100+ Free ABPS Anesthesiology (BCA) Practice Questions

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What is the approximate MAC (minimum alveolar concentration) of sevoflurane in 100% oxygen for a healthy 40-year-old adult?

1.15%

2.0%

6.0%

0.75%

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2026 Statistics

Key Facts: ABPS Anesthesiology (BCA) Exam

~200

Total MCQ Items

ABPS BCA Anesthesiology exam

~4 hr

Total Exam Time

Computer-based testing

~15%

Pharmacology Weight

Largest single domain on 2026 BCA content outline

~$1,800

2026 Exam Fee

ABPS/BCA (verify current schedule)

2.5 mg/kg

Dantrolene MH Bolus

MHAUS protocol — repeat to 10 mg/kg

1.5 mL/kg

20% Lipid Emulsion LAST Bolus

ASRA 2020 LAST checklist (then 0.25 mL/kg/min)

The ABPS Anesthesiology (BCA) Certification Exam is a 200-item, ~4-hour computer-based test administered by BCA/ABPS for residency-trained anesthesiologists. The blueprint weighs Pharmacology (~15%), Physiology (~12%), Equipment (~10%), Monitoring (~10%), Regional/Neuraxial (~10%), Airway (~10%), Cardiac/Thoracic (~8%), Obstetric (~8%), Pediatric (~7%), Critical Care/Pain (~5%), and Perioperative Complications (~5%). The 2026 fee is approximately $1,800; eligibility requires MD/DO with unrestricted license and anesthesiology residency completion.

Sample ABPS Anesthesiology (BCA) Practice Questions

Try these sample questions to test your ABPS Anesthesiology (BCA) 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 approximate MAC (minimum alveolar concentration) of sevoflurane in 100% oxygen for a healthy 40-year-old adult?

A.1.15%

B.2.0%

C.6.0%

D.0.75%

Explanation: Sevoflurane MAC in 100% O2 is approximately 2.0% in a healthy 40-year-old. Isoflurane MAC is 1.15%, desflurane MAC is 6.0%, and halothane MAC is 0.75%. MAC decreases roughly 6% per decade after age 40.

2A 70-kg patient develops seizures and ventricular arrhythmia immediately after an interscalene block with bupivacaine. Per ASRA, the recommended initial bolus dose of 20% lipid emulsion is:

A.0.25 mL/kg over 1 minute

B.1.5 mL/kg over 2-3 minutes

C.5 mL/kg over 5 minutes

D.10 mL/kg over 10 minutes

Explanation: ASRA's LAST checklist specifies an initial 20% lipid emulsion bolus of 1.5 mL/kg over 2-3 minutes (about 100 mL in a 70-kg adult), followed by an infusion of 0.25 mL/kg/min. Repeat boluses or doubling the infusion are options if cardiovascular stability is not restored, with a 12 mL/kg upper limit.

3What is the recommended initial IV bolus dose of dantrolene for an acute malignant hyperthermia crisis?

A.0.5 mg/kg

B.1 mg/kg

C.2.5 mg/kg

D.5 mg/kg

Explanation: MHAUS recommends an initial dantrolene bolus of 2.5 mg/kg IV, repeated every 5 minutes as needed, up to a cumulative dose of 10 mg/kg (more if signs persist). Triggering agents (volatile anesthetics, succinylcholine) must be stopped, the patient hyperventilated with 100% O2 at high flows, and supportive measures initiated.

4Mallampati class III is defined by visualization of which oropharyngeal structures with the patient seated, mouth open, and tongue protruded?

A.Soft palate, fauces, uvula, and pillars

B.Soft palate, fauces, and uvula

C.Soft palate and base of uvula only

D.Hard palate only

Explanation: Mallampati classification: Class I = soft palate, fauces, uvula, and pillars; Class II = soft palate, fauces, and uvula; Class III = soft palate and base of uvula; Class IV = hard palate only. Class III and IV are associated with increased risk of difficult laryngoscopy.

5Per ASA Standards for Basic Anesthetic Monitoring, continuous monitoring of which parameter is required during all anesthetics involving an artificial airway?

