Page 1 of 78
ANESTHESIOLOGY AND SURGICAL BOARD REVIEW 2026
QUESTIONS NEWEST 2026 EXAM QUESTIONS LATEST
VERSION SOLVED QUESTIONS & ANSWERS VERIFIED 100
%
SEE Exam Questions ACE
Therapeutic hypothermia has been studied in two patient populations: 1)
patients who have return of spontaneous circulation (ROSC) after cardiac
arrest, and 2) patients undergoing aneurysm clipping. The outcomes of these
large trials suggest that:
a. Both patient populations benefit from hypothermia
b. Neither patient population benefitted from hypothermia
c. Only the aneurysm study showed a benefit from hypothermia
d. Only the ROSC studies showed a benefit from hypothermia
D.
A 44-year-old man presents to the emergency room with a table saw injury to
the left hand. The surgeon plans to explore the wound and possibly repair
tendon and vascular injuries. The estimated operative duration is between 1-5
hours and an axilla block with bupivacaine is planned as the primary
anesthetic technique. The patient has a seizure with the inejction of
bupivacaine. Which of the following should be your FIRST therapeutic action?
- Administer a short-acting muscle relaxant to stop muscle contractions
-Administer intra-lipid
-Administer lidocaine to prevent cardiac arrhythmias
-Administer oxygen and ensure a patent airway
D. Administer oxygen. The treatment of local anesthetic toxicity is similar to the
management of other medical emergencies and focuses on airway, breathing and
circulation. Ensuring adequate oxygenation and ventilation is paramount to avoid
progressive acidosis.
Pathophysiologic factors affecting the anesthetic management of patients with
hypothyroidism include:
• hypernatremia
• hyperglycemia
, Page 2 of 78
• difficulty with intubation and airway management
• increased blood viscosity due to elevated hematocrit
difficulty with intubation and airway management.
Potential problems of hypothyroidism include hypoglycemia, anemia, hyponatremia
and difficulty during intubation because of a large tongue or the presence of a goiter.
Hypothermia secondary to a low metabolic rate is a common postoperative
complication.
A 73-year-old man with prostate adenocarcinoma presents for robotic-assisted
prostatectomy. His medical history is significant for poorly controlled,
refractory hypertension, COPD, chronic kidney disease, and non-obstructive
coronary artery disease. His home medications include aspirin,
hydrochlorothiazide, lisinopril, and amlodipine. His blood pressure in the pre-
op holding area is 177/98 mmHg. Anticipating likely intraoperative
hypertension, you consider the vasodilatory agents in your armamentarium.
Which of the following is MOST correct regarding these drugs?
a. The vasodilatory effects of nitroglycerin on the arterial and venous sides are
similar
b. The pharmacologic half-life of hydralazine is prolonged in patients with
chronic kidney disease
c. Nesiritide is less effective than nitroglycerin in reducing right atrial pressure
d. The most common acid-base disturbance seen with sodium nitroprusside
overuse is metabolic acidosis
C. Nitroglycerin is a much more potent venodilator than arterial dilator. Hydralazine is
metabolized by acetylation in the liver, so an increase in the half-life would not be
expected in a patient with chronic kidney disease. According to Barash, nesiritide is
even more effective than nitroglycerin in reducing right atrial pressure. Metabolic
acidosis is part of the triad of cyanide toxicity (along with tachyphylaxis and elevated
SvO2) that can be seen with sodium nitroprusside administration.
Which of the following BEST explains why higher settings of desflurane are
needed at higher altitudes to produce the same anesthetic effect?
-Decreased concentration of desflurane at higher altitudes
-Decreased partial pressure of desflurane at higher altitudes
-Decreased oxygen concentration at higher altitudes
-This statement is incorrect; equivalent settings produce the same anesthetic
effect
The partial pressure of most anesthetic vapors is dependent on temperature, not
barometric pressure, and in an extremely cold environment more anesthetic vapor
might be required. In one study, the delivered concentration of halothane increased
with altitude, but its alveolar partial pressure remained constant. Although the
concentration of the inspired volatile anesthetic was increased, the anesthetic effect
remained unchanged at the given vaporizer setting. In other words, halogenated
hydrocarbon vapors are delivered at a constant potency at constant temperature
irrespective of altitude. Desflurane is the only exception to this rule. Unlike variable-
bypass vaporizers, the Datex-Ohmeda (Steeton, UK) Tec 6 and Tec 6 plus
vaporizers require manual adjustments of the concentration control dial at altitudes
other than sea level to maintain a constant partial pressure of anesthetic.
, Page 3 of 78
An infant had a patent ductus arteriosus closed and is recovering in the NICU.
You note that the patient has new-onset stridor and hoarseness. Which of the
following is the MOST likely cause of this finding?
