FANZCA Fellowship of the Australian and New Zealand College of Anaesthetists — Questions and Answers

Question 1: Which of the following represents the most significant risk during a verbal medication order in the operating theater?

The circulating nurse not writing it down
Sound-alike drug name confusion without read-back confirmation (Correct answer)
The timing of the order relative to the surgical incision
The order being given before scrubbing

Correct answer: Sound-alike drug name confusion without read-back confirmation

Sound-alike drug name errors (e.g., morphine/hydromorphone) without read-back confirmation are a leading cause of medication errors in high-noise environments.

Question 2: Which ventilation strategy is recommended during one-lung ventilation to minimise ventilator-induced lung injury?

Tidal volume 4–6 mL/kg IBW, PEEP 5 cmH2O (Correct answer)
Tidal volume 10–12 mL/kg IBW, PEEP 0 cmH2O
Pressure control with high inspiratory pressure
High-frequency jet ventilation at all times

Correct answer: Tidal volume 4–6 mL/kg IBW, PEEP 5 cmH2O

Lung-protective ventilation during one-lung ventilation uses low tidal volumes (4–6 mL/kg IBW) with moderate PEEP to reduce barotrauma and volutrauma.

Question 3: ANZCA PS55 provides guidance on which emerging area of anaesthesia practice?

Anaesthesia in remote and rural locations
Simulation-based training requirements
Recommendations on minimum facilities for safe administration of anaesthesia
Environmental sustainability in anaesthesia (Correct answer)

Correct answer: Environmental sustainability in anaesthesia

ANZCA PS55 addresses the environmental sustainability of anaesthesia practice, including guidance on minimising the environmental impact of anaesthetic agents.

Question 4: ANZCA's PS15 professional document pertains to which aspect of anaesthesia practice?

Minimum standards for intrahospital transport
Recommendations for the pre-anaesthesia consultation (Correct answer)
Standards for procedural sedation
Management of difficult airways

Correct answer: Recommendations for the pre-anaesthesia consultation

ANZCA PS15 provides recommendations for the pre-anaesthesia consultation, detailing what the anaesthetist must assess before administering anaesthesia.

Question 5: What does ANZCA's 'Welfare of Anaesthetists' resource primarily address?

Mental health, wellbeing, and support resources for anaesthesia practitioners (Correct answer)
Salary negotiation strategies for Fellows
Physical ergonomics in the operating theatre only
Financial planning for retirement

Correct answer: Mental health, wellbeing, and support resources for anaesthesia practitioners

ANZCA's Welfare of Anaesthetists resources focus on mental health, burnout prevention, and supporting the psychological wellbeing of anaesthesia practitioners.

Question 6: Which of the following is the MOST important pre-operative assessment finding that predicts a difficult bag-mask ventilation?

Limited mouth opening less than 3 cm
Body mass index greater than 35 kg/m²
Mallampati Class III
Presence of a beard (Correct answer)

Correct answer: Presence of a beard

A beard is one of the MOANS predictors (Mask seal, Obesity/Obstruction, Age, No teeth, Snores/Stiff) and significantly impairs the ability to achieve a seal for bag-mask ventilation, though all listed factors contribute.

Question 7: In quality improvement methodology, a 'driver diagram' is used to:

Map the timeline of an adverse event for root cause analysis
Document patient flow through the perioperative pathway
Identify primary and secondary drivers that contribute to achieving a specific improvement aim (Correct answer)
Calculate statistical significance of outcome differences

Correct answer: Identify primary and secondary drivers that contribute to achieving a specific improvement aim

A driver diagram is a visual tool that links an improvement aim to its primary drivers and secondary drivers, guiding intervention selection.

Question 8: The FANZCA fellowship standard requires participation in quality improvement activities. Which of the following BEST describes a quality improvement project versus a research project?

QI aims to improve local systems using existing knowledge; research aims to generate new generalizable knowledge (Correct answer)
QI uses randomization while research does not
QI is conducted only by senior consultants while research involves trainees
QI requires ethics committee approval while research does not

Correct answer: QI aims to improve local systems using existing knowledge; research aims to generate new generalizable knowledge

Quality improvement projects apply existing evidence to improve local systems and processes, whereas research is designed to generate new generalizable knowledge.

Question 9: Which volatile anesthetic agent has the lowest blood-gas partition coefficient, resulting in the fastest induction and emergence?

Isoflurane
Sevoflurane
Halothane
Desflurane (Correct answer)

Correct answer: Desflurane

Desflurane has a blood-gas partition coefficient of approximately 0.45, the lowest among commonly used volatile agents, enabling the fastest induction and emergence.

Question 10: What is mandatory reporting?

A requirement to report all client information to authorities
A policy that only applies to government employees
A legal obligation to report certain situations such as abuse or neglect (Correct answer)
An optional recommendation for best practice

Correct answer: A legal obligation to report certain situations such as abuse or neglect

Mandatory reporting laws require professionals to report suspected abuse, neglect, or other specified situations to appropriate authorities.

Question 11: Under ANZCA Professional Document PS18, minimum monitoring during general anaesthesia must include which parameter at all times?

Invasive arterial pressure
Bispectral index
End-tidal CO2 only
Pulse oximetry (Correct answer)

Correct answer: Pulse oximetry

ANZCA PS18 mandates continuous pulse oximetry as a minimum monitoring standard throughout general anaesthesia.

Question 12: In perioperative cardiac risk assessment, what does the Revised Cardiac Risk Index (RCRI) estimate?

Risk of major adverse cardiac events (MACE) after noncardiac surgery (Correct answer)
Preoperative cardiac medication adjustment requirements
Likelihood of postoperative respiratory failure requiring reintubation
Intraoperative blood loss requiring transfusion

Correct answer: Risk of major adverse cardiac events (MACE) after noncardiac surgery

The RCRI uses six independent predictors (ischemic heart disease, heart failure, cerebrovascular disease, diabetes on insulin, creatinine >2 mg/dL, high-risk surgery) to estimate perioperative MACE risk.

Question 13: Which test is used to evaluate neuromuscular blockade recovery and specifically assesses fade at the laryngeal adductors?

Post-tetanic count (PTC)
Double-burst stimulation (DBS)
Acceleromyography at the corrugator supercilii (Correct answer)
Train-of-four (TOF) ratio at the adductor pollicis

Correct answer: Acceleromyography at the corrugator supercilii

The corrugator supercilii muscle has similar pharmacodynamic sensitivity to the laryngeal adductors, making acceleromyography at this site a better surrogate for airway muscle recovery than the adductor pollicis.

Question 14: Which indicator is considered a PROCESS measure rather than an OUTCOME measure in perioperative quality improvement?

Incidence of postoperative nausea and vomiting
Compliance rate with pre-induction checklist completion (Correct answer)
Rate of unplanned ICU admission
30-day postoperative mortality rate

Correct answer: Compliance rate with pre-induction checklist completion

Checklist compliance is a process measure reflecting what is done during care delivery, whereas mortality, ICU admission rates, and PONV incidence are outcome measures.

Question 15: Effective communication in a crisis (e.g., anaphylaxis during anesthesia) is best supported by which leadership strategy?

Designating a clear leader who directs tasks explicitly by name and confirms task completion (Correct answer)
Limiting communication to written instructions to avoid confusion
The most senior person performing all tasks independently
Allowing all team members to simultaneously suggest treatments

Correct answer: Designating a clear leader who directs tasks explicitly by name and confirms task completion

Clear role designation, directed task assignment, and closed-loop confirmation are crisis resource management principles that optimize team performance.

Question 16: How does ANZCA's remediation framework typically begin when a trainee is identified as underperforming?

Issuing a formal ANZCA examination failure notice
Immediate suspension from clinical duties
Early identification and a supportive learning plan developed collaboratively (Correct answer)
Referral to the Medical Board of Australia

Correct answer: Early identification and a supportive learning plan developed collaboratively

ANZCA's approach prioritises early, supportive intervention with a collaborative learning plan before escalating to formal processes.

Question 17: Which ANZCA member benefit includes access to professional indemnity insurance guidance?

ANZCA does not provide any indemnity guidance
Indemnity insurance arranged through NZMA
Automatic indemnity coverage through ANZCA membership
The College's risk management resources and guidelines (Correct answer)

Correct answer: The College's risk management resources and guidelines

ANZCA provides risk management resources and guidance to help members navigate professional indemnity considerations, though members must arrange their own insurance.

Question 18: In a patient with severe mitral stenosis undergoing non-cardiac surgery, which haemodynamic goal is most important?

Maintain high heart rate to increase cardiac output
Maintain low filling pressures to prevent pulmonary oedema
Avoid tachycardia to allow adequate ventricular filling (Correct answer)
Reduce systemic vascular resistance aggressively

Correct answer: Avoid tachycardia to allow adequate ventricular filling

In mitral stenosis, tachycardia reduces diastolic filling time across the stenotic valve, causing a critical drop in cardiac output and pulmonary oedema.

Question 19: Which type of shock is characterised by high cardiac output, low systemic vascular resistance, and low central venous oxygen saturation?

Cardiogenic shock
Distributive shock (Correct answer)
Hypovolaemic shock
Obstructive shock

Correct answer: Distributive shock

Distributive shock (e.g., septic shock) causes massive vasodilation with high cardiac output, low SVR, and despite elevated mixed venous O2 saturation initially, impaired cellular oxygen utilisation leads to lactic acidosis.

