ANZCA Examinations
Anaesthesia learning arranged as an operating-theatre mental model: physiology, pharmacology, equipment, perioperative risk, and clinical decision-making all visible in one searchable library.
Designed for repeated recall: basic science mechanisms, viva phrasing, crisis recognition, and perioperative planning stay connected.
Primary Exam
Pharmacology, physiology, physics, measurement, and equipment foundations built for mechanism-first recall.
Final Exam
Clinical anaesthesia, perioperative medicine, subspecialty decision-making, and pain medicine.
Oral Exam Topics
High-yield prompts, structured answers, and applied physiology for viva preparation.
Acid-Base Physiology
Acid-base homeostasis is maintained through the interplay of three major buffer systems: bicarbonate (primary), phosphate, and protein buffers. The Henderson-Hasselbalch equation (pH = pKa + log[HCO₃⁻/(0.03 × PCO₂)])...
Acid-Base Physiology
Acid-base balance maintains arterial pH 7.35-7.45 through chemical buffering, respiratory compensation, and renal regulation. pH: Negative logarithm of [H⁺]; normal [H⁺] 40 nEq/L (35-45); pH 7.40 = [H⁺] 40 nEq/L; pH...
Adductor Canal Block
Roof (Superficial Wall): Sartorius muscle : Forms the roof of the canal for most of its length Fascial thickening : Strong fascia covering sartorius contributes to canal formation Attachment : Fascia blends with...
Airway Assessment
Systematic airway assessment identifies 80-90% of difficult airways but has limited positive predictive value ( 10-15%), meaning many predicted difficult airways are easily managed and some predicted easy airways...
Airway Fire in the Operating Room - Prevention and Management
Immediate Management (Critical First 60 Seconds): Simultaneously: Remove all airway devices (ETT, LMA, nasal tube, etc.) Disconnect oxygen source - flood circuit with air Pour sterile saline into airway (300-500 mL if...
Alfentanil and Sufentanil Pharmacology
Alfentanil and sufentanil are synthetic 4-anilidopiperidine opioid agonists derived from fentanyl, sharing its characteristic phenylpiperidine structure but with distinct pharmacokinetic profiles that determine their...
Anaesthesia for Aortic Arch Surgery
Aortic arch surgery requires deep hypothermic circulatory arrest (DHCA) with or without selective cerebral perfusion (SCP) . Indications : Aortic aneurysm, acute dissection (Type A), atherosclerotic disease. Core...
Anaesthesia for Aortic Surgery
Aortic surgery ranges from open repair (high risk, physiological insult) to endovascular stent grafting (EVAR/TEVAR, less invasive but still significant). Anatomy: Ascending aorta (coronary arteries, aortic valve),...
Anaesthesia for Awake Craniotomy
Awake craniotomy allows direct cortical mapping of speech, motor, and sensory areas during resection of lesions near eloquent cortex. Indications : Low-grade gliomas, epileptogenic foci, deep brain stimulation...
Anaesthesia for Burns Patients
Burns anaesthesia presents challenges: airway management (inhalation injury, swelling), fluid resuscitation (Parkland formula: 4 mL/kg/%TBSA in 24 hours - half in first 8 hours), temperature control (massive heat loss...
Anaesthesia for Cardiac Valve Surgery
Valve surgery requires understanding of hemodynamic goals specific to each lesion . Aortic stenosis (AS): Maintain sinus rhythm, normal-high preload, avoid hypotension/tachycardia, treat dynamic obstruction with...
Anaesthesia for Carotid Artery Stenting (CAS)
Carotid artery stenting (CAS) is a minimally invasive alternative to carotid endarterectomy (CEA) for carotid stenosis. Indications : High surgical risk (medical comorbidities, hostile neck, previous CEA/restenosis),...
Anaesthesia for Carotid Endarterectomy
Carotid endarterectomy (CEA) removes atherosclerotic plaque to prevent stroke. Indications : Symptomatic carotid stenosis 50-70% (recent TIA/stroke), asymptomatic 80% (selective). Monitoring : Arterial line, cerebral...