A.Bispectral index (BIS)

B.End-tidal CO2 (capnography)

C.Cardiac output

D.Train-of-four

Explanation: ASA Basic Anesthetic Monitoring Standards require continuous capnography (end-tidal CO2 monitoring) during all anesthetics with an artificial airway (ETT, LMA, supraglottic device). BIS, cardiac output, and TOF are useful in specific clinical contexts but are not basic ASA monitoring requirements.

6A 28-year-old woman develops a positional frontal headache 24 hours after spinal anesthesia for cesarean delivery with a 25-gauge Quincke needle. The most appropriate first-line treatment for this post-dural puncture headache is:

A.Immediate epidural blood patch

B.Conservative management with hydration, caffeine, and oral analgesics

C.Intrathecal saline

D.Surgical dural repair

Explanation: Post-dural puncture headache (PDPH) is initially managed conservatively with hydration, caffeine, and oral analgesics. Most cases resolve within 1 week. Epidural blood patch (15-20 mL autologous blood) is reserved for severe or persistent symptoms not responsive to conservative therapy. Pencil-point needles (Sprotte, Whitacre) reduce PDPH risk vs cutting Quincke needles.

7Which of the following respiratory changes occurs in normal term pregnancy?

A.FRC decreases by approximately 20%

B.FRC increases by approximately 20%

C.Minute ventilation decreases by 15%

D.PaCO2 increases to approximately 50 mmHg

Explanation: In pregnancy, functional residual capacity (FRC) decreases by ~20% due to upward displacement of the diaphragm by the gravid uterus. Minute ventilation increases ~50% (mostly from increased tidal volume), driven by progesterone-mediated central respiratory drive. PaCO2 falls to approximately 30-32 mmHg (compensated respiratory alkalosis).

8Compared to adults, the pediatric airway in children under age 8 has which distinguishing anatomic feature?

A.The vocal cords are the narrowest point of the airway

B.The cricoid ring is the narrowest functional point of the airway

C.The epiglottis is small and flat

D.The larynx is positioned more posteriorly

Explanation: In infants and young children, the cricoid ring is the narrowest functional point of the airway (vs the vocal cords in adults), although recent imaging suggests the glottic opening may also be narrow. Other pediatric features include large occiput, large tongue, anterior/cephalad larynx (C3-C4 vs C5-C6 in adults), and a long, floppy, omega-shaped epiglottis.

9The hemodynamic management goals for a patient with severe aortic stenosis undergoing non-cardiac surgery include:

A.Tachycardia, low SVR, full preload

B.Normal-to-slow heart rate, sinus rhythm, full preload, maintained SVR

C.Bradycardia, low SVR, low preload

D.Tachycardia, high SVR, low preload

Explanation: Aortic stenosis goals: slow-normal HR (preserves diastolic filling time across the fixed obstruction), sinus rhythm (atrial kick contributes ~40% of LV filling), full preload, maintain SVR (perfuse hypertrophied LV; phenylephrine is preferred for hypotension), avoid hypotension and tachycardia. Mnemonic: slow, full, tight, sinus.

10What is the recommended dose of sugammadex for immediate reversal of profound rocuronium-induced neuromuscular blockade (i.e., a 'cannot intubate, cannot ventilate' rescue scenario)?

A.2 mg/kg

B.4 mg/kg

C.8 mg/kg

D.16 mg/kg

Explanation: Sugammadex dosing: 2 mg/kg for moderate block (TOF count >=2), 4 mg/kg for deep block (post-tetanic count 1-2 with no TOF response), and 16 mg/kg for immediate/profound reversal (e.g., 1.2 mg/kg rocuronium induction dose, 'CICO' rescue). Sugammadex encapsulates rocuronium and vecuronium but is ineffective for benzylisoquinolinium agents (cisatracurium, atracurium).