Question 20: In the context of FANZCA documentation standards, which of the following best describes the medicolegal significance of contemporaneous anesthetic records?

They are only reviewed during quality assurance audits
They are primarily administrative documents with no legal standing
They must be co-signed by the surgeon to be legally valid
They serve as primary evidence in legal proceedings and must reflect actual clinical events (Correct answer)

Correct answer: They serve as primary evidence in legal proceedings and must reflect actual clinical events

Contemporaneous anesthetic records are primary legal documents and courts interpret them as reflecting what actually occurred during the procedure.

Question 21: What is the principal anesthetic concern with a patient presenting for surgery with an undiagnosed difficult airway?

Delayed emergence from anesthesia
Increased risk of awareness under anesthesia
Higher requirement for muscle relaxants
Risk of 'cannot intubate, cannot oxygenate' (CICO) situation requiring surgical airway (Correct answer)

Correct answer: Risk of 'cannot intubate, cannot oxygenate' (CICO) situation requiring surgical airway

The most critical airway concern is progressing to a CICO scenario where neither bag-mask ventilation nor tracheal intubation can maintain oxygenation, potentially requiring emergency surgical airway.

Question 22: ANZCA's 'Transition to Fellowship' (TTF) program is designed to support which group?

International medical graduates seeking FANZCA
Trainees preparing for the Primary examination
Senior consultants transitioning to retirement
New Fellows in the early stages of independent specialist practice (Correct answer)

Correct answer: New Fellows in the early stages of independent specialist practice

The Transition to Fellowship program helps newly qualified Fellows adjust to independent specialist practice by providing mentoring, resources, and peer support.

Question 23: In the context of FANZCA examination blueprinting, what is the primary purpose of mapping exam questions to specific learning outcomes?

To rank candidates by specialty interest
To ensure content validity across the curriculum (Correct answer)
To simplify examiner preparation
To increase the number of questions per domain

Correct answer: To ensure content validity across the curriculum

Blueprinting maps questions to learning outcomes to ensure the exam has content validity and adequately samples the entire curriculum.

Question 24: What is the best approach when encountering a novel situation in practice?

Improvise without any reference to established methods
Avoid the situation entirely
Wait for someone else to handle it
Apply fundamental principles, consult resources, and seek guidance when needed (Correct answer)

Correct answer: Apply fundamental principles, consult resources, and seek guidance when needed

Novel situations require applying foundational knowledge, consulting available resources, and seeking expert guidance when needed.

Question 25: Which statement about multisource feedback (MSF) in ANZCA training is correct?

MSF only collects feedback from consultant anaesthetists
MSF gathers structured input from a broad range of clinical colleagues including nurses and technicians (Correct answer)
MSF results are not included in the training portfolio
MSF replaces all other workplace-based assessments

Correct answer: MSF gathers structured input from a broad range of clinical colleagues including nurses and technicians

MSF intentionally captures perspectives from diverse clinical team members to provide a well-rounded picture of the trainee's professional behaviour.

Question 26: How long does the typical training period last for the Fellowship program in Anaesthesia?

Six years.
Four years.
Three years.
Five years. (Correct answer)

Correct answer: Five years.

The typical training period for the FANZCA Fellowship program in Anaesthesia lasts five years. This extensive duration is necessary to acquire the comprehensive theoretical knowledge, diverse clinical skills, and practical experience required to become a competent and independent specialist anaesthetist, capable of managing a wide range of patient scenarios.

Question 27: ANZCA PS09 addresses which critical area of anaesthesia patient safety?

Post-operative nausea and vomiting management
Guidelines on sedation and/or analgesia for diagnostic and interventional procedures (Correct answer)
Anaesthesia for obstetric patients
Management of anaphylaxis during anaesthesia

Correct answer: Guidelines on sedation and/or analgesia for diagnostic and interventional procedures

ANZCA PS09 provides guidelines on the appropriate use of sedation and/or analgesia for diagnostic and interventional medical and surgical procedures.

Question 28: The Frank-Starling law of the heart states that within physiological limits, increased ventricular end-diastolic volume leads to:

Increased systemic vascular resistance
Increased stroke volume (Correct answer)
Reduced heart rate by baroreceptor activation
Decreased myocardial oxygen consumption

Correct answer: Increased stroke volume

The Frank-Starling mechanism describes how increased preload (end-diastolic volume) stretches myocardial fibres, optimising actin-myosin overlap and increasing the force of contraction, thereby increasing stroke volume.

Question 29: How often are candidates required to undergo assessments during their training?

Once a year.
At regular intervals throughout the training. (Correct answer)
Every two years.
Only at the end of the program.

Correct answer: At regular intervals throughout the training.

Candidates in the FANZCA Fellowship program are required to undergo assessments at regular intervals throughout their training. This continuous assessment approach allows for ongoing monitoring of progress, provides timely feedback, and ensures trainees are consistently meeting developmental milestones. It helps identify areas for improvement and supports comprehensive skill acquisition.

Question 30: A FANZCA fellow disagrees with a surgical colleague's management plan for a high-risk patient. The most appropriate initial communication strategy is:

Raise concerns directly with the surgeon using assertive but respectful language, citing patient safety (Correct answer)
Escalate immediately to hospital administration
Document the disagreement in the patient's notes and proceed as directed
Comply with the plan to preserve the professional relationship

Correct answer: Raise concerns directly with the surgeon using assertive but respectful language, citing patient safety

Assertive, respectful direct communication between colleagues is the first step in resolving clinical disagreements, prioritizing patient safety.

Question 31: In a patient with severe mitral stenosis, which haemodynamic goal is most critical during the perioperative period?

High heart rate to increase cardiac output
Systemic vasodilation to reduce afterload
Controlled heart rate to optimise diastolic filling time (Correct answer)
Aggressive volume loading to increase preload

Correct answer: Controlled heart rate to optimise diastolic filling time

In mitral stenosis, a controlled (slow) heart rate is essential to allow adequate time for ventricular filling across the stenosed valve and maintain cardiac output.

Question 32: What is the primary advantage of a video laryngoscope compared to a direct laryngoscope in the management of an anticipated difficult airway?

Provides an improved glottic view without requiring direct line of sight (Correct answer)
Eliminates the need for neuromuscular blockade
Removes the risk of dental trauma entirely
Allows blind nasal intubation

Correct answer: Provides an improved glottic view without requiring direct line of sight

Video laryngoscopes use an angled camera blade to visualise the glottis indirectly, significantly improving the view in patients where mouth opening, neck mobility, or anatomy prevents a direct line of sight.

Question 33: What is the mechanism of action of succinylcholine as a neuromuscular blocking agent?

Competitive antagonism at nicotinic acetylcholine receptors
Inhibition of acetylcholinesterase at the neuromuscular junction
Blockade of voltage-gated sodium channels in motor neurons
Depolarizing agonism at nicotinic acetylcholine receptors (Correct answer)

Correct answer: Depolarizing agonism at nicotinic acetylcholine receptors

Succinylcholine acts as a depolarizing agent by mimicking acetylcholine and persistently binding to nicotinic receptors, causing initial fasciculations followed by flaccid paralysis.

Question 34: What is the importance of maintaining professional boundaries?

Only new professionals need to worry about boundaries
Clear boundaries protect both the professional and the client relationship (Correct answer)
Boundaries are only important in healthcare settings
Boundaries reduce effectiveness by creating distance

Correct answer: Clear boundaries protect both the professional and the client relationship

Professional boundaries maintain the integrity of the professional-client relationship and protect all parties.

Question 35: What kind of support does the College offer to its Fellows in terms of professional development?

Assistance in private practice management.
Workshops, seminars, and online learning. (Correct answer)
Only access to medical literature.
Personal mentorship programs.

Correct answer: Workshops, seminars, and online learning.

The Australian and New Zealand College of Anaesthetists (FANZCA) supports its Fellows' professional development through a variety of structured learning opportunities. These include workshops for practical skills, seminars for in-depth knowledge, and flexible online learning modules. This comprehensive approach ensures Fellows can continuously update their expertise and stay current with advancements in anaesthesia.

Question 36: When sizing an endotracheal tube for a child using the age-based formula, which of the following correctly represents the uncuffed tube size calculation?

(Age/4) + 3
(Age/2) + 6
(Age/4) + 4 (Correct answer)
Age + 4

Correct answer: (Age/4) + 4

The standard formula for uncuffed endotracheal tube internal diameter in children is (age in years / 4) + 4, which reliably estimates appropriate tube size from approximately 1 to 8 years of age.

Question 37: The 'cannot intubate, can oxygenate' scenario is best managed initially by which of the following?

Insertion of a supraglottic airway device and considering surgical options (Correct answer)
Waking the patient up and rescheduling surgery
Repeated direct laryngoscopy attempts with different blades
Immediate front-of-neck access

Correct answer: Insertion of a supraglottic airway device and considering surgical options

When a patient can be oxygenated but cannot be intubated, maintaining oxygenation via a supraglottic airway is the immediate priority, followed by a calm assessment of options including waking the patient or proceeding cautiously with airway adjuncts.

Question 38: Which advanced module would a trainee select to gain expertise in anaesthesia for patients undergoing brain or spinal surgery?

