FMGE Anesthasia Syllabus

Anesthasia syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Anesthasia in FMGE, not a summary of it.

1. 1

   Introduction to Anesthesia

   2 topics

   • History of Anesthesia
     • Evolution of anesthesia techniques and drugs
   • Principles of Anesthesia
     • Goals of anesthesia (analgesia, amnesia, muscle relaxation, and homeostasis)
     • Stages of anesthesia
     • Monitoring techniques
2. 2

   Preoperative Evaluation

   3 topics

   • Preoperative assessment
     • Patient history (medical, surgical, and anesthesia history), physical examination, and laboratory investigations
   • Assessment of comorbidities
     • Cardiovascular, respiratory, renal, hepatic, and endocrine disorders
   • Optimization of medical conditions
     • Preoperative medication management, control of hypertension, diabetes, and other systemic diseases
3. 3

   Anesthetic Pharmacology

   3 topics

   • General Anesthetics
     • Inhalational Anesthetics
     • Intravenous Anesthetics
     • Adjunctive Drugs
   • Local Anesthetics
     • Mechanism of Action
     • Pharmacokinetics
     • Types
     • Adverse Effects
   • Neuromuscular Blocking Agents
     • Depolarizing Agents
     • Non-Depolarizing Agents
4. 4

   Anesthetic Techniques

   3 topics

   • General anesthesia
     • Inhalational anesthesia
     • Intravenous anesthesia
     • Balanced anesthesia techniques
   • Regional anesthesia
     • Spinal anesthesia
     • Epidural anesthesia
     • Peripheral nerve blocks
     • Local infiltration anesthesia
   • Monitored anesthesia care (MAC)
     • Sedation techniques for conscious sedation during minor procedures
5. 5

   Airway Management

   3 topics

   • Endotracheal Intubation
     • Indications
     • Equipment
     • Techniques
     • Complications
   • Supraglottic Airway Devices
     • Laryngeal Mask Airway (LMA)
     • Intubating LMA
     • Complications
   • Difficult Airway Management
     • Recognition of Difficult Airway
     • Strategies
     • Emergency Airway Algorithms
6. 6

   Anesthetic Complications

   3 topics

   • Hypotension
     • Causes
     • Diagnosis
     • Management
   • Hypoxemia
     • Causes
     • Diagnosis
     • Management
   • Malignant hyperthermia
     • Pathophysiology
     • Clinical features
     • Diagnosis
     • Management
7. 7

   Postoperative Care

   2 topics

   • Post-anesthesia care unit (PACU)
     • Monitoring (vital signs, pain assessment)
     • Management of postoperative complications (pain, nausea, vomiting)
     • Discharge criteria
   • Pain management
     • Analgesic techniques (opioids, nonsteroidal anti-inflammatory drugs)
     • Patient-controlled analgesia (PCA)
     • Regional anesthesia techniques for postoperative pain relief
8. 8

   Special Situations in Anesthesia

   3 topics

   • Pediatric Anesthesia
     • Anesthetic considerations in children (dose calculation, airway management)
     • Management of congenital abnormalities
   • Obstetric Anesthesia
     • Anesthesia techniques for cesarean section (spinal anesthesia, epidural anesthesia)
     • Management of preeclampsia
     • Fetal monitoring
   • Geriatric Anesthesia
     • Anesthetic considerations in elderly patients (physiological changes, comorbidities)
     • Management of postoperative delirium
9. 9

   Anesthesia for Specific Surgical Procedures

   3 topics

   • Cardiothoracic anesthesia
     • Anesthetic management for coronary artery bypass grafting (CABG)
     • Anesthetic management for valve replacement
     • Anesthetic management for thoracic surgery
   • Neurosurgical anesthesia
     • Anesthetic considerations for craniotomy
     • Anesthetic considerations for intracranial aneurysm clipping
     • Anesthetic considerations for spinal surgery
   • Orthopedic anesthesia
     • Anesthetic techniques for joint replacement surgery (total hip arthroplasty)
     • Anesthetic techniques for joint replacement surgery (total knee arthroplasty)
     • Management of acute pain
10. 10

    Emerging Trends in Anesthesia

    2 topics

    • Enhanced Recovery after Surgery (ERAS)
      • Multimodal perioperative care pathways to optimize patient outcomes and reduce length of hospital stay
    • Point-of-Care Ultrasound (POCUS)
      • Use of ultrasound for vascular access
      • Use of ultrasound for nerve localization
      • Use of ultrasound for diagnosis of pneumothorax during anesthesia

Anesthasia flashcards for FMGE

22 of 51 cards from the Anesthasia deck — real questions with worked answers.

1. Who performed the first successful public demonstration of ether anesthesia, and where and when?

   William T.G. Morton, on October 16, 1846, at the Massachusetts General Hospital (the 'Ether Dome'), administering ether to a patient operated on by John Collins Warren.

2. What are the three core components (the 'triad') of general anesthesia?

   Hypnosis/unconsciousness (amnesia), analgesia (loss of pain), and muscle relaxation/akinesia (areflexia). Some texts add suppression of autonomic/stress responses.

3. What is the Minimum Alveolar Concentration (MAC) of an inhalational anesthetic?

   The alveolar concentration of an inhaled agent at 1 atm that prevents movement in response to a surgical (skin) incision in 50% of patients. It is a measure of potency (lower MAC = more potent).