About the ABPS Anesthesiology (BCA) Exam

The ABPS Anesthesiology Certification Examination, administered by the Board of Certification in Anesthesiology (BCA) under the American Board of Physician Specialties (ABPS) — a non-ABMS multi-specialty certifying body distinct from the American Board of Plastic Surgery — validates the competencies required for anesthesiologists. Content spans pharmacology (volatile MAC, IV induction agents, opioids, NMBAs, local anesthetics with LAST/lipid emulsion 20% rescue), physiology (cardiovascular, respiratory, renal, neurophysiology), anesthesia equipment (machine checkout, vaporizers, breathing circuits, scavenging), monitoring (ASA Standards I-V, capnography, BIS, neuromuscular TOF), regional and neuraxial anesthesia (spinal, epidural, ultrasound-guided peripheral blocks, ASRA 2026 anticoagulation), airway management (Mallampati, ASA Difficult Airway Algorithm 2022, video laryngoscopy, supraglottic devices, FONA), cardiovascular and thoracic anesthesia (CABG, valve disease, OLV, TEE), obstetric anesthesia (preeclampsia, neuraxial labor analgesia, postpartum hemorrhage, AFE), pediatric anesthesia (uncuffed vs cuffed ETT, MH triggers, FDA 2017 warning under age 3), critical care, acute and chronic pain medicine, and perioperative complications (MH dantrolene 2.5 mg/kg, anaphylaxis epinephrine, PONV Apfel, ARDS, AKI, delirium). Eligibility requires an MD/DO with valid unrestricted license and completion of an anesthesiology residency.

Questions

200 scored questions

Time Limit

~4 hours CBT

Passing Score

Criterion-referenced scaled score set by BCA (modified Angoff standard)

Exam Fee

~$1,800 examination fee (ABPS/BCA 2026 — verify current schedule) (American Board of Physician Specialties (ABPS) — Board of Certification in Anesthesiology (BCA))

ABPS Anesthesiology (BCA) Exam Content Outline

~15%

Pharmacology

Volatile anesthetics (sevoflurane, desflurane, isoflurane) and MAC values, IV induction agents (propofol, ketamine, etomidate, dexmedetomidine), opioids (fentanyl, remifentanil, morphine, hydromorphone), neuromuscular blockers (succinylcholine, rocuronium, vecuronium, cisatracurium) and reversal (neostigmine/glycopyrrolate, sugammadex 2-4 mg/kg moderate vs 16 mg/kg immediate), local anesthetics (lidocaine, bupivacaine, ropivacaine) and LAST treatment with 20% lipid emulsion (1.5 mL/kg bolus, 0.25 mL/kg/min infusion per ASRA 2020), benzodiazepines and reversal (flumazenil), vasoactive drugs (phenylephrine, ephedrine, epinephrine, norepinephrine, vasopressin).

~12%

Physiology

Cardiovascular physiology (cardiac output, preload/afterload, Frank-Starling, coronary perfusion pressure), respiratory physiology (V/Q matching, dead space, shunt, oxyhemoglobin dissociation curve, FRC and closing capacity), renal physiology (GFR, RBF, autoregulation), neurophysiology (CBF, CPP, ICP, pressure-flow autoregulation), autonomic nervous system, acid-base balance and Stewart approach, hepatic and endocrine physiology, fluid/electrolyte balance, blood and coagulation cascade.

~10%

Anesthesia Equipment & Delivery

Anesthesia machine checkout (FDA 1993, ASA 2008 pre-use), vaporizers (variable bypass, desflurane Tec 6 heated and pressurized), breathing circuits (Mapleson A-F, circle system), CO2 absorbers (Compound A formation with sevoflurane in soda lime vs Amsorb), oxygen supply and pipeline failsafe, scavenging systems, ventilator modes (volume-control, pressure-control, PCV-VG), gas analyzers (paramagnetic O2, IR for CO2 and volatiles), infusion pumps and TCI, ASA closed-claims hazards, fire safety triad (oxidizer + fuel + ignition source).

~10%

Monitoring

ASA Standards for Basic Anesthetic Monitoring (oxygenation, ventilation, circulation, temperature), capnography waveform interpretation (phases I-IV, plateau slope), pulse oximetry physics and limitations (carboxyhemoglobin, methemoglobin, motion, perfusion), invasive arterial line placement and waveform analysis (pulse pressure variation), central venous and PA catheterization, processed EEG (BIS 40-60 target, SedLine, Patient State Index), neuromuscular monitoring (TOF, double-burst, post-tetanic count), SSEP/MEP for spine surgery, point-of-care ultrasound (FAST, lung, gastric).