Cardiothoracic Anaesthesia
Neuroanaesthesia (Correct answer)
Perioperative Medicine
Trauma Anaesthesia

Correct answer: Neuroanaesthesia

Neuroanaesthesia is the Advanced Training module focused on anaesthetic management for neurosurgical and spinal procedures.

Question 39: What is the purpose of applying back, upward, right-sided pressure (BURP) during direct laryngoscopy?

To facilitate passage of the tube past the arytenoids
To prevent passive regurgitation during intubation
To improve the laryngoscopic view by repositioning the larynx (Correct answer)
To reduce the risk of oesophageal intubation

Correct answer: To improve the laryngoscopic view by repositioning the larynx

BURP manoeuvre — applying backward, upward, and rightward pressure on the thyroid cartilage — repositions the larynx to improve the laryngoscopic grade of view, particularly for Grade II and III views.

Question 40: Which agent is the preferred reversal for rocuronium-induced neuromuscular blockade in a patient with renal failure?

Pyridostigmine
Neostigmine with glycopyrrolate
Sugammadex (Correct answer)
Edrophonium

Correct answer: Sugammadex

Sugammadex encapsulates rocuronium and is effective regardless of renal function, though the complex may accumulate; it remains preferred over neostigmine which requires ACh esterase activity.

Question 41: Which statistical method is most appropriate to assess inter-rater reliability between two FANZCA examiners scoring the same candidate's viva performance?

Student's t-test
ANOVA
Pearson correlation coefficient
Cohen's kappa (Correct answer)

Correct answer: Cohen's kappa

Cohen's kappa specifically measures agreement between two raters beyond chance, making it the standard for inter-rater reliability of categorical scores.

Question 42: A consultant anaesthetist wishes to act as a supervisor of training for ANZCA. Which prerequisite is mandatory before taking on this role?

Completion of ANZCA's supervisor of training workshop (Correct answer)
Completion of a formal medical education degree
Fellowship of at least 10 years
Approval from the hospital CEO

Correct answer: Completion of ANZCA's supervisor of training workshop

ANZCA requires all supervisors of training to complete the designated supervisor of training workshop before assuming the role.

Question 43: During assessment for regional anaesthesia, which coagulation parameter most specifically reflects the function of the extrinsic coagulation pathway?

Prothrombin time / INR (Correct answer)
Platelet function analyser (PFA-100) closure time
Activated partial thromboplastin time (aPTT)
Thromboelastography (TEG) clot formation time (K)

Correct answer: Prothrombin time / INR

Prothrombin time (PT/INR) measures the extrinsic and common coagulation pathways (Factors VII, X, V, II, fibrinogen) and is prolonged by warfarin and liver disease.

Question 44: A patient is transferred to ICU post-operatively. The most important communication strategy to ensure continuity of care is:

Leaving the anesthetic chart with the ward nurse
Verbal handover only with no written record
Sending a text message summary to the ICU registrar
Written and verbal structured handover including current clinical status, concerns, and anticipated issues (Correct answer)

Correct answer: Written and verbal structured handover including current clinical status, concerns, and anticipated issues

Both written and verbal structured handover is the gold standard to prevent communication failures at transitions of care.

Question 45: Which framework does ANZCA recommend for structured self-reflection in professional development portfolios?

SBAR communication tool
Root cause analysis
SOAP notes
Gibbs' Reflective Cycle (Correct answer)

Correct answer: Gibbs' Reflective Cycle

Gibbs' Reflective Cycle provides a systematic six-stage process that ANZCA recommends for meaningful self-reflection in portfolios.

Question 46: A patient undergoing thoracotomy has a double-lumen tube placed. Fibreoptic bronchoscopy shows the left upper lobe bronchus is partially obstructed by the tube cuff. What is the correct adjustment?

Deflate the cuff and proceed without isolation
Rotate the tube 90° clockwise
Withdraw the tube 1–2 cm until the cuff clears the left upper lobe orifice (Correct answer)
Replace with a right-sided double-lumen tube

Correct answer: Withdraw the tube 1–2 cm until the cuff clears the left upper lobe orifice

A left-sided DLT positioned too deep will obstruct the left upper lobe bronchus; withdrawal of 1–2 cm under fibreoptic guidance repositions the cuff below the carina.

Question 47: When a FANZCA fellow suspects a patient may have experienced awareness under anesthesia, best practice communication involves:

Waiting for the patient to raise the issue themselves
Documenting the suspicion only in the quality improvement database without patient disclosure
Avoiding the subject to prevent distress and psychological harm
Proactively asking the patient about their experience post-operatively using validated screening questions (Correct answer)

Correct answer: Proactively asking the patient about their experience post-operatively using validated screening questions

Proactive, compassionate questioning using tools like the Brice protocol is recommended to identify and support patients who may have experienced awareness.

Question 48: What are the potential consequences of practicing outside ones scope of practice?

Only a verbal warning from a supervisor
Automatic promotion for demonstrating initiative
No consequences if outcomes are positive
Disciplinary action, legal liability, and potential harm to clients (Correct answer)

Correct answer: Disciplinary action, legal liability, and potential harm to clients

Exceeding scope of practice can result in license revocation, legal action, and jeopardize client safety.

Question 49: The term 'professional boundaries' in communication for FANZCA fellows primarily refers to:

Maintaining appropriate physical distance from patients during examination
Ensuring interactions with patients and colleagues remain within the professional role, avoiding personal relationships that could compromise objectivity (Correct answer)
Limiting the number of questions asked during pre-operative assessment
Restricting communication to written formats to prevent misinterpretation

Correct answer: Ensuring interactions with patients and colleagues remain within the professional role, avoiding personal relationships that could compromise objectivity

Professional boundaries encompass maintaining role-appropriate relationships with patients and colleagues to protect objectivity and prevent exploitation.

Question 50: Which of the following is essential for all documentation entries?

A stamp with the facility name only
Just the date without a signature
Only the practitioners first name
Date, time, signature, and credentials of the person documenting (Correct answer)

Correct answer: Date, time, signature, and credentials of the person documenting

Complete entries require date, time, and authenticated signature with credentials for accountability and legal validity.

Question 51: Which of the following best describes a 'Training Network' in ANZCA's training structure?

A group of accredited hospitals coordinated to provide comprehensive training across multiple rotations (Correct answer)
A network of private billing arrangements among fellows
An online digital platform for remote learning
A database of available locum positions

Correct answer: A group of accredited hospitals coordinated to provide comprehensive training across multiple rotations

A Training Network is a group of ANZCA-accredited hospitals working together to provide trainees with diverse and comprehensive clinical experience.

Question 52: ANZCA PS41 specifically relates to which topic relevant to anaesthesia practice regulation?

Risk disclosure and informed consent in anaesthesia (Correct answer)
Responsibilities of the anaesthetist in a non-tertiary hospital
Anaesthesia for patients with do-not-resuscitate orders
The position of the anaesthetist as a specialist consultant

Correct answer: Risk disclosure and informed consent in anaesthesia

ANZCA PS41 outlines the obligations for risk disclosure and the process of obtaining informed consent for anaesthesia, reflecting both ethical and legal requirements.

Question 53: Which echocardiographic parameter is most useful for assessing diastolic dysfunction in the preoperative evaluation of a patient with heart failure with preserved ejection fraction (HFpEF)?

Left ventricular ejection fraction (LVEF)
E/e' ratio > 14 (Correct answer)
Tricuspid annular plane systolic excursion (TAPSE)
Left ventricular end-diastolic diameter

Correct answer: E/e' ratio > 14

An E/e' ratio >14 (ratio of mitral inflow E-wave velocity to tissue Doppler e' velocity) indicates elevated left ventricular filling pressures, characteristic of significant diastolic dysfunction.

Question 54: A patient has a plasma potassium of 6.8 mmol/L on preoperative bloods. Which ECG change is the most immediately life-threatening?

Sine wave pattern (Correct answer)
Widened QRS complex
Peaked T waves
Prolonged PR interval

Correct answer: Sine wave pattern

A sine wave pattern on ECG represents severe hyperkalaemia with fusion of widened QRS and peaked T waves, immediately preceding ventricular fibrillation.

Question 55: A patient's arterial line waveform shows pulsus paradoxus. Which condition is most likely?

Systolic heart failure
Hypertrophic cardiomyopathy
Aortic regurgitation
Cardiac tamponade (Correct answer)

Correct answer: Cardiac tamponade

Cardiac tamponade causes exaggerated interventricular dependence; inspiration reduces left ventricular filling disproportionately, causing a >10 mmHg fall in systolic BP — classic pulsus paradoxus.

Question 56: What type of educational resources are provided to Fellows for continuous professional development?

Seminars, online courses, workshops, and research access. (Correct answer)
Group study sessions and peer reviews.
Webinars and annual conferences only.
Only access to printed materials.

Correct answer: Seminars, online courses, workshops, and research access.

FANZCA provides a comprehensive suite of educational resources for continuous professional development. These include structured learning through seminars, online courses, and workshops, alongside crucial access to cutting-edge research. This diverse offering ensures Fellows have multiple avenues to enhance their knowledge and skills throughout their careers.

Question 57: Which document provides ANZCA's position on the use of capnography as a monitoring requirement during procedural sedation?

