100+ Free ABA Cardiac Anesth Practice Questions

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Question 1

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What is the recommended activated clotting time (ACT) goal prior to initiation of full cardiopulmonary bypass (CPB) after heparinization?

Greater than 180 seconds

Greater than 250 seconds

Greater than 400 seconds

Greater than 600 seconds

to track

2026 Statistics

Key Facts: ABA Cardiac Anesth Exam

~$2,100

Exam Fee

ABA 2026

28 views

ASE/SCA TEE Exam

2013 guidelines

>400-480 s

ACT Goal for CPB

Heparin 300-400 U/kg

$450K-$600K+

Cardiac Anesth Comp

MGMA 2024

12 months

Fellowship Required

ACGME-accredited

300-500 hrs

Avg Study Time

Board candidates

The ABA Adult Cardiac Anesthesiology boards sit atop one of anesthesiology's most competitive fellowship pipelines: ~70-75 ACGME-accredited positions annually feeding demand from ~1,100 US heart surgery programs. Cardiac anesthesiologists earn a ~15-25% salary premium over general anesthesiologists (median $450K-$600K+ in hospital-based cardiac practice, MGMA). The exam tests CPB physiology, comprehensive TEE (ASE/SCA 28 views), valve surgery, TAVR, MCS (LVAD/ECMO/Impella), aortic surgery with DHCA, and adult congenital heart disease at subspecialty depth.

Sample ABA Cardiac Anesth Practice Questions

Try these sample questions to test your ABA Cardiac Anesth exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1What is the recommended activated clotting time (ACT) goal prior to initiation of full cardiopulmonary bypass (CPB) after heparinization?

A.Greater than 180 seconds

B.Greater than 250 seconds

C.Greater than 400 seconds

D.Greater than 600 seconds

Explanation: For full cardiopulmonary bypass, most centers target an ACT greater than 400-480 seconds to prevent clot formation in the extracorporeal circuit. The typical heparin loading dose is 300-400 U/kg. An ACT below this threshold risks thrombosis within the bypass circuit and is a contraindication to initiating CPB.

2A 68-year-old male is undergoing CABG. After a heparin dose of 350 U/kg, the ACT remains at 320 seconds. What is the most likely explanation?

A.Protamine overdose

B.Antithrombin III deficiency

C.Factor V Leiden mutation

D.Platelet function disorder

Explanation: Heparin resistance, often due to antithrombin III (AT-III) deficiency, is a common cause of inadequate ACT response despite high heparin doses. Heparin potentiates AT-III to inhibit thrombin; without adequate AT-III, the ACT fails to rise. Management includes additional heparin, FFP, or recombinant AT-III concentrate.

3What is the standard dose of protamine used to reverse heparin after cardiopulmonary bypass?

A.1 mg protamine per 10 units heparin

B.1 mg protamine per 100 units heparin

C.1 mg protamine per 1000 units heparin

D.10 mg protamine per 100 units heparin

Explanation: Protamine is dosed at approximately 1 mg per 100 units of heparin given (or residual heparin). Full reversal typically requires 1-1.3 mg/100 U. Protamine is a basic protein that neutralizes acidic heparin through electrostatic binding. Excessive protamine may paradoxically cause anticoagulation and myocardial depression.

4A patient with a known history of heparin-induced thrombocytopenia (HIT) requires emergent CABG. Which anticoagulant is most appropriate for CPB?

A.Low-molecular-weight heparin (enoxaparin)

B.Warfarin

C.Bivalirudin

D.Protamine sulfate

Explanation: Bivalirudin is a direct thrombin inhibitor and the most widely used alternative to heparin for patients with HIT requiring CPB. Argatroban is another option. Both do not cross-react with HIT antibodies. ACT monitoring may be less reliable; ecarin clotting time is preferred. Doses and protocols vary by institution.

5Which of the following best describes del Nido cardioplegia compared to traditional blood cardioplegia?

A.Del Nido is administered every 20 minutes; blood cardioplegia is given once

B.Del Nido provides a longer single-dose arrest period (~90 minutes) using crystalloid with lidocaine and magnesium

C.Del Nido is used only for pediatric cases

D.Del Nido is warm while blood cardioplegia is cold

Explanation: Del Nido cardioplegia is a crystalloid-based solution containing lidocaine, magnesium, potassium, mannitol, sodium bicarbonate, and 20% patient blood. It provides a long single-dose arrest (typically up to 90 minutes) with fewer interruptions to surgery. Traditional blood cardioplegia requires re-dosing every 15-20 minutes.

6Retrograde cardioplegia is delivered via which anatomic structure?