~10%

Regional & Neuraxial Anesthesia

Spinal anesthesia (subarachnoid LA distribution, baricity, complications including PDPH and high spinal), epidural (loss of resistance, test dose with epinephrine 15 mcg, top-up vs infusion), combined spinal-epidural and dural puncture epidural, peripheral nerve blocks (interscalene, supraclavicular, infraclavicular, axillary, femoral, sciatic, popliteal, TAP, ESP, PECS), ultrasound-guided regional, ASRA 2026 anticoagulation guidelines for neuraxial/deep blocks (LMWH, DOACs, warfarin, antiplatelets), contraindications and infection risk.

~10%

Airway Management

Airway assessment (Mallampati class I-IV, thyromental distance, mouth opening, neck extension, upper lip bite test), ASA Difficult Airway Algorithm 2022 updates (emphasis on awake intubation when difficulty predicted, limit DL attempts to optimize first-pass), preoxygenation and apneic oxygenation, direct vs video laryngoscopy (Glidescope, McGrath, C-MAC), supraglottic airways (LMA Classic, ProSeal, Supreme, i-gel — second-generation with gastric port), awake fiberoptic intubation, front-of-neck access (cricothyrotomy), extubation criteria and high-risk extubation.

~8%

Cardiovascular & Thoracic Anesthesia

CABG anesthetic management, valvular heart disease (AS — slow/full/tight; AR — fast/full/forward; MS — slow/tight/RV care; MR — fast/full/forward), cardiomyopathies (HOCM, restrictive), heart transplantation, mechanical circulatory support (IABP, Impella, ECMO, LVAD), cardiopulmonary bypass physiology and protamine reversal, transesophageal echocardiography (TEE) standard 28 views per ASE/SCA, one-lung ventilation (DLT vs bronchial blocker), thoracic epidural for thoracotomy, hypoxic pulmonary vasoconstriction.

~8%

Obstetric Anesthesia

Maternal physiologic changes of pregnancy (increased CO 50%, increased MV 50%, decreased FRC 20%, hypercoagulability), aortocaval compression and left uterine displacement >20 weeks, neuraxial labor analgesia (epidural, CSE, dural puncture epidural), cesarean delivery (spinal vs epidural vs general — spinal preferred), preeclampsia/eclampsia and HELLP, magnesium sulfate seizure prophylaxis, postpartum hemorrhage uterotonics (oxytocin first-line, methergine, hemabate avoid in asthma, misoprostol), amniotic fluid embolism, ACOG/SOAP guidelines, neonatal resuscitation, fetal heart rate monitoring.

~7%

Pediatric Anesthesia

Pediatric airway differences (large occiput, anterior larynx, large tongue, cricoid as narrowest point in infants, omega-shaped epiglottis), ETT sizing (uncuffed vs cuffed — modern preference for cuffed with low cuff pressure ≤20 cmH2O), MAC variation by age (highest in infants 1-6 months), IV vs inhalational induction with sevoflurane, MH-triggering agents (all volatiles, succinylcholine), congenital heart disease anesthesia, neonatal physiology and persistent fetal circulation, FDA 2017 warning for repeated/prolonged general anesthesia under age 3, parental presence at induction, post-op apnea risk in former preterm infants <60 weeks PCA.

~5%

Critical Care & Pain Medicine

ARDS (Berlin definition, low Vt 6 mL/kg PBW, plateau pressure <30 cmH2O, prone positioning >12 hours), septic shock (Surviving Sepsis 2021 — 30 mL/kg crystalloid, norepinephrine first-line, antibiotics within 1 hour), acute kidney injury (KDIGO criteria), nutrition support, ICU sedation (RASS goal -2 to 0, CAM-ICU delirium screening), acute pain (multimodal analgesia, ERAS), chronic pain (neuropathic, low back, CRPS), opioid stewardship and CDC 2022 prescribing guideline, interventional pain (epidural steroid injections, RFA, spinal cord stimulators), buprenorphine/methadone perioperative management.