PS26
PS09 (Correct answer)
PS54
PS18

Correct answer: PS09

ANZCA PS09 (guidelines on sedation and analgesia for diagnostic and interventional procedures) addresses monitoring requirements including capnography during procedural sedation.

Question 58: The intubating laryngeal mask airway (ILMA/Fastrach) is designed to facilitate blind intubation. What is the recommended maximum number of intubation attempts through the ILMA?

3 attempts (Correct answer)
4 attempts
1 attempt
2 attempts

Correct answer: 3 attempts

A maximum of 3 intubation attempts through the ILMA is recommended; if unsuccessful, another strategy should be employed to avoid airway trauma and deteriorating conditions.

Question 59: Which methodology uses the Plan-Do-Study-Act cycle?

Continuous Quality Improvement (CQI) (Correct answer)
Lean Manufacturing exclusively
Statistical Process Control only
Root Cause Elimination

Correct answer: Continuous Quality Improvement (CQI)

The PDSA cycle is a cornerstone of CQI methodology, providing a structured approach to testing and implementing changes.

Question 60: For a pediatric patient requiring general anesthesia, which additional documentation consideration applies compared to an adult patient?

The child's assent, where developmentally appropriate, should be documented alongside parental consent (Correct answer)
Only the legal guardian's signature is required; child input is irrelevant
Parental consent is not required if the child appears cooperative
Pediatric cases require co-signature from a pediatrician

Correct answer: The child's assent, where developmentally appropriate, should be documented alongside parental consent

Obtaining and documenting a child's assent where age-appropriate is an ethical best practice that respects the developing autonomy of pediatric patients.

Question 61: In perioperative quality improvement, which of the following is an example of a 'balancing measure' when implementing a fast-track extubation protocol?

Rate of extubation within 1 hour of surgery completion
Patient satisfaction scores with recovery room care
Nursing compliance with postoperative monitoring guidelines
Rate of unplanned reintubation within 24 hours (Correct answer)

Correct answer: Rate of unplanned reintubation within 24 hours

Balancing measures detect unintended consequences of an improvement intervention; unplanned reintubation rate would indicate whether fast-track extubation compromises respiratory safety.

Question 62: A patient with a Cormack-Lehane Grade III laryngoscopic view is best described as having which of the following?

Neither epiglottis nor cords visible
Full view of the vocal cords
Only the epiglottis visible (Correct answer)
Partial view of the vocal cords

Correct answer: Only the epiglottis visible

A Cormack-Lehane Grade III view shows only the epiglottis with no part of the glottis visible, making intubation significantly more difficult and often requiring adjuncts such as a bougie.

Question 63: Under ANZCA's continuing professional development (CPD) framework, what is the minimum number of CPD hours a Fellow must complete per triennium?

150 hours
90 hours
180 hours
120 hours (Correct answer)

Correct answer: 120 hours

ANZCA Fellows are required to complete a minimum of 120 CPD hours per triennium to maintain their Fellowship.

Question 64: When documenting epidural insertion in a laboring patient, which information is most critical for the midwife and obstetric team receiving handover?

The brand of epidural kit used
Time from request to insertion only
Level inserted, number of attempts, drug infusion rate, block height, and any complications (Correct answer)
The anesthetist's personal preference for top-up regimen

Correct answer: Level inserted, number of attempts, drug infusion rate, block height, and any complications

Comprehensive epidural documentation including level, attempts, drugs, block assessment, and complications is essential for safe ongoing management by non-anesthetic staff.

Question 65: Which ANZCA professional document specifically addresses the pre-anaesthesia consultation?

PS04
PS07 (Correct answer)
PS15
PS28

Correct answer: PS07

ANZCA PS07 outlines the requirements for pre-anaesthesia consultation, including history, examination, investigations, and informed consent.

Question 66: When writing a post-operative anesthetic note for a patient who had an uneventful general anesthetic, the minimum required documentation includes:

The recovery nurse's assessment only
Only the total doses of opioids given
The surgeon's operative findings
Airway management, drug doses, fluid balance, and patient condition on leaving the operating room (Correct answer)

Correct answer: Airway management, drug doses, fluid balance, and patient condition on leaving the operating room

Post-operative notes must capture airway details, drugs, fluids, and patient status at handover as a minimum safety standard.

Question 67: What is the primary eligibility requirement for entering the Fellowship program of the Australian and New Zealand College of Anaesthetists?

Passing a written examination in general medicine.
Completion of postgraduate studies in anaesthesia.
Completion of a medical degree from any institution.
Completion of a recognized internship or equivalent. (Correct answer)

Correct answer: Completion of a recognized internship or equivalent.

The primary eligibility requirement for entering the Fellowship program of the Australian and New Zealand College of Anaesthetists (FANZCA) is the completion of a recognized internship or its equivalent. This foundational year of supervised clinical practice ensures that aspiring anaesthetists have a broad medical background and essential clinical experience before specializing.

Question 68: A FANZCA fellow is providing anesthesia in a remote location without electronic records. Which handwritten documentation standard still applies?

Documentation can be abbreviated significantly given resource limitations
A telephone summary to the receiving facility replaces written records
Only the final condition of the patient needs to be recorded
The same minimum documentation standards apply regardless of setting, including drug doses, times, and vital signs (Correct answer)

Correct answer: The same minimum documentation standards apply regardless of setting, including drug doses, times, and vital signs

ANZCA documentation standards are setting-independent; minimum requirements for safety and accountability apply in all locations.

Question 69: After a patient dies in the perioperative period, which documentation action is mandatory under ANZCA and hospital guidelines?

All perioperative records are destroyed to protect staff privacy
A complete and accurate final anesthetic record must be written and the case may require mandatory notification to the coroner depending on circumstances (Correct answer)
Only the surgeon's operative note is required for medicolegal purposes
The anesthetic record is sealed and transferred directly to the coroner without review

Correct answer: A complete and accurate final anesthetic record must be written and the case may require mandatory notification to the coroner depending on circumstances

Accurate final documentation is mandatory, and unexpected perioperative deaths often trigger mandatory coroner notification under state and territory legislation.

Question 70: Which of the following is the MOST reliable method for confirming correct endotracheal tube placement in the FANZCA and ANZCA framework?

Chest rise observed during ventilation
Continuous waveform capnography (Correct answer)
Visualisation of tube passing through cords
Chest auscultation bilaterally

Correct answer: Continuous waveform capnography

Continuous waveform capnography with sustained end-tidal CO2 over multiple breaths is the gold standard and most reliable method for confirming endotracheal tube placement, as recommended by ANZCA guidelines.

Question 71: Which Australian government body is responsible for regulating therapeutic goods including anaesthetic drugs?

TGA (Correct answer)
APVMA
ACCC
AHPRA

Correct answer: TGA

The Therapeutic Goods Administration (TGA) regulates therapeutic goods including medications, medical devices, and anaesthetic agents in Australia.

Question 72: A fellowship candidate is asked: 'What would you do if you arrived at an emergency and found the anaesthetic machine had failed?' This question primarily evaluates which competency?

Regulatory compliance knowledge
Crisis resource management and adaptability (Correct answer)
Technical knowledge of machine components
Pharmacological expertise

Correct answer: Crisis resource management and adaptability

Questions about equipment failure scenarios assess crisis resource management — prioritising patient safety, improvising, and leading under stress.

Question 73: When using a supraglottic airway device (SAD) such as the ProSeal LMA, what is the maximum recommended airway leak pressure (oropharyngeal leak pressure) that indicates adequate positioning?

10 cmH2O
30 cmH2O
20 cmH2O
25 cmH2O (Correct answer)

Correct answer: 25 cmH2O

An oropharyngeal leak pressure of 25 cmH2O or greater with the ProSeal LMA indicates an adequate seal for positive pressure ventilation; lower pressures may indicate malposition or inadequate cuff inflation.

Question 74: The Work Health and Safety (WHS) Act 2011 places a duty of care on anaesthetists as 'officers' of an organisation, meaning they must:

Exercise due diligence to ensure the organisation meets WHS obligations (Correct answer)
Hold a WHS officer certification
Report all near-misses within 24 hours to Safe Work Australia
Complete an annual WHS compliance audit

Correct answer: Exercise due diligence to ensure the organisation meets WHS obligations

As officers under the WHS Act, senior clinicians including consultants must exercise due diligence to ensure their organisation complies with WHS duties.

Question 75: What is the role of formative assessments during the Fellowship training?

To determine if a candidate can graduate.
To provide feedback for improvement. (Correct answer)
To assess theoretical understanding only.
To evaluate overall knowledge.

Correct answer: To provide feedback for improvement.

Formative assessments during the FANZCA Fellowship training play a crucial role in providing feedback for improvement. Unlike summative assessments, they are designed to guide learning and development, identifying strengths and weaknesses without necessarily determining progression. This continuous feedback loop helps candidates refine their skills and knowledge throughout the program.

Question 76: The ANZCA professional document PS29 relates specifically to which anaesthesia topic?

Statement on anaesthesia care of children (Correct answer)
Anaesthesia records and documentation
Minimum standards for conscious sedation for dental procedures
Recommendations for acute pain management

Correct answer: Statement on anaesthesia care of children

ANZCA PS29 provides a statement on anaesthesia care of children, addressing the unique considerations and standards required for paediatric patients.