-Surgical dissection causing recurrent laryngeal nerve injury
-Hypocalcemia after transfusion of packed red blood cells
-Laryngospasm after deep extubation
-Incorrectly sized endotracheal tube
Surgical dissection causing recurrent laryngeal nerve injury. The incidence of
recurrent laryngeal nerve injury with standard PDA ligation is reported to be 4.2% by
Fan et al. while other authors indicate 2.5% using VATS clipping. Symptoms
attributable to vocal cord paralysis regress in most cases and usually less than 1% of
patients have lasting dysfunction. Clip entrapment of the nerve has been cited to be
the mechanism of injury, but it may be that trauma induced by traction (or thermal
injury by electrocautery) may better explain the observed clinical outcome. Zbar et al.
reports a series of PDAs treated using open thoracotomy and indicates an incidence
of recurrent laryngeal nerve injury of 22.7% in extremely low-weight babies,
confirming the importance of the issue in premature infants. Decreased incidence of
this complication appears to have been achieved with VATS and may be a
consequence of improved vision from the video camera image.
requesting the use of a bipolar cautery
This rhythm strip indicates a paced rhythm with clearly visible pacer spikes.
Electrical interference from the electrocautery can be interpreted as
myocardial activity and can suppress the pacemaker generator. The use of a
bipolar cautery will reduce the electrical interference produced; if that is not
possible, then pure cut is better than "blend" or "coag."
Which muscle is the only abductor of the vocal cords?
-Cricothyroid muscle
-Thyroarytenoid muscle
-Posterior cricoarytenoid muscle
-Lateral cricoarytenoid muscle
posterior cricoarytenoid muscle. This is a challenging question that few people
answer correctly! Most anesthesiologists do not understand the muscles anatomy of
the larynx. The only abductor ("opener") of the vocal cords is the posterior
cricoarytenoid muscle. All muscles of the larynx apart from the cricothyroid muscle
are innervated by the recurrent laryngeal nerve; therefore, the only abductor muscle
of the vocal cords is innervated by the recurrent laryngeal nerve. If both recurrent
laryngeal nerves were severed during an operation such as a thyroidectomy, you
would expect severe airway obstruction.
Correct statements regarding cerebral metabolism include:
- the brain can only utilize glucose as an energy source
-forty percent of brain glucose consumption is anaerobically metabolized
-hyperglycemia can reduce the damage from focal hypoxic injury
-the adult brain consumes approximately 50 ml/min of oxygen
, Page 4 of 78
the adult brain consumes approximately 50 ml/min of oxygen
The adult brain consumes about 20% of the total body oxygen (50 ml/min). Neuronal
cells normally utilize glucose as their energy source, but can also utilize ketone
bodies and lactate. Hyperglycemia has been shown to worsen global and focal
hypoxic brain injury.
At approximately what level or above will a patient with spinal cord injury be at
GREATEST risk for autonomic hyperreflexia?
C8
T4
T7
T10
A spinal cord injury at or above T7 (T5-T8, depending on reference) predisposes a
patient to autonomic hyperreflexia. Autonomic hyperreflexia is typically first seen
within four to six months of spinal cord injury and can continue to occur for years.
With a stimulus below the level of the spinal cord injury lesion, intact lower motor
neurons send an impulse up the spinal cord. However, this impulse is interrupted at
the site of the spinal cord injury and unable to reach the cerebral cortex. This leads
to an impaired feedback loop. However, the ascending signal reaches the thoracic
sympathetic splanchnic nerves resulting in hypertension. This hypertension is
recognized by the carotid sinus and aortic arch baroreceptors leading to a
parasympathetic reflexive bradycardic response via the vagus nerve. No autonomic
nervous system changes occur below the level of spinal cord injury since these
signal pathways are also interrupted.
At approximately what carboxyhemoglobin level will a patient start to display
mild signs and symptoms (headache, nausea and vomiting) of carbon
monoxide toxicity?
5%
10%
15%
25%
A nonsmoker has a carboxyhemoglobin level < 5% whereas a smoker may have a
carboxyhemoglobin level of 4-9%. Symptoms such as headache, dizziness, nausea,
and vomiting may occur at a carboxyhemoglobin level of 15-20%.
Portal hypertension is defined as sustained portal vein pressure greater than:
5 mm Hg
10 mm Hg
20 mm Hg
25 mm Hg
10 mm Hg
Portal hypertension is defined as a sustained portal vein pressure of 10 mm Hg or
greater. This leads to the formation of portal-systemic collateral venous channels.
A baby is born at 39 weeks gestation with congenital diaphragmatic hernia.
The baby is cyanotic and limp. He has a slow, irregular respiratory pattern and
appears to be grimacing. His heart rate is 120 bpm at the one-minute of life.
Which APGAR score correctly corresponds with these findings?
