I. PHYSIOLOGICAL SCIENCES
A. PHYSIOLOGY
1. Respiration: Lung
Functions and Cellular Processes
a) Lung Volumes
1) definitions; methods of
measurement; normal values; time constants
2) spirometry; static and dynamic volumes; deadspace; nitrogen washout, body
plethysmography, 02, uptake, C02 production, exercise
testing
b) Lung Mechanics
1) compliance, pleural
pressure gradient, flow-volume loops and hysteresis, surfactant, La Place law
2) resistances; principles of gas flow measurement
3) methods of measurement
4) work of breathing
5) regulation of airway caliber
c) Ventilation - Perfusion
1) distribution of
ventilation
2) distribution of
perfusion, zones, hypoxic pulmonary vasoconstriction
3) measurement of V/Q
ratio, implications of A-aDO2, a-ADC02, VD/NT,
d) Qs/Qr,
1) definition: gas laws
2) pulmonary diffusion capacity
3) apneic oxygenation, diffusion hypoxia
e) Blood Gas Transport
1) 02,
transport; physical solubility; saturation, Hb-O2 dissociation
curve; 2,3-D PG,P50, respiratory enzymes; Hb as a buffer
2) CO2
transport; blood CO2 content; carbonic anhydrase; CO2
dissociation curve; Bohr effect, normal acid-base balance and compensation
3) temperature effect on
blood gases
f) Regulation of
Ventilation
1) respiratory center
2) central and peripheral chemoreceptors; proprioceptive receptors; respiratory
muscles and reflexes; innervation
3) CO2 and 02 response curves
g) Non-respiratory
Functions of Lungs
2. Cardiovascular
a) Cardiac Cycle
1) control of heart rate
2) synchronicity of pressure, flow, ECG, sounds, valve action
3) impulse propagation
4) normal ECG
5) electrophysiology
b) Ventricular Function
1) Frank-Starling law; pre
and afterload, intracardiac pressures
2) force, velocity, length, rate of shortening
3) myocardial contractility, measurement limitations
4) cardiac output: determinants and regulation
5) myocardial oxygen utilization
c) Venous Return
1) venous tone; controlling
factors
2) muscle action; intrathoracic pressure; body position
3) blood volume
d) Blood Pressure
1) systolic, diastolic,
mean, perfusion
2) intracardiac, pulmonary, venous (systernic, pulmonary)
3) systemic resistance, viscosity
4) baroreceptor function
e) Micro-Circulation
1) capillary diffusion;
osmotic pressure
2) pre-post capillary sphincter control
3) viscosity; rheology
f) Organ Perfusion
1) cerebral and spinal cord
2) coronary
3) pulmonary
4) renal
5) splanchnic - hepatic
6) muscle and skin
7) uterine and placental
g) Regulation of
Circulation and Blood Volume
1) central: vasomotor
center, pituitary renal axis
2) peripheral: receptors and reflexes
3) hormonal control
4) mixed venous oxygen tension and saturation
3. Central and Peripheral Nervous Systems
a) Brain
1) cerebral cortex;
functional organization
2) EEG
a) wave patterns, frequency
and amplitude, raw and processed
b) sleep, convulsions; 02 and CO2; brain death
c) depth of anesthesia; specific anesthetic and drug effects
3) sensory and motor evoked
responses
b) Spinal Cord
1) general organization;
brain stem; reticular activating system
2) spinal reflexes
3) spinal cord tracts
4) evoked potentials
c) Cerebrospinal Fluid
1) formation, volume,
composition, flow and pressure
2) blood brain barrier
3) brain volume, compliance
4) relation to blood composition and acid-base balance
d) Neuromuscular and
Synaptic Transmission
1) morphology; receptors
2) membrane potential; mechanism
3) action potential; characteristics, ion flux
4) synapse; transmitters, precursors, ions, termination of action, transmission
characteristics
e) Skeletal Muscle
Contractions; Depolarization, Role of Ca, Actin, Myosin; Energy Source and
Release
f) Pain Mechanism and
Pathways
1) nociceptors and
