ARKANSAS ANESTHESIOLOGY SPECIALIST
EXAM QUESTIONS WITH CORRECT ANSWERS
AND RATIONALES LATEST 2026 -2027 UPDATE
Section 1: Regional Anesthesia & Nerve Blocks (Questions 1-15)
Question 1
A single-injection popliteal sciatic nerve block is performed under
ultrasound guidance combined with peripheral nerve stimulation. The
21-gauge, 4-inch insulated needle appears to be at an ideal location
between the common fibular and tibial components, but no motor twitch
is noted at a current of 1.5 mA (pulse duration 0.1 ms, frequency 2 Hz).
What is the next best step for a successful sciatic nerve block?
A. Advance the needle
B. Retract the needle
C. Turn up the current on the peripheral nerve stimulator
D. Perform the nerve block in the current needle location
Correct Answer: D
Rationale: When the needle tip is in an ideal sonographic location
between the tibial and common peroneal components of the sciatic
nerve, absence of a motor twitch at 1.5 mA may occur due to variations
in nerve anatomy or the effects of local anesthetics. If ultrasound
confirms appropriate needle placement, proceeding with the block at that
location is appropriate. Advancing or retracting the needle may move it
out of the optimal position, and increasing the current is unnecessary
when imaging confirms correct placement.
,Question 2
Which agent for spinal anesthesia has the best pharmacokinetic profile
for outpatient surgery?
A. Bupivacaine
B. Chloroprocaine
C. Lidocaine
D. Tetracaine
Correct Answer: B
Rationale: Chloroprocaine has the shortest duration of action among
spinal anesthetics due to rapid hydrolysis by plasma cholinesterase,
making it ideal for ambulatory/outpatient surgery where rapid recovery
of motor and sensory function is desired. Lidocaine has been associated
with transient neurologic symptoms (TNS), while bupivacaine and
tetracaine have longer durations that are less suitable for short outpatient
procedures.
Question 3
A patient receiving an epidural for a hemipelvectomy using loss of
resistance to air technique has CSF noted at the needle hub after loss of
resistance. An epidural is attempted at another level and is successful.
Upon placing the dressing, the patient complains of a headache and
nausea. How should the proceduralist manage the headache?
A. Collect the patient's blood aseptically and perform an epidural blood
patch with existing epidural catheter
B. Encourage the patient to remain supine and give analgesics including
acetaminophen, NSAIDs, caffeine, and IV cosyntropin
C. Inject 2-3 mg of morphine through the epidural catheter now
,D. Deliver higher inspired oxygen, avoid nitrous oxide, and assure the
patient headache will improve in 24 hours
Correct Answer: A
Rationale: The patient has experienced an inadvertent dural puncture
during epidural placement. The presence of a functioning epidural
catheter provides an ideal opportunity to perform a prophylactic epidural
blood patch using the existing catheter, which can prevent or
immediately treat post-dural puncture headache. Conservative
management (B) is appropriate for mild symptoms but the blood patch is
more definitive. Option D is appropriate for pneumocephalus from loss
of resistance to air, but this presentation is classic for PDPH.
Question 4
A patient received a difficult epidural placement for an open colectomy.
Several days later, the patient complains of a headache that occurs
within 15 minutes of getting up out of bed, with nausea, blurred vision,
and deviation of the eyes in a horizontal plane with inability to abduct
both eyes. What is the next best course of management?
A. Offer an immediate blood patch, as neurologic signs are concerning
for abducens palsy
B. Epidural blood patch is high risk; offer IV caffeine, hydration, and
systemic analgesics first
C. Give IV cosyntropin 1 mg; if this fails, offer blood patch after 24
hours
D. Consult neurologist, as symptoms are atypical of PDPH prior to
intervention
Correct Answer: A
, Rationale: The patient is exhibiting signs of a post-dural puncture
headache (positional headache) complicated by bilateral abducens (CN
VI) palsy, as evidenced by the inability to abduct both eyes. Abducens
palsy is a known complication of PDPH due to traction on the sixth
cranial nerve from low CSF pressure. An epidural blood patch is
indicated and should be offered without delay; waiting for conservative
measures to fail may delay recovery and does not change the risk profile
of the blood patch.
Question 5
Which of the following is NOT TRUE regarding the use of 3 mL of
lidocaine 1.5% with 1:200,000 epinephrine as a test dose for epidural
placement?
A. This dose is equivalent to 45 mg of lidocaine, which when injected
intrathecally would result in dense motor and sensory block within 10
minutes
B. Epinephrine is for intravascular detection; concentration is 5 mcg/mL
(total dose 15 mcg), resulting in heart rate increase of 10 bpm and
systolic pressure increase of 30 mmHg if intravascular
C. Effects of the test dose on detection of intravascular placement are
blunted in elderly patients, patients under general anesthesia, and
patients on beta-blockade
D. The use of benzodiazepines for sedation would make signs of
systemic local anesthetic such as circumoral numbness or tinnitus less
sensitive markers for intravascular injection
Correct Answer: B
Rationale: The statement regarding epinephrine concentration is
incorrect. The concentration of epinephrine in 1:200,000 solution is 5
EXAM QUESTIONS WITH CORRECT ANSWERS
AND RATIONALES LATEST 2026 -2027 UPDATE
Section 1: Regional Anesthesia & Nerve Blocks (Questions 1-15)
Question 1
A single-injection popliteal sciatic nerve block is performed under
ultrasound guidance combined with peripheral nerve stimulation. The
21-gauge, 4-inch insulated needle appears to be at an ideal location
between the common fibular and tibial components, but no motor twitch
is noted at a current of 1.5 mA (pulse duration 0.1 ms, frequency 2 Hz).
