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Pediatric Anesthesiology Examination | |||
Revised – November 2019 | |||
Pediatric Anesthesiology Examination | The Content Outline for the Pediatric Anesthesiology Examination reflects the subject matter for the | ||
Pediatric Anesthesiology subspecialty. It is divided into five sections including Basic Science, Organ | |||
Based Basic and Clinical Sciences, Clinical Subspecialties, Clinical Science of Anesthesia, and Special | |||
Problems or Issues. The examination covers material from all of these sections. The outline reflects | |||
disease states, management considerations, and issues relatively unique to the pediatric patient. The | |||
subspecialty board certified pediatric anesthesiologist is expected to have knowledge within each of | |||
these categories and topics. | |||
[https://www.theaba.org/pdfs/PA_Content_Outline.pdf Pediatric Anesthesiology Examination Content Outline] | |||
(November 2019) | |||
As appropriate, items should be considered to include the changes that occur throughout the growth and development of the pediatric patient. | As appropriate, items should be considered to include the changes that occur throughout the growth and development of the pediatric patient. | ||
==I. BASIC SCIENCE== | ==I. BASIC SCIENCE== | ||
A. Anatomy | A. Anatomy | ||
:1. General Development | :1. General Development | ||
::a | ::a. Airway | ||
::b | ::b. Body habitus | ||
::c | ::c. Water, volume, and blood composition | ||
:2. Anatomy for Procedures | :2. Anatomy for Procedures | ||
::a | ::a. Airway management | ||
::b | ::b. Central neuraxial blockade | ||
::c | ::c. Peripheral nerve blockade | ||
::d | ::d. Vascular cannulation | ||
B. Physics and Anesthesia Equipment | B. Physics and Anesthesia Equipment | ||
:1. Respiration | :1. Respiration | ||
::a | ::a. Breathing circuits | ||
::b | ::b. Ventilation devices and techniques | ||
:2. Methods for Monitoring | :2. Methods for Monitoring | ||
::a | ::a. Brain, spinal cord, and neuromuscular function | ||
::b | ::b. Cardiac rhythm and vascular pressures | ||
::c | ::c. Oxygenation, gas concentration, and ventilation | ||
::d | ::d. Temperature | ||
C. Anesthetic Pharmacology: Physiologic States, Pathophysiologic States and Adverse Effects | :3. Ultrasound: Physics and Clinical applications | ||
C. Anesthetic Pharmacology: Physiologic States, Pathophysiologic States and | |||
Adverse Effects, Development Pharmacology | |||
:1. Pharmacokinetics and Pharmacodynamics | :1. Pharmacokinetics and Pharmacodynamics | ||
::a | ::a. Blood-brain barrier | ||
::b | ::b. Drug absorption | ||
::c | ::c. Drug distribution | ||
::d | ::d. Neuromuscular system | ||
::e | ::e. Biotransformation and excretion | ||
::f | ::f. Pharmacogenetics | ||
:2. Non-opioid Analgesics | :2. Non-opioid Analgesics | ||
:3. Opioid Analgesics | :3. Opioid Analgesics | ||
Line 47: | Line 55: | ||
:9. Sympathetic and Parasympathetic Agents | :9. Sympathetic and Parasympathetic Agents | ||
:10. Agents Affecting Coagulation | :10. Agents Affecting Coagulation | ||
==II. ORGAN-BASED BASIC AND CLINICAL SCIENCES== | ==II. ORGAN-BASED BASIC AND CLINICAL SCIENCES== | ||
A. Respiratory System | A. Respiratory System | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
::b | ::b. Respiratory mechanics, ventilation, and lung volumes | ||
::c | ::c. Oxygen transport | ||
::d | ::d. Surfactant, surface activity, and lung mechanics | ||
::e | ::e. Lung physiology | ||
::: | |||
::: | :::1. surfactant and surface tension | ||
::: | :::2. metabolism | ||
:::3. ventilation / perfusion matching | |||