nociceptive afferent neurons
2) dorsal horn modulation
3) spinal and supraspinal neurotransmission; opioid receptors
4) autonomic contributions to pain; visceral pain perception and transmission
5) social, vocational and psychological influences on pain perception
g) Autonomic Nervous System
1) sympathetic: receptors;
transmitters, synthesis; storage; release; responses; termination of action
parasympathetic: receptors; transmitters; synthesis; release; responses;
termination of action
3) ganglionic transmission
4) reflexes: afferent and efferent limbs
4. Hepatic Function
a) Dual Blood Supply and
its Regulation
b) Metabolic and Synthetic Functions
c) Excretory Functions
d) Mechanisms of Drug Metabolism and Excretion
e) Liver Function Tests
5. Renal Function
a) Blood Flow, Glomerular
Filtration, Tubular Reabsorption and Secretion
b) Renal Function Tests
c) Hormonal Regulation of Extracellular Fluid
d) Hormonal Regulation of Osmolality
e) Regulation of Acid-Base Balance
f) Drug Excretion
6. Endocrine Function (Pituitary; Thyroid;
Parathyroid, Adrenal Medulla, Adrenal Cortex and Pancreas)
7. Temperature Regulation
a) Temperature Sensing;
Central, Peripheral
b) Temperature Regulating Centers; Concept of Set Point
c) Heat Production and Conservation
d) Heat Loss; Mechanisms
e) Body Temperature Measurement; Sites; Gradients
f) Special Pediatric Considerations
8. Aging: Physiological and Pharmacological
Implications
1. General Concepts
a) Pharmacokinetics-,
Protein Binding; Partition Coefficients; pKa; Ionization; Tissue Uptake
b) Elimination; Biotransformation; Termination of Action
2. Anesthetics-Gases and Vapors
a) Physical Properties
b) Mechanism of Action
c) Effects on CNS
d) Effects on Circulation
e) Effects on Respiration
f) Effects on Neuromuscular Function
g) Effects on Renal Function
h) Effects on Hepatic Function
i) Effects on Hematologic and Immune Systems
j) Biotransformation - Toxicity
k) Minimum Alveolar Concentration
l) Trace Concentrations, OR Pollution, Personnel Hazards
3. Anesthetic-Intravenous (Opioid and Non-Opioid
Induction and Anesthetic Agents)
a) Mechanism of Action
b) Pharmacokinetics and Pharmacodynamics
c) Metabolism and Excretion
d) Effect on Circulation
e) Effect on Respiration
f) Effect on Other Organs
g) Adverse Effects
4. Anesthetics-Local
a) Mode of Action
b) Biotransformation and Excretion
c) Comparison of Drugs and Chemical Groups
d) Prolongation of Action
e) Toxicity
1) CNS
2) cardiac
3) allergy
4) preservatives
5) fetal
5. Muscle Relaxants (Depolarizing, Non-Depolarizing)
a) Mechanism of Action
b) Non-relaxant Side Effects
c) Abnormal Responses
d) Biotransformation and Excretion
e) Prolongation of Action; Tennination of Action
f) Antagonism
g) Drug Interactions (Antibiotics, H2 Blockers, Magnesium)
6. Autonomic Drugs
a). Sympathetic
1) transmitters and types
of receptors
2) target organ effects; metabolic effects
3) agonists: peripheral and central actions
4) antagonists: alpha and beta blockers, antihypertensives, ganglionic
blockers, peripheral vasodilators
5) tocolytic uses
b) Parasympathetic
1) transmitters
2) muscarinic effects
3) nicotinic effects
4) agonists: cholinergic and anticholinesterases
5) antagonists
7. Cardiovascular Drugs
a) Digitalis; Actions and
Toxicity
b) Positive Inotropes
c) Antiarrhythmics
d) Antianginal Drugs
e) Vasodilators
f) Electrolytes (Cardiac Effects)
g) Vasoconstrictors
8. CNS Drugs (Major Actions, Comparison of Drugs;
Effect on Respiration; Circulation, Adverse Effects)
a). Pre- and Postanesthetic
Medications
1) opioids
2) opioid antagonists, agonist-antagonists
3) barbiturates
4) tranquilizers: phenothiazines; butyrophenones; benzodiazepines
b) Antidepressants,
Anti-Parkinson Drugs
c) Ethyl Alcohol
d) Hypnotics: Barbiturate and Non-Barbiturate; Anticonvulsants
e) Analeptics; Physostigmine, Benzodiazepine Antagonists
f) Antiemetics: Phenothiazines; Butyrophenones; Metoclopramide;
Anticholinergics; Serotonin Antagonists
g) Antihistamines (H1, H2,
Mixed)
h) Drug Abuse and Addiction; Tolerance, Dependence
9. Diuretics
a) Mechanism of Action
b) Comparison of Drugs
c) Adverse Effects
d) Effect on Elecrolyte and Acid-Base Balance
e) Ultrafilteration
10. Immunosuppressive and Anti-Rejection Drugs
11. Drug Interactions
a) Protein Binding
b) pH Effect
c) Enzyme Induction and Inhibition
d) Hepatic Blood Flow
12. Pharmacogenetics
a) Malignant Hyperthermia
(including diagnosis and therapy)
b) Pseudocholinesterase Deficiency
13. Drug Reactions (Anaphylactoid, Anaphylaxis)
A. ANATOMY
1. Topographical Anatomy as Landmarks
a) Neck: Tracheotomy Site,
Cricoid Membrane, Internal and External Jugular Veins, Thoracic Duct, Carotid
and Vertebral Arteries, Stellate Ganglion
b) Chest: Pulmonary Lobes, Cardiac Landmarks, Auscultation Sites, Subclavian
Vein
c) Abdomen: Dimensions of Liver
d) Pelvis: Vertebral Level of Topographical Landmarks, Caudal Space
e) Extremities: Relationship of Bones, Nerves, and Arteries
2. Radiological Anatomy
a) Chest
b) Brain and Skull (including CT)
c) Spine (Cervical, Thoracic, Lumbar)
3. Respiratory System
a) Nose
b) Pharynx: Subdivisions; Innervation
c) Larynx
1) innervation; muscles;
blood supply; cartilages
2) vocal cords, positions with paralysis
3) differences between infant and adult
d) Trachea
1) structure and relationships
in neck and chest
e) Lungs
1) divisions and
bronchoscopic anatomy
2) bronchial and pulmonary circulations
3) microscopic anatomy
f) Muscles of Respiration, Accessory Muscles
4. Cardiovascular
System
a) Normal Anatomy of Heart
and Major Vessels
b) Heart Conduction System; External Innervation; Coronary Circulation
c) Blood Supply of Other Major Organs
5.Nervous System
a) Brain
1) major nuclei and
pathways
2) respiratory center
3) cerebral circulation, circle of Willis; venous drainage
b) Spinal Cord and Spine
1) variations in vertebral
configurations
2) spinal nerves (level of exit, covering, sensory distribution)
3) blood supply
c) Meninges
1) epidural, subdural and
subarachnoid spaces
2) parasympathetic; location of ganglia
a) cranial nerves; eye,
salivary glands, larynx
b) sacral nerves; innervation of pelvic structures
c) vagal reflex pathways
3) carotid and aortic
bodies, carotid sinus
6. Regional Anesthesia; Main Nerve Blocks
a) Autonomic: Stellate,
Celiac, Lumbar Sympathetic
b) Head and Neck: Cervical, Superior Laryngeal, Transtracheal
c) Extremities: Brachial Plexus, Ulnar, Radial, Median, Sciatic, Femoral,
Lateral Femoral Cutaneous, Obturator, Ilio-Inguinal
d) Trunk: Intercostal, Paravertebral Somatic
e) Spine: Epidural, Caudal, Spinal
B. BIOCHEMISTRY
1. Normal Body Metabolism
a) Carbohydrates
1) aerobic and anaerobic
utilization; chemical processes, enzymes
2) relationship to hormones; insulin; human growth hormone, glucocorticoids;
glucagon, epinephrine
3) effect of stress
b) Proteins
1) functions, hormones,
antibodies
2) RNA-DNA; genetics
3) cyclic AMP; function
c) Specific Organ
Metabolism (Brain, Heart)
2. Acid-Base Regulation: Buffer Systems; Effects of
Imbalance on Electrolytes and Organ Perfusion
3.Water and
Electrolytes: Distribution and Balance; Compartments
4. Hyperalimentation
C. PHYSICS
1. Mechanics
a) Pressure Measurement of
Gases, Liquids
b) Transducers, Regulators, Medical Gas Cylinders
2. Flow Velocity a) Viscosity-Density;
Laminar-Turbulent
b)
Flowmeters: Rotameter, Electromagnetic, Ultrasonic; Pneumotachogram.
3. Properties of Liquids, Gases, and Vapors
a) Diffusion of Gases
b) Solubility Coefficients
c) Relative and Absolute Humidity
d) Critical Temperature, Critical Pressure
4. Gas Laws
5. Vaporizers
a) Vapor Pressure and
Calculation of Anesthetic Concentrations
b) Vaporizer Types
6. Uptake and Distribution of Inhalation Agents
a) Uptake and Elimination
Curves; Effect of Ventilation, Circulation, Anesthetic Systems
b) Concentration Effect
c) Second Gas Effect
d) Nitrous Oxide and Closed Spaces
7. Design of Anesthesia Machines
8. Physics of Breathing System
a) Principles: Resistance,
Turbulent Flow, Mechanical Deadspace, Rebreathing, Dilution, Leaks, Gas
Mixtures, Humidity, Heat
b) Components: Connectors, Adaptors, Mask, Endotracheal Tube, Reservoir Bag,
Unidirectional Valves, Breathing Tubes, Relief Valve
c) Characteristics
1) Circle systems: closed
and semi-closed; adult; pediatric
2) non-circle systems: insufflation; open; semi-open
3) non-rebreathing valves
4) CO2, absorption: principles, cannisters, efficiency
d) Oxygen Supply Systems:
FIO2
e) Waste Gas Evacuation Systems
f) Fail Safe and Other Safety Features
9. Monitoring Methods
a) Vascular Pressures:
Arterial, CVP, PAP, LAP, LVEDP
b) Heart Function: Heart Tones, ECG, Echocardiography, Cardiokymography,
Cardiac Output
c) Brain and Spinal Cord Function: EEG (raw and processed), Evoked Potentials,
Wake-up Test, ICP, Cerebral Function Monitor
d) Neuromuscular Function: Nerve Stimulators, EMG
e) Ventilation: Respirometers, Inspiratory Force
f) Gas Concentrations: 02 CO2, Nitrogen, Anesthetic Gases and Vapors
g) Temperature
h) Oxygen: Oximetry, Transcutaneous 02
10. Instrumentation
a) Blood Gases: Electrodes
for pH, Po2, Pco2, Calibration, Temperature Corrections, Errors
b) Gas Concentrations: Infrared Absorption, Molecular Broadening Effects, Mass
Spectrometry, Gas Chromatography, Nitrogen Capnography
c) Cardiac Output: Fick, Dye Dilution, Thermodilution, Doppler
d) Pressure Transducers: Overshoot, Resonance, Damping
e) Doppler, Oscillometry
f) Blood Warmers, Cell Savers
g) Echocardiography
h) Coagulation Monitors
11. Ventilators
a) Classifications
b) Principles of Action: Assistors, Controllers; Pressure Limited, Volume
Pre-set; FIO, Control; Periodic Sigh; Monitors; Pressure, Oxygen, Apnea,
Insp/Exp Ratio; Bacterial Filters; IMV, CPAP, PEEP, Pressure Support, High
Frequency Ventilation; Maintenance; Microbiology; Complications; Pediatric
Adaptation
c) Nebulizers, Humidifiers
12. Alarms: Operating
Room, Electrical, Anesthesia Machine, Ventilators, Oxygen
13. Defibrillators:
Internal, External, Implantable; Energy, Cardioversion; Paddle Size and
Position
14. Pacemakers
a) Temporary; Permanent
(Epicardial, Endocardial), Transcutaneous
b) Types: Fixed Rate, Synchronized, Ventricular, Atrial, A-V Sequential
c) Standard Nomenclature
d) Reasons for Failure or Malfunction
15. Electrical; Fire
and Explosion Hazards
a) Source of Ignition;
Static, Misuse of Oxygen Cylinders
b) Prevention: Grounding, Isolation Transformers
c) Macro and Micro Current Hazards
d) Safety Regulations; NFPA
e) Lasers
16. Basic Electronics
D. MATHEMATICS
1. Simple Math: Logarithms;
Graph of Simple Equations; Exponential Function, Analysis of Biologic Curves
2. Statistics: Sample and Population; Probability; Mean and Mode; Standard
Deviation and Error; T-Test; Chi-Square; Correlation; Analysis of Variance
3. Computer: Data Handling; Data Processing; Data Analysis; Anesthesia
Applications
A. ANESTHESIA
PROCEDURES, METHODS AND TECHNIQUES
1. Evaluation of the
Patient and Preoperative Preparation
a) Physical Status
b) Premedication
1) interaction with chronic
drug therapy; anesthetic agents
2) adverse reactions to premedications; patient variability, dose response
curves, side effects
3) specific problems in disease states: hyper and hypothyroid, drug abuse,
glaucoma, uremia, increased CSF pressure, chronic steroid ingestion, obesity,
depression, COPD
4) pediatric and geriatric doses, routes of administration
5) role in patients with allergies
6) alteration of gastric fluid volume and pH, sphincter tone
c) NPO Recommendations
2. Regional Anesthesia
a) General: Premedication,
Patient Position, Equipment
b) Spinal, Epidural, Caudal
1) indications,
contraindications, techniques, complications, comparison of techniques
2) sites of actions
3) factors influencing onset, duration, and termination of action
4) systernic toxicity, test dose
5) complications: precipitating factors, prevention, therapy
c) Peripheral and Autonomic
Nerve Blocks: Indications, Contraindications, Techniques, Clinical Assessment
Complications
d) IV Regional: Mechanism,
Agents, Indications, Contraindications, Techniques, Complications
3. General Anesthesia
a) Stages and Signs of
Anesthesia; Awareness Under Anesthesia
b) Airway Management; Intubation, Fiberoptic Techniques, Awake; Techniques for
Difficult Intubation; Laryngeal Mask Airway; Endobronchial Intubation;
Complications
c) Hypocarbia-Hypercarbia: Systemic Effects
d) Hypoxemia; Systemic Effects
4. Intravenous Fluid Therapy During Anesthesia:
Water, Electrolyte, Glucose Requirements and Disposition
5. Complications (Etiology, Prevention, Treatment)
a) Trauma
1) upper airway, epistaxis
2) larynx and trachea; stridor; laryngospasm
3) eyes
4) vascular; arterial and venous thrombosis; thrombophlebitis; sheared
catheter, intra-arterial injections, air embolism
5) neurological: pressure injuries of mask, tourniquet, body position,
intraneural injections, retractors
6) burns
b) Chronic Environmental
Exposure; Mutagenicity, Teratogenicity, Carcinogenicity, Scavenging
c) Temperature
1) hypothermia: etiology,
treatment, prognosis
2) shivering
d) Nausea and Vomiting
1) physiology; etiology;
gastroesophageal sphincter; gastric emptying time
2) preoperative; full stomach and induction of anesthesia
3) use of antacids, H2 blockers, metoclopramide, transdermal scopolamine,
droperidol, ondansetron
4) pulmonary aspiration
e) Bronchospasm,
Laryngospasm
6. Special Techniques
a) Controlled Hypotension;
Choice of Drugs, Use of Posture, Ventilation
b) Controlled Hypothermia; Techniques, Systemic Effects, Shivering, Rewarming,
Complications
c) Hyperbaric Oxygen and Anesthesia Care
d) High Altitude Anesthesia
e) Barbiturate Coma
7. Postoperative Period
a) Pain Relief
1) Pharmacologic
a) drugs: opioids,
agonist-antagonists, local anesthetics, aIpha-2 agonists, nonsteroidal
anti-inflammatory drugs
b) routes: oral, SC, IM, IV (PCA), epidural, spinal, intrapleural, other
regional techniques
c) risks and benefits
2) other techniques; TENS;
cryotherapy; acupuncture
b) Respiratory Consequences
of Anesthesia
8. Anesthesia Record Keeping and Quality Assurance
B. DISEASE STATES - CLINICAL PROBLEMS AND THEIR
MANAGEMENT
1. Painful Disease States
a) Pathophysiology
1) Acute postoperative and
posttraurnatic pain
2) Cancer related pain
3) Chronic pain states
a) Radicular and
neuropathic pain: low back pain, postherpetic neuralgia
b) Visceral pain
c) Sympathetically mediated pain: reflex sympathetic dystrophy, causalgia
d) Other somatic pain conditions: myofascial, arthropathy, etc.
e) Central and deafferentation pain: phantom limb pain
b) Treatment
1) Cancer Pain
a) Systemic medications
b) Continuous spinal and epidural analgesia
c) Neurolytic and non-neurolytic blocks
2) Chronic pain
a) Systemic medications:
analgesics, anticonvulsants, psychotropics, etc.
b) Spinal and epidural analgesia
c) Peripheral nerve blocks
d) Sympathetic nerve blocks
e) Other techniques: TENS, epidural stimulation, neuroablation (surgical and
chemical neurolysis), etc.