Question 77: In the context of medication safety, 'look-alike, sound-alike' (LASA) drugs in anaesthesia are best managed by:

Physical separation, tall-man lettering, and independent double-checks for high-risk agents (Correct answer)
Relying on colour-coded syringe labels only
Removing all LASA drugs from theatre stock
Verbal orders without written confirmation to save time

Correct answer: Physical separation, tall-man lettering, and independent double-checks for high-risk agents

LASA drug errors are mitigated by physical segregation, tall-man lettering on labels, and independent double-check procedures for high-alert medications.

Question 78: A Fellow serving on a hospital mortality and morbidity (M&M) committee presents a case for educational review. This activity most appropriately maps to which ANZCA CPD category?

Educational activities
Measuring outcomes
Reviewing performance (Correct answer)
Passive learning

Correct answer: Reviewing performance

Participating in M&M review is a structured reflection on clinical practice, which aligns with the reviewing performance CPD category.

Question 79: What is assessed in the oral examination for Fellowship candidates?

Ability to manage clinical anaesthesia cases. (Correct answer)
Knowledge of anaesthetic drug formulations.
Knowledge of anaesthesia equipment.
Personal patient interaction skills.

Correct answer: Ability to manage clinical anaesthesia cases.

The oral examination for FANZCA Fellowship candidates specifically assesses their ability to manage clinical anaesthesia cases. This involves evaluating their clinical reasoning, decision-making skills, and capacity to articulate a safe and effective approach to various patient scenarios. It ensures candidates can apply their theoretical knowledge to practical, complex situations.

Question 80: Which component of the ANZCA Final Examination uses written short-answer questions (SAQs)?

The clinical viva component
Workplace-based assessment
Primary written paper
Written examination papers (Correct answer)

Correct answer: Written examination papers

The Final Examination written papers use SAQ format to test applied clinical knowledge across anaesthesia topics.

Question 81: Under Australian law, a drug interaction that constitutes an off-label use of an approved medicine means the use is:

Prohibited in hospital settings only
Automatically covered by the manufacturer's indemnity
Permissible but the prescriber assumes clinical and legal responsibility (Correct answer)
Illegal and subject to TGA prosecution

Correct answer: Permissible but the prescriber assumes clinical and legal responsibility

Off-label use is legally permissible in Australia, but the prescribing clinician bears full clinical and medicolegal responsibility for that use.

Question 82: What is the primary purpose of thorough documentation in professional practice?

To satisfy administrative preferences only
To fill time during slow periods
To create an accurate record for continuity of care and legal protection (Correct answer)
To demonstrate writing ability

Correct answer: To create an accurate record for continuity of care and legal protection

Documentation serves as the legal record of services provided and ensures continuity of care among providers.

Question 83: In FANZCA evaluation, which scenario best illustrates criterion-referenced rather than norm-referenced assessment?

All candidates who meet the defined standard pass, regardless of cohort size (Correct answer)
Candidates are ranked and the bottom quintile fails
Pass rates are adjusted to match historical averages
Only the top 30% of candidates pass each sitting

Correct answer: All candidates who meet the defined standard pass, regardless of cohort size

Criterion-referenced assessment passes all candidates who meet a predetermined standard, meaning pass rates vary based on cohort ability, not a fixed quota.

Question 84: What is the purpose of continuing education requirements for maintaining licensure?

To ensure professionals stay current with evolving knowledge and practices (Correct answer)
To generate revenue for course providers
To make relicensure as difficult as possible
To reduce the number of licensed professionals

Correct answer: To ensure professionals stay current with evolving knowledge and practices

Continuing education ensures professionals maintain competency and stay updated on advances in their field.

Question 85: Under Australian privacy legislation, an anesthetist may share a patient's clinical record with another treating clinician without explicit consent when:

The information is de-identified
The patient is unconscious and therefore unable to consent
The anesthetist believes it is in the patient's best interest
The disclosure is for the primary purpose of providing healthcare to that patient (Correct answer)

Correct answer: The disclosure is for the primary purpose of providing healthcare to that patient

The Privacy Act 1988 and Australian Privacy Principles permit disclosure for the primary purpose of healthcare treatment without requiring separate consent.

Question 86: A hospital reports its anaesthetic complication rate is 2.5% compared to a benchmark of 3.1%. Which caveat is MOST important when interpreting this comparison?

Lower rates always indicate better quality of care
Case-mix adjustment must be performed before valid comparisons can be made (Correct answer)
Benchmarking data from other institutions is always reliable and comparable
The hospital's sample size is always sufficient for valid comparison

Correct answer: Case-mix adjustment must be performed before valid comparisons can be made

Raw complication rates are meaningless without case-mix adjustment, as patient complexity, procedure types, and comorbidities significantly influence outcomes.

Question 87: When communicating a critical intraoperative result (e.g., arterial blood gas showing severe acidosis) to the surgical team, which technique most reliably confirms the information was received correctly?

Writing the result on a whiteboard in the theater
Read-back or closed-loop communication confirmation (Correct answer)
Asking the scrub nurse to relay the information
Speaking loudly to ensure everyone hears

Correct answer: Read-back or closed-loop communication confirmation

Closed-loop communication, where the receiver repeats back the critical value, is the standard technique to verify accurate transmission.

Question 88: According to the Difficult Airway Society (DAS) guidelines adopted in Australian and New Zealand anaesthetic practice, what is the maximum number of intubation attempts recommended before declaring a failed intubation?

3 attempts (Correct answer)
4 attempts
2 attempts
5 attempts

Correct answer: 3 attempts

DAS guidelines recommend no more than 3 laryngoscopy attempts (including one by a senior anaesthetist) before declaring failed intubation and moving to the next step in the algorithm.

Question 89: What does the post-nominal 'FANZCA' legally signify about the holder?

The holder is currently an accredited trainee in anaesthesia
The holder has been awarded Fellowship of the Australian and New Zealand College of Anaesthetists (Correct answer)
The holder has completed the Primary examination only
The holder is a registered specialist in intensive care medicine

Correct answer: The holder has been awarded Fellowship of the Australian and New Zealand College of Anaesthetists

FANZCA signifies that the holder has successfully completed all requirements and been awarded Fellowship of ANZCA, recognising them as a specialist anaesthetist.

Question 90: Functional residual capacity (FRC) is the lung volume at which:

Tidal breathing begins after a maximal inspiration
Maximum forced expiration ends
Residual volume plus expiratory reserve volume is achieved
Elastic recoil of the lung equals outward chest wall recoil (Correct answer)

Correct answer: Elastic recoil of the lung equals outward chest wall recoil

FRC is the resting end-expiratory lung volume where the inward elastic recoil of the lung exactly balances the outward recoil of the chest wall, requiring no active muscle work.

Question 91: What is the purpose of reassessment in ongoing patient care?

To monitor treatment effectiveness and adjust the care plan (Correct answer)
To generate additional billing codes
To satisfy accreditation requirements exclusively
To complete regulatory paperwork only

Correct answer: To monitor treatment effectiveness and adjust the care plan

Reassessment monitors how well the treatment plan is working and identifies needed adjustments to optimize patient outcomes.

Question 92: When performing a rapid sequence induction (RSI), cricoid pressure (Sellick's maneuver) is applied. What is the recommended force to apply once the patient loses consciousness?

40 Newtons
20 Newtons
30 Newtons (Correct answer)
10 Newtons

Correct answer: 30 Newtons

The recommended force for cricoid pressure once the patient loses consciousness is 30 Newtons (approximately 3 kg), which provides adequate compression of the oesophagus without distorting the airway.

Question 93: What is the primary purpose of ANZCA's Continuing Professional Development (CPD) program for fellows?

To allow fellows to retake failed examinations
To maintain and improve clinical competence and professional practice throughout a fellow's career (Correct answer)
To qualify for a higher fellowship grade
To fulfil requirements for hospital credentialing only

Correct answer: To maintain and improve clinical competence and professional practice throughout a fellow's career

ANZCA's CPD program ensures fellows maintain and improve their clinical knowledge and professional skills across their careers.

Question 94: Which of the following is a recognised contraindication to the use of a laryngeal mask airway (LMA) as the primary airway device during general anaesthesia?

Predicted difficult intubation with normal gastric emptying
Elective laparoscopic cholecystectomy with controlled ventilation
Non-fasted patient undergoing emergency appendicectomy (Correct answer)
Patient age over 70 years

Correct answer: Non-fasted patient undergoing emergency appendicectomy

A non-fasted patient (full stomach) is a recognised contraindication to LMA use as the device does not protect against pulmonary aspiration of gastric contents in the same way as a cuffed endotracheal tube.

Question 95: During awake fibreoptic intubation, a superior laryngeal nerve block is performed to anaesthetise which anatomical region?

Piriform fossae and laryngeal inlet above the cords (Correct answer)
Posterior pharyngeal wall and soft palate
Nasopharynx and posterior tongue
Trachea below the vocal cords

Correct answer: Piriform fossae and laryngeal inlet above the cords

The superior laryngeal nerve (internal branch) provides sensory innervation to the laryngeal inlet and piriform fossae above the vocal cords; blocking it anaesthetises this region to facilitate awake intubation.

Question 96: Which drug class used in anesthesia acts by inhibiting cyclooxygenase enzymes to provide multimodal analgesia as part of an opioid-sparing strategy?