:2. Clinical Sciences | :2. Clinical Sciences | ||
::a | ::a. Obstructive disease | ||
::: | :::1. upper airway | ||
::: | :::2. tracheobronchial | ||
::: | :::3. parenchymal | ||
::b | ::b. Restrictive disease | ||
::: | :::1. pleural | ||
::: | :::2. neurologic | ||
::: | :::3. musculoskeletal | ||
::c | ::c. Anesthesia for thoracic procedures | ||
::: | :::1. one lung ventilation | ||
::: | :::2. video-assisted thoracoscopy | ||
::: | :::3. mediastinal masses | ||
::: | :::4. chest wall surgery / reconstruction | ||
:::5. lung Transplantation | |||
B. Cardiovascular System | B. Cardiovascular System | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
::b | ::b. Fetal, transitional, and adult circulation | ||
::c. Benign heart murmur | |||
:2. Clinical Science | :2. Clinical Science | ||
:a | ::a. General considerations | ||
::: | :::1. cardiovascular effects on anesthetic uptake and delivery | ||
::: | :::2. anesthetic effects on the cardiovascular system | ||
::: | :::3. vasoactive medications | ||
::b | ::b. Disease states | ||
::: | :::1. acyanotic lesions | ||
::: | :::2. cyanotic lesions | ||
::: | :::3. palliative procedures | ||
::: | :::4. pulmonary hypertension | ||
::: | :::5. infectious diseases | ||
::: | :::6. cardiomyopathies | ||
::: | :::7. pericardial disease | ||
::: | :::8. intracardiac masses | ||
::: | :::9. arrhythmic lesions | ||
::: | :::10. heart transplantation | ||
::c | ::c. Anesthesia for cardiac procedures | ||
::: | :::1. complete anatomic and physiological repairs | ||
::: | :::2. single ventricle procedures | ||
::: | :::3. palliation surgery | ||
::: | :::4. management and consequences of cardiopulmonary bypass | ||
::: | :::5. deep hypothermic circulatory arrest | ||
::: | :::6. anesthesia for pacemaker / implantable cardiac defibrillator insertion and | ||
::: | replacement | ||
:d | :::7. anesthesia for diagnostic, interventional and electrophysical procedures | ||
:e | :d. Anesthesia for the adult with congenital heart disease | ||
:e. Cardiopulmonary resuscitation | |||
:f. Anesthesia for non-cardiac procedures in child with congenital heart disease | |||
C. Central and Peripheral Nervous Systems | C. Central and Peripheral Nervous Systems | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
::: | :::1. brain, fontanelles, cranial sutures, and spinal cord | ||
::: | :::2. myelinization, autonomic nervous systems, and pain pathways | ||
::: | :::3. neurodegenerative changes after anesthesia | ||
::b | ::b. Neurophysiology | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. General considerations | ||
::: | :::1. intracranial pressure and blood flow | ||
::: | :::2. pharmacology of diuretics, steroids, and anticonvulsant medications, | ||
::b | ::b. Disease states | ||
::: | :::1. autism, developmental delay, and attention-deficit hyperactivity disorder | ||
::: | :::2. hydrocephalus | ||
::: | :::3. tumors | ||
::: | :::4. seizure disorders | ||
::: | :::5. cerebrovascular disorders | ||
::: | :::6. open and closed head injuries | ||
::: | :::7. spinal cord disorders | ||
::: | :::8. neurodegenerative disorders | ||
::: | :::9. spasticity | ||
::: | :::10. Chiari malformations | ||
::c | ::c. Anesthesia for neurosurgical procedures | ||
::: | :::1. seizure surgery | ||
::: | :::2. intracranial tumors and vascular lesions | ||
::: | :::3. craniofacial reconstruction / cranioplasty | ||
::: | :::4. meningomyelocele / spinal surgery | ||
::: | :::5. neurologic imaging | ||
D. Gastrointestinal System | D. Gastrointestinal System | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Esophageal, stomach and intestine disorders | ||
::: | :::1. abdominal wall defects | ||
