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100+ Free ANZCA Final Exam Practice Questions

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2026 Statistics

Key Facts: ANZCA Final Exam Exam

150 MCQs

The ANZCA Final Exam written paper has 150 single-best-answer MCQs in 150 minutes

ANZCA - Anaesthesia exams

15 SAQs

The Final Exam SAQ paper has 15 short-answer questions in 150 minutes, held the same day as the MCQ

ANZCA - Anaesthesia exams

8 + 2 vivas

The viva component has 8 anaesthesia vivas and 2 medical vivas, each 15 minutes

ANZCA - Anaesthesia exams

40% MCQ + 40% SAQ

Candidates need at least 40% in both MCQ and SAQ sections to be invited to the vivas

ANZCA - Anaesthesia exams

A$7,330

2026 ANZCA Final Examination fee in Australia (tax free)

ANZCA - Anaesthesia exams

88 weeks FTE

Minimum clinical anaesthesia time required before eligibility to sit the Final Exam

ANZCA - Anaesthesia exams

3 viva days

From the 2026.1 FEx, anaesthesia and medical vivas are held across 3 separate days

ANZCA - Final examination: Change of viva schedule

100

Free original MCQ practice questions in this bank

OpenExamPrep

The ANZCA Final Examination is the exit exam of the anaesthesia training program: a written day of 150 MCQs and 15 SAQs (150 minutes each), followed months later by 8 anaesthesia vivas and 2 medical vivas (15 minutes each) over 3 days. Candidates need at least 40% in the MCQ and SAQ to reach the vivas, then an overall 50% with a pass in the anaesthesia viva section and at least 4 of 8 anaesthesia vivas passed. The 2026 exam fee is A$7,330 in Australia. This 100-question bank gives original advanced-level MCQ practice across general/regional anaesthesia, perioperative medicine, cardiac/thoracic/vascular, obstetric, paediatric, and neuroanaesthesia, intensive care/crisis management, pain medicine, applied pharmacology, and professionalism/ethics.

Sample ANZCA Final Exam Practice Questions

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

1Difficult Airway Society (DAS) guidelines - after failed intubation and failed facemask/supraglottic airway ventilation (a true CICO scenario), what is the recommended next step?
A.Emergency front-of-neck access (cricothyroidotomy)
B.Wake the patient
C.Attempt intubation again with a different laryngoscope
D.Deepen anaesthesia and continue attempts
Explanation: In CICO (can't intubate, can't oxygenate) emergency, DAS guidelines mandate emergency front-of-neck access via scalpel cricothyroidotomy without delay once oxygenation cannot be achieved by any less invasive route.
2What is the mechanism of action of sugammadex?
A.Inhibits acetylcholinesterase
B.Encapsulates rocuronium/vecuronium molecules, forming an inactive complex excreted renally
C.Competes with acetylcholine at nicotinic receptors
D.Blocks presynaptic calcium channels
Explanation: Sugammadex is a modified gamma-cyclodextrin that selectively binds and encapsulates aminosteroid neuromuscular blockers (rocuronium more than vecuronium), forming a stable complex excreted by the kidneys, allowing reversal independent of anticholinesterase mechanisms.
3A patient develops sudden hypotension, tachycardia and perioral numbness shortly after an interscalene brachial plexus block, progressing to seizure. What is the immediate priority?
A.Proceed with surgery and monitor closely
B.Give more local anaesthetic to complete the block
C.Administer 20% intravenous lipid emulsion and manage the airway/seizure per LAST protocol
D.Administer atropine and reassure the patient
Explanation: This is local anaesthetic systemic toxicity (LAST). Immediate management includes stopping the injection, airway support, seizure control, and early 20% lipid emulsion bolus (about 1.5 mL/kg) per ANZCA/ASRA guidance, with prolonged resuscitation if cardiac arrest occurs.
4Which volatile anaesthetic agents and depolarising muscle relaxant are absolute triggers to avoid in a patient with known malignant hyperthermia susceptibility?
A.Nitrous oxide and rocuronium
B.Propofol and suxamethonium
C.Volatile agents only; suxamethonium is safe
D.All potent volatile agents and suxamethonium
Explanation: All potent inhalational volatile agents (e.g., sevoflurane, isoflurane, desflurane) and suxamethonium are recognised triggers of malignant hyperthermia in susceptible individuals; a trigger-free (total intravenous) anaesthetic technique is used instead.
5What is the first-line pharmacological treatment for a confirmed malignant hyperthermia crisis?
A.Dantrolene sodium
B.Dexmedetomidine
C.Magnesium sulfate
D.Calcium gluconate
Explanation: Dantrolene directly inhibits ryanodine-receptor-mediated calcium release from the sarcoplasmic reticulum in skeletal muscle and is the specific first-line treatment, given as an IV bolus (starting around 2.5 mg/kg) with cessation of triggering agents and active cooling.
6During spinal anaesthesia for a lower-limb procedure, block height rises rapidly with bradycardia, hypotension and difficulty breathing. What complication is most likely?
A.Postdural puncture headache
B.High or total spinal block
C.Epidural haematoma
D.Local anaesthetic allergy
Explanation: Excessive cephalad spread of intrathecal local anaesthetic can produce a high or total spinal, causing sympathetic blockade (hypotension, bradycardia) and, if intercostal/phrenic involvement occurs, respiratory compromise, requiring airway support and haemodynamic resuscitation.
7A patient reports explicit recall of intraoperative events with pain during a general anaesthetic. Which factor is a well-established risk factor for accidental awareness during general anaesthesia (AAGA)?
A.Adequate MAC-matched volatile delivery
B.Deep TIVA delivered with target-controlled infusion
C.Neuromuscular blockade without adequate depth of anaesthesia
D.Use of processed EEG monitoring
Explanation: Neuromuscular blockade removes the ability to move in response to inadequate anaesthesia, a key risk factor identified in the NAP5 audit; other risks include difficult airway management, TIVA without depth monitoring, cardiac surgery, and emergency anaesthesia.
8Which airway adjunct is most useful for confirming correct tracheal tube placement immediately after intubation?
A.Pulse oximetry
B.Auscultation alone
C.Chest X-ray
D.Continuous waveform capnography
Explanation: Continuous waveform capnography demonstrating a sustained CO2 trace is the gold-standard, most reliable confirmation of tracheal (versus oesophageal) tube placement and is mandated by anaesthesia safety guidelines for every intubation.
9In rapid sequence induction for a patient at high aspiration risk, which manoeuvre is now considered a matter of individualised judgement rather than mandatory, given current evidence?
A.Routine application of cricoid pressure
B.Preoxygenation to end-tidal O2 above 90%
C.Head-up positioning
D.Availability of suction
Explanation: While traditionally taught, cricoid pressure lacks robust evidence of aspiration prevention, can worsen the laryngoscopic view, and modern RSI protocols increasingly regard it as optional/individualised rather than mandatory, unlike preoxygenation, positioning and suction availability which remain standard.
10An ultrasound-guided interscalene brachial plexus block is most likely to cause which recognised side effect due to phrenic nerve proximity?
A.Contralateral hemidiaphragmatic paresis
B.Ipsilateral hemidiaphragmatic paresis
C.Bilateral vocal cord palsy
D.Horner's syndrome only, with no diaphragmatic effect
Explanation: The phrenic nerve runs close to the brachial plexus at the interscalene level, so local anaesthetic spread commonly causes ipsilateral hemidiaphragmatic paresis (up to 100% incidence with standard volumes), which may be clinically significant in patients with limited respiratory reserve.

