100+ Free ANZCA Primary Practice Questions

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2026 Statistics

Key Facts: ANZCA Primary Exam

150 MCQs

The Primary MCQ paper has 150 single-best-answer questions

ANZCA - Anaesthesia exams

150 minutes

Time allowed for the 150-question MCQ paper

ANZCA - Anaesthesia exams

Pass/fail

The MCQ paper is reported pass/fail and not added to the overall mark

ANZCA - Anaesthesia exams

50%

Pass standard for each of the SAQ and viva sections

ANZCA - Anaesthesia exams

A$6,590

2026 Primary examination fee in Australia (NZ$8,270 in New Zealand)

ANZCA - Information on training fees

3 sections

The Primary exam has MCQ, SAQ and viva components

ANZCA - Anaesthesia exams

Twice yearly

The written paper is offered about twice a year (February/March and August)

ANZCA - Anaesthesia exams

100

Free original MCQ practice questions in this bank

OpenExamPrep

The ANZCA Primary Examination is the anaesthesia basic-sciences barrier exam run by the Australian and New Zealand College of Anaesthetists (ANZCA). Its multiple-choice paper has 150 single-best-answer questions in 150 minutes and is reported as pass/fail. Content is dominated by pharmacology and physiology, with applied anatomy and clinical measurement, equipment and statistics. The 2026 examination fee is A$6,590 in Australia (NZ$8,270 in New Zealand), and candidates must also pass the SAQ and viva sections, each set to a 50% pass standard. This 100-question bank gives original MCQ-style practice modelled on the Primary curriculum Learning Outcomes.

Sample ANZCA Primary Practice Questions

Try these sample questions to test your ANZCA Primary exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1The minimum alveolar concentration (MAC) of an inhalational agent is the alveolar concentration at which what proportion of subjects do not move in response to a standard surgical skin incision?

A.50%

B.95%

C.63%

D.100%

Explanation: MAC is defined as the alveolar concentration of an inhalational agent at 1 atmosphere that prevents movement to a standard surgical incision in 50% of subjects. It is a measure of anaesthetic potency, allowing agents to be compared.

2Which inhalational anaesthetic agent has the lowest blood:gas partition coefficient, giving it the fastest onset and offset of the volatile agents listed?

A.Isoflurane

B.Sevoflurane

C.Desflurane

D.Halothane

Explanation: Desflurane has the lowest blood:gas partition coefficient (about 0.42), so less agent dissolves in blood and alveolar partial pressure rises and falls quickly. This gives the fastest onset and offset of these agents.

3Propofol's rapid offset after a single induction bolus is primarily explained by which pharmacokinetic process?

A.Hepatic metabolism

B.Redistribution from brain to less well-perfused tissues

C.Renal excretion of unchanged drug

D.Hofmann elimination

Explanation: After a single bolus, propofol concentration in the brain falls mainly because the drug redistributes from the vessel-rich group to muscle and fat. Although propofol is also rapidly metabolised, redistribution accounts for the quick recovery from a single dose.

4Suxamethonium produces neuromuscular blockade by which mechanism?

A.Competitive antagonism at the nicotinic acetylcholine receptor

B.Persistent depolarisation of the motor end-plate as a receptor agonist

C.Inhibition of acetylcholinesterase

D.Blockade of presynaptic calcium channels

Explanation: Suxamethonium is a depolarising muscle relaxant: it binds and activates the nicotinic receptor like acetylcholine but is not rapidly hydrolysed at the junction, causing sustained depolarisation that initially fasciculates then blocks transmission. This is a phase I block.

5Suxamethonium is normally metabolised by which enzyme, the deficiency of which causes prolonged paralysis?

A.Acetylcholinesterase

B.Plasma (butyryl) cholinesterase

C.Monoamine oxidase

D.Catechol-O-methyltransferase

Explanation: Suxamethonium is hydrolysed in plasma by butyrylcholinesterase (plasma or pseudocholinesterase). Inherited or acquired deficiency, detected by a low dibucaine number, prolongs the duration of paralysis (suxamethonium apnoea).