N-methyl-D-aspartate antagonists
Alpha-2 agonists
NSAIDs (Correct answer)
Benzodiazepines

Correct answer: NSAIDs

NSAIDs reduce prostaglandin synthesis by inhibiting COX-1 and COX-2 enzymes, providing anti-inflammatory analgesia that reduces opioid requirements perioperatively.

Question 97: A patient undergoing anaesthesia has a sudden decrease in end-tidal CO2 to near zero while the airway pressure remains normal and SpO2 begins to fall. What is the MOST likely diagnosis?

Pulmonary embolism (Correct answer)
Bronchospasm
Kinked endotracheal tube
Oesophageal intubation

Correct answer: Pulmonary embolism

A sudden near-zero ETCO2 with previously normal ventilation (normal pressures) and concurrent haemodynamic collapse is the classic presentation of massive pulmonary embolism, which eliminates CO2 elimination by obstructing pulmonary circulation.

Question 98: What is the primary goal of a quality improvement program?

To identify and punish poor performers
To continuously enhance processes and outcomes (Correct answer)
To reduce staffing levels
To generate marketing materials

Correct answer: To continuously enhance processes and outcomes

Quality improvement focuses on systematic enhancement of processes, services, and outcomes for continuous betterment.

Question 99: A trainee anesthetist makes an inappropriate comment about a patient during a surgical case. As the supervising FANZCA fellow, your first responsibility is to:

Address the behavior directly and privately after the case and reinforce professional communication standards (Correct answer)
Document the comment in the patient's medical record
Inform the patient of the comment during recovery
Report the trainee to ANZCA immediately

Correct answer: Address the behavior directly and privately after the case and reinforce professional communication standards

Supervisors are responsible for immediate, constructive professional correction of trainees in a manner that preserves dignity and does not escalate in theater.

Question 100: What is one of the key benefits of the College’s networking opportunities for its Fellows?

Collaboration opportunities and peer networking. (Correct answer)
Free access to leadership programs.
Discounted conference fees.
Access to job postings worldwide.

Correct answer: Collaboration opportunities and peer networking.

One of the primary benefits of FANZCA's networking opportunities is fostering collaboration and peer networking among Fellows. These connections facilitate the sharing of knowledge, best practices, and support, which are essential for professional growth and innovation. Such interactions can lead to joint projects, mentorship, and enhanced clinical discussions.

Question 101: Which approach to quality improvement is characterized by incremental small tests of change using rapid PDSA cycles, as opposed to large-scale planned redesign?

The Model for Improvement with iterative PDSA cycles (Correct answer)
Lean Six Sigma DMAIC methodology
Business Process Reengineering (BPR)
Total Quality Management (TQM)

Correct answer: The Model for Improvement with iterative PDSA cycles

The Model for Improvement, developed by Associates in Process Improvement, uses iterative rapid PDSA cycles to test small changes incrementally before scale-up.

Question 102: ANZCA's annual conference (ASM) is primarily valued by members for which reason?

It provides CPD points, networking, and exposure to current research and practice (Correct answer)
It is mandatory for maintaining fellowship status
It replaces the need for in-hospital training
It is the only way to access ANZCA publications

Correct answer: It provides CPD points, networking, and exposure to current research and practice

The Annual Scientific Meeting (ASM) offers CPD opportunities, peer networking, and updates on the latest research and clinical developments in anaesthesia.

Question 103: A patient requests that their anaesthetic records not be shared with their general practitioner. The anaesthetist should:

Respect the request and withhold all records from the GP
Refer the patient to the hospital privacy officer before proceeding
Share records with the GP regardless, as continuity of care overrides privacy
Explore the reasons for the request, explain the importance of shared care, and document the patient's decision (Correct answer)

Correct answer: Explore the reasons for the request, explain the importance of shared care, and document the patient's decision

Exploring the patient's concerns while explaining the clinical benefits of record sharing balances patient autonomy with the duty to support continuity of care.

Question 104: A 70 kg adult receives 2 mg/kg propofol for induction. Their blood pressure drops from 130/80 to 70/40 mmHg. What is the most appropriate immediate intervention?

Give metaraminol 0.5–1 mg IV bolus (Correct answer)
Administer phenylephrine 100 mcg IV bolus
Administer noradrenaline infusion
Start vasopressin infusion

Correct answer: Give metaraminol 0.5–1 mg IV bolus

Metaraminol 0.5–1 mg IV bolus is a practical first-line vasopressor for propofol-induced hypotension, restoring SVR rapidly without significant tachycardia.

Question 105: What is the pharmacological rationale for using dexmedetomidine as a sedative in the ICU or as an adjunct in anesthesia?

It inhibits histamine H1 receptors causing sedation
It selectively activates alpha-2 adrenoceptors to produce sedation, analgesia, and anxiolysis without significant respiratory depression (Correct answer)
It enhances GABA-mediated inhibition in the cortex
It blocks dopamine D2 receptors to reduce agitation

Correct answer: It selectively activates alpha-2 adrenoceptors to produce sedation, analgesia, and anxiolysis without significant respiratory depression

Dexmedetomidine's selective alpha-2 agonism in the locus coeruleus and spinal cord produces cooperative sedation and analgesia while preserving respiratory drive.

Question 106: Which approach to FANZCA examination feedback is most likely to support a failed candidate's future success?

Advising the candidate to study more broadly
Offering specific, actionable feedback linked to identifiable competency gaps (Correct answer)
Providing a numerical score without commentary
Sharing the candidate's score relative to the cohort only

Correct answer: Offering specific, actionable feedback linked to identifiable competency gaps

Specific, actionable feedback tied to competency gaps enables targeted remediation and is the most effective form of post-examination feedback for improvement.

Question 107: The WHO Surgical Safety Checklist has been shown to reduce postoperative complications primarily through which mechanism?

Ensuring only credentialed surgeons perform high-risk procedures
Improving surgical technique through standardized steps
Automating documentation to reduce administrative burden
Enhancing team communication, verifying critical information, and reducing errors of omission (Correct answer)

Correct answer: Enhancing team communication, verifying critical information, and reducing errors of omission

The WHO Surgical Safety Checklist reduces complications by facilitating team communication, confirming critical safety information, and preventing errors of omission at key transition points.

Question 108: Which ASA physical status classification applies to a patient with severe systemic disease that is a constant threat to life?

ASA II
ASA IV (Correct answer)
ASA V
ASA III

Correct answer: ASA IV

ASA IV denotes a patient with severe systemic disease that is a constant threat to life, such as recent MI, ongoing cardiac ischemia, severe valvular dysfunction, or septic shock.

Question 109: Which of the following best describes the purpose of a pre-anesthetic consultation note?

To record only the ASA physical status classification
To satisfy billing requirements for the pre-operative visit
To document the patient's history, examination findings, risk stratification, anesthetic plan, and consent discussion (Correct answer)
To provide the surgeon with a clearance certificate

Correct answer: To document the patient's history, examination findings, risk stratification, anesthetic plan, and consent discussion

The pre-anesthetic consultation note comprehensively records the assessment, plan, and consent process, forming the foundation of safe anesthetic care.

Question 110: What is the SOAP format used for in documentation?

Organizing clinical notes into Subjective, Objective, Assessment, and Plan sections (Correct answer)
Categorizing cleaning supplies
Scheduling staff assignments
Rating patient satisfaction scores

Correct answer: Organizing clinical notes into Subjective, Objective, Assessment, and Plan sections

SOAP format provides a structured approach to clinical documentation: Subjective data, Objective findings, Assessment, and Plan.

Question 111: What is the significance of 'accreditation' of a training post for ANZCA trainees?

It signifies the post is only available to PGY3 doctors
It means the hospital is a public institution
It guarantees the trainee a salary increase
It confirms the post meets College standards for anaesthesia training (Correct answer)

Correct answer: It confirms the post meets College standards for anaesthesia training

ANZCA accreditation of a training post confirms that it meets the College's standards for providing appropriate supervised training in anaesthesia.

Question 112: Which regional anaesthesia technique provides the best analgesia for a patient with fractured neck of femur awaiting surgical repair?

Fascia iliaca compartment block (Correct answer)
Obturator nerve block
Femoral nerve block
Lumbar plexus block

Correct answer: Fascia iliaca compartment block

The fascia iliaca compartment block reliably covers the femoral, lateral femoral cutaneous, and partially the obturator nerve, providing superior analgesia for femoral neck fractures.

Question 113: A fellow needs to communicate an unexpected finding of severe intraoperative hypotension to the patient post-operatively. Principles of open disclosure require the anesthetist to:

Delegate disclosure to the hospital risk management team only
Wait until a formal investigation is complete before speaking to the patient
Minimize details to avoid patient anxiety
Provide a factual account of what happened, the impact, and steps taken, with an apology if appropriate (Correct answer)

Correct answer: Provide a factual account of what happened, the impact, and steps taken, with an apology if appropriate

Open disclosure principles require prompt, honest, and compassionate communication with patients and families when an unexpected adverse event occurs.

Question 114: Why is root cause analysis important in quality improvement?

It eliminates the need for data collection
It replaces the need for corrective actions
It assigns blame to specific individuals
It identifies the underlying cause of problems rather than just symptoms (Correct answer)

Correct answer: It identifies the underlying cause of problems rather than just symptoms

Root cause analysis goes beyond surface-level symptoms to identify fundamental causes, enabling effective and lasting solutions.

