ABA Applied Examination at a glance
Format
Two 35-minute SOE sessions plus a separate OSCE component (7 stations).
Examiners
Two ABA-certified anesthesiologist examiners, using standardized guided questions.
What it tests
Clinical judgment, adaptability to changing clinical conditions, organization, and presentation of information.
What BoardSim covers
This simulator addresses the SOE component only. It does not simulate the OSCE.
The four phases of each SOE session
Pre-Operative Evaluation
Patient assessment, comorbidity optimization, risk stratification, and pre-procedure decision-making before induction.
Intra-Operative Management
Induction, airway, maintenance, monitoring, fluid/transfusion, and management of intraoperative events.
Post-Operative Care
Extubation criteria, post-op analgesia, disposition, ventilatory support, and management of post-op complications.
Additional Topics
Rotating subject areas — obstetric anesthesia, pediatrics, regional/neuraxial, cardiac, neuroanesthesia, anaphylaxis, temperature regulation, ethics, etc.
BoardSim's 5-phase flow (Pre-Op → Plan → Intra-Op → Crisis → Emergence/Post-Op) follows this structure, broken into finer phases so scoring is more granular.
Case-by-case mapping
Each case is mapped twice — to the four SOE session phases and to the ABA Initial Certification Content Outline (source PDF ) — the ABA's master subject taxonomy used across BASIC, ADVANCED, and APPLIED exams. Each code (e.g. II.D.3.g.3.a) maps to a specific topic in that document.
Laparoscopic Appendectomy
Morbid Obesity · Full Stomach
High-yield Intra-Operative Management stem with strong Pre-Op and Post-Op phases. Aspiration risk and difficult-airway management appear frequently in real SOE sessions.
SOE session phases covered
Pre-Operative Evaluation
- ASA Physical Status Classification
- Airway assessment (Mallampati, TMD, neck circumference, ULBT)
- Aspiration risk stratification (NPO status, gastric emptying)
- Comorbidity optimization (T2DM, HTN, OSA)
- Preoperative aspiration prophylaxis pharmacology
Intra-Operative Management
- Rapid Sequence Induction (modified RSI, cricoid pressure)
- Video laryngoscopy as first-line airway technique
- Cannot intubate / cannot oxygenate (CICO) algorithm
- Drug dosing in obesity (TBW vs IBW vs LBW)
- Lung-protective ventilation in obesity (tidal volume, PEEP)
- Pneumoperitoneum physiology
- Reverse Trendelenburg positioning
Post-Operative Care
- Extubation criteria in OSA / obese patients
- Postoperative monitoring level (ICU / step-down / PACU)
- Continued CPAP therapy
Additional Topics
- Aspiration event management
- Failed intubation / failed ventilation crisis algorithm
ABA Content Outline cross-reference
I.B.1Evaluation of the Patient and Preoperative PreparationI.B.3.c.1Difficult Airway Assessment (Mallampati Classification, Range of Motion)I.B.3.c.2Techniques for Managing Airway — ASA Difficult Airway AlgorithmI.B.3.c.3Devices: Flexible Fiberoptic, Video LaryngoscopesI.B.3.c.5Transcutaneous or Surgical Airway (CICO backup)I.B.3.c.7Intubation and Tube Change Adjuncts (Bougies)I.B.6.hAspiration of Gastric ContentsII.C.2.b.1.b.2Restrictive Pulmonary Disease — ObesityII.C.4.b.1Morbid Obesity / Anesthesia for Bariatric SurgeryII.D.6Anesthesia for Laparoscopic Surgery
Pediatric T&A · Severe OSA
Post-Tonsillectomy Hemorrhage
Classic 'Additional Topics — Pediatric Anesthesia' stem, with intra-op and post-op management. Mirrors the pediatric scenarios used in published SOE samples.