A.Aortic root above the cross-clamp

B.Coronary sinus

C.Left atrial appendage

D.Pulmonary artery

Explanation: Retrograde cardioplegia is delivered through a catheter placed in the coronary sinus, allowing distribution via the cardiac venous system. It is particularly useful when there are severe coronary stenoses that prevent antegrade delivery, or for aortic valve surgery when antegrade delivery is disrupted.

7How many standard views are recommended in the 2013 ASE/SCA comprehensive intraoperative TEE exam guidelines?

A.20 views

B.24 views

C.28 views

D.32 views

Explanation: The 2013 ASE/SCA guidelines for performing a comprehensive intraoperative TEE exam recommend 28 standard views organized into midesophageal, transgastric, upper esophageal, and deep transgastric imaging planes. This standardized protocol ensures thorough structural and functional assessment of the heart and great vessels.

8Which TEE view is optimal for alignment with the left ventricular outflow tract (LVOT) Doppler for calculating aortic valve area?

A.Midesophageal 4-chamber view

B.Midesophageal aortic valve short-axis (ME-AV-SAX)

C.Deep transgastric long-axis or transgastric long-axis

D.Upper esophageal aortic arch view

Explanation: The deep transgastric long-axis view (or transgastric long-axis) provides the best parallel Doppler alignment with the LVOT and aortic valve flow, which is essential for accurate continuous-wave Doppler measurements used in aortic valve area calculation by continuity equation and in peak/mean gradient quantification.

9A peak aortic valve velocity of 4.5 m/s with a mean gradient of 48 mmHg and a dimensionless index (DI) of 0.20 is most consistent with what severity of aortic stenosis?

A.Mild

B.Moderate

C.Severe

D.Critical/Very Severe

Explanation: Severe aortic stenosis is defined by peak velocity greater than 4.0 m/s, mean gradient greater than 40 mmHg, and DI less than 0.25 (or AVA less than 1.0 cm2). Values of 4.5 m/s, 48 mmHg, and DI 0.20 meet all criteria for severe AS. Critical AS typically refers to peak velocity greater than 5.0 m/s or mean gradient greater than 60 mmHg.

10Which of the following findings is most consistent with severe mitral regurgitation by quantitative TEE?

A.Regurgitant volume 25 mL, EROA 0.15 cm2

B.Regurgitant volume 40 mL, EROA 0.30 cm2

C.Regurgitant volume 65 mL, EROA 0.45 cm2

D.Regurgitant volume 15 mL, EROA 0.08 cm2

Explanation: Severe mitral regurgitation is defined by regurgitant volume >=60 mL, regurgitant fraction >=50%, and effective regurgitant orifice area (EROA) >=0.40 cm2 (primary MR). Additional supportive findings include systolic pulmonary vein flow reversal, central jet occupying >50% of LA, and dilated LA/LV.

About the ABA Cardiac Anesth Exam

The ABA Adult Cardiac Anesthesiology subspecialty certification validates expertise in perioperative management of adult cardiac surgical patients, including CPB, intraoperative TEE, valve surgery, TAVR, adult congenital heart disease, aortic surgery, and mechanical circulatory support. Candidates must complete an ACGME-accredited 12-month fellowship (or qualifying practice pathway) after ABA primary certification.

Questions

100 scored questions

Time Limit

~4 hours (written) + separate OSCE/SOE

Passing Score

Criterion-referenced (pass/fail; specific cut not published by ABA)

Exam Fee

~$2,100 application + exam fee (American Board of Anesthesiology (ABA))

ABA Cardiac Anesth Exam Content Outline

20%

Cardiopulmonary Bypass & Myocardial Protection

CPB priming, heparin dosing (300-400 U/kg, ACT >400-480 s), HIT alternatives (bivalirudin), cardioplegia (del Nido vs blood), weaning from CPB, and protamine reversal.

25%

Perioperative TEE & Imaging

ASE/SCA 2013 comprehensive 28-view intraoperative exam, valvular quantification (AS peak gradient + DI, MR EROA, AR jet ratio), LV/RV function, 3D TEE for MitraClip and TAVR.

20%

Valvular & Structural Heart Surgery

CABG, mitral repair vs replacement, Carpentier classification, Ross procedure, valve-sparing root (David), TAVR sizing, MitraClip, paravalvular leak assessment.

15%

Aortic Surgery & Adult Congenital Heart Disease

Stanford A vs B dissection, DHCA/selective antegrade cerebral perfusion, TAAA with CSF drainage and spinal cord protection, Fontan, tetralogy of Fallot, Eisenmenger.

