A. Basic Sciences

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4) Metabolism, Fluid Distribution and Renal Function

5) Thermal Regulation (Neutral Temperature, Nonshivering Thermogenesis)

6) Fetal Hemoglobin

7) Prematurity, Apnea of Prematurity

8) Bronchopulmonary Dysplasia

g. Congenital Heart and Major Vascular Disease

1) Cyanotic Defects

2) Acyanotic Defects

3) Primary Pulmonary Hypertension

4) Major Vascular Malformations: Coarctation, Persistent Patent Ductus Arteriosus, Vascular Rings.

5) Altered Uptake/Distribution of IV and Inhalation Anesthetics

6) Anesthetic Considerations

a) Cardiac Surgery; Corrective and Palliative

b) Noncardiac Surgery

c) Chronic Congenital Heart Disease, Corrected, Uncorrected, and Palliated

(1) In Childhood Beyond the Newborn and Infant Periods

(2) In Adulthood

h. Emergencies in the Newborn

1) Diaphragmatic Hernia

2) Tracheoesophageal Fistula and Esophageal Atresia

3) Neonatal Lobar Emphysema

4) Pyloric Stenosis

5) Necrotizing Enterocolitis

6) Omphalocele/Gastroschisis

7) Respiratory Distress Syndrome: Etiology, Management, Ventilation Techniques

8) Myelomeningocele

i. Pediatric Medical Problems with Anesthetic Implications

1) Respiratory: Upper Respiratory Infections (Colds, Epiglottitis, Laryngotracheobronchitis), Bronchopulmonary Dysplasia, Cystic Fibrosis

2) Musculoskeletal: Muscular Dystrophies, Myotonias, Etc.

3) Developmental Delay, Cerebral Palsy, Autism

4) Childhood Obesity

5) Endocrine Diseases: Childhood Diabetes, Congenital Adrenal Hyperplasia, Etc.

6) Skeletal Abnormalities with Or without Systemic Implications : Klippel-Feil, Achondroplasia, Marfan’s, Morquio’s, Osteogenesis Imperfect

7) Trisomy 21 and Other Chromosomal Abnormalities

8) Juvenile Rheumatoid Arthritis

9) Anemias: Congenital and Acquired: Iron Deficiency, Physiologic Anemia, Sickle Cell, Thalassemia, Etc.

10) Malignant Hyperthermia in Children; Susceptibility, Associated Diseases, Anesthetic Management of MH Susceptibility, Intraoperative Diagnosis, Treatment

j. Anesthetic Implications for Common Non-Neonatal Pediatric Subspecialty Surgery

1) Otolaryngology: Cleft Lip and Palate, Tonsillectomy and Adenoidectomy, Common Ear Procedures, Peritonsillar Abscess, Flexible and Rigid Bronchoscopy, Diagnostic and Therapeutic Laryngoscopy Techniques (Jet Ventilation, Laser Implications), Airway Foreign Bodies

2) Neurosurgery: Craniotomies for Tumor Or Vascular Malformations, Hydrocephalus, Ventriculoperitoneal Shunts, Craniofacial Procedures, Tethered Spinal Cord, Halo Placement Implications

3) Thoracic Surgery: Anterior Mediastinal Mass, Lung Isolation Techniques, Pectus Excavatum and Carinatum

4) General and Urologic Surgery: Laparotomy vs Laparoscopy, Bowel Surgery, Urologic Surgery (Wilms Tumor, Ureteral Reimplantation, Bladder and Urethral Malformations, Neuroblastoma)

5) Orthopedic Surgery: Fractures and Dislocations, Congenital Hip Dysplasia, Foot and Hand Malformations; Scoliosis Implications and Repair

6) Ophthalmologic: Strabismus, Cataract, Glaucoma Procedures, Etc.