Anaesthesia for Cerebral Aneurysm Clipping
Cerebral aneurysm clipping requires strict blood pressure control (avoid hypertension pre-clipping, maintain normotension/mild hypotension during dissection), brain relaxation (mannitol, CSF drainage), and readiness...
Anaesthesia for Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) requires myocardial protection during ischemic arrest, hemodynamic optimization , and management of bleeding/coagulopathy . Preoperative : Continue antiplatelet agents (aspirin),...
Anaesthesia for Day Surgery
Day surgery (ambulatory surgery) requires rapid, smooth emergence , effective analgesia allowing oral intake and mobility, minimal PONV , and safe discharge . Patient selection : ASA I-III generally acceptable, BMI...
Anaesthesia for Deep Brain Stimulation
Deep brain stimulation (DBS) requires awake intraoperative assessment for optimal electrode placement (microelectrode recording + clinical testing). Anaesthesia strategy : light general anaesthesia for frame...
Anaesthesia for Dental Extractions
Dental extraction anaesthesia requires managing the "shared airway" with the dental surgeon while ensuring patient safety and comfort. Key considerations: (1) Airway management : Nasal intubation, reinforced LMA...
Anaesthesia for Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive technique for treating chronic rhinosinusitis, nasal polyps, and skull base pathology. Key anaesthetic challenges include:
Anaesthesia for Head Injury
Traumatic brain injury (TBI) affects 700 per 100,000 population annually in Australia, with anaesthetic management focused on preventing secondary brain injury by optimizing cerebral oxygenation and perfusion....
Anaesthesia for Heart Transplantation
Heart transplantation is the gold standard treatment for end-stage heart failure refractory to medical/device therapy. Indications : Dilated cardiomyopathy (50-60%), ischemic cardiomyopathy (25-35%), congenital heart...
Anaesthesia for Laparoscopic Surgery
Laparoscopic surgery presents unique physiological challenges: pneumoperitoneum (CO₂ insufflation 12-15 mmHg) increases intra-abdominal pressure causing cardiovascular effects (↓venous return initially, then ↑SVR and...
Anaesthesia for Laser Eye Surgery
Comprehensive guide to anaesthesia for PRK, LASIK, sedation requirements, and patient fixation for ANZCA Fellowship examination
Anaesthesia for Lung Resection
Lung resection includes pneumonectomy (entire lung), lobectomy (single lobe), segmentectomy/wedge (sublobar), and sleeve resection (bronchoplastic). Indications : Primary lung cancer (NSCLC 85%, SCLC 15%),...
Anaesthesia for Lung Transplantation
Lung transplantation is performed for end-stage lung disease refractory to medical therapy. Indications : COPD (30-35%), interstitial lung disease (25-30%), cystic fibrosis (15-20%), pulmonary hypertension (5-10%),...
Anaesthesia for Middle Ear Surgery
Middle ear surgery encompasses tympanoplasty, mastoidectomy, stapedectomy, and cholesteatoma surgery. Key anaesthetic considerations include:
Anaesthesia for Myasthenia Gravis
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder causing fatigable muscle weakness due to anti-acetylcholine receptor (AChR) antibodies (80-85%) or anti-MuSK antibodies (5-8%). Anaesthetic challenges :...
Anaesthesia for Obesity
Obesity (BMI 30 kg/m²) affects 30% of Australian adults and presents significant anaesthetic challenges due to physiological changes including reduced functional residual capacity (FRC), increased airway resistance,...
Anaesthesia for Ophthalmic Trauma
Comprehensive guide to anaesthesia for open globe injuries, orbital fractures, and intraocular pressure management for ANZCA Fellowship examination
Anaesthesia for Organ Transplantation
Organ transplantation presents unique challenges: Kidney transplant (most common, end-stage renal disease) - avoid nephrotoxins, maintain perfusion, manage hyperkalemia, avoid hypotension post-anastomosis. Liver...
