulants and Anti-platelet Agents2. Regional Anesthesiaa. General Topics: Premedication, Patient Position, Equipment, Monitoring and Sedationb. Spinal, Epidural, Caudal, Combined Spinal/Epidural1) Indications, Contraindications2) Sites of Actions3) Factors Influencing Onset, Duration, and Termination of Action4) Systemic Toxicity, Test Dose5) Complications; Precipitating Factors, Prevention, Therapy, Implications of Anticoagulants andPlatelet Inhibitors: American Society of Regional Anesthesia and Pain Medicine (ASRA)Guidelines6) Physiologic Ef
b) Pharmacokinetics and Pharmacodynamics c) Metabolism and Excretion d) Effect on Circulation e) Effect on Respiration f) Effect on Other Organs g) Side Effects and Toxicity h) Indications and Contraindications 7) Dexmedetomidine . a) Mechanism of Action b) Pharmacokinetics and Pharmacodynamics c) Metabolism and Excretion d) Effect on Circulation
Dr. Tim Casias - Anesthesiology Dr. Nathan Rudin - Rehabilitation Dr. Nalini Sehgal - Rehabilitation Dr. Michelle Poliak-Tunis - Rehabilitation Dr. Ben Walker - Anesthesiology Dr. Bonnie Weigert - Rehabilitation Dr. Peggy Kim - Anesthesiology Dr. Aleksandra Zgierska – Family Medicine Dr. Miguel Leal - Cardiology Dr. Annie Kelly - Cardiology
The 38th Annual International Symposium: Clinical Update in Anesthesiology, Surgery . and Perioperative Medicine . Complimentary workshops, including: Ultrasound-Guided Regional Block; Transthoracic Echocardiography; POCUS. The Department of Anesthesiology, Perioperative and Pain Medicine at the
pediatric anesthesiology Eric Cheon, MD Special interests: Perioperative and intraoperative care of patients undergoing liver transplantation, anesthesia informatics, outcome data, research, pediatric anesthesiology Jeremy Deer, MD Special interests: Cardiac anesthesia, pediatric anesthesiology, Fellowship Education Director Richard M. Dsida, MD
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Review of Documentation for Board Certification Since Certification is dependent on passing the Advanced PTEeXAM, applications for certification are reviewed after the . or general surgery) may not be counted toward this requirement. Fellowship training in cardiothoracic or cardiovascular anesthesiology must be obtained at an institution with
improve your learning experience and to better match exam requirements. The single best way to improve your performance is to DO MORE QUESTIONS!Know The American Board of Anesthesiology ; and American Osteopathic Board of Anesthesia ExamThe exam is approximately 6 hours and consists of 330 questions with a pass rate of 80%. The exam covers
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