ANZCA Final Exam Resources

Past Questions

SAQs

Past SAQs

Past SAQs

Exam

Title

Stem

Pass Rate

Research Status

Model Answer

Question 1

Outline the perioperative management of a methamphetamine‑intoxicated 20‑year‑old who requires urgent surgery.

38.6%

Question 2

Discuss potential strategies for postoperative analgesia following shoulder rotator cuff repair.

91.8%

Question 3

List the benefits and risks of erector spinae plane block (ESPB) for the management of rib fracture pain. (30%)

Describe your technique for performing an ESPB in a patient with unilateral fractures of ribs 4 – 7. (70%)

81.3%

Question 4

Outline the assessment and immediate management of a patient in the post anaesthesia care unit (PACU) with respiratory failure after emergency open abdominal surgery.

46.2%

Question 5

Outline the limitations and possible complications of the use of supraglottic airway devices. (70%)

Describe a structured approach to the assessment of a patient with dysphonia after the use of a supraglottic airway. (30%)

65.5%

Question 6

Discuss the considerations when providing anaesthesia to a 2‑year‑old for removal of an inhaled foreign body.

67.8%

Question 7

Discuss the anaesthesia and analgesia planning considerations for a G1P0 pregnant patient with a body mass index of 60 kg/m2 who is referred for antenatal anaesthesia assessment.

32.7%

Question 8

Discuss the advantages and disadvantages of the use of social media in anaesthesia and perioperative medicine.

25.1%

Question 9

Discuss the perioperative management of a patient with severe asthma who is scheduled for elective laparoscopic cholecystectomy in two weeks’ time.

62.0%

Question 10

Outline the functional elements of an intraoperative cell salvage system. (30%)

Discuss the indications, advantages and disadvantages of intraoperative cell salvage. (70%)

81.9%

Question 11

Describe macroshock and microshock.

Outline mechanisms for preventing macroshock and microshock in the operating room.

45.0%

Question 12

Discuss the perioperative anaesthetic management considerations of a patient with inoperable pancreatic cancer causing obstructive jaundice who requires endoscopic retrograde cholangiopancreatography (ERCP) intervention.

60.2%

Question 13

State the diagnosis in each of the three following electrocardiograms (ECGs) and discuss their implications for anaesthesia.

⁠

33.3%

Question 14

Outline the principles of opioid stewardship.

27.5%

Question 15

List the risk factors for venous air embolism and arterial air embolism. (30%)

Discuss the diagnosis and management of intraoperative massive venous air embolism in a patient under general anaesthesia. (70%)

55.0%

Question 1

You are asked to review a healthy 20-year-old patient for severe post-operative pain in a stand-alone day surgery unit. Describe your assessment and justify your management.

77.0%

Question 2

Describe both the surface anatomy and anatomical relations of the internal jugular vein relevant to central venous cannulation.

59.2%

Question 3

Describe the mechanism of action of tranexamic acid and evaluate its use in obstetric anaesthesia practice.

72.8%

Question 4

Discuss the strategies you would use to mitigate the risk of a fire in the operating room. (50%)

Outline the steps to take in the event of fire in the operating room. (50%)

85.0%

Question 5

Discuss the preoperative assessment and risk stratification of an adult patient with a repaired congenital cardiac lesion, scheduled for an elective laparoscopic cholecystectomy.

71.8%

Question 6

Evaluate the use of a processed electroencephalogram (EEG) as a routine monitor during general anaesthesia.

58.7%

Question 7

Discuss the anaesthetic considerations for a patient requiring cerebral aneurysm coiling.

13.6%

Question 8

List the risk factors for the development of a bronchopleural fistula. (30%)

Justify your airway management plan for a bronchopleural fistula repair. (70%)

51.6%

Question 9

Discuss your perioperative analgesic management plan for a 20 kg, four-year-old child undergoing elective adenotonsillectomy.