Anaesthesia for Parotid Surgery
Comprehensive guide to anaesthesia for parotidectomy including facial nerve monitoring, Frey syndrome, and sialogogue use for ANZCA Fellowship examination
Anaesthesia for Patients with Pacemakers and ICDs
Patients with cardiac implantable electronic devices (CIEDs) including pacemakers and implantable cardioverter-defibrillators (ICDs) require systematic perioperative management to prevent device malfunction from...
Anaesthesia for Posterior Fossa Surgery
Posterior fossa surgery (sitting/prone park bench position) carries unique risks: venous air embolism (VAE, 20-40% incidence, 1% clinically significant), trigeminal-cardiac reflex (TCR, severe bradycardia/asystole...
Anaesthesia for Pyloric Stenosis
Infantile hypertrophic pyloric stenosis (IHPS) is a medical emergency requiring correction of hypochloraemic hypokalaemic metabolic alkalosis BEFORE surgery - it is NOT a surgical emergency. Presentation is typically...
Anaesthesia for Radical Neck Dissection
Comprehensive guide to anaesthesia for radical neck dissection including airway compromise, carotid protection, and shoulder dysfunction for ANZCA Fellowship examination
Anaesthesia for Renal Transplantation
for ANZCA Finals : - ESRD Physiology : Cardiovascular disease (leading cause of death), anaemia, platelet dysfunction, hyperkalaemia, metabolic acidosis, altered drug pharmacokinetics - Preoperative : Dialysis within...
Anaesthesia for Salivary Gland Surgery
Salivary gland surgery requires meticulous attention to the facial nerve (parotid surgery) and airway management. Key considerations: (1) Facial nerve preservation : Electromyography (EMG) monitoring mandatory for...
Anaesthesia for Spinal Surgery
Spinal surgery anaesthesia requires positioning considerations (prone/lateral/sitting), neurophysiological monitoring (SSEPs/MEPs), blood loss management (cell salvage, controlled hypotension), and air embolism...
Anaesthesia for the Septic Patient
Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection, with septic shock defined as sepsis with persistent hypotension requiring vasopressors despite adequate fluid...
Anaesthesia for Thoracic Aortic Surgery
Thoracic aortic surgery includes open repair and endovascular (TEVAR) approaches. Open repair requires left heart bypass (partial) or deep hypothermic circulatory arrest (DHCA) for arch/proximal descending, with...
Anaesthesia for Tonsillectomy
Tonsillectomy presents unique anaesthetic challenges due to the shared airway with the surgeon, risk of post-tonsillectomy haemorrhage (PTH) , and frequent paediatric population. Key considerations include:
Anaesthesia for Trauma
Trauma is the leading cause of death in Australians aged 1-44 years, with major trauma requiring coordinated multidisciplinary care including damage control resuscitation (DCR) principles. Primary survey follows ABCDE...
Anaesthesia for Vitreoretinal Surgery
Comprehensive guide to anaesthesia for scleral buckle, pneumatic retinopexy, gas tamponade, and complex vitrectomy for ANZCA Fellowship examination
Anaesthesia in Liver Failure
Liver failure presents complex perioperative challenges due to impaired synthetic function, coagulopathy, fluid shifts, and multi-organ involvement. Classification: Acute liver failure (ALF—encephalopathy within 8...
Anaesthesia in Renal Failure
Chronic kidney disease (CKD) stage 4-5 (eGFR <30 mL/min) and acute kidney injury (AKI) present significant perioperative risks due to fluid overload, electrolyte abnormalities, coagulopathy, and altered drug...
Anaesthesia in the Elderly
Ageing physiology significantly impacts anaesthetic management due to reduced functional reserve in cardiovascular, respiratory, renal, hepatic, and neurological systems. Pharmacokinetic changes include reduced lean...
Anaesthesia in the Elderly
Geriatric anaesthesia (age 65-70) requires understanding of age-related physiological changes and pharmacokinetic/pharmacodynamic alterations . Cardiovascular : Reduced compliance, diastolic dysfunction, fixed stroke...