6Atracurium is unique among the common neuromuscular blockers because it undergoes Hofmann elimination. This process is best described as:

A.Enzymatic hydrolysis by plasma cholinesterase

B.Spontaneous, non-enzymatic breakdown dependent on temperature and pH

C.Hepatic conjugation with glucuronide

D.Renal tubular secretion

Explanation: Hofmann elimination is a spontaneous, non-enzymatic chemical degradation that depends on normal body temperature and pH. Because it is independent of hepatic and renal function, atracurium is useful in organ failure; alkalosis and warmth speed the process.

7Sugammadex reverses neuromuscular blockade produced by rocuronium by which mechanism?

A.Inhibiting acetylcholinesterase to raise junctional acetylcholine

B.Encapsulating rocuronium in plasma to form an inactive complex

C.Blocking presynaptic muscarinic autoreceptors

D.Directly stimulating the nicotinic receptor

Explanation: Sugammadex is a modified gamma-cyclodextrin that encapsulates aminosteroid relaxants such as rocuronium and vecuronium in plasma, forming a tightly bound inactive complex. This lowers free drug, drawing the relaxant away from the junction and reversing block.

8Neostigmine is given with an antimuscarinic such as glycopyrrolate during neuromuscular reversal mainly to prevent which effect?

A.Tachyarrhythmia and hypertension

B.Muscarinic effects such as bradycardia, salivation and bronchospasm

C.Prolonged depolarising block

D.Histamine release and hypotension

Explanation: Neostigmine raises acetylcholine at all cholinergic sites, including muscarinic receptors, causing bradycardia, increased secretions, bronchoconstriction and gut activity. An antimuscarinic such as glycopyrrolate is co-administered to block these unwanted muscarinic effects.

9Local anaesthetics block nerve conduction by acting predominantly on which target?

A.Voltage-gated sodium channels on the axonal membrane

B.GABA-A chloride channels

C.Voltage-gated potassium channels

D.Nicotinic acetylcholine receptors

Explanation: Local anaesthetics bind the intracellular portion of voltage-gated sodium channels, preferentially in the open and inactivated states, preventing the sodium influx required for action potential propagation. This use-dependent block underlies their effect.

10A local anaesthetic with a pKa closer to physiological pH will, all else equal, tend to have a:

A.Slower onset because less drug is non-ionised

B.Faster onset because a greater fraction is non-ionised at tissue pH

C.Longer duration of action

D.Greater degree of protein binding

Explanation: Only the non-ionised (uncharged) form crosses the nerve membrane. A pKa closer to physiological pH means a larger fraction is non-ionised at tissue pH, so more drug penetrates the nerve and onset is faster. This is why lidocaine (pKa about 7.9) acts faster than bupivacaine.

About the ANZCA Primary Exam

The ANZCA Primary Examination (PEx) is the basic-sciences barrier examination of the ANZCA anaesthesia training program in Australia and New Zealand. It tests applied physiology, pharmacology, anatomy, clinical measurement, equipment, quality and safety, and a candidate must pass it to progress to advanced training. The exam has three sections: a multiple-choice paper of 150 single-best-answer questions (reported as pass/fail), a short-answer paper of 15 questions, and three vivas. The MCQ paper runs for 150 minutes and samples the entire breadth of the Primary curriculum Learning Outcomes, with pharmacology and physiology dominating the content. This bank provides original single-best-answer MCQ practice for that paper, weighted toward pharmacology and physiology with applied anatomy and clinical measurement.

Assessment

The full Primary exam has three sections: an MCQ paper of 150 single-best-answer questions (pass/fail), an SAQ paper of 15 short-answer questions (50% pass), and three vivas of 20 minutes each (50% pass). This bank covers the MCQ section only.

Time Limit

The MCQ paper is 150 minutes for 150 questions. The SAQ paper is a separate 150-minute session on the same written-exam day, and the three vivas total about 66 minutes.

Passing Score

The MCQ paper is pass/fail and does not contribute to the overall mark. The SAQ and viva sections each have a 50% pass standard, and a candidate must pass every section to pass the Primary examination.

