ABA BASIC Exam (American Board of Anesthesiology) — Questions and Answers

Question 1: Which pharmacokinetic parameter best predicts the duration of action of a single bolus dose of a highly lipophilic drug like thiopental?

Bioavailability
Volume of distribution (Correct answer)
Clearance
Elimination half-life

Correct answer: Volume of distribution

With highly lipophilic drugs like thiopental, redistribution into peripheral tissues (reflected by volume of distribution) terminates the effect of a single bolus, not elimination.

Question 2: A patient under general anesthesia for orthopedic surgery develops a sudden increase in peak airway pressure from 18 to 42 cmH2O. The FIRST step in evaluation is:

Increase the FiO2 to 1.0 and activate the MH protocol
Manually ventilate with a self-inflating bag to assess compliance and rule out circuit obstruction (Correct answer)
Administer albuterol for suspected bronchospasm
Obtain a stat portable chest X-ray

Correct answer: Manually ventilate with a self-inflating bag to assess compliance and rule out circuit obstruction

Manual ventilation with a bag disconnects the ventilator circuit and allows the clinician to distinguish patient-related causes (bronchospasm, pneumothorax) from machine/circuit problems.

Question 3: During a Bier block (IVRA), the tourniquet must remain inflated for at least how long after local anesthetic injection to prevent systemic toxicity?

10 minutes
20 minutes (Correct answer)
5 minutes
30 minutes

Correct answer: 20 minutes

A minimum of 20 minutes allows sufficient local anesthetic tissue binding, reducing the risk of rapid systemic absorption upon tourniquet deflation.

Question 4: Sugammadex reverses rocuronium by which mechanism?

Redistributing rocuronium into peripheral compartments
Inhibiting acetylcholinesterase at the neuromuscular junction
Encapsulating rocuronium in a cyclodextrin complex in plasma (Correct answer)
Competitively displacing rocuronium from ACh receptors

Correct answer: Encapsulating rocuronium in a cyclodextrin complex in plasma

Sugammadex is a modified gamma-cyclodextrin that encapsulates rocuronium and vecuronium, forming a tight complex in plasma that removes them from the neuromuscular junction.

Question 5: A parturient at 38 weeks gestation presents for emergent cesarean delivery under general anesthesia. Which combination of measures BEST reduces aspiration risk at induction?

Inhalation induction with sevoflurane in the left lateral decubitus position
Propofol infusion with rocuronium and a non-depolarizing modified RSI
Preoxygenation, sodium citrate, cricoid pressure during RSI with succinylcholine (Correct answer)
Awake fiberoptic intubation with topical anesthesia and sedation

Correct answer: Preoxygenation, sodium citrate, cricoid pressure during RSI with succinylcholine

For obstetric general anesthesia, the combination of antacid (sodium citrate), preoxygenation, and rapid sequence induction with cricoid pressure minimizes aspiration risk at a critical airway moment.

Question 6: What is the correct order for donning personal protective equipment (PPE)?

Gown, mask, goggles, gloves (Correct answer)
Mask, gloves, gown, goggles
Gloves, gown, mask, goggles
Goggles, gloves, mask, gown

Correct answer: Gown, mask, goggles, gloves

The correct donning sequence (gown, mask, goggles, gloves) ensures proper coverage and minimizes contamination risk.

Question 7: A resident who takes an approved leave of absence during residency training may need to extend their program by what increment to meet ACGME time-in-training requirements?

Days equal to the leave taken
A full additional year regardless of leave duration
At least one additional month per academic year affected
Weeks rounded to the nearest full rotation block (Correct answer)

Correct answer: Weeks rounded to the nearest full rotation block

ACGME programs typically require that time missed during an approved leave be made up in increments matching rotation block lengths to ensure all required experiences are completed.

Question 8: Which of the following is a CORRECT application of the Universal Protocol for preventing wrong-site surgery?