What is the next best step for a successful sciatic nerve block?
A. Advance the needle
B. Retract the needle
C. Turn up the current on the peripheral nerve stimulator
D. Perform the nerve block in the current needle location
Correct Answer: D
Rationale: When the needle tip is in an ideal sonographic location
between the tibial and common peroneal components of the sciatic
nerve, absence of a motor twitch at 1.5 mA may occur due to variations
in nerve anatomy or the effects of local anesthetics. If ultrasound
confirms appropriate needle placement, proceeding with the block at that
location is appropriate. Advancing or retracting the needle may move it
out of the optimal position, and increasing the current is unnecessary
when imaging confirms correct placement.
,Question 2
Which agent for spinal anesthesia has the best pharmacokinetic profile
for outpatient surgery?
A. Bupivacaine
B. Chloroprocaine
C. Lidocaine
D. Tetracaine
Correct Answer: B
Rationale: Chloroprocaine has the shortest duration of action among
spinal anesthetics due to rapid hydrolysis by plasma cholinesterase,
making it ideal for ambulatory/outpatient surgery where rapid recovery
of motor and sensory function is desired. Lidocaine has been associated
with transient neurologic symptoms (TNS), while bupivacaine and
tetracaine have longer durations that are less suitable for short outpatient
procedures.
Question 3
A patient receiving an epidural for a hemipelvectomy using loss of
resistance to air technique has CSF noted at the needle hub after loss of
resistance. An epidural is attempted at another level and is successful.
Upon placing the dressing, the patient complains of a headache and
nausea. How should the proceduralist manage the headache?
A. Collect the patient's blood aseptically and perform an epidural blood
patch with existing epidural catheter
B. Encourage the patient to remain supine and give analgesics including
acetaminophen, NSAIDs, caffeine, and IV cosyntropin
C. Inject 2-3 mg of morphine through the epidural catheter now
,D. Deliver higher inspired oxygen, avoid nitrous oxide, and assure the
patient headache will improve in 24 hours
Correct Answer: A
Rationale: The patient has experienced an inadvertent dural puncture
during epidural placement. The presence of a functioning epidural
catheter provides an ideal opportunity to perform a prophylactic epidural
blood patch using the existing catheter, which can prevent or
immediately treat post-dural puncture headache. Conservative
management (B) is appropriate for mild symptoms but the blood patch is
more definitive. Option D is appropriate for pneumocephalus from loss
of resistance to air, but this presentation is classic for PDPH.
Question 4
A patient received a difficult epidural placement for an open colectomy.
Several days later, the patient complains of a headache that occurs
within 15 minutes of getting up out of bed, with nausea, blurred vision,
and deviation of the eyes in a horizontal plane with inability to abduct
both eyes. What is the next best course of management?
A. Offer an immediate blood patch, as neurologic signs are concerning
for abducens palsy
B. Epidural blood patch is high risk; offer IV caffeine, hydration, and
systemic analgesics first
C. Give IV cosyntropin 1 mg; if this fails, offer blood patch after 24
hours
D. Consult neurologist, as symptoms are atypical of PDPH prior to
intervention
Correct Answer: A
, Rationale: The patient is exhibiting signs of a post-dural puncture
headache (positional headache) complicated by bilateral abducens (CN
VI) palsy, as evidenced by the inability to abduct both eyes. Abducens
palsy is a known complication of PDPH due to traction on the sixth
cranial nerve from low CSF pressure. An epidural blood patch is
indicated and should be offered without delay; waiting for conservative
measures to fail may delay recovery and does not change the risk profile
of the blood patch.
Question 5
Which of the following is NOT TRUE regarding the use of 3 mL of
lidocaine 1.5% with 1:200,000 epinephrine as a test dose for epidural
placement?
A. This dose is equivalent to 45 mg of lidocaine, which when injected
intrathecally would result in dense motor and sensory block within 10
minutes
B. Epinephrine is for intravascular detection; concentration is 5 mcg/mL
(total dose 15 mcg), resulting in heart rate increase of 10 bpm and
systolic pressure increase of 30 mmHg if intravascular
C. Effects of the test dose on detection of intravascular placement are
blunted in elderly patients, patients under general anesthesia, and
patients on beta-blockade
D. The use of benzodiazepines for sedation would make signs of
systemic local anesthetic such as circumoral numbness or tinnitus less
sensitive markers for intravascular injection
Correct Answer: B
Rationale: The statement regarding epinephrine concentration is
incorrect. The concentration of epinephrine in 1:200,000 solution is 5