70.9%

Question 10

Evaluate the practice of deliberately-induced intraoperative hypotension.

53.1%

Question 11

Discuss the anaesthetic considerations for a patient with myotonic dystrophy presenting for an emergency laparotomy.

60.1%

Question 12

Outline the physiological changes associated with carotid artery clamping and unclamping during carotid endarterectomy. (50%)

Outline intra-operative protection strategies to minimise harm from these manoeuvres. (50%)

27.2%

Question 13

Discuss the requirement for, and potential barriers to, open disclosure in the following intraoperative scenarios:

A) drug administration error

B) vagally-induced asystole necessitating a brief episode of chest compressions

51.2%

Question 14

List the limitations of awake fibreoptic intubation. (30%)

Discuss the options for securing the airway following unsuccessful awake fibreoptic intubation for an adult presenting with acute epiglottitis. (70%)

53.5%

Question 15

Describe the assessment and management of a patient with a suspected pneumothorax in the post anaesthesia care unit (PACU) following a paravertebral block for a mastectomy.

47.4%

Question 1

Evaluate the use of long-acting opioids in the treatment of acute pain.

51.1%

Question 2

Describe a perioperative pathway for hip replacement surgery with an expected in-hospital length of stay of less than 24 hours.

60.0%

Question 3

Discuss the management of a patient with life-threatening haemorrhage from major pelvic trauma.

63.9%

Question 4

Evaluate the usage of the pulmonary artery catheter in anaesthesia.

62.2%

Question 5

Evaluate the use of each of the following for preoperative cardiac risk stratification:

plasma biomarkers (chose ONE of natriuretic peptides OR troponin)

Duke Activity Status Index (DASI) stair-climbing test

cardiopulmonary exercise testing (CPX/CPET)

65.0%

Question 6

Outline the treatment strategies for chronic heart failure.

75.5%

Question 7

List the clinical features that suggest a diagnosis of pulmonary embolism under general anaesthesia. (30%)

Outline your immediate management of intraoperative pulmonary embolism. (70%)

80.0%

Question 8

Discuss the elements of perioperative management that improve outcomes in patients undergoing emergency laparotomy.

51.7%

Question 9

Outline your preoperative assessment of a 1-year-old patient requiring a ventriculoperitoneal shunt revision.

51.1%

Question 10

Discuss the potential benefits and risks of supranormal oxygen levels in the perioperative setting.

75.0%

Question 11

Outline the sensory innervation of the hip. (30%)

Describe one motor-sparing regional anaesthesia technique to provide analgesia to a patient undergoing surgery for a fractured neck of femur. (70%)

71.7%

Question 12

Describe the benefits and limitations of meta-analyses.

28.3%

Question 13

Discuss the perioperative management of a patient undergoing urgent thyroidectomy following failed medical therapy for thyrotoxicosis.

63.3%

Question 14

You have been called to the emergency department to see a patient with a post-tonsillectomy haemorrhage.

Discuss your initial assessment and management of this patient (50%).

Describe your anaesthesia management for the return to theatre for exploration of haemorrhage (50%).

87.2%

Question 15

Discuss the potential complications associated with hysteroscopy and their anaesthetic management.

21.1%

Question 1

List the branches of the coronary arteries and the myocardial territories and structures they supply. Outline the ECG leads that correspond to the blood supply. Describe the ECG changes in a NSTEMI.

48.9%

Question 2

Outline the immediate management of an unconscious trauma patient in the ED who has a suspected cervical spine injury.

65.5%

Question 3

A 30 yo pt is scheduled for laser resection of a subglottic mass to relieve mild stridor. Justify your intraoperative anaesthetic management of this case.

74.0%

Question 4

Discuss the periop management of a previously well pt presenting for transsphenoidal resection of a non-secretory pituitary macroadenoma.

25.6%

Question 5

An 82 yo patient is booked for excision of a floor of mouth squamous cell carcinoma and neck dissection, with a radial forearm free flap reconstruction. Discuss the issues relevant to the intraop anaesthetic management for this procedure.