The time-out must include confirmation of patient identity, procedure, and site before incision (Correct answer)
A time-out is performed after skin incision once the team is assembled
The surgeon marks the operative site only if the patient is awake and cooperative
Site marking is optional for midline procedures and internal organs

Correct answer: The time-out must include confirmation of patient identity, procedure, and site before incision

The Universal Protocol requires a time-out immediately before incision confirming correct patient identity, procedure, and operative site/side.

Question 9: A patient on chronic phenytoin therapy requires higher doses of rocuronium. This is best explained by:

Upregulation of acetylcholine receptors
Increased acetylcholinesterase activity
Induction of hepatic CYP enzymes accelerating rocuronium metabolism (Correct answer)
Competitive antagonism at the nicotinic receptor

Correct answer: Induction of hepatic CYP enzymes accelerating rocuronium metabolism

Phenytoin induces hepatic CYP enzymes, accelerating the metabolism of rocuronium and reducing its duration and potency.

Question 10: A patient with a pacemaker (VVI mode) undergoes electrocautery. Which intraoperative measure BEST reduces the risk of pacemaker inhibition?

Convert the pacemaker to asynchronous (DOO or VOO) mode preoperatively (Correct answer)
Avoid any muscle relaxants to prevent EMG interference
Use monopolar electrocautery in continuous rather than blend mode
Increase the pacemaker lower rate limit to 80 bpm intraoperatively

Correct answer: Convert the pacemaker to asynchronous (DOO or VOO) mode preoperatively

Converting a demand pacemaker to asynchronous mode eliminates sensitivity to electromagnetic interference from electrocautery, ensuring continuous pacing.

Question 11: During a preoperative visit, a patient scheduled for abdominal surgery is noted to have a serum sodium of 124 mEq/L. The surgery is elective. What is the most appropriate decision?

Administer 3% saline intraoperatively to normalize sodium during the case
Perform the procedure under regional anesthesia to avoid the risks of general anesthesia
Postpone surgery and correct hyponatremia to above 130 mEq/L before proceeding (Correct answer)
Proceed with cautious intraoperative fluid management

Correct answer: Postpone surgery and correct hyponatremia to above 130 mEq/L before proceeding

Severe hyponatremia (Na < 130 mEq/L) increases the risk of cerebral edema and seizures; elective surgery should be deferred until the sodium is safely corrected.

Question 12: What physiologic parameter does a pulse oximeter directly measure?

Hemoglobin concentration
Carbon dioxide in exhaled gas
Arterial partial pressure of oxygen (PaO2)
Functional oxygen saturation of hemoglobin (SpO2) (Correct answer)

Correct answer: Functional oxygen saturation of hemoglobin (SpO2)

Pulse oximetry uses differential light absorption at two wavelengths to measure the functional oxygen saturation of hemoglobin non-invasively.

Question 13: Why is it important to check for drug allergies before administration?

To satisfy pharmacy inventory requirements
To complete insurance paperwork
To prevent potentially life-threatening allergic reactions (Correct answer)
To determine the correct billing code

Correct answer: To prevent potentially life-threatening allergic reactions

Checking allergies prevents serious reactions including anaphylaxis, which can be fatal if not identified beforehand.

Question 14: Which class of pathogens is MOST associated with prion disease transmission and requires specialized decontamination beyond standard sterilization?

Prions (misfolded proteins) (Correct answer)
Gram-negative bacteria
Lipid-enveloped viruses
Spore-forming bacteria

Correct answer: Prions (misfolded proteins)

Prions are resistant to conventional sterilization; instruments used in high-risk neurological procedures require specific protocols (e.g., NaOH treatment or prolonged autoclaving).

Question 15: A 30-year-old woman with a history of pseudocholinesterase deficiency is scheduled for laparoscopic surgery. Which preoperative consideration is most important?

Avoid all opioids due to prolonged metabolism
Avoid succinylcholine and ensure adequate reversal monitoring if mivacurium is considered (Correct answer)
Use only volatile anesthetics to prevent prolonged block
Pretreat with neostigmine before induction

Correct answer: Avoid succinylcholine and ensure adequate reversal monitoring if mivacurium is considered

Pseudocholinesterase deficiency prolongs the action of succinylcholine (and mivacurium) by impairing hydrolysis; these agents should be avoided or used with prolonged neuromuscular monitoring.