::: | :::2. intestinal rotation defects | ||
::: | :::3. atresias, stenoses and webs | ||
::: | :::4. inflammatory states | ||
::: | :::5. duplications and cysts | ||
::: | :::6. hernias | ||
::: | :::7. necrotizing enterocolitis | ||
::b | ::b. Liver, biliary tract and spleen disorders | ||
::c | ::c. Anorectal disorders | ||
::d | ::d. Morbid obesity / bariatric surgery | ||
::e | ::e. Gastrointestinal endoscopy | ||
::f | ::f. Esophageal / gastrointestinal foreign bodies | ||
::g | ::g. Liver, intestinal, and multivisceral transplantation | ||
E. Renal / Urinary | E. Renal/Urinary | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
::b | ::b. Homeostasis functions | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Renal failure | ||
::b | ::b. Phimosis and hypospadias | ||
::c | ::c. Ureteropelvic junction obstruction | ||
::d | ::d. Vesicoureteral reflux | ||
::e | ::e. Bladder exstrophy | ||
::f | ::f. Renal transplantation | ||
F. Endocrine/Metabolic | F. Endocrine/Metabolic | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
::b | ::b. Puberty and variants | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Adrenal disorders | ||
::b | ::b. Diabetes mellitus | ||
::c | ::c. Diabetes insipidus | ||
::d | ::d. Disorders of sodium regulation | ||
::e | ::e. Pheochromocytoma | ||
::f | ::f. Thyroid disorders | ||
::g) | ::g. 22q.11 deletion syndrome (DiGeorge) | ||
G. Hematology/Oncology | G. Hematology/Oncology | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
::a | ::a. Prenatal and postnatal development | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Hematology | ||
::: | :::1. anemias | ||
::: | :::2. coagulation disorders | ||
::b | ::b. Oncology | ||
::: | :::1. leukemia | ||
::: | :::2. neuroblastoma | ||
::: | :::3. retinoblastoma | ||
::: | :::4. sarcomas / osteosarcomas | ||
::: | :::5. Wilms tumor | ||
::c | ::c. Chemotherapeutic agents and side effects | ||
::d | ::d. Radiotherapy | ||
::e | ::e. Bone marrow and stem cell transplants | ||
::: | :::1. graft versus host disease | ||
::f | ::f. Immunologic disorders (congenital and acquired) | ||
H. Genetics | H. Genetics | ||
:1. Anatomy and Physiology | :1. Anatomy and Physiology | ||
:2. Clinical Sciences | :2. Clinical Sciences | ||
::a | ::a. Chromosomal abnormalities | ||
::b | ::b. Craniofacial syndromes | ||
::c | ::c. Effects of environmental agents | ||
::d | ::d. Endocrine disorders | ||
::e | ::e. Immunologic disorders | ||
::f | ::f. Inborn errors of metabolism | ||
::g | ::g. Malignant hyperthermia | ||
::h | ::h. Mitochondrial myopathies | ||
::i | ::i. Myopathic disorders | ||
::j | ::j. Myotonias | ||
::k | ::k. Muscular dystrophies | ||
::l | ::l. Neurologic disorders | ||
::m | ::m. Overgrowth syndromes | ||
::n | ::n. Osteochondrodysplastic syndromes | ||
::o | ::o. Skin and connective tissue disorders | ||
==III. CLINICAL SUBSPECIALTIES== | ==III. CLINICAL SUBSPECIALTIES== | ||
A. Fetal | A. Fetal | ||
:1. General Considerations | :1. General Considerations | ||
::a | ::a. Fetal oxygenation | ||
::b | ::b. Fetal pain and stress | ||
::c | ::c. Fetal monitoring | ||
:2. Clinical Science | :2. Clinical Science | ||
:a | ::a. Fetal surgery | ||
:b | ::b. Ex utero intrapartum treatment (EXIT) procedure | ||
B. Neonatal | B. Neonatal | ||
:1. General Considerations | :1. General Considerations | ||
::a | ::a. Apgar scoring | ||
::b | ::b. Post conceptional age and organ system maturity | ||
::c | ::c. Effects of anesthesia and surgery on cognitive development | ||
::d | ::d. Stress response | ||
::e | ::e. Transport medicine | ||