62.8%

Question 6

Discuss the implications of anticoagulation as well as an appropriate anticoagulant management strategy for a 25 yo with a mechanical valve for the duration of pregnancy, delivery and the postpartum period.

43.9%

Question 7

Describe your technique to provide caudal epidural analgesia for an infant weighing 10kg undergoing hypospadias surgery.

43.9%

Question 8

A 56 yo patient with a phaeochromocytoma is scheduled for a lap adrenalectomy. Justify your preop investigations for this patient (30%).

Discuss your goals for preop optimization and how to achieve them (70%).

78.9%

Question 9

Justify strategies used to mitigate postop delirium in an elderly patient requiring hip fracture fixation.

65.9%

Question 10

Describe the innervation relevant to the stages of labour (30%). Evaluate the regional analgesia options for each stage (70%).

60.1%

Question 11

Outline the major considerations for organ donation after circulatory death (DCD).

51.6%

Question 12

Outline the circumstances where the dosing of paracetamol requires modification (50%). Describe the management principles of paracetamol toxicity (50%).

56.1%

Question 13

Data regarding the conduct and outcomes of anaesthesia are now widely collected eg National Anaesthesia Clinical Outcomes Registry (NACOR). Outline the benefits and the potential errors that can occur when using this data for research.

44.4%

Question 14

Discuss the preoperative elements of an Enhanced Recovery After Surgery (ERAS) program for a patient requiring major colorectal surgery.

62.3%

Question 15

Identify the axes A and B (with units), and the points labelled C through H on the following spirometry loop:

⁠

Outline how these spirometry parameters change in:

Chronic obstructive pulmonary disease

Idiopathic pulmonary fibrosis

Extrathoracic tracheal obstruction

75.8%

Question 1

Evaluate the methods for detection of myocardial ischaemia in the anaesthetised patient.

45.3%

Question 2

Discuss the intraoperative and postoperative pain management of a trauma patient who requires a semi- elective below knee amputation for an isolated injury.

77.3%

Question 3

Discuss the perioperative management of a patient requiring clot retrieval for an acute ischaemic stroke.

33.3%

Question 4

You are asked to review a 32-year-old G1P1 woman complaining of right leg weakness the day after an instrumental vaginal birth of a 4.2 kg baby under epidural analgesia.

Describe your assessment of the patient and management of the likely differential diagnoses.

80.7%

Question 5

A 56-year-old male with haemophilia A is scheduled to undergo a total knee replacement. Describe the pathogenesis of haemophilia A and its complications. (50%) Discuss how the presence of haemophilia A influences your perioperative management of this patient. (50%)

60.0%

Question 6

Justify the ongoing clinical use of nitrous oxide and ENTONOX. (50%)

Discuss how the environmental impact of their use can be minimised. (50%)

55.3%

Question 7

Describe the anatomy relevant to performing an adductor canal block. (50%) Outline the indications, limitations, and technique of performing an adductor canal block. (50%)

72.0%

Question 8

A patient presenting for surgery has a DDDR pacemaker. a) Explain the NASPE/BPEG Generic (NBG) pacemaker classification system. b) Describe the assessment and preoperative management of this DDDR device.

*NASPE/BPEG - North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group.

73.3%

Question 9

Discuss the intraoperative considerations for a patient undergoing a pneumonectomy.

34.7%

Question 10

Discuss the use of ultrasound during the initial presentation of a patient with major trauma.

62.7%

Question 11

A 75-year-old man presents with an acute dissection of the descending thoracic aorta. His blood pressure measures 190/110 mmHg. Justify your plan for his preoperative blood pressure management. (30%) Describe the potential complications of thoracic endovascular aortic repair (TEVAR) and how you would mitigate them. (70%)

37.3%

Question 12

Discuss the advantages and disadvantages of the use of neuromuscular blocking drugs in a patient admitted to the intensive care unit.

