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

Question 1: 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?

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

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

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

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 3: Which volatile anaesthetic agent has the lowest blood:gas partition coefficient among currently used agents?

Halothane
Isoflurane
Desflurane (Correct answer)
Sevoflurane

Correct answer: Desflurane

Desflurane has a blood:gas partition coefficient of approximately 0.45, the lowest among currently used volatile agents, resulting in the fastest induction and emergence.

Question 4: What is the pharmacological rationale for using dexmedetomidine as a sedative in the ICU or as an adjunct in anesthesia?

It enhances GABA-mediated inhibition in the cortex
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 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 5: 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
Approval from the hospital CEO
Fellowship of at least 10 years

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

The ANZCA Cardiac Anaesthesia module only
The ANZCA Trauma Anaesthesia module only
There is no ANZCA pathway for this subspecialty
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 7: In the 'can't intubate, can't oxygenate' (CICO) scenario, what is the preferred surgical airway technique in current ANZCA-endorsed guidelines?

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

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

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

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 9: An anaesthetist discovers a critical defect in anaesthetic equipment mid-case. Which action is most appropriate?

Inform the surgeon and allow them to decide whether to continue
Immediately switch to backup equipment, ensure patient safety, then report per hospital incident protocol (Correct answer)
Continue the case and report the defect postoperatively
Tag the equipment out of service but continue using it if no backup is available

Correct answer: Immediately switch to backup equipment, ensure patient safety, then report per hospital incident protocol

Patient safety takes priority; switching to backup equipment and reporting via the incident management system is the required response.

Question 10: Which document provides ANZCA's position on the use of capnography as a monitoring requirement during procedural sedation?

PS26
PS18
PS54
PS09 (Correct answer)

Correct answer: PS09

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

Question 11: 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
Chest auscultation bilaterally
Continuous waveform capnography (Correct answer)
Visualisation of tube passing through cords

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 12: 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?

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

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

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

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 14: What is the primary purpose of ANZCA's Continuing Professional Development (CPD) program for Fellows?

To generate revenue for the College
To maintain and enhance professional competence throughout a career (Correct answer)
To replace the fellowship examination requirements
To satisfy medical board requirements only

Correct answer: To maintain and enhance professional competence throughout a career

ANZCA's CPD program is designed to support Fellows in maintaining and improving their knowledge, skills, and performance across their career.

Question 15: A patient with a Cormack-Lehane Grade III laryngoscopic view is best described as having which of the following?

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

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

Along the floor of the nasal cavity below the inferior turbinate (Correct answer)
Through the middle meatus
Superior turbinate
Middle 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 17: Under ANZCA Professional Document PS18, minimum monitoring during general anaesthesia must include which parameter at all times?

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

Correct answer: Pulse oximetry

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

Question 18: 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)
Oesophageal intubation
Bronchospasm
Kinked endotracheal tube

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 19: In New Zealand, anaesthetists are registered under which authority?

ANZCA directly
New Zealand Ministry of Health
Medical Council of New Zealand (MCNZ) (Correct answer)
Health and Disability Commissioner

Correct answer: Medical Council of New Zealand (MCNZ)

The Medical Council of New Zealand (MCNZ) registers all medical practitioners including anaesthetists and sets the standards for vocational registration.

Question 20: The FANZCA Code of Professional Conduct requires anesthetists to maintain thorough clinical records primarily because:

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

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

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

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

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

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 23: A candidate in the FANZCA viva voce is asked to 'compare and contrast' volatile anaesthetic agents. Which evaluation approach does this question format primarily test?

Psychomotor skill application
Analysis through systematic differentiation (Correct answer)
Factual recall of pharmacokinetics
Affective domain assessment

Correct answer: Analysis through systematic differentiation

Compare and contrast questions assess analytical ability by requiring candidates to identify similarities and differences through systematic evaluation.

Question 24: What is the purpose of ANZCA's 'Structured Training in Anaesthesia Research' (STAR) program?

To replace the clinical components of fellowship training
To fund overseas conference attendance exclusively
To provide research grants to senior Fellows only
To equip trainees and Fellows with skills in research methodology and evidence-based practice (Correct answer)

Correct answer: To equip trainees and Fellows with skills in research methodology and evidence-based practice

The STAR program develops research literacy and methodology skills in ANZCA trainees and Fellows to support evidence-based anaesthesia practice.

Question 25: A patient is transferred to ICU post-operatively. The most important communication strategy to ensure continuity of care is:

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

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 26: A patient undergoing laparoscopic cholecystectomy develops sudden hypotension and raised end-tidal CO2 during insufflation. What is the most likely cause?

CO2 embolism (Correct answer)
Pneumothorax
Aortic dissection
Anaphylaxis

Correct answer: CO2 embolism

CO2 gas embolism during laparoscopic insufflation causes a characteristic rise in ETCO2 followed by a sudden fall as cardiac output drops, with concurrent hypotension.

Question 27: Which ANZCA professional document addresses the safe use of neuromuscular blocking agents and the requirement for monitoring neuromuscular function?

PS56 (Correct answer)
PS31
PS18
PS08

Correct answer: PS56

ANZCA PS56 provides recommendations on the use of neuromuscular blocking agents, including the requirement for quantitative neuromuscular monitoring before extubation.

Question 28: Which drug class used in anesthesia acts by inhibiting cyclooxygenase enzymes to provide multimodal analgesia as part of an opioid-sparing strategy?

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

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 29: When assessing a patient with a history of latex allergy for anaesthesia, which associated food allergy most commonly co-exists due to cross-reactivity?

Avocado (Correct answer)
Wheat
Peanuts
Shellfish

Correct answer: Avocado

Latex-fruit syndrome involves cross-reactivity between latex and certain fruits, with avocado, banana, kiwi, and chestnut being the most commonly implicated foods.

Question 30: 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
The anesthetist's personal preference for top-up regimen
Level inserted, number of attempts, drug infusion rate, block height, and any complications (Correct answer)

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.

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.

Questions

35 min

Time Limit

50%

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