::f | ::f. Neonatal resuscitation | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Surgical disease states | ||
:: | :::1. amniotic bands | ||
:: | :::2. congenital cystic adenomatoid malformation | ||
:: | :::3. congenital diaphragmatic hernia | ||
:: | :::4. duodenal atresia | ||
:: | :::5. hernia | ||
:: | :::6. hypertrophic pyloric stenosis | ||
:: | :::7. myelomeningocele | ||
:: | :::8. necrotizing enterocolitis | ||
:: | :::9. neonatal lobar emphysema | ||
:: | :::10. omphalocele and gastroschisis | ||
:: | :::11. sacrococcygeal teratoma | ||
:: | :::12. tracheo-esophageal fistula | ||
:: | :::13. vein of Galen malformation | ||
:b | ::b. Medical disease states | ||
:: | :::1. apnea and bradycardia | ||
:: | :::2. anemia | ||
:: | :::3. bronchopulmonary dysplasia | ||
:: | :::4. failure to thrive | ||
:: | :::5. intraventricular hemorrhage | ||
:: | :::6. kernicterus | ||
:: | :::7. persistent pulmonary hypertension | ||
:: | :::8. persistent fetal circulation | ||
:: | :::9. retinopathy of prematurity | ||
:::10. neonatal abstinence syndrome | |||
C. Painful Disease States | C. Painful Disease States | ||
:1. Pathophysiology | :1. Pathophysiology | ||
::a | ::a. Procedural, postoperative, and posttraumatic pain | ||
::b | ::b. Pain in the neonate | ||
::c | ::c. Chronic pain states | ||
:2. Treatment | :2. Treatment | ||
::a | ::a. Regional analgesia | ||
::b | ::b. Pharmacologic and non-pharmacologic techniques of pain management | ||
::c | ::c. Complementary and alternative pain management | ||
D. Otolaryngology | D. Otolaryngology | ||
:1. Airway Procedures | :1. Airway Procedures | ||
::a | ::a. Bronchoscopic procedures | ||
::b | ::b. Tonsillectomy, adenoidectomy, and abscess drainage | ||
::c | ::c. Tracheotomy | ||
::d | ::d. Choanal atresia repair | ||
::e | ::e. Laryngotracheal reconstruction | ||
::f | ::f. Laser procedures | ||
:2. Otologic Procedures | :2. Otologic Procedures | ||
::a | ::a. Myringotomy and tubes | ||
::b | ::b. Cochlear implant, tympanoplasty, and mastoidectomy | ||
E. Plastic and Oral-Maxillary Facial Surgery | E. Plastic and Oral-Maxillary Facial Surgery | ||
:1. Coexisting Diseases | :1. Coexisting Diseases | ||
::a | ::a. Craniofacial syndromes | ||
::b | ::b. Congenital heart disease | ||
::c | ::c. Increased intracranial pressure | ||
::d | ::d. Obstructive sleep apnea | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Craniosynostosis repairs | ||
::b | ::b. Cleft repairs | ||
::c | ::c. Hypoplasia repairs | ||
::d | ::d. Syndactyly repairs | ||
::e | ::e. Tissue flaps and tissue expanders | ||
::f | ::f. Vascular malformations | ||
::g | ::g. Mandibular repairs | ||
F. Ophthalmology | F. Ophthalmology | ||
:1. General Considerations | :1. General Considerations | ||
::a | ::a. Physiology | ||
::b | ::b. Pharmacology of ophthalmologic medications | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Enucleations | ||
::b | ::b. Retinopathy of prematurity | ||
::c | ::c. Trauma | ||
::d | ::d. Tear duct probing | ||
::e | ::e. Strabismus repair | ||
G. Orthopedic Surgery | G. Orthopedic Surgery | ||
:1. Coexisting Diseases | :1. Coexisting Diseases | ||
::a | ::a. Cardiopulmonary disease | ||
::b | ::b. Congenital malformations | ||
::c | ::c. Myopathic disease | ||
::d | ::d. Neuromuscular disease | ||
::e | ::e. Oncologic disease | ||
::f | ::f. Systemic disease | ||
:2. Clinical Science | :2. Clinical Science | ||
::a | ::a. Anterior, posterior, and combined spine fusion | ||
::b | ::b. Chest wall reconstruction | ||
::c | ::c. Tourniquet management | ||
H. Trauma and Burns | H. Trauma and Burns | ||
:1. Trauma | :1. Trauma | ||
