A 53-year-old male is emergently brought to the operating room for repair of a bleeding gastric ulcer. The patient is sedated from a previous upper endoscopy performed to diagnose the bleeding. The patient weighs 133 kg, has a bull neck, and has a known difficult airway. The patient’s heart rate is 140 and his blood pressure is 90/60 mm Hg. He is breathing spontaneously and has an oxygen saturation of 94% on room air. The surgeon is waiting. What is your plan?

An 80-year-old male with a past medical history of moderate left carotid artery stenosis presents for a left carotid endarterectomy (CEA). How would you monitor the patient’s central nervous system (CNS) during the procedure? Would you use a regional or general anesthetic? Why?

A 57-year-old female is scheduled for an urgent appendectomy. She is on vacation. She reports that 3 years ago she had a cardiac transplant in her home state. She reports feeling well now, and that she is seen regularly for all of her required follow-up appointments. What further information would you like? What testing or labs would you like? How does her cardiac transplant affect your anesthetic?

You are taking care of a 24-year-old female, G1P0, for a cesarean section. Her epidural has been dosed with 20 mL of 2% lidocaine plus 1:200,000 of epinephrine. She had adequate prenatal care and had been laboring without progression for the previous 20 hours. When the baby is delivered, the child makes no sound and no attempts at breathing. The nurses turn to you for help. What will you do? Can you leave the mother to attend to the baby? Who do you have the ultimate responsibility to care for? Assuming you get a colleague to help care for the mother, how would you evaluate and resuscitate the baby?

A 27-year-old male presents to the operating room after falling off scaffolding at a concert 3 hours ago. He is having his left tibia repaired. He denies any other injury. His toxicology screen is positive for alcohol and cocaine. What would be an acceptable evaluation of his cervical spine?

Three days after a reportedly uneventful bilateral mastectomy, the patient’s bilirubin is 7 mg/dL and she appears jaundiced. The patient is told that her jaundice is due to her anesthesia, and is referred to you to evaluate. How do you approach the patient? What do you say to the patient? What do you say to the surgeon? What tests or exams do you order? What are the management options available?

A 50-year-old female complains of persistent nausea and vomiting 5 hours after the drainage of a subhepatic abscess under general anesthesia. How will you proceed? What is your workup plan? What is your treatment plan?

A one-month-old male comes to the operating room (OR) for a pyloromyotomy. He has been volume resuscitated and has normal electrolytes. He has a 24-gauge IV in his right hand. What kind of blood pressure monitoring would you like for this patient?

A 60-year-old woman presents to the emergency department with a history of “the worst headache of her life.” Paramedics report that although she is presently drowsy, she did briefly lose consciousness in the ambulance. Her blood pressure is 175/80 mm Hg with a heart rate of 60. Her other vital signs are all stable. A CT scan reveals a grade 3 subarachnoid hemorrhage (SAH). The neurosurgical team posts the case as an aneurysm clipping scheduled for the following morning. What are your concerns? How will you evaluate the patient? How will you induce and maintain general anesthesia in this patient?

A 68-year-old female, 231 lb. and 5’1” tall, with a history of hypertension, diabetes mellitus, and large joint chronic arthritis, is scheduled for a laparoscopic cholecystectomy. The patient is noncompliant with her medication: atenolol and glyburide. On the morning of the surgery, the patient’s blood pressure was 145/86 mm Hg, heart rate (HR) 88, respiratory rate (RR) 20, oxygen saturation 97% on room air, and temperature 36.8 °C. Her blood glucose was 186 mg/dL. Physical examination revealed no abnormalities, and the airway was assessed as a Mallampati class II. After a smooth induction of general anesthesia with midazolam, fentanyl, propofol, and rocuronium, a #7.0 endotracheal tube was placed atraumatically. Anesthesia was maintained with mechanical ventilation, isoflurane, oxygen, air, fentanyl boluses, and rocuronium. About 30 minutes after the incision, the patient’s HR increased to 112 beats/min and her blood pressure became 184/99 mm Hg. The anesthesiologist also noticed a depression of the ST segment in the monitored V5 cardiac lead.

