A patient with hypertrophic obstructive cardiomyopathy develops dynamic LVOT obstruction during laparoscopic insufflation (BP 75/40, HR 130). What perioperative intervention is MOST appropriate?

Which patient characteristic MOST increases risk of perioperative MI?

During pericardial window surgery, the BP drops after induction. What is the MOST likely cause?

Which ventilatory strategy BEST supports a failing RV?

A septic patient remains hypotensive despite adequate volume replacement. Which MAP target is MOST appropriate according to current evidence?

A trauma patient with a pacemaker is scheduled for emergent laparotomy. You cannot obtain device interrogation. Which is the BEST action?

A CABG patient on metoprolol has HR 55, BP 130/60 before minor surgery. What is the BEST perioperative plan?

Atrial Fibrillation with RVR Intraoperatively, a patient becomes irregularly tachycardic (HR 150). BP is 95/60. What is the FIRST priority?

A woman with severe mitral stenosis becomes tachycardic during tumor resection. What is the BEST intervention?

A patient develops ST-segment depression during thyroidectomy. What is the MOST appropriate immediate action?

Which hemodynamic goal is MOST appropriate for AR?

A patient post-CPB remains hypotensive despite high-dose norepinephrine. What is the NEXT step?

A patient post-CPB remains hypotensive despite high-dose norepinephrine. What is the NEXT step?

A patient with EF 15% becomes hypotensive (MAP 50) despite phenylephrine. Which is the BEST drug?

Which induction agent is LEAST likely to worsen pulmonary hypertension?

TEE shows empty LV cavity, kissing papillary muscles, and hyperdynamic motion. The BEST cause is:

A patient with ischemic mitral regurgitation becomes hypotensive during induction. What is the MOST appropriate initial step?

During attempted separation from CPB, the BP is low and TEE shows a distended RV. Which intervention is MOST appropriate?

A patient with VF after induction has defibrillation pads on. What is the CORRECT next action?

Which of the following MOST reliably decreases with improved cardiac output?

Which statement BEST reflects respect for patient autonomy?

In anesthesia practice, beneficence primarily means:

Which of the following is REQUIRED for valid informed consent?

Standard of care is defined as:

When a resident encounters an unsafe surgeon request, the FIRST escalation is usually to:

A leader who sets direction clearly and expects compliance without negotiation demonstrates:

A patient requiring emergency surgery refuses blood transfusion on religious grounds. The hemoglobin is 5 g/dL. What is the MOST ethical action?

You notice a senior resident smells of alcohol before a case. What is the MOST appropriate action?

Intraoperative Error Disclosure You accidentally place an epidural that resulted in a dural puncture. The surgical team says “don’t mention it to the family.” The BEST action is:

A pharmaceutical representative offers you an expensive gift “in support of residents.” Accepting it MOSTLY violates which principle?

A surgeon insists on starting a case even though the defibrillator is malfunctioning. What should you do FIRST?

A terminal cancer patient is for palliative procedure under sedation. The family insists on “full resuscitation.” The patient’s advance directive states DNR. The MOST appropriate action:

A resident posts a photo of an unusual airway case (no identifiers). Which BEST describes this action?

Two emergency cases arrive simultaneously: a ruptured ectopic pregnancy and a closed tibial fracture with compartment syndrome. Only one OR is available. What is the MOST ethical principle guiding prioritization?

Two consultants disagree on the anesthetic plan, creating confusion among residents. As the team leader, the BEST strategy is:

You followed standard ASA monitoring but the patient unexpectedly arrests. Family alleges negligence. Which defense BEST applies?

A surgeon shouts at staff and throws instruments during a bleeding emergency. What is the MOST appropriate anesthesia leadership response?

You discover that a nurse administered the wrong concentration of norepinephrine. The patient remains stable. What is the BEST next step?

A novice resident is assigned a complex pediatric case without your knowledge. What is the BEST course of action?