k. Outpatient Pediatric Anesthesia

1) Indications and Contraindications

2) Anesthetic Considerations: Premedication, Induction, Maintenance, Monitoring

3) Postoperative Considerations: Recovery Period, Discharge Criteria, Post-Discharge Monitoring/Follow-Up

l. Postoperative Analgesia

1) Systemic Medications and Routes of Administration, Multimodal Therapy

2) Regional Techniques: Caudal, Epidural, Nerve Blocks

m. Postoperative Nausea and Vomiting: Risk Factors, Prophylaxis, Treatment

n. Pediatric Sedation: Guidelines, Pharmacology, Credentialing, Indications, Monitoring, Complications

o. Pediatric Anesthesia Outside the Operating Rooms: Diagnostic and Interventional Radiologic Procedures, Gastroenterology Laboratory, MRIs, Radiation Therapy

3. Obstetric Anesthesia

a. Maternal Physiology

1) Effects of Pregnancy on Uptake and Distribution

2) Respiratory (Anatomy, Lung Volumes and Capacities, Oxygen Consumption, Ventilation, Blood Gases, Acid Base)

3) Cardiovascular (Aorto-Caval Compression, Regulation of Uterine Blood Flow)

4) Renal

5) Liver (Albumin/Globulin Ratio, Protein Binding of Drugs)

6) Gastrointestinal (Gastric Acid, Motility, Anatomic Position, Gastroesophageal Sphincter Function)

7) Hematology (Blood Volume, Plasma Proteins, Coagulation)

8) Placenta

a) Placental Exchange - O2, CO2

b) Placental Blood Flow

c) Barrier Function

b. Maternal-Fetal Considerations

1) Pharmacology

a) Anesthetic Drugs and Adjuvants

b) Oxytocic Drugs (Indications, Adverse Effects)

c) Tocolytic Drugs (Indications, Adverse Effects)

d) Antiseizure Drugs; Interactions (Magnesium Sulfate)

e) Mechanisms of Placental Transfer, Placental Transfer of Specific Drugs

f) Fetal Disposition of Drugs

g) Drug Effects on Newborn

2) Amniotic Fluid (Amniocentesis, Oligohydramnios, Polyhydramnios)

3) Antepartum Fetal Assessment and Therapy (Ultrasonography, FHR Monitoring, Nonstress Test, Stress Test, Biophysical Profile)

4) Anesthetic Techniques and Risks (Elective vs. Emergency, General vs. Regional)

a) Systemic Medications: Opioids, Sedatives, Inhalational Agents

b) Regional Techniques

(1) Epidural, Caudal, Spinal, Combined Spinal/Epidural

(2) Paracervical Block, Lumbar Sympathetic Block, Pudendal Block

c) Complications (Aspiration, Nerve Palsies)

5) Physiology of Labor (Metabolism, Respiration, Cardiovascular, Thermoregulation)

6) Influence of Anesthetic Technique on Labor

7) Cesarean Delivery: Indications, Urgent/Emergent, Anesthetic Techniques and Complications, Difficult Airway, Aspiration Prophylaxis

c. Pathophysiology of Complicated Pregnancy

1) Problems During Pregnancy and Delivery

a) Anesthesia for Cerclage or Non-Obstetric Surgery

b) Ectopic Pregnancy

c) Spontaneous Abortion

d) Gestational Trophoblastic Disease (Hydatid Mole)

e) Autoimmune Disorders (Lupus, Antiphospholipid Syndrome)

f) Endocrine (Thyroid, Diabetes, Pheochromocytoma)

g) Heart Disease (Valvular Disorders, Pulmonary Hypertension, Congenital Heart Disease, Arrhythmias, Cardiomyopathy)

h) Hematologic (Sickle Cell Anemia, Idiopathic Thrombocytopenic Purpura, Von Willebrand Disease, Disseminated Intravascular Coagulation (DIC), Anticoagulant Therapy, Rh and ABO Incompatibility)

i) Hypertension (Chronic, Pregnancy-Induced)

j) Neurologic (Seizures, Myasthenia, Spinal Cord Injury, Multiple Sclerosis, Subarachnoid Hemorrhage)

k) Respiratory (Asthma, Respiratory Failure)

l) Renal

m) Human Immunodeficiency Virus Infection

2) Problems of Term and Delivery

a) Intrapartum Fetal Assessment (Fetal Heart Rate Monitoring, Fetal Scalp Blood Gases, Fetal Pulse Oximetry)