Question 16: Which statement correctly describes the pharmacodynamic interaction between volatile anesthetics and opioids?

They are antagonistic: opioids increase MAC requirements
Opioids primarily reduce MAC-awake, not MAC
They are additive to synergistic: opioids significantly reduce MAC (Correct answer)
They are independent: each provides analgesia through unrelated pathways

Correct answer: They are additive to synergistic: opioids significantly reduce MAC

Opioids produce a synergistic interaction with volatile anesthetics, substantially reducing MAC by approximately 50% at clinically used doses.

Question 17: Which of the following correctly describes a 'lapsed' ABA certificate?

A certificate suspended after a malpractice judgment
A certificate voluntarily surrendered to the ABA by the diplomate
A certificate placed on administrative hold pending license verification
A certificate that has expired due to failure to meet MOCA requirements (Correct answer)

Correct answer: A certificate that has expired due to failure to meet MOCA requirements

A lapsed certificate is one that has expired because the diplomate failed to fulfill MOCA 2.0 requirements within the required cycle.

Question 18: Which volatile anesthetic is contraindicated in patients with a history of malignant hyperthermia?

Xenon
Propofol
Nitrous oxide
Sevoflurane (Correct answer)

Correct answer: Sevoflurane

All potent volatile halogenated agents, including sevoflurane, can trigger malignant hyperthermia in susceptible individuals via uncontrolled ryanodine receptor activation.

Question 19: The ABA's Part 4 of MOCA 2.0 requires diplomates to participate in which type of activity?

Structured peer-review of operative reports
Mandatory ASA Annual Meeting attendance
Annual written knowledge examination
Simulation-based assessment or quality improvement activity (Correct answer)

Correct answer: Simulation-based assessment or quality improvement activity

MOCA 2.0 Part 4 requires diplomates to complete simulation training or a quality improvement/patient safety activity at least once every 5 years.

Question 20: A patient under general anesthesia develops sudden bradycardia (HR 28 bpm) with hypotension. What is the FIRST drug to administer?

Atropine 0.5–1 mg IV (Correct answer)
Epinephrine 1 mg IV
Vasopressin 40 units IV
Norepinephrine infusion

Correct answer: Atropine 0.5–1 mg IV

Atropine is the first-line agent for symptomatic bradycardia due to increased vagal tone, given as 0.5–1 mg IV.

Question 21: A celiac plexus block for pancreatic cancer pain interrupts pain signals traveling through which structure?

Splanchnic nerves via the celiac ganglion (Correct answer)
Sympathetic chain at T1
Vagus nerve trunk
Phrenic nerve

Correct answer: Splanchnic nerves via the celiac ganglion

Celiac plexus block interrupts splanchnic nerve pain signals traveling through the celiac ganglion from upper abdominal viscera.

Question 22: A patient with suspected malignant hyperthermia (MH) crisis develops a temperature of 39.8°C, masseter spasm, and rising ETCO2. What is the FIRST priority intervention?

Obtain arterial blood gas and serum creatine kinase
Administer dantrolene 2.5 mg/kg IV
Discontinue all triggering agents and change to a clean circuit (Correct answer)
Apply active surface cooling measures immediately

Correct answer: Discontinue all triggering agents and change to a clean circuit

Removing the triggering agent (volatile anesthetics and succinylcholine) is the first step in MH management before dantrolene administration.

Question 23: Midazolam produces amnesia primarily through its action on which receptor?

Alpha-1 GABA-A receptor subunits (Correct answer)
Muscarinic M1 receptors
NMDA receptors
Alpha-2 adrenergic receptors

Correct answer: Alpha-1 GABA-A receptor subunits

Benzodiazepines like midazolam potentiate GABA-A receptors containing the alpha-1 subunit in the hippocampus, producing anterograde amnesia.