2. Respiratory System
a) Obstructive Disease
1) upper airway:
congenital, infectious, neoplastic, traumatic, foreign body
2) tracheobronchial: congenital, infectious, neoplastic, traumatic, foreign
body
3) parenchymal: asthma, bronchitis, emphysema, lung abscess, bronchiectasis,
cystic fibrosis, mediastinal masses
b) Restrictive Disease
1) neurologic: CNS
depression, spinal cord dysfunction, peripheral nervous system
2) musculoskeletal: muscular, skeletal, obesity, chest trauma
3) parenchymal: atelectasis, pneumonia, interstitial pneumonitis, pulmonary
fibrosis, respiratory distress syndrome, bronchopulmonary dysplasia
4) pleural and mediastinal: pneumo-, hemo-, and chylothorax, pleural effusion,
empyema, bronchopleural fistula, cardiornegaly
5) other: pain, abdominal distention
c) Management of the
Patient with Respiratory Disease
1) evaluation: H & P,
CYR, ABGs, PFTs; assessment of perioperative risk
2) anesthetic management
a) preoperative
preparation: respiratory therapy, drug therapy (antibiotics, bronchodilators,
mucolytics)
b) intraoperative management
1) monitoring
2) choice of anesthesia
3) anesthetic techniques: nonpulmonary surgery, thoracic and pulmonary surgery,
one-lung ventilation, lung transplantation
c) postoperative care: pain
management, respiratory therapy, ventilator support, extubation criteria
3) management of
respiratory failure
a) supportive medical
therapy
b) monitoring
c) nonventilatory respiratory management: 02 therapy and toxicity,
tracheobronchial toilet, positive airway pressure, respiratory drugs
d) ventilatory management
1) criteria for ventilatory
commitment and weaning
2) choice of ventilator
3) mode of ventilation: conventional mechanical ventilation, PEEP, CPAP, IMV,
SIMV, pressure support, high frequency ventilation (positive pressure, jet,
oscillation)
4) complications of mechanical ventilation
3. Cardiovascular
System
a) Ischemic Heart Disease
1) risk factors
2) manifestations
3) diagnosis of myocardial infarction; clinical, ECG, enzymes
4) anesthesia risk
5) treatment of angina; drugs, surgical
6) determinants of myocardial oxygen requirements and delivery, silent
ischemia, postoperative ischemia
7) intraoperative diagnosis and treatment of ischemia
b) Valvular Heart Disease
1) classification
2) diagnosis
3) anesthetic considerations
c) Rhythm Disorders and
Conduction Defects
1) electrophysiology
2) chronic abnormalities: etiology, diagnosis, therapy
a) AICD implantation
3) intraoperative
dysrhythmia: etiology, diagnosis, therapy
4) perioperative use of
pacemaker: indications, complications
d) Heart Failure and
Cardiomyopathy (Ischemic, Viral, Hypertrophic)
1) definition and
functional classification
2) compensatory responses
3) right or left ventricular dysfunction
a) etiology
b) signs and symptoms
c) diagnostic tests
4) treatment
a) pulmonary edema
b) pulmonary hypertension
c) cardiogenic shock
d) cardiac transplantation
e) Cardiac Tamponade and
Constrictive Pericarditis
1) etiology
2) diagnosis
3) anesthetic management
f) CirculatoryAssist
1) cariopulmonary bypass
a) components (pump,
oxygenator, heat exchanger, filters)
b) mechanisms of gas exchange
c) priming solutions
d) anticoagulation and antagonism; ACT, heparin assays, antithrombin III,
protamine reactions
e) anesthetic considerations during bypass
2) intrazortic balloon:
rationale, indications, linfitations
3) artificial heart and
ventricular assist devices: internal and external
g) Myocardial Preservation:
physiology, techniques, complications
h) Pulmonary Embolism
1) etiology: blood, air,
fat
2) diagnosis
3) treatment; acute, preventive
i) Hypertension
1) etiology,
pathophysiology, course of disease
2) drug treatment, interactions with anesthetics, risk of anesthesia
3) intra or postoperative hypertension
a) differential diagnosis
and treatment
j) Peripheral Circulatory
Failure
1) etiology,
classification, pathophysiology