48.0%

Question 13

Compare the algorithms for advanced life support of adults and term newborns and explain the rationale for the differences.

74.7%

Question 14

A patient has undergone an eight-hour elective cervical spine fusion involving both anterior and posterior approaches. Outline your approach to the extubation of this patient.

56.0%

Question 15

The following is the venous blood gas (VBG) result of a five-week-old infant with pyloric stenosis.

2022.2 Question 15 VBG

⁠

Interpret this VBG. Describe your preoperative resuscitation and justify your criteria for proceeding to surgery.

70.7%

Question 1

Describe your preoperative assessment of a patient with oesophageal cancer scheduled for an oesophagectomy and justify your strategy to optimise them before surgery.

64.1%

Question 2

Outline your management of a patient with chronic daily headache.

79.0%

Question 3

The following are the arterial blood gas (ABG) results of a patient with chronic liver disease:

SAQ 2022.1 Q3 ABG

⁠

Interpret this ABG.

List the causes of hypoxia in patients with chronic liver disease.

Describe how you would differentiate between the causes of hypoxia in patients with chronic liver disease.

31.3%

Question 4

Describe the factors that ensure the safety and quality of a ward-based postoperative epidural analgesia service.

45.6%

Question 5

Describe a technique for front of neck access to the airway in a ‘Can’t Intubate, Can’t Oxygenate’ situation. (50%)

Outline the potential complications and limitations of this technique. (50%)

86.7%

Question 6

A patient with primary pulmonary hypertension is scheduled for laparoscopic bowel resection.

Their current medication is bosentan PO 125mg bd.

Discuss how their condition influences your perioperative management.

54.9%

Question 7

An 80-year-old man is in the post anaesthesia care unit (PACU) following a transurethral resection of prostate under spinal anaesthesia.

He is restless, saturating poorly on air and refusing to keep an oxygen mask on. List the likely differential diagnoses and describe your management.

37.9%

Question 8

⁠

Identify the points labelled A to F on this intra-aortic balloon pump (IABP) pressure-time trace at the commencement of 1:2 augmentation. (30%)

Outline the aims of IABP placement and discuss the underlying physiological principles. (70%)

49.7%

Question 9

Discuss how pregnancy influences your perioperative management of a patient at 25 weeks gestation scheduled for laparoscopic appendicectomy.

49.7%

Question 10

Describe your response to a formal complaint made by a patient about you to your head of department.

83.6%

Question 11

Discuss the perioperative management of a patient on haemodialysis who is to undergo a renal transplant.

39.0%

Question 12

A patient with Type 1 diabetes mellitus is scheduled for laparoscopic cholecystectomy.

Outline your perioperative management of their diabetes.

33.3%

Question 13

Describe the sensory and motor innervation of the airway relevant for topicalisation for an awake nasal fibreoptic intubation.

37.9%

Question 14

Discuss the safety precautions and equipment requirements for providing anaesthesia in the MRI suite.

41.0%

Question 15

Justify your perioperative management plan of a six-year-old child with a penetrating eye injury.

43.1%

Question 1

Define the terms ‘train-of-four’ (TOF) and ‘double burst stimulation’ (DBS) with respect to a peripheral nerve stimulator (PNS). (30%)

Evaluate the use of a quantitative peripheral nerve stimulator when using neuromuscular blocking agents in anaesthetic practice. (70%)

64.9%

Question 2

A patient is admitted to hospital following a diagnosis of intrauterine fetal death (IUFD) at 35 weeks gestation. Discuss your considerations for the anaesthetic management of her labour and delivery.

59.1%

Question 3

You have just intubated a patient who has respiratory failure due to severe bacterial pneumonia. They remain hypoxaemic with an SpO2 of 82%.

Describe your immediate actions and justify your strategies to improve oxygenation whilst awaiting the patient’s retrieval to a tertiary centre.