Question 115: Which international framework does ANZCA's curriculum most closely align with in structuring competency domains for anaesthesia training?

Miller's Pyramid of Clinical Competence
Frank et al. CanMEDS Physician Competency Framework (Correct answer)
Bloom's Taxonomy of Educational Objectives
Kirkpatrick's Four Levels of Evaluation

Correct answer: Frank et al. CanMEDS Physician Competency Framework

ANZCA's curriculum explicitly draws on the CanMEDS framework, organising training around roles such as Medical Expert, Communicator, Collaborator, and Scholar.

Question 116: Informed consent documentation for an elective anesthetic should specifically include:

Only the signature of the operating surgeon
A generic hospital consent form without procedure-specific risks
The anesthetist's clinical reasoning for the chosen technique
The risks discussed, alternatives offered, and confirmation the patient had opportunity to ask questions (Correct answer)

Correct answer: The risks discussed, alternatives offered, and confirmation the patient had opportunity to ask questions

Consent documentation must reflect individualized discussion including specific risks, alternatives, and opportunity for patient questions.

Question 117: The FANZCA Code of Professional Conduct requires anesthetists to maintain thorough clinical records primarily because:

Regulatory bodies conduct random audits of all cases
Hospital accreditation bodies mandate a minimum number of entries per case
Records are required to calculate anesthetic billing accurately
Accurate records support continuity of care, accountability, and patient safety (Correct answer)

Correct answer: Accurate records support continuity of care, accountability, and patient safety

The College emphasizes that thorough documentation underpins safe continuity of care and professional accountability.

Question 118: When documenting drug allergies in an anesthetic record, the most clinically important information to record alongside the drug name is:

The patient's self-reported severity rating
The prescribing doctor who last documented the allergy
The nature of the reaction (e.g., anaphylaxis, rash, intolerance) and how it was diagnosed (Correct answer)
The year the allergy was first reported

Correct answer: The nature of the reaction (e.g., anaphylaxis, rash, intolerance) and how it was diagnosed

Recording the type and severity of reaction, and whether allergy testing confirmed it, guides future management and cross-reactivity risk assessment.

Question 119: An anaesthetist holding FANZCA who moves to the United Kingdom — which statement best describes their recognition pathway?

They are immediately eligible to practice as a consultant without further assessment
FANZCA holders are not eligible to work in the UK
They must apply for recognition through the GMC and may be assessed under a specialist recognition process (Correct answer)
FANZCA is automatically recognised by the Royal College of Anaesthetists UK

Correct answer: They must apply for recognition through the GMC and may be assessed under a specialist recognition process

FANZCA holders wishing to practice in the UK must apply to the General Medical Council and may need to go through a specialist recognition assessment process.

Question 120: What is expected of a candidate during the training for the Fellowship in Anaesthesia?

Complete written exams only.
Complete only hands-on clinical training.
Only attend educational seminars.
Engage in supervised clinical work and assessments. (Correct answer)

Correct answer: Engage in supervised clinical work and assessments.

During the FANZCA Fellowship training, candidates are expected to actively engage in supervised clinical work and undergo regular assessments. This structured approach ensures they gain practical experience in diverse anaesthetic settings under expert guidance, while assessments monitor their progress and confirm they are meeting the required competency standards for specialist practice.

Question 121: Which physiological parameter most accurately reflects the degree of alveolar ventilation in an intubated patient breathing spontaneously?

End-tidal CO2 (ETCO2) (Correct answer)
Tidal volume
SpO2
Peak airway pressure

Correct answer: End-tidal CO2 (ETCO2)

End-tidal CO2 (ETCO2) directly reflects alveolar ventilation because CO2 elimination is proportional to minute ventilation; rising ETCO2 indicates hypoventilation and falling ETCO2 indicates hyperventilation.

Question 122: What is the primary advantage of remifentanil over other opioids for total intravenous anesthesia (TIVA)?

It is metabolized by plasma esterases, giving a predictably short context-sensitive half-time regardless of infusion length (Correct answer)
It produces prolonged postoperative analgesia
It has no effect on the respiratory system
It can be administered orally for premedication

Correct answer: It is metabolized by plasma esterases, giving a predictably short context-sensitive half-time regardless of infusion length

Remifentanil is hydrolyzed by non-specific tissue and plasma esterases, resulting in a context-sensitive half-time of approximately 3–5 minutes regardless of infusion duration.

Question 123: A FANZCA fellow is asked to complete a mandatory incident report following an anesthetic near-miss. The primary purpose of such reporting systems in Australia is:

To identify system failures and improve patient safety through learning (Correct answer)
To document events for insurance purposes
To satisfy medicolegal liability requirements
To assign blame and discipline the responsible clinician

Correct answer: To identify system failures and improve patient safety through learning

Incident reporting systems such as AIMS are designed for systems-based learning and quality improvement, not individual blame.

Question 124: What is the primary purpose of workplace-based assessments (WBAs) in ANZCA training?

To provide formative feedback and document trainee competence in clinical settings (Correct answer)
To satisfy medical indemnity insurance requirements
To replace the Primary Examination for experienced trainees
To determine hospital staffing levels

Correct answer: To provide formative feedback and document trainee competence in clinical settings

WBAs provide formative and summative assessment of trainee competence during actual clinical work, forming part of the training portfolio.

Question 125: Which evaluation design is most appropriate for assessing whether the FANZCA examination predicts long-term clinical performance of fellows?

Face validity review by senior examiners
Predictive validity study with longitudinal follow-up (Correct answer)
Cross-sectional survey of current candidates
Concurrent validity comparison with another exam

Correct answer: Predictive validity study with longitudinal follow-up

Predictive validity is assessed by tracking whether examination scores correlate with future clinical performance outcomes over time.

Question 126: What should a professional do upon discovering a colleague is practicing while impaired?

Ignore it to protect the colleague
Report through appropriate channels as required by professional duty (Correct answer)
Confront the colleague publicly
Wait to see if problems develop

Correct answer: Report through appropriate channels as required by professional duty

Professionals have a duty to report impaired colleagues to protect clients and help the colleague receive assistance.

Question 127: Under ANZCA professional standards, which of the following best describes the minimum monitoring requirement during general anaesthesia?

Blood pressure measurement every 10 minutes is acceptable
Pulse oximetry alone is sufficient for short procedures
Capnography is optional if end-tidal CO2 is visually estimated
Continuous ECG, pulse oximetry, capnography, and non-invasive blood pressure are mandatory (Correct answer)

Correct answer: Continuous ECG, pulse oximetry, capnography, and non-invasive blood pressure are mandatory

ANZCA PS18 mandates continuous ECG, pulse oximetry, capnography, and regular non-invasive blood pressure monitoring as minimum standards during general anaesthesia.

Question 128: How does ANZCA's 'Fellowship by Assessment' pathway differ from the standard training program?

It is designed for experienced overseas-trained specialists seeking Australian/NZ recognition (Correct answer)
It bypasses all written examinations
It is faster and requires fewer years of training
It is only available to New Zealand-trained doctors

Correct answer: It is designed for experienced overseas-trained specialists seeking Australian/NZ recognition

Fellowship by Assessment is a pathway for overseas-trained specialists who have already completed anaesthesia training to have their qualifications recognised by ANZCA.

Question 129: Which regulatory requirement specifically governs anaesthetist-to-patient ratios and supervision levels for trainees in Australia?

Fair Work Act staffing provisions
AHPRA Medical Board supervision guidelines
TGA clinical trial regulations
ANZCA PS08 (Correct answer)

Correct answer: ANZCA PS08

ANZCA PS08 outlines the supervision requirements for anaesthesia trainees, specifying appropriate supervision levels based on trainee stage.

Question 130: What is the landmark used to identify the cricothyroid membrane for emergency front-of-neck access (FONA)?

The space between the thyroid cartilage and the hyoid bone
The space between the cricoid cartilage and the first tracheal ring
The space between the first and second tracheal rings
The space between the thyroid cartilage and the cricoid cartilage (Correct answer)

Correct answer: The space between the thyroid cartilage and the cricoid cartilage

The cricothyroid membrane lies between the inferior border of the thyroid cartilage and the superior border of the cricoid cartilage; it is the preferred site for emergency FONA because of its accessibility and proximity to the skin surface.

Question 131: What is the primary reason propofol produces pain on injection when administered through a peripheral IV?

Its high osmolality damages vessel walls
Its highly alkaline pH irritates the vein
It causes direct endothelial histamine release
Its lipid emulsion vehicle activates bradykinin and free nerve endings (Correct answer)

Correct answer: Its lipid emulsion vehicle activates bradykinin and free nerve endings

Propofol's lipid emulsion can activate the kinin cascade and stimulate free nerve endings in the vessel wall, causing the characteristic injection pain.

Question 132: A patient scheduled for total knee replacement is taking dabigatran 150 mg twice daily. According to bridging guidelines for normal renal function, when should the last dose be taken preoperatively for high bleeding-risk surgery?

48–72 hours before surgery (Correct answer)
24 hours before surgery
5–7 days before surgery
12 hours before surgery

Correct answer: 48–72 hours before surgery

For high bleeding-risk surgery with normal renal function (CrCl >50 mL/min), dabigatran should be stopped 48–72 hours (2–3 days) before the procedure.