2) anesthetic management of patient in shock
k) Vascular Diseases
1) cerebral circulation;
luxury perfusion, steals, infarcts, intracranial hemorrhage
2) carotid endarterectomy: anesthetic management, monitoring of cerebral
perfusion, complications
3) abdominal aneurysm resection: anesthetic management
4) arterial occlusive disease
5) aneurysms of ascending, descending and arch of aorta
l) Cardiopulmonary
Resuscitation
1) recognition
2) management - drugs, defibrillators, monitors, ACLS guidelines
3) complications of therapy
4. Central Nervous
System
a) Seizures
b) Coma: Traumatic, Infectious, Metabolic, CVA, Cerebral Hypoxia
1)
c) Drug Intoxication (CNS
Drugs, Carbon Monoxide, Insecticides)
d) Paraplegia, Quadriplegia, Spinal Shock, Autonomic Hyperreflexia
e) Neuromuscular Diseases
f) Tetanus
g) Special Problems of Anesthesia for Neurosurgery
1) increased intracranial
pressure
2) posture
3) air embolism
4) neuroradiological investigative procedures; CT scan, MRI
5) cerebral protection from hypoxia, ischernia, glucose effects
6) meningomyelocele
7) aneurysms and A-V malformations, cerebral vasospasm
8) anesthetic and ventilatory effects on cerebral blood flow and metabolism
9) fluid management
5. Other Entities:
a) Massive Obesity
b) Hepatic Disease
1) preoperative laboratory
values
2) anesthesia choice (hepatocellular disease, ascites, portal hypertension)
3) postoperative hepatic dysfunction, hepatorenal syndrome
4) hepatic transplantation
c) Diabetes Mellitus
1) pathophysiology
2) control of blood glucose
3) elective anesthesia - perioperative management
4) emergency anesthesia - hypoglycernia; hyperglycernia and ketoacidosis
5) hyperosmolar coma
6) pancreas transplantation
d) Renal Disease
1) pathophysiology of renal
disease and uremia
2) anesthetic choice in reduced renal function
3) anesthetic management in renal failure, A-V shunts
4) anesthetic management in renal transplantation
5) postoperative oliguria and anuria
6) inappropriate ADH secretion
7) pharmacokinetic implications
e) Endocrine Disorders
1) pituitary disease
a) hypopituitarism,
pituitary removal - substitution therapy
1) diabetes
insipidus
b) hyperpituitarism
1) acromegaly - airway
management
2) inappropriate ADH
secretion
2) thyroid disease
a) hyperthyroidism
1) metabolic and
circulatory effects
2) anesthetic management
3) thyroid storm
b)
hypothyroidism
1) circulatory and metabolic effects
2) substitution therapy
3) anesthetic implications
3) parathyroid
a) hyperparathyroid;
physiological effects
b) hypoparathyroid; postop manifestations
4) adrenal disease
a)
Cushing's Syndrome
b)
primary aldosteronism
c) Addison's Disease
d) pheochromocytorna
1) circulatory and
metabolic manifestations
2) diagnosis
3) anesthetic management
5) carcinoid syndrome
f) Intestinal Obstruction
1) causes; paralytic ileus;
mechanical; vascular
2) physiological changes; fluid and electrolyte; respiratory
3) anesthesia management: full stomach; fluid therapy; nitrous oxide
g) Hematologic Disorders
1) disease of blood
a) anemias; compensatory
mechanisms
b) potycythemias; primary vs. secondary
c) clotting disorders: congenital, acquired, pharmacologic (anticoagulants and
antagonists)
d) hemoglobinopathies
2) transfusions
a) blood preservation,
storage
b) blood filters and pumps
c) effects of cooling and heating; blood warmers
d) blood components, volume expanders
e) preparation for transfusion: type and cross, type and screen,
uncrossmatched. blood, autologous blood, designated donors
3) reactions to
transfusions
a) febrile
b) allergic
c) hemolytic: acute and delayed
4) complications of
transfusions
a) infections: hepatitis,
AIDS, CMV, others
b) citrate intoxication
c) electrolyte and acid base abnormalities
d) massive transfusion: coagutopathies, hypothermia
e) pulmonary
5) alternatives to
transfusion: hemodilution, sequestration, autotransfusion, blood substitutes
h) Pediatric Anesthesia
1) apparatus: breathing