A consultant reports unsafe sedation practices in minor ORs. According to ethical and legal standards, leadership MUST ensure:

Shock is BEST defined as:

Which is part of the Berlin criteria for ARDS?

According to current Surviving Sepsis guidelines, the FIRST-line vasopressor is:

Normal intracranial pressure (ICP) is:

Ketamine is useful in hypotensive trauma because it:

The recommended initial imaging test for DVT is:

A patient remains hypotensive despite 30 mL/kg fluids and norepinephrine at 0.3 µg/kg/min. Next BEST step?

A patient with ARDS (P/F = 90, on low-tidal volume ventilation) becomes severely dyssynchronous. What is the MOST appropriate intervention?

In ICU, a septic patient becomes fluid overloaded (anasarca, rising CVP) with worsening oxygenation. Creatinine is rising. The BEST intervention is:

A COPD patient becomes hypotensive after intubation and starting positive pressure ventilation. Cause MOST likely?

You are called for sudden desaturation and hypotension in a ventilated patient. Breath sounds absent on right, high airway pressures. MOST appropriate first action?

Massive Transfusion Coagulopathy After 8 units PRBC and 6 units FFP, the patient remains coagulopathic with oozing. Most appropriate?

A TBI patient has sudden unilateral blown pupil, bradycardia, and hypertension. BEST immediate measure?

A patient repeatedly fails spontaneous breathing trials despite good gas exchange. Which factor MUST be assessed first?

A patient has high lactate, warm extremities, bounding pulses, yet low SVR and poor cardiac contractility on bedside echo. MOST likely type of shock?

16. ECMO Candidate Selection A 32-year-old with refractory ARDS despite proning, paralysis, and inhaled nitric oxide continues with P/F = 55. Best next step?

A post-laparotomy patient has fever, hypotension, and rising lactate. Bedside ultrasound shows intra-abdominal fluid collection. MOST important intervention?

A patient with severe pulmonary hypertension develops acute RV failure. Which vasoactive agent is BEST?

A ventilated patient with severe asthma shows high airway pressures and air-trapping with hypotension. BEST immediate action?

A patient with ARDS on FiO2 1.0, PEEP 16 still has SpO2 78%. Tidal volume already low, paralyzed. NEXT BEST step?

Which age-related cardiovascular change is MOST consistent in elderly patients?

Elderly patients have an increased risk of hypothermia primarily due to:

Which pharmacologic change MOST affects anesthetic dosing in the elderly?

Elderly patients have a reduced response to which of the following?

Aging lungs are characterized by:

Decreased MAC in the elderly is MOST associated with:

A 78-year-old frail woman is scheduled for emergency laparotomy. Preoperative BP is 95/55 with HR 105. Which induction plan BEST reduces hemodynamic collapse?

An 81-year-old man is given midazolam 1 mg for anxiolysis and becomes profoundly sedated with hypoventilation. What factor MOST explains this?

A 75-year-old with dementia becomes agitated preoperatively. Which approach BEST minimizes postoperative delirium risk?

An 88-year-old woman develops postoperative urinary retention after spinal anesthesia. MOST likely mechanism?

An 83-year-old patient develops profound hypotension after propofol induction. Which age-related change explains the response?

In an 80-year-old undergoing lap chole, decreased FRC + increased closing capacity MOST predispose to:

An 87-year-old develops apnea and bradycardia after a standard fentanyl dose. Why?

A 79-year-old develops a high spinal. MOST likely cause?

Rocuronium dosing in a 76-year-old:

Analgesic choice in an 82-year-old with CKD:

78-year-old with postoperative delirium; mechanism related to intraoperative hypotension:

Which intervention BEST reduces delirium in an 84-year-old with frailty and CKD?

A 90-year-old develops delirium after long surgery with anemia, hyponatremia, ↑ creatinine. Why?

Pulse oximetry uses which wavelengths to measure oxygen saturation?

What is the PRIMARY purpose of an Anesthesia Information Management System (AIMS)?