b) Preeclampsia and Eclampsia

c) Supine Hypotensive Syndrome

d) Aspiration of Gastric Contents

e) Embolic Disorders (Amniotic Fluid Embolism, Pulmonary Thromboembolism)

f) Antepartum Hemorrhage (Placenta Previa, Abruptio Placenta, Uterine Rupture)

g) Postpartum Hemorrhage (Uterine Atony, Placenta Accreta)

h) Cord Prolapse

i) Retained Placenta

j) Dystocia, Malposition, and Malpresentation (Breech, Transverse Lie)

k) Maternal Cardiopulmonary Resuscitation

l) Fever and Infection

m) Preterm Labor

n) Vaginal Birth After Cesarean Section (VBAC)

o) Multiple Gestation

3) Resuscitation of Newborn

a) Apgar Scoring

b) Umbilical Cord Blood Gas Measurements

c) Techniques and Pharmacology of Resuscitation

d) Intrauterine Surgery (Maternal and Fetal Considerations, Intrauterine Fetal Resuscitation)

4. Otorhinolaryngology (ENT) Anesthesia: Airway Endoscopy; Microlaryngeal Surgery; Laser Surgery, Hazards, Complications (Airway Fires, Etc.)

5. Anesthesia For Plastic Surgery, Liposuction

6. Anesthesia For Laparoscopic Surgery; Cholecystectomy; Gynecologic Surgery; Gastric Stapling; Hiatus Hernia Repair; Anesthetic Management; Complications

7. Ophthalmologic Anesthesia, Retrobulbar and Peribulbar Blocks; Open Eye Injuries

8. Orthopedic Anesthesia; Tourniquet Management, Complications, Regional Vs. General Anesthesia

9. Trauma, Burn Management, Mass Casualty, Biological Warfare

10. Anesthesia for Ambulatory Surgery

a. Patient Selection and Preoperative Management

b. Anesthetic Management

c. Discharge Criteria and Postoperative Follow-Up, Including Continuous Nerve Blocks

d. Office-Based Anesthesia: Equipment, Safety, Organization, Patient Management

11. Geriatric Anesthesia / Aging

a. Pharmacological Implications, MAC Changes

b. Physiological Implications: CNS, Circulatory, Respiratory, Renal, Hepatic

12. Critical Care

a. Shock States

1) Etiology, Classification, Pathophysiology

2) Septic Shock and Life-Threatening Infection

3) Systemic Inflammatory Response Syndrome

4) Multiple Organ Dysfunction Syndrome

b. Poisoning and Drug Overdose

c. Near-Drowning

d. Infection Control

1) General and Universal Precautions

2) Needle Stick Injury

3) Catheter Sepsis

4) Nosocomial Infections

5) Antibiotics: Antibacterial, Antifungal, Antiviral, Antiparasitic; Antimicrobial Resistance

E. Special Problems or Issues in Anesthesiology

1. Electroconvulsive Therapy

2. Organ Donors: Pathophysiology and Clinical Management

3. Radiologic Procedures; CT Scan; MRI-Anesthetic Implications/Management, Anesthesia in Locations Outside the Operating Rooms

4. Ethics, Practice Management, and Medicolegal Issues

a. Professionalism and Credentialing, Licensure

b. Ethics, Advance Directives/Do Not Resuscitate (DNR) Orders; Patient Privacy Issues, e.g., Health Insurance Portability and Accountability Act (HIPAA)

c. Malpractice: Definition, Legal Actions and Consequences, National Practitioner Database, Closed Claims Findings, Anesthetic Accidents, Professional Liability Insurance

d. Practice Management; Medicare/Medicaid Requirements

e. Primary Certification, Recertification, Maintenance of Certification and Related Issues (Professional Standing, Lifelong Learning, Cognitive Knowledge, Clinical Practice Assessment, Systems-Based Practice)

f. Costs of Medical/Anesthesia Care, Operating Room Management

g. Patient Safety

1) Definitions: Medical Error, Adverse Event, Sentinel Event

2) Medication Errors: Assessment and Prevention

3) Reporting: Mandatory and Voluntary Systems, Legal Requirements

4) Disclosure of Errors to Patients

5) Safety Practices: Process-Based, Evidence-Based

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