SOE session phases covered
Pre-Operative Evaluation
- Pediatric preoperative assessment
- Severity of pediatric OSA (PSG, AHI, nadir SpO₂)
- Failure to thrive in chronic OSA
- Parental presence vs pharmacologic premedication
Intra-Operative Management
- Inhalation induction (sevoflurane) without IV access
- Pediatric endotracheal tube selection (cuffed RAE)
- Pediatric drug dosing on TBW
- Dexamethasone for airway edema + PONV
Post-Operative Care
- Pediatric extubation strategy (lateral, awake)
- 23-hour observation criteria for severe OSA
- Pediatric analgesia: avoidance of codeine (FDA black-box)
- Multimodal analgesia in opioid-sensitive populations
Additional Topics
- Post-tonsillectomy hemorrhage management
- Pediatric hypovolemic shock recognition & resuscitation
- Laryngospasm: PPV, deepening, succinylcholine IM/IV dosing
- Modified RSI in the bleeding child (full stomach with blood)
ABA Content Outline cross-reference
II.D.2.bPediatric Premedication: Drugs, Routes, Parental PresenceII.D.2.c.1Pediatric Induction TechniquesII.D.2.c.2.bPediatric Opioid Dosing and SensitivityII.D.2.c.2.cPediatric Neuromuscular Blockers — Succinylcholine, Age-Related PharmacodynamicsII.D.2.eProblems in Intubation/Extubation — Full Stomach, Awake/Fiberoptic, Laryngospasm, StridorII.D.2.i.1Pediatric Medical Problems — Respiratory (Upper Respiratory Infections)II.D.2.j.1Otolaryngology — Tonsillectomy and AdenoidectomyII.D.2.kOutpatient Pediatric Anesthesia — Discharge CriteriaII.D.2.lPediatric Postoperative Analgesia — Multimodal TherapyII.D.2.mPediatric Postoperative Nausea and VomitingII.D.9.a.2Resuscitation from Hemorrhagic Shock
STAT Cesarean · Severe Preeclampsia
HELLP · Failed Epidural · Difficult Airway
Maps directly to the obstetric anesthesia / pre-eclampsia stem in the ABA's published SOE sample (Session 1, Additional Topics).
SOE session phases covered
Pre-Operative Evaluation
- Severe-features preeclampsia / HELLP recognition
- Magnesium sulfate pharmacology and seizure prophylaxis
- Anticipating difficult airway in pregnancy (Mallampati progression, edema)
- Aspiration prophylaxis in obstetrics (bicitra, metoclopramide, famotidine)
Intra-Operative Management
- General anesthesia for stat cesarean (Category 1)
- RSI in pregnancy (preoxygenation, cricoid pressure, drug dosing)
- Left uterine displacement
- Magnesium-NMB interaction (potentiation of NDMRs)
- Blunting sympathetic response to laryngoscopy in severe HTN
- BP control: labetalol, hydralazine, esmolol, nitroglycerin
Post-Operative Care
- Postpartum magnesium continuation (24h)
- HDU / ICU disposition for severe preeclampsia
- Awake extubation with potentiated NMB
- Postpartum eclampsia monitoring
Additional Topics
- Postpartum hemorrhage (PPH) management
- Uterotonic pharmacology and contraindications
- Massive transfusion in OB
- Eclamptic seizure management
ABA Content Outline cross-reference
II.D.3.g.1Cesarean Delivery — Indications (Elective/Urgent/Emergent)II.D.3.g.3.aGeneral Anesthesia for Cesarean — Difficult Airway, Aspiration ProphylaxisII.D.3.g.3.bGeneral Anesthesia for Cesarean — Pharmacologic Effects on Uterine ToneII.D.3.g.4Cesarean Postoperative Considerations — Pain, Respiratory MonitoringII.D.3.jPathophysiology and Management of Complicated PregnancyII.D.3.k.1Maternal Comorbidities — Cardiovascular and Hypertensive Disorders (Chronic/Gestational HTN)II.D.3.k.5Maternal Comorbidities — Hematologic Diseases (Thrombocytopenia / HELLP)II.A.2.aAdvanced Pharmacology — Magnesium Sulfate, NMB InteractionsI.C.6Hematologic System — Coagulation, Massive Transfusion
Awake Fiberoptic · Unstable C-Spine
Halo Immobilization · Trauma
Tests Intra-Operative Management airway expertise and Additional Topics — neuroanesthesia / trauma. Awake fiberoptic intubation is a frequent oral-board topic.
SOE session phases covered
Pre-Operative Evaluation
- Airway assessment in cervical spine injury (halo, range of motion)
- Trauma full-stomach assumption
- Pre-induction neurologic exam documentation
Intra-Operative Management
- Awake fiberoptic intubation technique (oral & nasal)
- Airway topicalization (nebulized, atomized, transtracheal, SLN blocks)
- Local anesthetic dosing limits and LAST prevention
- Sedation strategy preserving respiratory drive (dexmedetomidine)
- Pre-induction antisialogogue (glycopyrrolate)
- Maintenance of MAP for spinal cord perfusion pressure
- TIVA selection when neuromonitoring (SSEP/MEP) is required
Post-Operative Care
- Awake extubation in C-spine injury
- Documented post-extubation neuro exam
Additional Topics
- Neuroanesthesia for spine surgery
- Trauma anesthesia
ABA Content Outline cross-reference
I.B.3.c.1Difficult Airway Assessment (Anatomic Correlates)I.B.3.c.2Airway Management — Awake vs. Asleep, ASA Difficult Airway AlgorithmI.B.3.c.3Devices: Flexible FiberopticII.C.1.d.1.d.1Airway Management in the Patient with Cervical Spine DiseaseII.C.1.d.1.fSpecial Problems of Anesthesia for Neurosurgery — Positioning, Cerebral ProtectionII.D.9Trauma AnesthesiaII.D.9.bManagement of Traumatic Brain / Spinal Cord InjuryI.B.2Regional Anesthesia — Local Anesthetic Pharmacology, LAST PreventionII.A.1.fDrug Delivery Devices — Sedation (Dexmedetomidine)
Malignant Hyperthermia Crisis
Intra-op MH · Mid-Case Recognition
Tests a high-stakes Intra-Operative Management crisis. MH-style 'temperature' and 'anaphylaxis' stems appear in published SOE samples as Additional Topics.