A 47-year-old female presents for a total knee arthroplasty. Her medical history is positive for hypertension, rheumatoid arthritis, and a previous history of opioid use disorder. Her current medications include hydrochlorothiazide (HCTZ), lisinopril, and buprenorphine hydrochloride (Subutex). The patient states that if possible she would like to avoid narcotics. What is your anesthetic plan? What is Subutex? How will it affect your anesthetic medications? Is it possible to completely avoid narcotics in the peri-operative period?

A 7-year-old male is scheduled for a herniorrhaphy. The child has no prior medical history. Per his parents, he had a previous tonsillectomy with no complications at age 2. He is adopted, so no family history is available. He has a mask induction with sevoflurane. After induction, an intravenous (IV) line is placed. Twenty minutes into the case the resident notes some mild tachycardia and a slowly increasing end-tidal CO2 (ETCO2). What are you concerned about? What tests would you order? Assuming this is malignant hyperthermia (MH), how would you treat it?

A famous vocalist presents to the operating room for removal of a vocal cord lesion. The surgeon is concerned about further damage to this patient’s vocal cords and requests that the patient not be intubated. Given the shared nature of the airway and assuming the patient is otherwise healthy, how would you manage the anesthesia and the airway for this case? One suggestion by the surgeon is to use high-frequency jet ventilation. How is this managed and what are your concerns with this form of ventilation? Are there any patients for whom this type of ventilation is not appropriate? What additional monitoring is required to perform this type of ventilation?

A 54-year-old male is scheduled for a left knee arthroscopy for anterior cruciate ligament (ACL) reconstruction at an ambulatory center. The patient reports that a tooth was dislodged during a previous cholecystectomy. The patient has a past medical history significant for severe obstructive sleep apnea (OSA), where his previous sleep study indicated an apnea–hypopnea index (AHI) of 65 events per hour, minimum oxygen saturation 65% and mean oxygen saturation of 80%, and the patient spent 30% of total sleep time below oxygen saturation of 90%. The sleep study was done two years ago, and he gained some more weight due to the knee injury and limited physical activity. While he was advised to use positive airway pressure therapy, details of the machine settings were not known as he stopped using the machine a few months after the second therapeutic sleep study. He continues to snore loudly, his wife has observed him to have multiple “breathing stops” while asleep, he uses the bathroom 4–5 times per night, and is always found to be “sleepy” during the day. The patient has hypertension that is well controlled on a β-blocker and an ACE inhibitor. He has a blood pressure of 155/84 mm Hg, heart rate of 105, respiratory rate of 20, neck circumference of 45 cm, a temperature of 35.6 °C and current BMI of 48 kg/m2. His hematocrit is 49% and serum bicarbonate is 30 mmol/L. Is this patient a candidate for an outpatient surgery? How would you induce anesthesia? Would you prefer to do a regional or general anesthetic? Are you concerned that he is a difficult intubation? How would you manage his post-operative pain? Will he need special post-operative monitoring?

A 24-year-old male professional recording artist presents to an otolaryngologist with the complaint of hoarseness. On exam he was found to have vocal cord nodules and a laser laryngoscopy was scheduled. This patient has no significant medical history. His surgical history is significant for a tonsillectomy and adenoidectomy as a child under general anesthesia without any complications. What type of laser may be used? What safety precautions will be necessary in the operating room?

A 47-year-old female presents for an open reduction and internal fixation (ORIF) of the left femur after an automobile accident. Her past medical history is significant for hypertension. She has been a one-pack-per-day smoker for the past 20 years. The patient’s oxygen saturation is 93% on 2 L nasal cannula. What pre-operative tests would you like? Why? How will her low oxygen saturation affect your anesthetic plan?

A 25-year-old female, G2P1, in labor has a cervix dilated to 6 cm. You have placed an epidural and are verifying the level when the obstetrical resident comes in to rupture the patient’s membranes. Upon rupture, the fetal heart rate drops suddenly. The obstetrical resident notes that she can now feel the umbilical cord. What is the diagnosis? What is your anesthetic plan for this emergent cesarean section?