ANZCA Part 1 SAQs

Hit the headings and use loads of examples with some detail about the examples (as per examiners report)

Should probably have a line or two about HPV for the awake patient

Errors is a separate question don’t @me

Cool graph on ketamine nightmares that is worth drawing

Table at the start

Draw compartment model. PK/PD structure. PK needs to include accumulation and elimination.

More than just a valsalva but similar principles. Don’t forget frank starling graph and indirect effects.

Classify into mild and mod-severe

Pretty neat

The buffering part is hard to get my head around

Protective: RID (reservoir, immunological, drugs). Regulatory: SEAMS (storage, endocrine, acid base, metabolic, synthesis)

Weirdly not put into a section of its own in Nunn’s or West’s. Ended up using deranged physiology for most of it. Use a graph for FRC and CC.

Brandis very good again. Do a graph at the end with arterial and venous lines showing Haldane effect.

Acronym for machine features is POP (pressure, oxygen, power)

Had to look in different parts of different books for this one 😡 inefficient but done

Brandis is my pick for this question. Graphs I’ve talked about are from there too.

Filling pressure, compliance, afterload. Then section on IPPV/SV for showing off.

Hasn’t come up in 10 years and poor pass rate, core topic

A hard one. Can exclude certain parts for questions specifically on lung compliance.

So much rote learning that means nothing

Maternal (uterine artery) O2 = 105mmHg, CO2 = 30mmHg. Foetal (umbilical artery) O2 = 20mmHg, CO2 = 50mmHg.

Very short, if you know the content you can get a pass pretty quickly

Amsorb sounds pretty good

Not been asked for a while, much easier to approach and understand this question once you have a good grasp of viscosity/density and laminar/turbulent flow

Graph with glucose flux on y axis and plasma glucose on x axis

Also asked as mineralocorticoids and glucocorticoids

There are probably more but this is enough for me

Lots of different terminology for the states of VDNaC and the gates. Voltage = M gate (outer gate). Time = H gate (inner gate). Resting = closed M open H. Active = both open. Inactive = open M closed H.

Almost complete credit to Stan Tay at adrenaline memories.

Most of this answer is in PD

Draw the flowchart from angiotensinogen onwards

Breadth over depth

Adrenaline memories answer very good. I changed some of the headings to simplify it with how I understand it. The key is understanding the difference in venodilation and vasodilation.

A hard one to do in 10 mins but thankfully examiners report says Doppler and CO measurement are “extra marks” rather than pass marks.

Learn those formulas and effect of temperature (common MCQ)

Povidine iodine and alcoholic chlorhexidine. This is a 2-3/5 answer. Apart from knowing that I shouldn’t inject chlorhex into someone’s spinal cord I’m not sure how this makes me a better anaesthetist.

This is a good starting point and probably a pass as per examiners reports, but if you get time then add more detail (e.g. baroreceptor reflexes to volume changes, CVS effects of potential hyperkalaemia)

Get the headings down and the rest will follow

Renal and acid base will be the death of me

Na+ transport passive as per Power and Kam. Doesn’t make sense to me but it’s a recommended text so going to run with it 👍🏽

Hard one to do in 10 mins, practice practice practice

Keep it simple stupid

Graph from ketamine nightmares is elite for understanding but not sure I would have time to draw three graphs. Could do the full table for VQ at dead space/apex/ideal alveolar gas/base/shunt with O2 and CO2 values if you get time.

Model answers not ideal so came up with my own, tried to keep it simple

Mainly from Stan Tay at Adrenaline Memories

Makeup question by ex chair of examiners. Answer based off a friend’s answer (Matt Avery) that she gave a 5/5 to!

Graph very important. TEG probably simpler but I chose ROTEM because it’s what they actually use at work and this exam is all about becoming a better anaesthetist!

Has been asked both as a written SAQ and with a booklet containing images and shorter questions

Serotonergic, COX3, endogenous cannabinoids. Management of toxicity to be covered in another episode.

At the start I think it’s worth putting abbreviations to denote A for anterior, P for posterior, M for medial, L for lateral

Look up a diagram. Best one I could find was Ketamine Nightmares (had both on same axes and content rather than saturation %). Also correction that bicarbonate carriage is by combination with water via carbonic anhydrase, not by “combination with bicarbonate”.

Pretty rude of the surgeons to impose this on us, don’t you think?

Minor error where I said Cl content increases the strong ion difference but actually it decreases it… my bad (Stewart approach 🤦‍♂️). But still the point stands that it causes a minor hyperchloraemic acidosis with the alkalosis of H+ being consumed by cori cycle for metabolism of lactate as the dominant process from CSL infusion.

An annoyingly broad question that asked for the onset and offset, also didn’t specify topical or subcutaneous or nerve block. A narrower scope would make for an easier question.

A good one to practice. Those CVS reflexes at the end are tricky.

Numbers for equilibration of compartments refer to 3 time constants (not half lives) and are from Hemmings and Egan. Sevo 2 min FRC, 9 min VRG, 7 hrs MG, 5 days FG. Des 2 min FRC, 8 min VRG, 5 hrs MG, 3 days FG.

Nail your definitions, graph, table, and learn the numbers for effect site concentrations

Everyone use TIVA so that this is out of the syllabus ASAP or at least only given as much importance as knowing that ether has a BGPC of 12

This is a 2/5 probably needs more examples and detail

Look up a diagram

A really hard one to get done in 10 mins especially if you include graphs. Focus on answering the question.

Sometimes I think study sux 😂

Breadth over depth

Re alloimmunisation it’s worth adding possible future transfusion reactions as well as haemolytic disease of the newborn

Kudos to all the TIVA divas, imagine in 20 years time if pharmacokinetics of volatiles isn’t in the syllabus 🤯

YouTube was helpful for learning to pronounce Adamkiewicz

A hard one to do in 10 mins. Breadth over depth. Look up an oxygen cascade diagram for the intro if you don’t have one in your head.

99% of this from Stan Tay at adrenaline memories

This one was a mouthful and I think I absolutely butchered the Starling equation

My blood group is B+

Ouch. Thanks to Lauren Foster for suggesting this answer should include opioids increasing chronic pain by NMDA agonism, increased spinal dysnorphins, down regulation of opioid receptor number and sensitivity

Look up fast vs slow response diagram to supplement this episode