::a | ::a. Age-related mechanisms and associated injuries | ||
::b | ::b. Incidence, patterns, implications of abuse | ||
::c | ::c. Management of the polytrauma victim | ||
::d | ::d. Hypothermia and submersion injury | ||
:2. Burns | :2. Burns | ||
::a | ::a. Types, mechanisms, locations and implications of injuries | ||
::b | ::b. Inhalation injuries/airway management | ||
::c | ::c. Fluid resuscitation and calculating burn surface area | ||
::d | ::d. Anesthetic and pain management of the burn patient | ||
==IV. CLINICAL SCIENCE OF ANESTHESIA== | ==IV. CLINICAL SCIENCE OF ANESTHESIA== | ||
A. Evaluation and Preoperative Preparation of the Pediatric Patient (See Specific Disease States) | A. Evaluation and Preoperative Preparation of the Pediatric Patient (See Specific | ||
Disease States) | |||
:1. Normal developmental milestones | :1. Normal developmental milestones | ||
:2. Evaluation of Coexisting Disease | :2. Evaluation of Coexisting Disease | ||
::a | ::a. Cerebral palsy | ||
::b | ::b. Cystic fibrosis | ||
::c | ::c. Down syndrome | ||
::d | ::d. Gastro-esophageal reflux | ||
::e | ::e. Latex allergy | ||
::f | ::f. Mediastinal masses | ||
::g | ::g. Reactive airway disease | ||
::h | ::h. Upper respiratory tract infections | ||
::i | ::i. Congenital heart disease | ||
::j | ::j. Autism spectrum disorders | ||
:3. Physical Examination | :3. Physical Examination | ||
:4. Laboratory Testing | :4. Laboratory Testing | ||
Line 347: | Line 359: | ||
C. Regional Anesthesia and Analgesia | C. Regional Anesthesia and Analgesia | ||
:1. Pharmacology and Toxicity of Local Anesthetics | :1. Pharmacology and Toxicity of Local Anesthetics | ||
:2. Central Neuraxial Blockade: Indications, Contraindications, Techniques, Adjuvants, and Controversies | :2. Central Neuraxial Blockade: Indications, Contraindications, Techniques, Adjuvants, | ||
:3. Peripheral Nerve Blockade: Indications, Contraindications, Techniques, Adjuvants, and Controversies | and Controversies | ||
:3. Peripheral Nerve Blockade: Indications, Contraindications, Techniques, Adjuvants, | |||
and Controversies | |||
D. General Anesthesia | D. General Anesthesia | ||
:1. Stages and Signs of Anesthesia | :1. Stages and Signs of Anesthesia | ||
:2. Induction Techniques | :2. Induction Techniques | ||
:3. Airway Management | :3. Airway Management | ||
::a | ::a. Indications, techniques, limitations, and devices for mask ventilation | ||
::b | ::b. Indications, techniques, limitations, and devices for endotracheal intubation | ||
::c | ::c. Management of the difficult airway | ||
::d | ::d. Methods for single lung ventilation and lung separation | ||
E. Complications of Anesthesia | E. Complications of Anesthesia | ||
:1. Airway Obstruction | :1. Airway Obstruction | ||
Line 381: | Line 395: | ||
:4. Management of the Post Anesthetic Care Unit | :4. Management of the Post Anesthetic Care Unit | ||
H. Monitored Anesthesia Care and Sedation | H. Monitored Anesthesia Care and Sedation | ||
I. Acute and Chronic Pain Management | |||
==V. SPECIAL PROBLEMS OR ISSUES== | ==V. SPECIAL PROBLEMS OR ISSUES== | ||
A. | A. Special Surgical Procedures | ||
B. Professional Issues | B. Professional Issues | ||
:1. | :1. Ethical and Legal Obligations of Pediatric Anesthesia Care and Research | ||
:2. Teaching, Supervision, and the Anesthesia Care Team | :2. Teaching, Supervision, and the Anesthesia Care Team | ||
:3. Practice-based Learning and Improvement | :3. Practice-based Learning and Improvement | ||
:4. Continuous Quality Improvement | :4. Continuous Quality Improvement | ||
C. Principles of Biostatistics and Pediatric Study Design | |||
D. Substance Abuse |