Iraqi Board Anesthesia common mistakes
Iraqi Board Anesthesia · Understand the traps and how to avoid them.
When a question gives a drug dose, vaporizer setting, or infusion rate, the candidate answers from the number alone without converting units, checking whether the value is per kg or absolute, or asking whether the described effect (e.g., MAC, context-sensitive half-time) actually fits the stated clinical scenario.
Basic-science pharmacology is often memorized as isolated facts (a MAC value, a half-life) rather than as quantitative relationships, so under time pressure the candidate pattern-matches a familiar number instead of reasoning through the calculation and the units.
What to do instead
For every numeric item, write the units of the given values and the units of the answer before choosing, then do the arithmetic explicitly. Practice a fixed set of calculations (dilution, infusion rate, local anesthetic maximum dose with and without adrenaline, MAC multiples, oxygen delivery) until unit-checking is automatic, and always test the chosen answer against the clinical scenario described.
The candidate manages an airway question by naming a single device (e.g., 'intubate' or 'use a supraglottic airway') rather than working through a structured failed-airway algorithm, and does not state the decision points for maintaining oxygenation, limiting attempts, or proceeding to a surgical airway.
Airway algorithms are learned as lists of devices rather than as a branching sequence with defined limits, so the candidate cannot place the scenario at the correct step or justify the next action when the first plan fails.
What to do instead
Rehearse the airway algorithm aloud as a flowchart: plan A to plan D, with explicit limits (number of attempts, oxygenation targets, when to call for help, when to declare cannot-intubate-cannot-oxygenate). For each practice scenario, state the current step, the evidence that it failed, and the trigger for moving to the next step.
In preoperative assessment items, the candidate focuses on the named diagnosis and misses the question's actual ask, which is often about functional capacity, risk index calculation, or which specific investigation would change management, and so recommends tests reflexively rather than indicating what result would alter the plan.
Candidates equate thoroughness with ordering tests and are trained to recall disease associations rather than to justify each test by its management consequence; risk-stratification tools are memorized by name but not by the variables they contain.
What to do instead
Answer preoperative items in two sentences: what the patient's functional and risk status is, and what the next step changes. Before selecting any investigation, ask 'what will I do differently if this is abnormal?' and reject options that cannot change management. Learn the components of the common risk indices and the accepted indications for cardiac and pulmonary testing.
The candidate describes a regional technique by its name and landmark only, without stating the target nerve or compartment, the expected sensory and motor block, the relevant local anesthetic dose limit, and the specific complication to be monitored; similarly, for monitoring items, the candidate names a monitor without saying what artifact or limitation makes it unreliable in the given patient.
Technique details and monitor limitations are studied as separate lists, so the candidate cannot connect a block to its failure pattern or a monitor to the physiology that confounds it (e.g., hypotension, hypothermia, shivering, electrocautery, low perfusion).
What to do instead
Build one-page summaries per block (target, landmarks, volume and concentration, expected block, complications, contraindications) and per monitor (what it measures, sources of error, when it misleads). For each item, force yourself to name at least one limitation of the chosen answer before confirming it.
For coexisting disease and specialty-surgery items, the candidate applies a generic anesthetic plan and does not adjust for the specific pathophysiology, such as avoiding a drug that worsens a fixed cardiac output, choosing agents in renal or hepatic impairment, or timing extubation and postoperative ventilation for a patient with respiratory disease or raised intracranial pressure.
Physiology is recalled in isolation from pharmacology, so the candidate does not translate a disease state into concrete drug choices, target values, and monitoring priorities; specialty cases are also under-practiced relative to general anesthesia.
What to do instead
For each major comorbidity (ischemic heart disease, aortic stenosis, COPD, renal failure, diabetes, raised intracranial pressure, obesity, obstructive sleep apnea), write the three or four intraoperative goals and the drugs or techniques that threaten them. Practice converting each goal into a specific target (blood pressure range, PaCO2 range, glucose range) and a monitoring choice.
In critical care and resuscitation items, the candidate gives a single intervention (a fluid bolus, a vasopressor, a drug dose) without stating the reassessment endpoint, the sequence relative to other priorities, or the reason the alternative would be harmful in that specific shock state or rhythm.
Resuscitation is memorized as a checklist of actions rather than as a prioritized cycle with defined endpoints, and shock types are not distinguished physiologically, so the candidate cannot rank options when several seem plausible.
What to do instead
Practice the resuscitation cycle explicitly: recognize the problem, intervene, reassess against a named endpoint, and escalate. For each shock category and each arrhythmia, state the first action, the endpoint, and the one intervention that would be wrong and why. Learn current resuscitation guidelines as algorithms with decision points, not as lists.
The candidate answers postoperative-complication items by naming the diagnosis (e.g., 'postoperative nausea and vomiting', 'respiratory depression', 'malignant hyperthermia') but omits the immediate stabilizing action, the confirmatory finding, and the specific treatment, so the answer is diagnostically correct but clinically incomplete.
Candidates treat these items as recall of a label rather than as a management sequence, and they under-estimate how often the question is testing the first 60 seconds of management and the trigger for escalating care.
What to do instead
For each common postoperative complication, rehearse a three-step template: immediate action, key confirmatory finding, definitive treatment plus disposition. Include the drugs and doses you would actually give and the observation that tells you the patient is improving.
The candidate does not engage with professionalism, consent, capacity, communication, or health-system items because they seem like 'soft' questions, and picks the option that is most clinically aggressive or most deferential to authority rather than the one consistent with informed consent, capacity assessment, disclosure of error, and appropriate escalation.
These domains are under-represented in study plans, so candidates lack a decision framework and default to hierarchy or to avoiding conflict, which is usually the wrong answer in ethics items.
What to do instead
Learn a short ethics framework: assess capacity (understand, retain, weigh, communicate), respect informed refusal, disclose harm honestly, escalate through the proper channel, and document. Practice applying it to scenarios involving Jehovah's Witness refusal, obstetric emergency, pediatric consent, and intraoperative error, and always choose the option that preserves patient autonomy and safety over convenience or hierarchy.
The candidate spends disproportionate time on a small number of calculation-heavy or unfamiliar items and leaves later questions unanswered, or changes answers on review without a stated reason, and does not flag uncertain items for a second pass.
Exam technique is rarely practiced under timed conditions, so candidates cannot judge the cost of a long item, and anxiety drives answer-changing without evidence.
What to do instead
Take at least two full-length timed practice papers under exam conditions. Adopt a rule: if an item is not resolved in a set time, mark it, choose the best current answer, and move on. On review, change an answer only when you can name the specific fact that makes the original wrong.
The candidate answers physics and equipment items by recalling a device's name or a formula symbolically but cannot explain the underlying principle, so questions about flow regimes, vaporizer output, breathing-circuit function, scavenging, electrical safety, or capnography waveform interpretation are answered by association rather than by reasoning from the physical law.
Physics is studied as isolated equations without connecting them to the equipment actually used in the operating room, and waveform or circuit questions are not practiced as interpretation tasks.
What to do instead
For each equipment topic, derive the relevant relationship from first principles (e.g., Poiseuille and turbulent flow, Dalton and Henry laws, vapor pressure and splitting ratio, circuit compliance) and then apply it to a concrete clinical question. Practice reading capnography and pressure-volume waveforms by describing the abnormality, its cause, and the corrective action.