Arab Board Anesthesia Final Written common mistakes
Arab Board Anesthesia Final Written · Understand the traps and how to avoid them.
Committing to a single diagnosis on a stem describing an intraoperative crisis (e.g., sudden desaturation, hypotension, or high airway pressure) and answering the first plausible cause, rather than systematically listing and excluding alternatives in the order that would kill the patient fastest.
Crisis stems are written to have several plausible distractors that fit one or two data points; candidates pattern-match to the most familiar keyword instead of applying an airway-breathing-circulation or differential-by-system approach under time pressure.
What to do instead
Practise a fixed mental algorithm for each crisis category (desaturation, hypotension, high peak pressure, hypercarbia, arrhythmia): verbalise the full differential, then use the discriminating data in the stem (bilateral vs unilateral findings, response to a manoeuvre, timing relative to an event) to eliminate options before selecting.
Choosing the 'most correct-sounding' option on dose, timing, or threshold questions instead of the numerically correct one (e.g., local anaesthetic maximum doses, vasopressor infusion concentrations, transfusion triggers, defasciculating or reversal doses).
Candidates rely on vague recollection and pick options that look familiar; numerical pharmacology and threshold facts are under-rehearsed because they feel low-yield compared with concepts.
What to do instead
Build a one-page high-yield numbers sheet (LA max doses with and without adrenaline, sugammadex and neostigmine dosing, epinephrine/phenylephrine infusion ranges, transfusion thresholds, paediatric fluid and ETT sizes, oxygen delivery devices) and rehearse it to recall, not recognition, weekly.
Answering airway questions by selecting a device or plan without first classifying the airway (predictors present or absent, anticipated difficulty, aspiration risk, awake vs asleep, rescue plan) as the stem's findings demand.
Airway algorithms are memorised as flowcharts but not applied to the specific combination of predictors in the stem; candidates jump to 'fibreoptic intubation' or 'videolaryngoscope' without checking whether the question is about plan A, plan B, or rescue.
What to do instead
For every airway stem, explicitly identify: predictors, aspiration risk, whether spontaneous ventilation must be preserved, and which phase of the algorithm the question targets; then select the option consistent with that phase.
Ignoring the obstetric, paediatric, or geriatric physiological context and answering with adult-general principles (e.g., standard rapid sequence dosing in pregnancy, standard fluid volumes in neonates, standard MAC assumptions in the elderly).
Subspecialty stems look familiar and candidates default to general-adult rules; altered pharmacokinetics, altered physiology, and altered risk thresholds are not actively applied.
What to do instead
Create a context checklist (pregnant, neonate/infant, elderly, obese, hepatic/renal failure, cardiac) and for each stem state aloud two or three ways that context changes dosing, monitoring, or technique before answering.
Mismanaging the sequence of resuscitation in perioperative arrest or anaphylaxis stems (e.g., giving vasopressor before adrenaline in anaphylaxis, or omitting early defibrillation or reversible-cause review in arrest).
Candidates know the individual drugs and interventions but not their priority order and timing; stems with several correct-sounding actions test sequencing rather than knowledge of any single item.
What to do instead
Rehearse the anaphylaxis and ALS algorithms as ordered sequences with doses and routes; for each option ask 'is this the next action or a later action?' rather than 'is this a valid action?'.
Selecting a regional or neuraxial technique without checking contraindications and the specific block's complication profile (coagulopathy, infection, raised intracranial pressure, hypovolaemia, pneumothorax risk, phrenic spread, LAST management).
Block questions are often answered on the basis of 'which block covers this surgery' alone; contraindications and complications are recalled separately and not integrated into the decision.
What to do instead
For every regional stem, run a fixed screen: indication, contraindication, anticoagulation timing, expected complications, and rescue/LAST plan; then choose the option that is safe as well as effective.
Misreading the question's exact task (e.g., 'the most likely cause' vs 'the next step' vs 'the most appropriate initial investigation' vs 'which is contraindicated') and answering a different question than the one asked.
Under time pressure, candidates recognise the clinical scenario and answer their own implicit question; stems deliberately include options that are correct answers to adjacent questions.
What to do instead
Underline or mentally re-state the interrogative in each stem before reading the options, and reject any option that answers a different question even if factually true.
Failing to apply monitoring and equipment physics conceptually (e.g., pulse oximetry failure modes, capnography waveform interpretation, ECG artefact, alarm troubleshooting, ventilator pressure-volume relationships) and instead guessing.
Physics and equipment are perceived as low-yield and memorised as isolated facts; candidates cannot translate a described waveform or failure scenario into a cause.
What to do instead
Study monitoring by failure mode: for each monitor, list what causes a false high, false low, or absent reading, and practise interpreting described waveforms and ventilator loops rather than images.
Answering preoperative assessment and perioperative medicine questions by reflex (e.g., ordering all tests, stopping all medications, cancelling surgery) rather than applying risk stratification, guideline-based investigation, and individualised optimisation.
Candidates default to defensive over-investigation or to rigid rules; stems test selective testing, medication continuation decisions (antiplatelets, anticoagulants, ACE inhibitors, SGLT2 inhibitors), and functional capacity assessment.
What to do instead
For each preoperative stem, identify the specific risk being modified, whether the test or change would alter management, and the guideline-based timing; choose the option that changes management, not the most cautious-sounding one.
Treating ethics, professionalism, patient safety, and quality improvement items as 'common sense' and selecting the option that protects the clinician or the institution rather than the one consistent with consent, capacity, disclosure, and system-based error analysis.
These domains are under-rehearsed relative to clinical content; candidates do not know the frameworks (informed consent elements, capacity assessment, duty of candour, root cause analysis, WHO safety checklist, audit vs research) well enough to discriminate options.
What to do instead
Learn the named frameworks and apply them explicitly: for ethics items identify the governing principle and the patient's rights; for safety items classify the error (human vs system) and choose the systems-based corrective action.