83.6%

Question 4

Describe the clinical presentation of venous carbon dioxide embolism during laparoscopic surgery and outline your management.

64.3%

Question 5

Justify your strategies for managing severely elevated intracranial pressure.

86.5%

Question 6

Discuss the perioperative strategies you would use to mitigate the risks of prolonged surgery in the prone position.

55.6%

Question 7

An adult is brought to your district hospital after a house fire. They have sustained burns to 75% of their total body surface area (TBSA).

Discuss your management prior to their transfer to a Burns Unit.

59.6%

Question 8

Discuss how a diagnosis of Addison’s disease would influence your perioperative management of a patient who requires an urgent laparotomy for bowel obstruction.

49.1%

Question 9

Describe the elements of informed consent for anaesthesia. (50%)

Discuss the informed consent process in the context of the following clinical situations: (50%)

A 20-year-old primigravida in late first stage of labour requests epidural analgesia.

A 15-year-old is scheduled for posterior spinal instrumentation for severe idiopathic scoliosis.

63.2%

Question 10

A 60-year-old patient is scheduled for stenting of a tracheobronchial mass. Outline your perioperative management.

59.1%

Question 11

A 14-year-old with severe autism is rescheduled for dental surgery. The operation was previously abandoned due to their poor cooperation with the team.

Justify your perioperative management plan.

70.2%

Question 12

Describe the nerve supply to the breast. (30%)

Describe an appropriate regional technique to provide perioperative analgesia for a patient undergoing a total mastectomy and justify your choice. (70%)

73.7%

Question 13

A 55-year-old patient with atrial fibrillation (AF) requires general anaesthesia in the cardiac catheter laboratory for electrophysiological (EP) study and catheter ablation.

Discuss the principles of remote location anaesthesia relevant to this case.

53.8%

Question 14

Discuss the principles of damage control resuscitation in severe trauma.

73.1%

Question 15

Outline the clinical features, differential diagnoses, and management of serotonin syndrome in the perioperative period.

70.2%

Question 1

Outline the anatomy relevant to performing a brachial plexus block using the axillary approach. (70%)

Describe the limitations of this block when used for upper limb surgery. (30%)

58.2%

Question 2

Explain your strategies to minimise the risk of hypoxia during induction, maintenance and emergence from anaesthesia in a morbidly obese patient undergoing a laparoscopic total hysterectomy.

72.4%

Question 3

In a large clinical trial, patients were randomised into two groups to study the impact of bispectral index (BISTM) monitoring on the incidence of awareness.

The table below shows the results.

Results

⁠

Data analysis found that the statistical difference in the incidence of awareness had a p value of 0.022.

The study reported that BIS-guided anaesthesia reduced the risk of awareness by 82% (95% confidence interval 17-98%) with an odds ratio of 0.2 and a number needed to treat of 140.

Define the following terms and explain their meaning in relation to this study:

p value

risk reduction

confidence interval

odds ratio

number needed to treat

85.2%

Question 4

A 24-year-old woman requires urgent manual removal of placenta due to ongoing bleeding following a vaginal delivery (estimated blood loss 1500ml).

Outline your initial management prior to her arrival in theatre. (50%)

Discuss the options available for managing persistent uterine atony in theatre. (50%)

69.4%

Question 5

This is the standard 12-lead electrocardiogram (ECG) of a 56-year-old man in the post-anaesthesia care unit (PACU) two hours after an emergency laparotomy for bowel obstruction.

He is complaining of shortness of breath, abdominal pain and has a blood pressure of 160/110mmHg.

⁠

He has a history of hypertension controlled with atenolol and hydrochlorothiazide. The preoperative ECG is missing. The anaesthetic assessment only notes that it showed sinus rhythm.

Considering all the clinical information, interpret this ECG and outline the appropriate management of this patient in PACU.