Exam Fee

The 2026 Primary examination fee is A$6,590 (tax free) in Australia and NZ$8,270 (incl. 15% GST) in New Zealand. The withdrawal fee after the closing date is A$750 / NZ$940. (Australian and New Zealand College of Anaesthetists (ANZCA))

ANZCA Primary Exam Content Outline

35%

Pharmacology

Pharmacokinetic and pharmacodynamic principles, inhalational agents and MAC, intravenous induction agents, opioids, neuromuscular blocking drugs and reversal, local anaesthetics and toxicity, and autonomic, cardiovascular and other drug groups applied to anaesthesia.

35%

Physiology

Respiratory physiology and gas exchange, cardiovascular physiology and the cardiac cycle, renal and fluid physiology, central nervous system and the neuromuscular junction, and blood, oxygen carriage and acid-base balance.

15%

Applied Anatomy

Clinically relevant regional anatomy: the airway, vertebral column and neuraxial structures, brachial plexus and peripheral nerve blocks, thorax, heart and great vessels, and surface landmarks used for anaesthetic and vascular procedures.

15%

Clinical Measurement, Physics and Statistics

Principles of measuring pressure, flow and volume, gas analysis and capnography, pulse oximetry, temperature and cardiac output measurement, electrical safety, humidity, and basic statistics and data interpretation for clinical research.

How to Pass the ANZCA Primary Exam

What You Need to Know

Passing score: The MCQ paper is pass/fail and does not contribute to the overall mark. The SAQ and viva sections each have a 50% pass standard, and a candidate must pass every section to pass the Primary examination.
Assessment: The full Primary exam has three sections: an MCQ paper of 150 single-best-answer questions (pass/fail), an SAQ paper of 15 short-answer questions (50% pass), and three vivas of 20 minutes each (50% pass). This bank covers the MCQ section only.
Time limit: The MCQ paper is 150 minutes for 150 questions. The SAQ paper is a separate 150-minute session on the same written-exam day, and the three vivas total about 66 minutes.
Exam fee: The 2026 Primary examination fee is A$6,590 (tax free) in Australia and NZ$8,270 (incl. 15% GST) in New Zealand. The withdrawal fee after the closing date is A$750 / NZ$940.

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ANZCA Primary Study Tips from Top Performers

1Map your study to the ANZCA curriculum Appendix 2 Learning Outcomes so that pharmacology and physiology, which dominate the MCQ paper, get the bulk of your time.

2Practise pacing at roughly one minute per question; the MCQ paper allows 150 minutes for 150 single-best-answer items, so you cannot dwell on any one stem.

3For pharmacology, learn real numbers cold: MAC values, pKa and protein binding of local anaesthetics, context-sensitive half-times and receptor mechanisms.

4For physiology, be able to draw and explain core curves and cycles such as the oxyhaemoglobin dissociation curve, cardiac cycle pressure-volume loop and CO2 response curve.

5Treat clinical measurement and physics as scoring topics: understand transducers, capnography, oximetry, the Bohr and Beer-Lambert principles, and basic statistics.

6Use single-best-answer technique: read the lead-in carefully, predict the answer before reading options, and choose the single most correct response rather than the first plausible one.

Frequently Asked Questions

How many questions are on the ANZCA Primary MCQ paper?

The MCQ paper has 150 single-best-answer multiple-choice questions answered in 150 minutes. The full Primary exam also includes a 15-question SAQ paper and three vivas.

Is the ANZCA Primary MCQ paper scored or just pass/fail?

ANZCA reports the MCQ paper as pass/fail; it does not contribute to the overall exam mark. The SAQ and viva sections each carry a 50% pass standard and a candidate must pass every section.

What subjects does the ANZCA Primary exam cover?

It covers applied physiology, pharmacology, anatomy, clinical measurement, equipment, quality and safety. Pharmacology and physiology together make up the large majority of the content.

How much does the ANZCA Primary examination cost in 2026?

The 2026 fee is A$6,590 (tax free) in Australia and NZ$8,270 (incl. GST) in New Zealand. The fee covers all three sections of the exam, and a withdrawal fee applies after the closing date.

When is the ANZCA Primary exam held?

The written paper is held twice a year, typically around February/March and August. Trainees sit it during basic training and must pass it to progress to advanced anaesthesia training.

Are these official ANZCA practice questions?

No. These are original OpenExamPrep questions modelled on the published Primary curriculum Learning Outcomes. ANZCA provides its own curriculum, study guide and recommended reading list separately.