SOE session phases covered
Intra-Operative Management
- Recognition of MH trigger sequence (succinylcholine + volatile)
- Masseter rigidity at induction (early warning sign)
- Discontinuation of triggering agents and circuit change
- Conversion to total intravenous anesthesia (TIVA)
- Hyperventilation with FiO₂ 1.0
- Dantrolene preparation, dosing, repeat dosing, Ryanodex alternative
- Active cooling (IV, body cavity, surface)
- Hyperkalemia treatment (calcium, insulin/dextrose, bicarb, hyperventilation, albuterol)
- Arrhythmia management — avoiding calcium channel blockers with dantrolene
- MHAUS Hotline activation
Post-Operative Care
- ICU monitoring (24-hour minimum for recrudescence)
- Rhabdomyolysis management (UOP, alkalinization)
- Continued dantrolene dosing
Additional Topics
- Family counseling and disclosure
- Genetic testing referral (RYR1, CACNA1S)
- Family member screening
- MedicAlert and MHAUS Registry enrollment
ABA Content Outline cross-reference
I.B.6.iCommon Complications — Malignant Hyperthermia (Genetics, Pathophysiology)II.A.2.a.1.aPharmacogenetics — Malignant Hyperthermia (Diagnosis and Therapy)I.A.4Basic Pharmacology — Volatile Anesthetics, Succinylcholine, DantroleneI.C.6Hematologic System — Acid-Base, HyperkalemiaII.D.12Critical Care — ICU Management, Rhabdomyolysis, Recrudescence MonitoringII.D.2.i.10Malignant Hyperthermia in Children — Susceptibility (counseling implication)II.E.4Ethics and Medico-Legal Issues — Family Disclosure, Genetic Testing Referral
VATS Lobectomy · One-Lung Ventilation
Severe COPD · Prior MI · LVEF 38%
Mirrors the lobectomy / prior-MI stem in the ABA's published SOE sample (Session 1) — induction choice, DLT placement, OLV hypoxemia, intra-op hemorrhage, post-op pain and MI. One of the most direct content overlaps with published ABA materials.
SOE session phases covered
Pre-Operative Evaluation
- Pulmonary risk stratification (FEV₁, DLCO, ppoFEV₁, 6MWT)
- Cardiac risk stratification (RCRI, METs, ACC/AHA algorithm)
- Timing of non-cardiac surgery after PCI / DES
- Dual antiplatelet therapy (DAPT) management
- Smoking cessation and perioperative impact
- Bronchodilator optimization
Intra-Operative Management
- Lung isolation: double-lumen tube vs bronchial blocker
- Right-sided vs left-sided DLT selection rationale
- Fiberoptic confirmation of DLT position after lateral positioning
- OLV protective ventilation settings (TV on IBW, PEEP, FiO₂)
- Hypoxic pulmonary vasoconstriction physiology and pharmacology
- Stepwise hypoxemia rescue during OLV
- Restrictive fluid strategy in thoracic surgery
- Hemodynamic management in reduced LVEF
Post-Operative Care
- Thoracic extubation criteria
- Chest tube management and air leak considerations
- ICU vs step-down disposition in high-risk thoracic
- Pulmonary toilet (incentive spirometry, ambulation)
- Thoracic epidural analgesia (placement, dosing, complications)
- Erector spinae plane (ESP) block
- Paravertebral block
Additional Topics
- Anesthesia for patients with cardiac disease
- Post-op myocardial ischemia management
- Tension pneumothorax in the non-operative lung
ABA Content Outline cross-reference
I.B.1Evaluation of the Patient and Preoperative PreparationI.B.3.c.6Endobronchial Intubation — Double-Lumen Tubes, Bronchial Blockers, PositioningII.C.2.c.2.b.3.cOne-Lung Ventilation (Anesthetic Techniques for Thoracic Surgery)II.C.2.c.2.b.3.bThoracic and Pulmonary Surgery — Anesthetic ManagementII.C.2.c.2.cPostoperative Care after Thoracic Surgery — Pain, Respiratory Therapy, Extubation CriteriaII.C.2.c.1Evaluation of Respiratory Disease — PFTs, ABGs, Perioperative Risk AssessmentII.C.3Cardiovascular System — CAD, Reduced LVEF, Perioperative Cardiac RiskI.B.2.b.5Regional Anesthesia Complications — Implications of Anticoagulants (ASRA Guidelines, DAPT)II.B.1.bAdvanced Neuraxial Blocks — Thoracic EpiduralII.B.2Special Techniques — Erector Spinae Plane, Paravertebral BlocksII.D.6Anesthesia for Laparoscopic/Robotic Surgery (relevant — VATS port-based)
How cases are built and reviewed
Each case is built around a high-yield SOE topic combination and cross-referenced against publicly available clinical guidelines and textbooks.