3
4
ANESTHESIOLOGY AND SURGICAL BOARD REVIEW 2026
QUESTIONS NEWEST 2026 EXAM QUESTIONS LATEST
VERSION SOLVED QUESTIONS & ANSWERS VERIFIED 100
%
SEE Exam Questions ACE
Therapeutic hypothermia has been studied in two patient populations: 1)
patients who have return of spontaneous circulation (ROSC) after cardiac
arrest, and 2) patients undergoing aneurysm clipping. The outcomes of these
large trials suggest that:
a. Both patient populations benefit from hypothermia
b. Neither patient population benefitted from hypothermia
c. Only the aneurysm study showed a benefit from hypothermia
d. Only the ROSC studies showed a benefit from hypothermia
D.
A 44-year-old man presents to the emergency room with a table saw injury to
the left hand. The surgeon plans to explore the wound and possibly repair
tendon and vascular injuries. The estimated operative duration is between 1-5
hours and an axilla block with bupivacaine is planned as the primary
anesthetic technique. The patient has a seizure with the inejction of
bupivacaine. Which of the following should be your FIRST therapeutic action?
- Administer a short-acting muscle relaxant to stop muscle contractions
-Administer intra-lipid
-Administer lidocaine to prevent cardiac arrhythmias
-Administer oxygen and ensure a patent airway
D. Administer oxygen. The treatment of local anesthetic toxicity is similar to the
management of other medical emergencies and focuses on airway, breathing and
circulation. Ensuring adequate oxygenation and ventilation is paramount to avoid
progressive acidosis.
Pathophysiologic factors affecting the anesthetic management of patients with
hypothyroidism include:
• hypernatremia
• hyperglycemia
, Page 2 of 78
• difficulty with intubation and airway management
• increased blood viscosity due to elevated hematocrit
difficulty with intubation and airway management.
Potential problems of hypothyroidism include hypoglycemia, anemia, hyponatremia
and difficulty during intubation because of a large tongue or the presence of a goiter.
Hypothermia secondary to a low metabolic rate is a common postoperative
complication.
A 73-year-old man with prostate adenocarcinoma presents for robotic-assisted
prostatectomy. His medical history is significant for poorly controlled,
refractory hypertension, COPD, chronic kidney disease, and non-obstructive
coronary artery disease. His home medications include aspirin,
hydrochlorothiazide, lisinopril, and amlodipine. His blood pressure in the pre-
op holding area is 177/98 mmHg. Anticipating likely intraoperative
hypertension, you consider the vasodilatory agents in your armamentarium.
Which of the following is MOST correct regarding these drugs?
a. The vasodilatory effects of nitroglycerin on the arterial and venous sides are
similar
b. The pharmacologic half-life of hydralazine is prolonged in patients with
chronic kidney disease
c. Nesiritide is less effective than nitroglycerin in reducing right atrial pressure
d. The most common acid-base disturbance seen with sodium nitroprusside
overuse is metabolic acidosis
C. Nitroglycerin is a much more potent venodilator than arterial dilator. Hydralazine is
metabolized by acetylation in the liver, so an increase in the half-life would not be
expected in a patient with chronic kidney disease. According to Barash, nesiritide is
even more effective than nitroglycerin in reducing right atrial pressure. Metabolic
acidosis is part of the triad of cyanide toxicity (along with tachyphylaxis and elevated
SvO2) that can be seen with sodium nitroprusside administration.
Which of the following BEST explains why higher settings of desflurane are
needed at higher altitudes to produce the same anesthetic effect?
-Decreased concentration of desflurane at higher altitudes
-Decreased partial pressure of desflurane at higher altitudes
-Decreased oxygen concentration at higher altitudes
-This statement is incorrect; equivalent settings produce the same anesthetic
effect
The partial pressure of most anesthetic vapors is dependent on temperature, not
barometric pressure, and in an extremely cold environment more anesthetic vapor
might be required. In one study, the delivered concentration of halothane increased
with altitude, but its alveolar partial pressure remained constant. Although the
concentration of the inspired volatile anesthetic was increased, the anesthetic effect
remained unchanged at the given vaporizer setting. In other words, halogenated
hydrocarbon vapors are delivered at a constant potency at constant temperature
irrespective of altitude. Desflurane is the only exception to this rule. Unlike variable-
bypass vaporizers, the Datex-Ohmeda (Steeton, UK) Tec 6 and Tec 6 plus
vaporizers require manual adjustments of the concentration control dial at altitudes
other than sea level to maintain a constant partial pressure of anesthetic.
, Page 3 of 78
An infant had a patent ductus arteriosus closed and is recovering in the NICU.
You note that the patient has new-onset stridor and hoarseness. Which of the
following is the MOST likely cause of this finding?
