AOBA Anesthesiology common mistakes
AOBA Anesthesiology · Understand the traps and how to avoid them.
On pharmacology items, selecting the drug whose class matches the stem but ignoring the specific pharmacokinetic qualifier (e.g., choosing a long-acting agent for a question asking which drug best suits a brief outpatient procedure, or picking a renally cleared relaxant for a patient with renal failure).
Candidates memorize drug classes as blocks and pattern-match on the class name, then stop reading once a familiar drug appears, so the modifying phrase (onset, duration, organ of elimination, active metabolite) is never applied.
What to do instead
Before answering, underline the qualifier in the stem (duration, route, organ function, patient age) and run a two-step check: does the drug class fit, and does this specific agent's kinetics fit the qualifier? Build a one-page table of onset/duration/elimination for each drug family and rehearse it against qualifier-style stems.
On physiology items, answering from a memorized 'normal value' rather than reasoning through the direction of the perturbation described (e.g., predicting how a shunt, a Valsalva maneuver, or positive-pressure ventilation shifts a measured variable).
Much of physiology is taught as static numbers, so under time pressure candidates retrieve the resting value and treat it as the answer instead of tracing cause and effect through the described scenario.
What to do instead
For any 'what happens to X when Y changes' stem, write the causal chain in three links (intervention, primary physiologic change, measured consequence) before looking at options. Practice by explaining each option's direction of change, not just the correct one.
On preanesthetic evaluation items, reflexively ordering or choosing the maximal test set (full labs, stress testing, echo) for every patient instead of stratifying by the specific risk factors and surgery urgency in the stem.
Candidates conflate 'thorough' with 'correct' and fear missing a workup item, so they choose the most extensive option rather than the one matched to the described risk profile.
What to do instead
For each evaluation stem, first classify the patient's risk tier and the surgery's urgency from the stated facts, then select the option that changes management at that tier. Rehearse the principle that a test is indicated only if a positive or negative result would alter the anesthetic plan.
On equipment and monitoring items, choosing the numerically impressive or higher-technology monitor rather than the one that detects the specific problem described (e.g., selecting a device that measures oxygenation when the stem describes a ventilation or circuit-integrity failure).
Candidates associate 'advanced monitoring' with 'safer' and answer by device prestige rather than by matching the monitored variable to the failure mode in the scenario.
What to do instead
For each monitoring stem, name the physiologic variable at risk first, then choose the device that measures that variable. Make a two-column list pairing common intraoperative failures (hypoventilation, disconnection, embolism, ischemia) with the monitor that detects each earliest.
On airway management items, selecting a technique based on a single feature (e.g., a predicted difficult airway alone) while ignoring the competing constraint in the stem, such as aspiration risk, cervical spine stability, or the need to avoid a sympathetic surge.
Candidates anchor on the most salient keyword ('difficult airway') and answer that algorithm, dropping the second and third constraints that the question deliberately built in.
What to do instead
Before choosing, list every constraint stated in the stem and eliminate any option that fails even one of them. Practice stems that combine two constraints (difficult airway plus full stomach, or difficult airway plus unstable spine) until the habit of checking all constraints is automatic.
On regional anesthesia items, focusing on block technique and landmark/dose while overlooking the complication or contraindication embedded in the stem (e.g., anticoagulation status, local anesthetic systemic toxicity risk, or infection at the site).
Regional questions are often read as pure anatomy or technique recall, so candidates answer the 'how to perform' question and miss the 'is this safe in this patient' question actually being asked.
What to do instead
For every regional stem, run a safety checklist before technique: coagulation status, infection, patient consent/positioning, total local anesthetic dose including adjuncts, and rescue plan for toxicity. Answer the safety question first, then the technique question.
On intraoperative hemodynamic and respiratory items, treating an abnormal number in isolation (e.g., choosing a vasopressor for hypotension) without interpreting it against the described context such as hypovolemia, depth of anesthesia, or mechanical ventilation settings.
Candidates respond to the abnormal value as a standalone trigger and reach for the drug or intervention that 'fixes the number,' skipping the diagnostic step of why the number is abnormal in this scenario.
What to do instead
For each hemodynamic or respiratory stem, state the likely cause in one sentence (preload, contractility, afterload, rhythm, ventilation, or depth) before selecting an intervention. Choose the option that treats the cause, and reject options that only mask the number.
On subspecialty items, applying the general-adult default plan to a patient whose physiology differs (pregnant patient, neonate or infant, patient with elevated intracranial pressure, or patient with severe cardiac dysfunction) instead of adjusting for the altered physiology described.
Most study time is spent on general adult anesthesia, so under pressure candidates retrieve the standard plan and fail to re-derive it for the special population's altered physiology.
What to do instead
For each subspecialty stem, first name the population-specific physiologic difference (e.g., aortocaval compression, immature hepatic/renal clearance, pressure-dependent cerebral perfusion, fixed cardiac output), then choose the plan that respects it. Build a one-page 'what changes' sheet per subspecialty and rehearse it before practice blocks.
On critical care and postoperative items, choosing the intervention that addresses the immediate symptom (e.g., giving a fluid bolus or opioid for a low urine output or pain complaint) without first establishing the diagnosis or excluding a more dangerous cause described in the stem.
Candidates treat postoperative and ICU scenarios as symptom-management questions and skip the diagnostic reasoning step that the stem is actually testing.
What to do instead
For each postoperative or ICU stem, state the differential in order of lethality and choose the option that either confirms or excludes the most dangerous cause before treating symptoms. Practice by writing the top three diagnoses for each scenario before reading the answer choices.
On chronic pain and professional/ethical items, answering from personal opinion or a single remembered guideline number rather than applying the stated principle (e.g., informed consent elements, opioid risk mitigation, or conflict-of-interest disclosure) to the facts given.
These domains feel less 'scientific' than pharmacology or physiology, so candidates rely on intuition or a half-remembered rule and do not systematically apply the governing principle to the scenario.
What to do instead
For chronic pain and professional items, name the governing principle first (beneficence, informed consent, controlled-substance safeguards, scope of practice), then test each option against it. Review the ethical and regulatory frameworks as explicit content, not as common sense.