The additional-topics block: three minutes per topic
Why examiners ask this
In the ABA sample exam, each 35-minute session ends with a 10-minute block of additional topics, and each block carries three unrelated mini-cases: pre-eclampsia, post-CABG tamponade and hypothermia in one session; a tracheoesophageal fistula, outpatient epidural with a wet tap, and anaphylaxis in radiology in the other.1 Each one arrives cold: a new patient, a new operation, no stem to review and no time to settle. The block exists to sample breadth and to test adaptability in its purest form, because the context changes completely every three minutes. Candidates who did well in the main stem lose ground here by carrying the previous case into the next one or by spending six minutes on the first topic and never reaching the third. Organization and judgment are graded hardest in this block, because there is no time to recover from a slow start.
The 60-second answer
I treat each additional topic as a self-contained 3-minute case with a hard reset at the start. When the examiner reads the scenario I listen for three things: the patient, the setting, and the one abnormal fact. I restate the problem in one sentence so the examiner hears that I have the right patient: "A 4-year-old, two hours after tonsillectomy, now bleeding." Then I give the priority and the first two or three actions with reasons, the finding that would change my plan, and I stop. The examiner almost always asks one or two follow-ups that push the topic one level deeper, and I answer those in the same shape. When the examiner says "let's move on," I let the case go completely, take a breath, and listen to the next scenario as if the session had just started. Three topics, three resets, no carryover.
Decision points and the "why"
- Restate the patient in one line — it buys two seconds, confirms I heard the scenario correctly, and lets the examiner correct a misheard detail before I build a plan on it. A plan for the wrong patient scores nothing.
- Find the one abnormal fact — additional topics are short, so every detail is deliberate. A full stomach, a pacemaker, a platelet count of 60,000, a Jehovah's Witness: the abnormal fact is the question. I build the answer around it rather than reciting a generic anesthetic.
- Lead with the safety-critical action — the scenario often drops me into the middle of an event. I name what threatens life first, act, then explain. "Oxygen, call for help, the surgeon applies pressure" precedes any discussion of etiology.
- Hold depth in reserve — I give the consultant-level summary and let the examiner choose the depth. A candidate who front-loads every detail leaves nothing for the follow-up and burns the time the examiner budgeted for the next topic.
- Let the examiner drive the clock — the examiner manages timing and will cut me off when the topic has been sampled. Being cut off is not failure; it is the schedule. I do not argue to finish the point.
- Reset between topics — I physically pause, sit back and listen. Carrying the hemodynamic frame of a bleeding tonsil into a question about a neonate with a tracheoesophageal fistula is a common and avoidable error.
The complication they will inject
The block breaks in three predictable ways. The first is the topic I do not know: a rare syndrome or a drug I have not used. I state the governing principle, the safe default action, and the resource I would use, then stop: "I would treat this as a difficult airway with a full stomach and confirm the drug interaction with pharmacy before induction." Three attributes survive even without recall. The second is the inject inside the mini-case: the examiner adds a complication 90 seconds in. I run recognize, communicate, treat, reassess in two sentences; the block is too short for anything longer. The third is the clock: the examiner says "one more topic" with 90 seconds left. I compress to priority and one action, because a short complete answer scores better than a long incomplete one.
Pitfalls that cost points
- Spending the whole block on the first topic by volunteering every detail I know.
- Carrying the previous topic's assumptions into the next scenario.
- Asking for information the examiner has already given; it signals that I was not listening.
- Opening with a differential diagnosis when the scenario describes an active crisis that needs an action.
- Visible frustration at being moved on; the next examiner question is graded on composure too.
Rapid-why
Q: Are the additional topics related to the stem? A: No. In the ABA sample they are independent mini-cases from other subspecialties, so I prepare breadth, not depth on the stem.1
Q: How many topics are in the block? A: Plan for three in 10 minutes, about three minutes each; the examiner controls the exact number and pace.
Q: What if the examiner moves on before I finish? A: I let it go. The examiner has sampled what they needed, and returning to it costs time on the next topic.
Q: Should I ask clarifying questions? A: Only one, and only if the answer changes my first action; otherwise I state my assumption and proceed.
Numbers to know
| Item | Value |
|---|---|
| Additional-topics block | 10 min at the end of each session1 |
| Topics per block | 3 in the ABA sample1 |
| Session length | 35 min, tone at the end2 |
| Time per topic | ~3 min |
| Opening restatement | 1 sentence, under 5 s |
| Target first answer | 30–45 s |
Links
- How the SOE is scored: what examiners grade, Structuring an answer in 45 seconds, Handling the mid-case complication, Using the 20- and 10-minute stem review, OSCE day: stations, timing, who is in the room
- ABA Sample Standardized Oral Exam Questions; ABA APPLIED Exam Manual
Sources
- 1.Sample Standardized Oral Exam Questions · ABA · theaba.orgPublic sample; block names and minutes are taken from the sample sessions.
- 2.What to Expect for Your APPLIED Exam (APPLIED Exam Manual) · ABA, 2026 · theaba.orgRevised July 2026.
Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.