~5%

Perioperative Complications & Safety

Malignant hyperthermia (RYR1 mutation, dantrolene 2.5 mg/kg IV bolus repeat to 10 mg/kg, MHAUS hotline 1-800-644-9737), anaphylaxis (epinephrine first-line; NMBAs/rocuronium, latex, antibiotics common triggers), PONV (Apfel score: female, non-smoker, history of PONV/motion sickness, post-op opioids — prophylaxis with 5-HT3 antagonists, dexamethasone, scopolamine, NK1 antagonists), hypothermia and active warming, awareness under anesthesia (BIS 40-60 target), corneal abrasion and positioning injuries (ulnar neuropathy most common), ASA closed-claims database, postoperative delirium and POCD, perioperative MI and MINS, transfusion reactions (TRALI, TACO, hemolytic).

How to Pass the ABPS Anesthesiology (BCA) Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by BCA (modified Angoff standard)
Exam length: 200 questions
Time limit: ~4 hours CBT
Exam fee: ~$1,800 examination fee (ABPS/BCA 2026 — verify current schedule)

Keys to Passing

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

ABPS Anesthesiology (BCA) Study Tips from Top Performers

1Memorize MAC values cold: sevoflurane 2.0%, isoflurane 1.15%, desflurane 6.0%, nitrous oxide 104%. MAC decreases with age (~6% per decade after 40), hypothermia, opioids, alpha-2 agonists, and pregnancy. MAC increases with hyperthermia, chronic alcohol use, and red hair (MC1R variants). MAC-awake ≈ 0.3-0.5 MAC; MAC-BAR (blocks adrenergic response) ≈ 1.5-2.0 MAC. Highest MAC: infants 1-6 months.

2LAST (Local Anesthetic Systemic Toxicity) is a near-certain exam topic. Treatment per ASRA: stop injection, call for help, manage airway with 100% O2, suppress seizures with benzodiazepines (avoid propofol if hemodynamically unstable), give 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion (double if persistent hypotension); cap at 12 mL/kg. Avoid vasopressin, calcium channel blockers, beta-blockers, and large doses of epinephrine (>1 mcg/kg).

3Malignant hyperthermia: RYR1 mutation triggered by ALL volatile anesthetics and succinylcholine. Earliest sign is rising end-tidal CO2 despite increased minute ventilation. Treatment: stop triggering agents, hyperventilate with 100% O2 at high flows, dantrolene 2.5 mg/kg IV bolus, repeat every 5 minutes up to 10 mg/kg until reversal, cool patient (target <38°C), treat hyperkalemia and acidosis, monitor for rhabdomyolysis. MHAUS hotline: 1-800-644-9737.

4ASA Difficult Airway Algorithm 2022 update emphasizes: (1) careful pre-induction airway assessment with multiple predictors, (2) awake intubation when difficulty is predicted, (3) limit attempts at direct or video laryngoscopy (typically 3 attempts max) to preserve oxygenation and avoid trauma, (4) early use of supraglottic airway as rescue, (5) front-of-neck access (cricothyrotomy) when CICO scenario arises, (6) consider extubation as a high-risk procedure in difficult airways.

5ASRA 2026 anticoagulation timing for neuraxial blocks (high-yield ranges): unfractionated heparin SC ≤5000 U BID — no delay; therapeutic UFH IV — wait 4-6 hours and check aPTT; LMWH prophylactic (enoxaparin 40 mg) — wait 12 hours; LMWH therapeutic (enoxaparin 1 mg/kg BID) — wait 24 hours; warfarin — INR ≤1.5; clopidogrel — hold 5-7 days; ticagrelor — hold 5 days; rivaroxaban/apixaban — hold 72 hours; dabigatran — hold 5 days (longer with renal impairment).

6Valvular heart disease anesthetic goals (memorize one phrase per lesion): Aortic stenosis = slow, full, tight, sinus (avoid tachycardia and vasodilation; phenylephrine for hypotension). Aortic regurgitation = fast, full, forward (avoid bradycardia and high SVR). Mitral stenosis = slow, full, tight, RV care (avoid tachycardia, hypoxia, hypercarbia). Mitral regurgitation = fast, full, forward (afterload reduction helps). HOCM = slow, full, tight (avoid inotropes; phenylephrine + beta-blocker).