Question 24: Which of the following best describes the 'surgical safety checklist' Sign-Out phase according to WHO guidelines?

Reviewing key concerns for recovery and specimen labeling before the patient leaves the OR (Correct answer)
Checking equipment function and team member introductions before the procedure
Confirming patient identity, site, and consent before anesthesia induction
Verifying antibiotic administration and anticipated blood loss at incision

Correct answer: Reviewing key concerns for recovery and specimen labeling before the patient leaves the OR

The Sign-Out phase occurs before the patient leaves the OR and covers instrument counts, specimen labeling, equipment issues, and recovery concerns.

Question 25: When evaluating a patient with suspected difficult airway, which combination of findings most strongly supports planning for awake intubation?

Short neck, snoring history, tongue size 3+
Mallampati class II, thyromental distance 7 cm, prior uneventful intubation
Mallampati class IV, limited neck extension, history of failed intubation (Correct answer)
BMI 32, Mallampati class III, beard

Correct answer: Mallampati class IV, limited neck extension, history of failed intubation

Multiple converging predictors—Mallampati IV, limited neck extension, and prior documented failed intubation—represent the highest-risk profile and mandate an awake airway technique.

Question 26: A patient refuses a blood transfusion on religious grounds despite a life-threatening hemorrhage. The anesthesiologist should:

Seek an emergency court order to override the refusal
Honor the refusal if the patient is competent and properly informed (Correct answer)
Administer blood because saving life overrides religious beliefs
Transfer care immediately without any further discussion

Correct answer: Honor the refusal if the patient is competent and properly informed

A competent adult's informed refusal of treatment must be respected regardless of the anesthesiologist's personal or religious views.

Question 27: A patient who has been adequately informed asks about an off-label use of a sedative for home use post-discharge. The anesthesiologist's ethical approach is to:

Refer the patient to their primary care physician without discussion
Refuse any off-label prescribing categorically
Prescribe it without comment because patient autonomy allows it
Provide evidence-based information and prescribe only if clinically justified (Correct answer)

Correct answer: Provide evidence-based information and prescribe only if clinically justified

Off-label prescribing is legal and sometimes appropriate when evidence-based, but requires honest discussion of risks and clinical justification.

Question 28: A patient scheduled for an elective procedure discloses active suicidal ideation during the pre-anesthesia evaluation. What is the anesthesiologist's immediate responsibility?

Document the disclosure and inform the surgical team only
Postpone the elective procedure and initiate psychiatric consultation and safety planning before discharge (Correct answer)
Proceed with the elective surgery and notify psychiatry postoperatively
Reassure the patient and proceed if they state they will not act on the ideation

Correct answer: Postpone the elective procedure and initiate psychiatric consultation and safety planning before discharge

Active suicidal ideation requires immediate psychiatric evaluation and safety planning before any elective procedure can proceed.

Question 29: An attending anesthesiologist is simultaneously supervising four CRNAs in separate rooms. A complication arises in one room. Ethically, the attending must:

Manage the complication remotely by phone to avoid abandoning the other rooms
Physically respond to the emergency room while ensuring the other cases are safely covered (Correct answer)
Immediately terminate all four cases to focus on the emergency
Delegate all four rooms to the charge nurse and respond

Correct answer: Physically respond to the emergency room while ensuring the other cases are safely covered

The attending must personally respond to the emergency while arranging adequate coverage for the other supervised cases.

Question 30: The ABA BASIC Exam is typically taken after completion of which training milestone?

CA-3 year
CA-2 year (Correct answer)
CA-1 year
Internship year

Correct answer: CA-2 year

The BASIC Exam is designed to be taken after the CA-2 year, testing foundational anesthesiology knowledge.

ABA BASIC Exam (American Board of Anesthesiology)

The ABA BASIC Exam is a high-stakes written examination assessing foundational knowledge in anesthesiology sciences required for initial board certification, covering basic sciences, clinical sciences, organ-based sciences, and special anesthesia problems.

200

Questions

240 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds