10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The Pediatric Anesthesiology exam has 200 questions and runs 4 hours.
These 10 free Pediatric Anesthesiology questions are organized by exam domain, so you can see how each part of the Pediatric Anesthesiology Subspecialty Certification blueprint is tested. Reveal the answer and explanation under each question.
Domain 2: Basic Concepts (20-24%)
Question 1
A cardiac catheterization saturation run in a 3-year-old yields systemic arterial saturation 98%, mixed venous saturation 64%, pulmonary arterial saturation 81%, and pulmonary venous saturation 98%. Samples represent a steady state, hemoglobin concentration is the same at all sites, and dissolved oxygen can be neglected. The Fick-derived pulmonary-to-systemic blood-flow ratio and its interpretation are:
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Correct answer: C - Qp:Qs = 2:1, indicating net left-to-right shunting.
Question 2
During resuscitation of a 7-year-old with bowel perforation and shock, arterial testing shows pH 7.09, PaCO2 48 mm Hg, and bicarbonate 14 mmol/L. Serum sodium is 138 mmol/L, chloride 102 mmol/L, albumin 4.0 g/dL, and lactate 6.8 mmol/L. The laboratory's normal anion-gap range, excluding potassium, is 8-12 mmol/L. Interpret the acid-base disturbance.
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Correct answer: C - High-anion-gap metabolic acidosis with superimposed respiratory acidosis.
Domain 3: Pharmacology (3-7%)
Question 3
At completion of surgery in an 8-month-old with normal renal function, quantitative monitoring at the adductor pollicis shows no train-of-four responses and a post-tetanic count of 2. Rocuronium was last given 35 minutes earlier. Ventilation and circulation are stable. Under current U.S. prescribing information, which reversal regimen matches this depth of block?
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Correct answer: A - Sugammadex 4 mg/kg IV, based on actual body weight.
Domain 4: Anesthesia Equipment for Pediatrics (2-6%)
Question 4
An additional heat-and-moisture exchanger is placed between the circle-circuit Y-piece and the tracheal tube of a 3.5-kg infant. Over the next several minutes, end-tidal CO2 rises from 38 to 62 mm Hg. Exhaled tidal volume, respiratory rate, peak airway pressure, temperature, and blood pressure are unchanged. The capnogram retains its usual shape. What equipment change addresses the most likely cause?
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Correct answer: D - Remove the added exchanger and use a low-dead-space humidification arrangement.
Domain 5: Monitoring (2-6%)
Question 5
After topical benzocaine is used during upper gastrointestinal endoscopy in a 13-year-old, SpO2 remains 86% despite administration of 100% oxygen. Two probes at different sites show strong plethysmographic signals. Ventilation and blood pressure are normal. An arterial blood gas reports PaO2 286 mm Hg, PaCO2 38 mm Hg, and a calculated oxygen saturation of 100%. Which measurement would resolve the discrepancy?
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Correct answer: B - Measure the arterial methemoglobin fraction with laboratory co-oximetry.
Domain 6: Preoperative Evaluation (1-5%)
Question 6
Preoperative assessment of a 7-year-old with Down syndrome reveals normal gait, strength, and reflexes. There is no neck pain, change in hand use, or bowel or bladder dysfunction. The child has never had cervical-spine imaging and is scheduled for elective tympanostomy tubes. Regarding cervical-spine assessment, the appropriate plan is to:
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Correct answer: A - Proceed without screening radiographs, using careful cervical positioning during airway management.
Domain 8: Specific Techniques (51-55%)
Question 7
During induction for cardiac catheterization, a 9-month-old with unrepaired tetralogy of Fallot becomes profoundly cyanotic. SpO2 falls from 83% to 57%, blood pressure is 50/24 mm Hg, and heart rate is 178/min. The systolic murmur is now much quieter. Tracheal intubation is confirmed, ventilation is effective with 100% oxygen, and an initial fluid bolus has not restored perfusion. Which vasoactive drug is most likely to improve both systemic pressure and pulmonary blood flow?
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Correct answer: B - Phenylephrine
Question 8
An infant born at 29 weeks' gestation undergoes inguinal hernia repair at a postmenstrual age of 45 weeks. Hemoglobin is 8.6 g/dL. Surgery is completed under awake spinal anesthesia without sedatives or opioids. Ninety minutes later, the infant is feeding, moving both legs, and has had no apnea. How should the anesthetic technique influence the recovery plan?
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Correct answer: C - Continue inpatient cardiorespiratory monitoring despite the uneventful spinal anesthetic.
Question 9
A 5-week-old awaiting pyloromyotomy has received intravenous fluid replacement. Capillary refill and urine output have normalized. Repeat laboratory results are sodium 143 mmol/L, chloride 101 mmol/L, potassium 4.0 mmol/L, bicarbonate 34 mmol/L, and pH 7.49. The surgeon asks to proceed because dehydration and the chloride deficit have improved. What is the appropriate response?
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Correct answer: D - Continue fluid therapy and defer induction until the metabolic alkalosis has resolved.
Question 10
Laparoscopic insufflation in an 11-year-old with an extracardiac Fontan circulation raises central venous pressure from 12 to 20 mm Hg while mean arterial pressure falls from 67 to 43 mm Hg. Airway pressures rise, but SpO2 remains 94%, end-tidal CO2 is 38 mm Hg, and sinus rhythm is unchanged. Blood loss is negligible. Which adjustment most directly reverses the precipitating physiology?
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Correct answer: A - Reduce insufflation pressure and mean airway pressure while maintaining gas exchange.
The rest of the Pediatric Anesthesiology blueprint
The Pediatric Anesthesiology exam also covers these domains. Drill them in the full free practice test:
Domain 1: History (1-3%)
Domain 7: Anesthetic Procedures & Methods (4-8%)
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