Frequently Asked Questions

What is the ABPS Anesthesiology (BCA) Certification Examination?

The ABPS Anesthesiology Certification Examination is administered by the Board of Certification in Anesthesiology (BCA) under the American Board of Physician Specialties (ABPS) — a non-ABMS multi-specialty certifying body. It validates the competencies required for anesthesiologists across pharmacology, physiology, equipment, monitoring, regional/neuraxial techniques, airway management, cardiac and thoracic anesthesia, obstetric anesthesia, pediatric anesthesia, critical care, pain medicine, and perioperative complications and safety.

Who is eligible to take the BCA Anesthesiology exam?

Candidates must hold an MD, DO, or equivalent doctoral medical degree with a valid unrestricted medical license, have completed an ACGME-accredited (or equivalent) anesthesiology residency program, and document clinical anesthesiology practice. Letters of reference attesting to anesthesiology training and clinical competence are required, along with adherence to the ABPS Code of Ethics and Professionalism. Application requirements follow the published ABPS/BCA schedule.

How is the ABPS Anesthesiology exam different from the ABA exam?

The ABA (American Board of Anesthesiology) is the ABMS-recognized board, with a multi-stage pathway (BASIC, ADVANCED, APPLIED). The ABPS BCA is a separate non-ABMS certification recognized by some hospitals, states, and military/government employers. Many practicing anesthesiologists choose BCA when they need an alternative certification pathway, while others hold both. Always verify with your employer and state medical board which certifications they recognize.

What is the format of the exam?

The BCA Anesthesiology exam is a computer-based test comprising approximately 200 single-best-answer multiple-choice questions over about 4 hours. Items are blueprinted to the BCA content outline: Pharmacology (~15%), Physiology (~12%), Equipment (~10%), Monitoring (~10%), Regional/Neuraxial (~10%), Airway (~10%), Cardiac/Thoracic (~8%), Obstetric (~8%), Pediatric (~7%), Critical Care/Pain (~5%), and Perioperative Complications (~5%). Testing is offered at secure CBT centers per the BCA schedule.

How much does the 2026 exam cost?

The 2026 BCA Anesthesiology examination fee is approximately $1,800 — always verify the current schedule on the ABPS website. Candidates should also budget for prep resources (Miller's Anesthesia, Barash Clinical Anesthesia, Big Blue/Hall, M5 question banks) and ongoing Continuous Certification (CC) fees after passing. Cancellation and refund policies follow the BCA schedule with decreasing refunds as the exam date approaches.

How is the exam scored?

BCA uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports typically include domain-level feedback so candidates know their strongest and weakest content areas — useful for retake preparation if needed.

What are the highest-yield topics for the BCA Anesthesiology exam?

Highest-yield topics include the ASA Difficult Airway Algorithm 2022 framework (emphasis on awake intubation when difficulty predicted), ASRA 2026 anticoagulation guidelines for neuraxial blocks, malignant hyperthermia recognition and dantrolene dosing (2.5 mg/kg IV bolus, repeat to 10 mg/kg, MHAUS hotline 1-800-644-9737), LAST recognition and 20% lipid emulsion rescue (1.5 mL/kg bolus then 0.25 mL/kg/min), MAC values for volatile agents, valvular heart disease load/HR goals, preeclampsia and PPH management, FDA 2017 pediatric anesthesia warning under age 3, ARDS lung-protective ventilation, and PONV Apfel score prophylaxis.

How should I study for this exam?

Use a structured 6-12 month plan layered on residency or clinical practice. Map to the BCA content outline: begin with pharmacology and physiology (the largest combined block), then equipment and monitoring, then airway and regional/neuraxial techniques, then cardiac/OB/peds subspecialty content, and close with critical care, pain, and complications/safety. Use Miller's Anesthesia or Barash Clinical Anesthesia, Big Blue (Hall) for review, ASA practice guidelines, ASRA documents, MHAUS protocols, and high-volume MCQ practice. Complete 2-3 timed full-length mock exams in the final 4-6 weeks.