Anesthesiology APPLIED Exam › Exam skills and answer structure

Using the 20- and 10-minute stem review

Exam skills and answer structure·~5 min read· Physician-reviewed✓ Sourced · 2

Stem

In the orientation room, the proctor hands you the first stem and starts a 20-minute clock. It is a full page: a 71-year-old man, 92 kg, for elective open abdominal aortic aneurysm repair, with a systolic murmur, a coronary stent placed four months ago on clopidogrel, a potassium of 3.1, a recent cough, and a note that he lives alone. Pens and paper are provided.

Question

How do you use these 20 minutes?

Ideal answer

HeadlineThree reads, whole, hunt, map, then the plan in block order, on checkpoints: first pass by minute 3, hunt by 10, map by 17.

First pass, fast and whole: who, what operation, what urgency. Here: an elderly man, elective open aortic repair.
Second pass, the hunt: every abnormal finding, medication, number and throwaway phrase, because each is a planned question: the murmur, the potassium of 3.1, the clopidogrel, "lives alone," "recent cough."
Third pass, the map: for each mark, its question, my one-sentence answer and the inject: the murmur predicts hypotension on induction, the fresh stent thrombosis if the antiplatelet stops.
The plan in session-block order: preoperative issues and what I would optimize, induction and maintenance with reasons, two expected complications, the disposition.
The last minutes, my first answer, said out loud in my head, because it sets the tone.

Breaking down the answer

The stem is a question map — the review is the only unscored time in the SOE, and it decides how the scored time goes. Session 1 gives 20 minutes with the first stem in the orientation room; session 2 gives 10 minutes with the second.¹
Long and short stems — in the ABA sample, the first stem is a full history, examination and laboratory panel, the second a single paragraph.² Stems are written backwards from the questions, so mapping them shows organization and judgment in the first two minutes.
Every drug is a question — a normal potassium is filler; an abnormal one is a question about delaying surgery. Anticoagulants set up neuraxial timing, beta-blockers continuation, a steroid stress dosing, an MAOI drug interactions.
Read the urgency line twice — "emergent," "urgent," "elective" decides whether optimization is on the table. The examiner will test delaying an elective case for a potassium of 3.1 against proceeding with a ruptured viscus.
Write the inject before the examiner does — a sitting position would predict air embolism. Knowing the inject is coming turns adaptability from a test into a rehearsed answer.
Plan in block order — in the ABA sample, session 1 goes intra-op then post-op, and session 2 pre-op then intra-op, each followed by additional topics.² I organize the plan in the order I will be asked.
Build the map, then memorize it — exam staff hand out the materials and the orientation room has pens; personal pens and papers stay in the locker.¹ I follow the proctor on what enters the room and plan as if the map lives in my head.

Follow-up question

Twelve minutes in, you hit a line naming a syndrome you have never heard of, and you realize you spent seven minutes writing about the murmur alone. What do you do?

Follow-up answer

HeadlineTwo problems, an unknown and a clock, and I do not spend five more minutes on either.

For the syndrome I write the principle the examiner is after: an unfamiliar syndrome is a question about airway, cardiac and metabolic implications, so I plan to ask about and examine for those three. An unfamiliar drug is a question about its class and interactions, so I plan to say its class and what I would check before an anesthetic. For the clock, back to my checkpoints: finish the hunt now and build the map by minute 17, so the last three minutes still go to the opening answer. In session 2 the checkpoints are 2, 5 and 8.

Pitfalls that cost points

Writing a full anesthetic record instead of a question map; the examiner does not want the record.
Assuming a detail is irrelevant; nothing in the stem is irrelevant.
Planning only the ideal anesthetic and not the alternatives; the examiner will remove my first choice.

Rapid-fire

Q: Why is the second session's stem shorter? A: The 10-minute short stem tests a different skill: planning from less information and asking the right questions in the preoperative block.

Q: Do I state what I would ask the patient preoperatively? A: Yes, briefly and prioritized by the stem's findings; the examiner then supplies the answers or says the patient is already in the room.

Q: What if the stem has no abnormal findings? A: Then the questions are about the operation and the inject; I plan around the procedure's known complications and the patient's age.

Q: Can I ask the examiner about something unclear in the stem? A: Yes, in the first block, as a focused clinical question; it reads as judgment if it is relevant and as stalling if it is not.

Numbers to know

Item	Value
Session 1 review	20 min, long stem¹
Session 2 review	10 min, short stem¹
Reading passes	3: whole, hunt, map
Session 1 checkpoints	First pass by 3 min, hunt by 10, map by 17
Session 2 checkpoints	2, 5 and 8 min
Rehearsal of the opening answer	Last 2–3 min

Sources

1.What to Expect for Your APPLIED Exam (APPLIED Exam Manual) · ABA, 2026 · theaba.orgRevised July 2026.
2.Sample Standardized Oral Exam Questions · ABA · theaba.orgPublic sample; block names and minutes are taken from the sample sessions.

Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.