15%

Mechanical Circulatory Support

IABP counterpulsation, Impella 2.5/5.0/CP/5.5, VA vs VV-ECMO, Harlequin syndrome, HeartMate 3 LVAD management, suction events, RV failure post-LVAD.

Coagulation & Post-Op Management

HIT (4Ts), DOAC reversal (idarucizumab, andexanet), ROTEM/TEG, LCOS, tamponade, KDIGO AKI, vasoplegia treatment.

How to Pass the ABA Cardiac Anesth Exam

What You Need to Know

Passing score: Criterion-referenced (pass/fail; specific cut not published by ABA)
Exam length: 100 questions
Time limit: ~4 hours (written) + separate OSCE/SOE
Exam fee: ~$2,100 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABA Cardiac Anesth Study Tips from Top Performers

1Master the ASE/SCA 2013 comprehensive TEE exam (28 standard views) cold — probe manipulation, angle, depth, and key pathology shown in each view are high-yield for both written and OSCE stations.

2Know quantitative valve assessment thresholds: AS (peak velocity >4 m/s, mean gradient >40 mmHg, DI <0.25), severe MR (EROA >=0.40 cm2, regurgitant volume >=60 mL), severe AR (jet/LVOT >65%, VC >6 mm).

3Memorize anticoagulation numbers: heparin 300-400 U/kg for CPB, ACT >400-480 s, protamine 1 mg per 100 U heparin, bivalirudin for HIT, and DOAC reversal agents (idarucizumab for dabigatran, andexanet for Xa inhibitors).

4Build mental frameworks for hemodynamic goals in each valve lesion (AS/MS: slow, full, sinus, maintain SVR; AR/MR: fast, forward, reduce afterload) and for MCS devices (IABP, Impella sizes, VA vs VV-ECMO, LVAD suction events).

5Practice oral/OSCE scenarios: Type A dissection induction, failure to wean from CPB, post-LVAD RV failure, and TAVR complications. Structured answers (assess, differential, diagnostic, treatment) impress examiners.

Frequently Asked Questions

Who is eligible for the ABA Adult Cardiac Anesthesiology exam?

Candidates must hold ABA primary certification in Anesthesiology and have completed an ACGME-accredited 12-month Adult Cardiac Anesthesiology fellowship, OR qualify through the ABA's practice pathway (documented cardiac anesthesia case volume over several years). Exact requirements are updated in the ABA candidate handbook.

How is the ABA Cardiac Anesthesiology exam structured?

The exam combines a computer-based written multiple-choice test administered at Pearson VUE (approximately 4 hours) with a Standardized Oral Examination (SOE) or OSCE component assessing clinical judgment and communication. Both must be passed for certification.

What is the fee for the ABA Cardiac Anesthesiology certification?

The combined application and examination fee is approximately $2,100 in 2026. Fees are subject to change; check the current ABA fee schedule. Fellowship programs and hospital CME stipends often cover the cost.

What topics carry the most weight on the exam?

Perioperative TEE (roughly a quarter of content), followed by CPB and valvular/structural heart surgery. Mastery of the ASE/SCA 2013 comprehensive TEE exam (28 standard views) and quantitative valve assessment is essential, as is CPB physiology, cardioplegia, and MCS management.

Is the ABA Cardiac Anesthesiology certification worth the time and cost?

Yes for most fellowship-trained cardiac anesthesiologists. Board-certified cardiac anesthesiologists command a 15-25% salary premium, have competitive advantage for academic/tertiary positions, and are increasingly required for hospital cardiac surgery credentialing. MGMA 2024 data suggests median compensation of $450K-$600K+.

What resources are recommended for ABA Cardiac Anesthesiology prep?

Core texts include Kaplan's Cardiac Anesthesia, Perrino's Practical Approach to TEE, and the ASE/SCA 2013 TEE guidelines. Popular courses include TEE Echo Week, the ASE/SCA board review, and Hensley's CPB review. Practice questions with detailed rationales are essential for identifying knowledge gaps.

How long does it take to recertify under MOCA 2.0?

ABA subspecialty certifications follow continuous Part 3/MOCA 2.0 requirements (quarterly question streaming and CME), rather than a 10-year re-examination. Subspecialty validity is renewable through ongoing MOCA participation and CME specific to cardiac anesthesiology.

How hard is the ABA Cardiac Anesthesiology exam?

The exam is considered very challenging, with subspecialty-depth questions that go well beyond general anesthesiology boards. Fellowship graduates with 300-500 hours of focused study — especially on TEE — generally report success on first attempt, but the oral/OSCE component can be intimidating without targeted prep.