Which type of medical error is MOST reduced by barcode medication administration (BCMA)?

What does “interoperability” mean in hospital information systems?

Capnography measures:

The MOST secure method for accessing electronic patient records is:

A patient’s intraoperative ETCO₂ waveform suddenly shows a sloping “shark-fin” pattern. What IT-based monitor interpretation MOST helps the anesthesiologist?

During a case, all monitors drop simultaneously except the pulse oximeter, which still displays a pleth waveform. What is the MOST likely cause?

An OR adopts closed-loop anesthetic delivery linked to BIS monitoring. What is the MOST important safety feature?

You are reviewing trends on the patient’s EMR. The MAP has gradually decreased over 30 minutes but individual readings look normal. What IT tool MOST helps identify the clinical deterioration?

A ventilator alarm shows “increased peak pressure.” The spirometry loop on the monitor displays a narrowed flow-volume curve. Which interpretation is MOST accurate?

A resident documents an intraoperative hypotensive episode 2 hours late. EMR audit trail flags the entry. What is the MOST appropriate response?

You receive an automated early-warning alert from the EMR that a patient is trending toward sepsis (tachycardia, rising RR, temperature 38.5). What should the anesthesiologist do first?

A postoperative patient on PCA suddenly shows apnea on capnography but pulse oximetry remains normal. What IT interpretation is MOST important?

The OR adopts RFID tagging for equipment. What problem does this MOST effectively solve?

A patient with MH susceptibility is scheduled. The EMR displays a pop-up alert. Which is the MOST important IT-driven action?

A poor-quality pleth waveform on pulse oximetry is seen. What is the MOST appropriate interpretation?

A hospital introduces tele-anesthesia for remote monitoring of ORs. Which scenario MOST benefits from this technology?

The EMR shows a sudden drop in ETCO₂ from 35 to 15 mmHg. Pulse oximetry is normal. What is the MOST urgent diagnosis to rule out?

A new AIMS update introduces automated medication dosing error alerts. Which scenario BEST illustrates its benefit?

The MOST important goal of the WHO Surgical Safety Checklist is:

Which ASA standard requires continuous monitoring of oxygenation?

The MOST common cause of anesthesia-related claims in closed-claims analyses is:

A time-out before incision confirms:

Which step MOST reduces medication errors during anesthesia?

Capnography during sedation is MOST important because it:

A patient under general anesthesia suddenly shows loss of ETCO₂, but SpO₂ is still 100%. First priority action?

During induction, the BP drops to 60/40. You discover no IV fluids connected due to line misplacement. What is the MOST appropriate next step?

A nurse reports rising temperature and tachycardia during surgery. The ETCO₂ is climbing rapidly. To prevent catastrophic harm, which action is MOST critical?

During a laparoscopic case, the insufflation pressure suddenly rises and the patient becomes hypoxic. What patient safety threat must be prioritized?

A resident attempts intubation repeatedly without success, causing desaturation. According to airway safety principles, the attending should:

A patient becomes hypotensive after spinal anesthesia. The anesthesiologist is temporarily out of the OR. What safety issue is MOST violated?

In PACU, a patient receiving PCA morphine becomes somnolent with RR 6/min. What is the highest priority?

You notice that a surgeon insists on starting a case even though the defibrillator is missing. What is the safest response?

An elderly patient with sepsis is receiving norepinephrine through a peripheral IV. The extremity shows blanching and pain. What is the BEST action?

Intraoperatively, a medication syringe looks identical to another with a different drug. What is the MOST effective system-level solution?

A patient with known difficult airway is brought to ER for urgent surgery. The team failed to check the difficult-airway cart. What is the MOST critical risk introduced?

During prone positioning, you discover pressure on the eyes from the headrest. What immediate action preserves patient safety?

A staff member spills IV antibiotics onto the anesthesia cart leading to contamination of airway instruments. What should be done?

While securing an epidural, you note the wrong patient sticker on the chart. The nurse insists it's correct. What is your BEST action?