4. List the four stages of general anesthesia (Guedel's classification).

   Stage I: analgesia (induction to loss of consciousness); Stage II: excitement/delirium; Stage III: surgical anesthesia; Stage IV: medullary depression/overdose (respiratory and cardiac arrest).

5. What does the ASA Physical Status Classification I through VI represent?

   I: normal healthy; II: mild systemic disease; III: severe systemic disease; IV: severe disease that is a constant threat to life; V: moribund, not expected to survive without operation; VI: brain-dead organ donor. Suffix 'E' = emergency.

6. According to standard guidelines, what are the preoperative fasting times for clear liquids, breast milk, and solid food/non-human milk?

   Clear liquids: 2 hours; breast milk: 4 hours; infant formula/non-human milk/light meal: 6 hours; fatty/fried foods or full meal: 8 hours.

7. What components make up the Mallampati classification, and what does it predict?

   It assesses visibility of oropharyngeal structures with mouth open/tongue out: Class I (soft palate, uvula, pillars), II (soft palate, uvula), III (soft palate, base of uvula), IV (only hard palate). Predicts difficult laryngoscopy/intubation.

8. In preoperative cardiac assessment, what does the term METs (metabolic equivalents) measure and what value suggests adequate functional capacity?

   METs measure functional/exercise capacity. ≥4 METs (e.g., climbing a flight of stairs, brisk walking) indicates adequate capacity, generally allowing surgery without further cardiac testing.

9. What is the recommended perioperative management of a patient's chronic beta-blocker therapy?

   Beta-blockers should be continued perioperatively (not started acutely on the day of high-risk surgery) to avoid rebound tachycardia/ischemia from withdrawal.

10. How should oral hypoglycemic agents and metformin specifically be managed before surgery?

    Most oral hypoglycemics are held on the morning of surgery; metformin is typically stopped on the day of surgery (risk of lactic acidosis, especially with contrast/renal impairment), and insulin is dose-adjusted with glucose monitoring.

11. By what mechanism do most general anesthetics produce CNS depression?

    Most enhance inhibitory GABA-A receptor (chloride channel) activity; some (ketamine, nitrous oxide, xenon) act primarily by antagonizing excitatory NMDA glutamate receptors.

12. Which IV induction agent is the drug of choice for hemodynamic stability in shock/cardiac patients, and what is its main adverse effect?

    Etomidate (preserves blood pressure and cardiac output); its main adverse effect is adrenocortical suppression (inhibits 11-beta-hydroxylase), plus myoclonus and pain on injection.

13. What distinctive features make ketamine unique among induction agents?

    It is an NMDA antagonist producing 'dissociative anesthesia,' provides analgesia and bronchodilation, maintains airway reflexes, and increases heart rate/BP (sympathomimetic) — useful in shock/asthma; downside is emergence delirium/hallucinations.

14. Why is nitrous oxide avoided in patients with closed air-filled spaces (e.g., pneumothorax, bowel obstruction)?

    Nitrous oxide diffuses into closed gas-filled spaces faster than nitrogen diffuses out, causing expansion of the space and increased pressure/volume.

15. By what mechanism do local anesthetics block nerve conduction?

    They block voltage-gated sodium channels from the intracellular side, preventing depolarization and propagation of the action potential.

16. What structural feature divides local anesthetics into two classes, and give one example of each?

    The intermediate linkage: esters (e.g., procaine, tetracaine, cocaine) metabolized by plasma pseudocholinesterase; amides (e.g., lidocaine, bupivacaine, ropivacaine) metabolized in the liver. (Amides have one 'i' before -caine.)

17. What is the maximum safe dose of lidocaine with and without epinephrine?

    Plain lidocaine: ~4.5 mg/kg (max ~300 mg); lidocaine with epinephrine: ~7 mg/kg (max ~500 mg), as epinephrine slows systemic absorption.

18. What are the signs of local anesthetic systemic toxicity (LAST), and what is the specific antidote?

    CNS first: perioral numbness, tinnitus, metallic taste, seizures, then cardiovascular collapse (bupivacaine is most cardiotoxic). Treatment: stop injection, ABCs, and 20% intravenous lipid emulsion ('lipid rescue').

19. Differentiate depolarizing from non-depolarizing neuromuscular blocking agents.

    Depolarizing (succinylcholine) is an ACh-receptor agonist causing persistent depolarization (fasciculations then paralysis), not reversed by anticholinesterases. Non-depolarizing (rocuronium, vecuronium) are competitive antagonists, reversed by anticholinesterases or sugammadex.

20. Why is succinylcholine the fastest-onset/shortest-acting muscle relaxant, and what are its serious adverse effects?

    Rapid onset (~30-60s) and short duration (~5-10 min) because it is hydrolyzed by plasma pseudocholinesterase. Adverse effects: hyperkalemia, malignant hyperthermia trigger, bradycardia, increased intraocular/intracranial/intragastric pressure, and prolonged block in pseudocholinesterase deficiency.

21. What reversal agent specifically encapsulates rocuronium and vecuronium, and how does it work?

    Sugammadex, a modified gamma-cyclodextrin that encapsulates (chelates) aminosteroidal non-depolarizing blockers, rapidly reversing neuromuscular blockade even from deep block.

22. When neostigmine is used to reverse neuromuscular blockade, why must an anticholinergic be co-administered?

    Neostigmine (an anticholinesterase) raises ACh at muscarinic sites causing bradycardia, salivation, and bronchospasm; glycopyrrolate or atropine is given to block these muscarinic effects.

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