Critical actions are sourced from Miller's Anesthesia (10e), Barash (9e), Chestnut's Obstetric Anesthesia (6e), Coté & Lerman (6e), the ASA Difficult Airway Algorithm (2022), the MHAUS Emergency Therapy Protocol, and the ACC/AHA Perioperative Cardiovascular Evaluation Guideline.
The AI examiner is given each case's critical-action list as a hidden rubric, so scoring reflects whether you demonstrated correct management — not whether you recalled a piece of trivia.
Peer review by board-certified anesthesiologists is ongoing. Reviewer names will be listed here once review is complete.
Sources & references
ABA public materials
- Standardized Oral Examination — Sample Questions — American Board of Anesthesiology (2022)
Source for the four-phase SOE structure used as our session template.
- APPLIED Examination Information — American Board of Anesthesiology (ongoing)
Source for session length, examiner format, and exam scope description.
Textbooks
- Miller's Anesthesia— Gropper et al., 10th ed., Elsevier, 2024ISBN 978-0-323-93273-6
- Clinical Anesthesia— Barash, Cullen, Stoelting et al., 9th ed., Wolters Kluwer, 2024ISBN 978-1-9751-7028-9
- Chestnut's Obstetric Anesthesia: Principles and Practice— Chestnut, Wong, Tsen et al., 6th ed., Elsevier, 2020ISBN 978-0-323-56688-9
- A Practice of Anesthesia for Infants and Children— Coté, Lerman, Anderson, 6th ed., Elsevier, 2019ISBN 978-0-323-42974-0
- Principles and Practice of Anesthesia for Thoracic Surgery— Slinger, 2nd ed., Springer, 2019ISBN 978-3-030-00858-1
Guidelines & landmark papers
- 2022 ASA Practice Guidelines for Management of the Difficult Airway — Apfelbaum JL et al., Anesthesiology 2022;136(1):31-81doi: 10.1097/ALN.0000000000004002
- MHAUS Emergency Therapy for Malignant Hyperthermia — Malignant Hyperthermia Association of the United States
Active hotline: 1-800-MH-HYPER (1-800-644-9737).
- 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management — Fleisher LA et al., Circulation 2014;130(24):e278-e333doi: 10.1161/CIR.0000000000000106
- ACOG Practice Bulletin 222: Gestational Hypertension and Preeclampsia — American College of Obstetricians and Gynecologists, Obstet Gynecol 2020;135(6):e237-e260
- FDA Drug Safety Communication: Codeine in Pediatric Patients — U.S. Food and Drug Administration, 2017
Source for the codeine contraindication in the pediatric T&A case.
Cases in BoardSim are informed by these sources. No copyrighted text is reproduced.
About BoardSim
Built independently, for residents. BoardSim is an independent preparation tool created to help anesthesiology residents practice oral-board-style clinical reasoning. It references the American Board of Anesthesiology and the Standardized Oral Examination as published in publicly available materials.
Every case is an original work. Every clinical scenario in BoardSim is an original work, written specifically for this simulator. The cases are informed by published anesthesiology curricula — Miller's Anesthesia, Barash's Clinical Anesthesia, Chestnut's Obstetric Anesthesia, Coté & Lerman, the ASA Difficult Airway Algorithm, the MHAUS Emergency Therapy Protocol, and the ACC/AHA Perioperative Cardiovascular Evaluation Guideline — and contain no reproduced passages from those copyrighted sources or from any ABA examination, question bank, or unpublished examination material.
Built for preparation, not certification credit. BoardSim focuses purely on practice and preparation. Official examination credit — including CME, AMA PRA Category 1 Credit™, MOCA® 2.0 points, and ABA certification itself — is awarded by the American Board of Anesthesiology and ACCME-accredited bodies. BoardSim does not currently offer formal credit, and using it does not contribute toward maintenance of certification.
ABA®, American Board of Anesthesiology®, Standardized Oral Examination, and SOE are trademarks or service marks of the American Board of Anesthesiology, Inc., which neither sponsors nor endorses this product. All other organizational names and marks are trademarks of their respective owners.
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