circuits, humidity, thermal control
2) premedication: drugs, dosage, routes, vehicles
3) agents and techniques
a) anesthetic: actions
different from adults
b) neuromuscular blockers (sensitivity, congenital diseases)
c) regional anesthesia
4) fluid therapy and blood
replacement, physiologic anemia
5) problems in intubation
(full stomach, diaphragmatic hernia, T-E fistula, Pierre-Robin, awake
intubation)
6) neonatal physiology
a) respiratory
1) development, anatomy,
surfactant
2) pulmonary oxygen toxicity
3) pulmonary function
4) lung volumes vs. adult
5) airway differences, infant vs. adult
b) cardiovascular
1) transition, fetal to
adult
2) persistent fetal circulation
c) retinopathy of
prematurity: anesthetic implications
d) metabolism, fluid distribution and renal function
e) thermal regulation (neutral temperature, brown fat)
f) fetal hemoglobin
g) apnea of prematurity
7) congenital heart disease
a) cyanotic defects,
primary pulmonary hypertension
b) acyanotic defects
c) altered uptake/distribution of IV and inhalation anesthetics
d) other anesthetic considerations
8) emergencies in the
newborn
a) diaphragmatic hernia
b) T-E fistula
c) neonatal lobar emphysema
d) pyloric stenosis
e) necrotizing enterocolitis
f)
omphalocele/gastroschisis
g) RDS: etiology, management, ventilation techniques
h) myelomeningocele
9) postoperative analgesia
i) Obstetrical Anesthesia
1) maternal physiology
a) effects on uptake and
distribution
b) respiratory (anatomy, blood gas, acid base)
c) cardiovascular (aorto-caval compression, regulation of uterine blood flow)
d) renal
e) liver (A/G ratio, drug binding)
f) gastrointestinal (gastric acid, motility, anatomic position,
gastroesophageal function)
g) coagulation
h) placenta
1) placental exchange -
gases, 02, C02
2) placental blood flow
2) maternal-fetal
a) pharmacology
1) anesthetic drugs and
adjuvants
2) oxytocics, interactions
3) tocolytics
4) antitoxemic drugs; interactions
5) mechanisms of placental transfer
6) fetal disposition of drugs
7) drug effects on newborn
b) amniotic fluid (L/S
ratio)
c) anesthetic techniques
and risks (elective vs. emergency) (antacids, general, regional, local, nerve
blocks)
d) physiology of labor
e) influence of anesthetic
technique on labor
f) fetal monitoring
3) pathophysiology and
complicated pregnancy
a) problems during
pregnancy
1) anesthesia for the
non-obstetric procedure
2) endocrine (thyroid, diabetes)
3) hypertension
4) rheumatic or congenital heart disease
5) neurologic (seizures, myasthenia, paraplegia)
6) respiratory (asthma)
7) renal
8) Rh and ABO incompatibilities
9) ectopic pregnancy
b) problems of term and
delivery
1) evaluation of fetus
2) toxemia
3) placenta previa
4) supine hypotensive syndrome
5) aspiration of gastric contents
6) amniotic fluid embolism, DIC
7) dystocia and malposition; multiple pregnancy
8) abruptio placenta
9) retained placenta
10) cord prolapse;
11) uterine atony
12) breech presentation
c) resuscitation of newbom
1) evaluation and Apgar
scoring
2) neurobehavioral testing
3) techniques and pharmacology of resuscitation
4) intrauterine surgery
6. Special Problems in:
a) ENT Surgery: Airway
Endoscopy; Microlaryngeal Surgery; Laser Surgery, Hazards, Complications
b) Plastic Surgery
c) Laparoscopic Surgery; Cholecystectomy; Thoracoscopy; Gynecologic Surgery;
Anesthetic Management; Complications
d) Urologic Surgery-, Lithotripsy
e) Ophthalmologic Surgery, Retrobulbar Block; Open Eye Injuries
f) Orthopedic Surgery; Tourniquet Management, Complications
g) Trauma, Burn Management
h) Radiologic Procedures; CT Scan; MRI-Anesthetic Implications, Management
i) Ambulatory Surgery: Patient Selection; Anesthetic Management; Discharge
Criteria
j) Electroconvulsive Therapy
k) Nutrition and Hyperalimentation in the Surgical or Critically Ill Patient
l) Adverse Outcomes: Anesthetic Accidents; Closed Claims Findings; Professional
Liability
m) Costs of Medical/Anesthesia Care