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The Anesthesiology exam has 200 questions and runs 4 hours.
These 10 free Anesthesiology questions are organized by exam domain, so you can see how each part of the Board Certification in Anesthesiology - Initial Written Examination blueprint is tested. Reveal the answer and explanation under each question.
A 68-year-old needs urgent surgery for a strangulated hernia. Retinal-detachment repair five days earlier left an intraocular gas bubble that is still present. The proposed anesthetic is propofol induction followed by sevoflurane with nitrous oxide and oxygen. How should the recent eye procedure alter this plan?
Correct answer: C - Maintain sevoflurane anesthesia in an oxygen-air mixture.
During propofol anesthesia, a previously easy-to-ventilate patient receives a rapid IV fentanyl bolus. The abdomen becomes tense, and manual inflation suddenly requires much greater pressure. The tracheal tube position is unchanged, a suction catheter passes freely, and bilateral air entry is present. No neuromuscular blocker has been administered. Which mechanism explains the sudden increase in inflation pressure?
Correct answer: D - Fentanyl-induced skeletal muscle rigidity
A mechanically ventilated adult with severe asthma develops hypotension after the respiratory rate is increased from 12 to 24 breaths/min to reduce hypercapnia. Measured total PEEP rises from 6 to 18 cm H₂O even though set PEEP remains 5 cm H₂O. The tracheal tube is patent, the circuit functions normally, and tension pneumothorax has been excluded. Bronchodilator treatment and circulatory support are underway. The ongoing ventilator adjustment most likely to reverse the underlying problem is to:
Correct answer: D - Reduce respiratory rate and tidal volume to lengthen exhalation.
An hour after laparoscopic surgery, an adult has repeated vomiting despite dexamethasone 4 mg IV at induction and ondansetron 4 mg IV before emergence. Oxygenation, blood pressure and pain control are satisfactory. Antiemetics from additional drug classes are available. How should pharmacologic rescue be chosen?
Correct answer: C - Give a rescue antiemetic from a third drug class.
On the morning of elective inguinal hernia repair, a patient reports taking semaglutide 0.5 mg two days earlier. The weekly dose has been unchanged for nine months. There is no nausea, vomiting, abdominal discomfort, bloating, constipation, or history of delayed gastric emptying. Standard fasting requirements are met, and no additional aspiration risk is identified. Under the 2024 multisociety guidance, how should semaglutide use affect today’s anesthetic plan?
Correct answer: A - Proceed while continuing the maintenance regimen.
After thyroid surgery, a professional singer has a nearly normal conversational voice but cannot reach previously effortless high notes. Both vocal folds abduct and adduct on laryngoscopy, and there is no stridor. The nerve injury most consistent with this selective loss of pitch control involves the:
Correct answer: B - External branch of the superior laryngeal nerve
A tachypneic adult with abdominal sepsis has an arterial pH of 7.44, PaCO₂ 23 mmHg, and bicarbonate 15 mEq/L. The anion gap is 23 mEq/L (laboratory reference 8-12). For metabolic acidosis, expected PaCO₂ is 1.5 × bicarbonate + 8, with a range of ±2 mmHg. Despite the near-normal pH, the acid-base interpretation is:
Correct answer: C - Mixed metabolic acidosis and respiratory alkalosis
Induction of anesthesia produces a blood pressure of 76/40 mm Hg and a sinus rate of 112/min in a man with obstructive hypertrophic cardiomyopathy. Blood loss is negligible. Echocardiography shows an underfilled, vigorously contracting left ventricle with increased dynamic outflow obstruction. Crystalloid replacement is underway. Which vasoactive choice best addresses the demonstrated mechanism?
Correct answer: B - Phenylephrine to increase systemic vascular resistance
At 38 weeks, a woman with established gestational thrombocytopenia presents for a scheduled cesarean delivery. Her platelet count is 82,000/µL, consistent with several recent measurements. She has no abnormal bleeding, hypertension, evidence of disseminated intravascular coagulation, or antithrombotic exposure. She prefers to remain awake. Which anesthetic plan is best supported?
Correct answer: A - Offer spinal anesthesia after individualized risk discussion.
A 36-week newborn remains apneic after the initial resuscitation measures. An endotracheal tube is placed, and 30 seconds of positive-pressure ventilation produces consistent chest movement. The ECG heart rate remains 48/min, confirmed by auscultation. The next resuscitation step is:
Correct answer: D - Begin coordinated chest compressions and ventilation at 3:1.
The Anesthesiology exam also covers these domains. Drill them in the full free practice test:
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