Anaesthetic Machine
Modern anaesthetic machines integrate gas delivery, vaporization, breathing systems, and monitoring with multiple safety features. Gas supply: Central pipeline (oxygen 400 kPa, air, nitrous oxide) or cylinders (oxygen...
Anaesthetic Monitoring Standards
ANZCA Professional Standard PS41 (Anaesthetic Machine Monitoring Standards) mandates minimum monitoring for all patients undergoing general, regional, or sedation anaesthesia. Continuous monitoring: Inspired and...
Atracurium and Cisatracurium: Pharmacology
Atracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocker with unique Hofmann elimination (chemical degradation at physiological pH and temperature) and ester hydrolysis by plasma cholinesterases....
Atracurium Pharmacology
Atracurium besylate is an intermediate-acting, non-depolarizing benzylisoquinolinium neuromuscular blocking agent (NMBA) characterised by organ-independent elimination through Hofmann elimination (spontaneous chemical...
Atropine Pharmacology
Atropine is a naturally occurring tropane alkaloid and the prototypical competitive muscarinic acetylcholine receptor antagonist. As a tertiary amine with a pKa of 9.7, it crosses the blood-brain barrier and produces...
Autonomic Nervous System & Cardiovascular Control
The autonomic nervous system (ANS) regulates involuntary functions, divided into sympathetic (thoracolumbar T1-L2, fight-or-flight) and parasympathetic (craniosacral S2-S4, rest-and-digest) divisions. Sympathetic...
Awareness Under Anaesthesia
Accidental awareness during general anaesthesia (AAGA) is the unintended recall of intraoperative events by patients who received general anaesthesia, occurring in approximately 0.1-0.2% of general surgical cases (1-2...
Awareness Under Anaesthesia and Depth of Anaesthesia Monitoring
Accidental awareness during general anaesthesia (AAGA) is a rare but devastating complication with an incidence of approximately 1:19,000 anaesthetics in the UK (NAP5 data). It is defined as explicit recall of sensory...
Axillary Block
Axillary brachial plexus block targets the terminal branches of the brachial plexus as they surround the axillary artery in the axilla. Coverage : Forearm, wrist, hand (entire upper limb below mid-humerus)....
Bariatric Surgery Anaesthesia
Mechanical Alterations: Increased intra-abdominal pressure : Elevated by 5-15 mmHg above normal due to central adiposity, reducing diaphragmatic excursion Decreased FRC : Reduced by 30-50% in morbid obesity (BMI 40...
Beach Chair Position Anaesthesia
Beach chair position (BCP) involves elevating the head and torso 30-70 degrees from supine with legs lowered, primarily used for shoulder surgery. Physiological effects : Gravitational effects on cerebral perfusion...
Beta-Blockers Pharmacology
Beta-adrenergic receptor antagonists (beta-blockers) competitively inhibit catecholamine binding at beta-adrenoceptors, producing negative chronotropy (reduced heart rate), negative inotropy (reduced contractility),...
Brachial Plexus Blocks
The brachial plexus (C5-T1 roots) provides motor and sensory innervation to the upper limb. Four principal approaches exist for brachial plexus blockade: interscalene (shoulder surgery, 100% phrenic nerve palsy),...
Breathing Circuits and Systems
Anaesthetic breathing circuits deliver fresh gas to patient and remove expired CO₂, classified by rebreathing characteristics and presence of CO₂ absorption. Mapleson classification (non-rebreathing): A (Magill):...
Bupivacaine
Bupivacaine is a potent, long-acting amide local anaesthetic widely used for neuraxial blocks (epidural, spinal), peripheral nerve blocks, and labour analgesia. Structure: Amide local anaesthetic (pipecoloxylidide),...
Caesarean Section Anaesthesia
Caesarean section is the most common major surgical procedure in Australia, with approximately 30-35% of births delivered by caesarean section. Neuraxial anaesthesia (spinal, epidural, or combined spinal-epidural) is...