Question 133: What should be done if an error is discovered in a patient record?

Use white-out to cover the mistake
Ignore it if no one has noticed
Remove the page and rewrite it
Draw a single line through the error, correct it, and initial with date (Correct answer)

Correct answer: Draw a single line through the error, correct it, and initial with date

The standard correction method preserves the original entry while making the correction transparent and traceable.

Question 134: Awake fibreoptic intubation (AFOI) is considered the technique of choice in which of the following clinical scenarios?

Adult patient with known difficult airway and full stomach (Correct answer)
Pregnant patient at 28 weeks for elective Caesarean section
Patient with anaphylaxis and angioedema
Paediatric patient with a foreign body airway obstruction

Correct answer: Adult patient with known difficult airway and full stomach

AFOI is the preferred technique for the adult patient with a known difficult airway and full stomach as it maintains protective airway reflexes, allows confirmation of tube placement before induction, and avoids the risks of RSI in a difficult airway.

Question 135: What is the primary purpose of professional regulation in the FANZCA field?

To create bureaucratic barriers for new applicants
To generate revenue for regulatory bodies
To limit the number of professionals in the field
To protect the public by ensuring practitioners meet minimum competency standards (Correct answer)

Correct answer: To protect the public by ensuring practitioners meet minimum competency standards

Professional regulation exists primarily to protect the public by establishing and enforcing standards of practice and competency.

Question 136: Which action constitutes a breach of client confidentiality?

Discussing a case with a supervisor for consultation
Documenting information in the secure client record
Reporting suspected abuse as required by law
Sharing client information with unauthorized parties without consent (Correct answer)

Correct answer: Sharing client information with unauthorized parties without consent

Sharing client information without consent or legal authorization violates confidentiality principles.

Question 137: In the 'can't intubate, can't oxygenate' (CICO) scenario, what is the preferred surgical airway technique in current ANZCA-endorsed guidelines?

Scalpel-finger-bougie cricothyroidotomy (Correct answer)
Surgical tracheostomy
Percutaneous tracheostomy
Needle cricothyroidotomy with jet ventilation

Correct answer: Scalpel-finger-bougie cricothyroidotomy

The scalpel-finger-bougie (or scalpel-bougie) technique for front-of-neck access is currently the recommended approach in CICO emergencies as it is faster, more reliable, and less prone to failure than needle techniques in adults.

Question 138: What does the ANZCA curriculum term 'simulation-based education' primarily aim to achieve in anaesthesia training?

Assess basic science knowledge
Provide administrative training for theatre management
Allow deliberate practice of rare or high-stakes scenarios in a safe environment (Correct answer)
Replace clinical rotations entirely

Correct answer: Allow deliberate practice of rare or high-stakes scenarios in a safe environment

Simulation-based education enables trainees to practice managing infrequent but critical events without patient risk.

Question 139: ANZCA PS07 specifically addresses which regulatory aspect of anaesthesia practice?

Guidelines on blood transfusion in anaesthesia
Standards for record keeping in anaesthesia
Recommendations for the post-anaesthesia recovery room (Correct answer)
Requirements for pre-operative fasting

Correct answer: Recommendations for the post-anaesthesia recovery room

ANZCA PS07 outlines the recommended standards for post-anaesthesia recovery facilities, staffing, and monitoring requirements.

Question 140: During nasotracheal intubation, at which turbinate level should the tube be directed to minimise the risk of bleeding?

Middle turbinate
Along the floor of the nasal cavity below the inferior turbinate (Correct answer)
Through the middle meatus
Superior turbinate

Correct answer: Along the floor of the nasal cavity below the inferior turbinate

The nasotracheal tube should be directed along the floor of the nasal cavity, inferior to the inferior turbinate, as this path has the lowest vascular density and minimises the risk of haemorrhage.

Question 141: A patient is scheduled for posterior fossa craniotomy. Which positioning complication carries the greatest risk in the sitting position?

Venous air embolism (Correct answer)
Macroglossia
Brachial plexus stretch injury
Pressure sores

Correct answer: Venous air embolism

Venous air embolism is a major hazard in the sitting craniotomy position as open venous sinuses are above the heart level, allowing air entrainment.

Question 142: A FANZCA fellow discovers a critical error in a previously signed anesthetic record. The most appropriate course of action is to:

Destroy the original and rewrite an accurate record
White-out the incorrect entry and write the correction over it
Leave the error and add a separate incident report without amending the record
Draw a single line through the error, add a correction with date and signature, and never alter the original (Correct answer)

Correct answer: Draw a single line through the error, add a correction with date and signature, and never alter the original

The correct method is to draw a single line through the error, write the correction, and add the date and signature to maintain record integrity.

Question 143: In the context of FANZCA training, the ANZCA Anaesthesia Training Program Handbook specifies that trainees must demonstrate competence through which assessment framework?

Supervisor recommendation letters only
Annual written examination only
Workplace-based assessments (WBAs) and summative examinations (Correct answer)
Case log submission without formal assessments

Correct answer: Workplace-based assessments (WBAs) and summative examinations

The ANZCA training program uses a combination of workplace-based assessments (WBAs) and formal summative examinations to assess trainee competence.

Question 144: In a root cause analysis (RCA) following an anaesthetic adverse event, which team composition is MOST appropriate?

Hospital administrators and risk managers only
The anaesthetist involved in the event only
Only senior anaesthetists not involved in the case
A multidisciplinary team including those involved and process experts, excluding blame-focused individuals (Correct answer)

Correct answer: A multidisciplinary team including those involved and process experts, excluding blame-focused individuals

RCA is most effective with a multidisciplinary team including those with direct knowledge of the event and process experts, conducted in a blame-free environment focused on systems.

Question 145: What is the role of the ANZCA 'Education, Training and Assessment Committee' (ETAC)?

To oversee the design, delivery, and quality of training and assessment programs (Correct answer)
To handle complaints about Fellows
To manage College finances
To accredit overseas anaesthesia qualifications only

Correct answer: To oversee the design, delivery, and quality of training and assessment programs

ETAC is responsible for overseeing the quality and currency of ANZCA's education, training, and assessment frameworks.

Question 146: Under ANZCA's impaired colleague policy, if a Fellow reasonably suspects a colleague has a substance use disorder affecting patient safety, what is their primary professional obligation?

Keep the matter confidential to protect the colleague's privacy
Raise the concern through appropriate channels to protect patients, while supporting the colleague (Correct answer)
Wait until a patient adverse event confirms the impairment
Inform the police before notifying any medical authority

Correct answer: Raise the concern through appropriate channels to protect patients, while supporting the colleague

Patient safety takes precedence; Fellows are obliged to act on reasonable concerns about impairment while following structured support pathways rather than abandoning the colleague.

Question 147: Which laryngoscope blade design provides the best view when the epiglottis is long and floppy and cannot be lifted indirectly?

Bullard blade
McCoy blade
Miller blade (Correct answer)
Macintosh blade

Correct answer: Miller blade

The Miller (straight) blade directly lifts the epiglottis, making it superior when the epiglottis is long, floppy, or omega-shaped and cannot be lifted indirectly via the vallecula as with a Macintosh blade.

Question 148: A trainee who wishes to subspecialise in providing anaesthesia to critically ill patients admitted to the ICU would pursue which ANZCA-linked pathway?

There is no ANZCA pathway for this subspecialty
The ANZCA Cardiac Anaesthesia module only
The ANZCA Trauma Anaesthesia module only
The ANZCA Intensive Care Medicine joint training program (Correct answer)

Correct answer: The ANZCA Intensive Care Medicine joint training program

ANZCA offers a joint training program with the College of Intensive Care Medicine (CICM) for trainees seeking dual fellowship in anaesthesia and ICM.

Question 149: Which topical anaesthetic agent is most commonly used for awake fibreoptic intubation of the airway due to its rapid onset and relatively low systemic toxicity at clinical doses?

Lignocaine (lidocaine) 4% (Correct answer)
Tetracaine 2%
Benzocaine 20%
Cocaine 10%

Correct answer: Lignocaine (lidocaine) 4%

Lignocaine (lidocaine) 4% is the most widely used topical agent for awake fibreoptic intubation due to its favourable safety profile, rapid onset, and well-established maximum safe dose of approximately 9 mg/kg when applied topically.

Question 150: The Coroners Act in Australian states and territories requires that an anaesthetist notify the coroner when a patient death occurs:

Only if a medication error was involved
Whenever a death occurs in the operating theatre
In unexpected circumstances or when the cause of death is uncertain (Correct answer)
Anytime within 24 hours of any anaesthetic

Correct answer: In unexpected circumstances or when the cause of death is uncertain

Deaths that are unexpected, occur in suspicious circumstances, or where the cause is uncertain must be reported to the coroner under state/territory Coroners Acts.

FANZCA Fellowship of the Australian and New Zealand College of Anaesthetists

The FANZCA Final Examination (FEx) assesses trainee anaesthetists across clinical anaesthesia, perioperative care, pharmacology, and professional practice. The written component includes a 150-question MCQ paper and short-answer questions, plus clinical and medical vivas.

150

Questions

150 min

Time Limit

50%

To Pass

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