66.8%

Question 6

You will be anaesthetising a 63-year-old man with severe Parkinson’s disease who is booked for an inguinal hernia repair.

Discuss the issues that are relevant to providing perioperative care for this patient.

56.4%

Question 7

Your department has exceeded its drug budget for the last financial year.

You have been asked to develop a departmental policy document for the rational use of sugammadex.

Discuss the issues to be considered.

27.6%

Question 8

A patient takes a 60mg slow-release morphine tablet twice daily for chronic low back pain. They have been appropriately investigated and there is no surgically treatable pathology.

In relation to this patient

List the risks of long-term opioid therapy. (30%)

Justify the appropriate treatment of chronic low back pain. (70%)

85.7%

Question 9

Evaluate the equipment available for the delivery of oxygen to postoperative patients on a general surgical ward.

86.2%

Question 10

List the signs of malignant hyperthermia. (30%)

Outline the immediate management of a patient where malignant hyperthermia is suspected. (70%)

67.3%

Question 11

Discuss the issues relevant to the perioperative care of a seven-year-old child with Down Syndrome who has sustained a supracondylar fracture of the humerus.

64.3%

Question 12

A patient presents on the day of surgery with a blood pressure of 180/110mmHg.

Justify your decision to proceed with or postpone surgery for this patient.

25.5%

Question 13

A 77-year-old patient is admitted to hospital with a fractured neck of femur requiring total hip arthroplasty. Physical examination on admission reveals signs of congestive cardiac failure.

Outline how congestive cardiac failure influences the perioperative risk for this patient. (30%)

Discuss how the finding of congestive cardiac failure influences your perioperative management of this patient. (70%)

84.2%

Question 14

Discuss the options for anticoagulation management in the perioperative period for a patient taking warfarin for atrial fibrillation who requires a laparotomy for ischaemic bowel.

53.6%

Question 15

Evaluate the use of five (5) of the following additives that may be combined with local anaesthetics for neural blockade.

adrenaline

clonidine

dexamethasone

glucose

hyaluronidase

midazolam

morphine

neostigmine

sodium bicarbonate

67.3%

Question 1

You are asked to assess and anaesthetise a 54-year-old patient for a laparoscopic cholecystectomy. They received a heart transplant ten years ago.

Discuss the issues relevant for this patient.

61.6%

Question 2

A 75-year-old man is scheduled for elective endovascular repair of a thoraco-abdominal aortic aneurysm.

List the potential complications of this procedure in this patient and discuss your strategies to mitigate these complications.

63.6%

Question 3

A young adult male is assaulted and sustains a maxillary fracture. He is scheduled for an open reduction and internal fixation (ORIF) of the maxillary fracture on the emergency list.

Outline the relevant anaesthetic considerations.

21.2%

Question 4

Justify your choice and dosing of drugs when providing anaesthesia for electroconvulsive therapy (ECT).

58.6%

Question 5

A patient with chronic liver disease requires gastroscopy for investigation of chronic anaemia.

A preoperative arterial blood gas (ABG) on room air demonstrates:

ABG

⁠

Interpret this ABG and list possible causes of hypoxia in this patient. (50%)

Justify your anaesthetic technique for gastroscopy in this patient. (50%)

47.5%

Question 6

A 30-year-old woman at full term collapses in early labour and is unresponsive.

List the most likely causes of her collapse. (30%)

A presumptive diagnosis of amniotic fluid embolism is made. Describe the immediate and ongoing management of this patient. (70%)

59.6%

Question 7

An infant born at 30 weeks gestation is booked for repair of bilateral inguinal herniae at 46 weeks post-conceptual age.

Discuss the important issues when providing perioperative care for this infant.

63.6%

Question 8

A patient with type 2 diabetes mellitus requires urgent lower limb arterial bypass surgery. Their medications include dapagliflozin (a sodium-glucose cotransporter 2 inhibitor).

Outline your specific concerns and management of this patient for this procedure

50.5%

Question 9