-Surgical dissection causing recurrent laryngeal nerve injury
-Hypocalcemia after transfusion of packed red blood cells
-Laryngospasm after deep extubation
-Incorrectly sized endotracheal tube
Surgical dissection causing recurrent laryngeal nerve injury. The incidence of
recurrent laryngeal nerve injury with standard PDA ligation is reported to be 4.2% by
Fan et al. while other authors indicate 2.5% using VATS clipping. Symptoms
attributable to vocal cord paralysis regress in most cases and usually less than 1% of
patients have lasting dysfunction. Clip entrapment of the nerve has been cited to be
the mechanism of injury, but it may be that trauma induced by traction (or thermal
injury by electrocautery) may better explain the observed clinical outcome. Zbar et al.
reports a series of PDAs treated using open thoracotomy and indicates an incidence
of recurrent laryngeal nerve injury of 22.7% in extremely low-weight babies,
confirming the importance of the issue in premature infants. Decreased incidence of
this complication appears to have been achieved with VATS and may be a
consequence of improved vision from the video camera image.
requesting the use of a bipolar cautery
This rhythm strip indicates a paced rhythm with clearly visible pacer spikes.
Electrical interference from the electrocautery can be interpreted as
myocardial activity and can suppress the pacemaker generator. The use of a
bipolar cautery will reduce the electrical interference produced; if that is not
possible, then pure cut is better than "blend" or "coag."
Which muscle is the only abductor of the vocal cords?
-Cricothyroid muscle
-Thyroarytenoid muscle
-Posterior cricoarytenoid muscle
-Lateral cricoarytenoid muscle
posterior cricoarytenoid muscle. This is a challenging question that few people
answer correctly! Most anesthesiologists do not understand the muscles anatomy of
the larynx. The only abductor ("opener") of the vocal cords is the posterior
cricoarytenoid muscle. All muscles of the larynx apart from the cricothyroid muscle
are innervated by the recurrent laryngeal nerve; therefore, the only abductor muscle
of the vocal cords is innervated by the recurrent laryngeal nerve. If both recurrent
laryngeal nerves were severed during an operation such as a thyroidectomy, you
would expect severe airway obstruction.
Correct statements regarding cerebral metabolism include:
- the brain can only utilize glucose as an energy source
-forty percent of brain glucose consumption is anaerobically metabolized
-hyperglycemia can reduce the damage from focal hypoxic injury
-the adult brain consumes approximately 50 ml/min of oxygen
, Page 4 of 78
the adult brain consumes approximately 50 ml/min of oxygen
The adult brain consumes about 20% of the total body oxygen (50 ml/min). Neuronal
cells normally utilize glucose as their energy source, but can also utilize ketone
bodies and lactate. Hyperglycemia has been shown to worsen global and focal
hypoxic brain injury.
At approximately what level or above will a patient with spinal cord injury be at
GREATEST risk for autonomic hyperreflexia?
C8
T4
T7
T10
A spinal cord injury at or above T7 (T5-T8, depending on reference) predisposes a
patient to autonomic hyperreflexia. Autonomic hyperreflexia is typically first seen
within four to six months of spinal cord injury and can continue to occur for years.
With a stimulus below the level of the spinal cord injury lesion, intact lower motor
neurons send an impulse up the spinal cord. However, this impulse is interrupted at
the site of the spinal cord injury and unable to reach the cerebral cortex. This leads
to an impaired feedback loop. However, the ascending signal reaches the thoracic
sympathetic splanchnic nerves resulting in hypertension. This hypertension is
recognized by the carotid sinus and aortic arch baroreceptors leading to a
parasympathetic reflexive bradycardic response via the vagus nerve. No autonomic
nervous system changes occur below the level of spinal cord injury since these
signal pathways are also interrupted.
At approximately what carboxyhemoglobin level will a patient start to display
mild signs and symptoms (headache, nausea and vomiting) of carbon
monoxide toxicity?
5%
10%
15%
25%
A nonsmoker has a carboxyhemoglobin level < 5% whereas a smoker may have a
carboxyhemoglobin level of 4-9%. Symptoms such as headache, dizziness, nausea,
and vomiting may occur at a carboxyhemoglobin level of 15-20%.
Portal hypertension is defined as sustained portal vein pressure greater than:
5 mm Hg
10 mm Hg
20 mm Hg
25 mm Hg
10 mm Hg
Portal hypertension is defined as a sustained portal vein pressure of 10 mm Hg or
greater. This leads to the formation of portal-systemic collateral venous channels.
A baby is born at 39 weeks gestation with congenital diaphragmatic hernia.
The baby is cyanotic and limp. He has a slow, irregular respiratory pattern and
appears to be grimacing. His heart rate is 120 bpm at the one-minute of life.
Which APGAR score correctly corresponds with these findings?
3
4