Calcium Channel Blockers Pharmacology
Calcium channel blockers (CCBs) inhibit voltage-gated L-type calcium channels, reducing calcium influx into cardiac and vascular smooth muscle cells. Classification is based on chemical structure : dihydropyridines...
Can't Intubate Can't Oxygenate (CICO)
What is it? Can't Intubate Can't Oxygenate (CICO) is a life-threatening airway emergency where tracheal intubation has failed AND oxygenation cannot be achieved via facemask or supraglottic airway (SGA). This...
Cancer Pain Management - WHO Ladder and Beyond
Cancer pain affects 30-50% of patients during treatment and 70-90% of patients with advanced disease. It is the most feared symptom of cancer and significantly impacts quality of life, function, and psychological...
Cancer Surgery and Anaesthesia
What is it? Anaesthesia for cancer surgery requires specialized knowledge of cancer biology, immunosuppression effects, optimal surgical timing, and perioperative considerations that differ significantly from...
Capnography - Physics, Waveform Analysis, and Clinical Applications
Capnography is the continuous measurement and graphical display of carbon dioxide (CO₂) concentration in respiratory gases. It utilises infrared absorption spectroscopy at the characteristic CO₂ wavelength of 4.26 μm...
Carbon Dioxide Transport
Carbon dioxide (CO2) is transported from tissues to lungs via three mechanisms: dissolved CO2 (5-10%), bicarbonate (60-70%), and carbamino compounds (20-25%). The bicarbonate pathway involves carbonic anhydrase...
Cardiac Cycle & Pressure-Volume Loops
The cardiac cycle consists of systole (isovolumetric contraction, ejection) and diastole (isovolumetric relaxation, filling). Pressure-volume (PV) loops graphically represent left ventricular pressure vs volume...
Cardiac Tamponade
Cardiac tamponade is life-threatening compression of the heart by fluid (blood, effusion) in the pericardial space impairing diastolic filling and reducing cardiac output. Pathophysiology: Pericardial pressure...
Cardiomyoplasty and Skeletal Muscle Ventricle
Cardiomyoplasty is an experimental surgical technique using skeletal muscle to assist or replace cardiac function. Two approaches exist: (1) Dynamic cardiomyoplasty—wrapping the latissimus dorsi muscle around the...
Cardiopulmonary Bypass Cannulation
Cardiopulmonary bypass (CPB) cannulation establishes extracorporeal circulation for cardiac surgery. Arterial cannulation (ascending aorta 95%, femoral 3%, axillary 2%) delivers oxygenated blood (cannula size: 20-24...
Cardiovascular Physiology
The cardiovascular system maintains perfusion to all tissues through coordinated heart function, vascular tone, and blood volume regulation. Cardiac output (CO): 5-6 L/min (HR 60-100 bpm × SV 60-100 mL); determined by...
Cerebral Blood Flow and Metabolism
Cerebral blood flow (CBF) is tightly regulated to maintain constant oxygen and glucose delivery to the brain, which has high metabolic demand (20% of resting oxygen consumption, 2% of body weight). Normal CBF: 50...
Cerebrovascular Surgery: AVMs, Moyamoya, and Stroke Revascularisation
Cerebrovascular surgery (AVM resection, Moyamoya bypass, stroke revascularisation) requires meticulous haemodynamic control to maintain cerebral perfusion while avoiding catastrophic complications. Key principles:
Chronic Pain Assessment
"Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
Clinical Governance in Anaesthesia
Comprehensive guide to quality improvement, audit, morbidity meetings, and clinical governance frameworks for ANZCA Fellowship examination
Clonidine Pharmacology
Clonidine is a selective alpha-2 (α2) adrenergic receptor agonist with central sympatholytic, sedative, and analgesic properties that make it valuable in perioperative medicine. It is an imidazoline derivative that...
Coagulation and Haemostasis
Haemostasis maintains blood fluidity while preventing bleeding through vascular, platelet, and coagulation factors working in concert. Primary haemostasis: Vascular spasm, platelet adhesion (glycoprotein Ib-von...