About the ANZCA Final Exam Exam

The ANZCA Final Examination (FEx) is the capstone exit examination of the ANZCA anaesthesia training program, sat during advanced training once a trainee has completed introductory and basic training, at least 26 weeks FTE of advanced training, and at least 88 weeks FTE of clinical anaesthesia time. The written component (150 MCQs in 150 minutes and 15 SAQs in 150 minutes) is held on a single day at exam centres across Australia and New Zealand; candidates who reach the required MCQ and SAQ thresholds are invited to a viva voce examination held months later, comprising 8 anaesthesia vivas and 2 medical vivas of 15 minutes each across a 3-day schedule. The exam assesses the knowledge, applied knowledge, and clinical judgement expected of a trainee ready to practise as a specialist anaesthetist, drawing on the ANZCA Roles in Practice, Clinical Fundamentals, and Specialised Study Units across the full anaesthesia training curriculum. This bank provides original single-best-answer practice questions at a comparable advanced level, spanning general and regional anaesthesia, perioperative medicine, cardiac/thoracic/vascular anaesthesia, obstetric and paediatric anaesthesia, neuroanaesthesia, intensive care and crisis management, acute and chronic pain medicine, applied pharmacology and physiology, and professionalism/ethics/patient safety.

Assessment

A single written exam day with 150 single-best-answer MCQs (150 minutes) and 15 short-answer questions (150 minutes), followed months later by a 3-day viva schedule comprising 8 anaesthesia vivas and 2 medical vivas (15 minutes each). This bank provides original MCQ-style practice items in the same advanced-anaesthesia style.

Time Limit

150 minutes for the MCQ paper and 150 minutes for the SAQ paper on the written exam day; each viva is 15 minutes, with anaesthesia and medical vivas held across 3 separate days.

Passing Score

Candidates need at least 40% in both the MCQ and SAQ to be invited to vivas, then an overall mark of at least 50%, a pass in the anaesthesia viva section, a pass in at least one other section, and a pass (5/10 or higher) in at least 4 of the 8 anaesthesia vivas.

Exam Fee

The 2026 Final Examination fee is A$7,330.00 (tax free) in Australia and NZ$9,195.00 (plus GST) in New Zealand; a withdrawal fee of A$870.00 / NZ$1,095.00 applies if the candidate withdraws. (Australian and New Zealand College of Anaesthetists (ANZCA))

ANZCA Final Exam Exam Content Outline

14%

General and Regional Anaesthesia

Difficult airway algorithm and CICO management, rapid sequence induction, regional/peripheral nerve blocks, local anaesthetic systemic toxicity, malignant hyperthermia, neuromuscular blockade/reversal, and accidental awareness.

14%

Perioperative Medicine

Cardiac risk stratification, perioperative medication management (anticoagulants, SGLT2 inhibitors, statins), fasting guidelines, ERAS, VTE prophylaxis, postoperative delirium, frailty, CPET, and perioperative myocardial injury (MINS).

12%

Cardiac, Thoracic and Vascular Anaesthesia

Cardiopulmonary bypass and weaning, protamine reactions, one-lung ventilation and lung isolation, aortic stenosis, EVAR versus open AAA repair, carotid endarterectomy, TOE monitoring, and pacemaker/device management.

10%

Obstetric Anaesthesia and Analgesia

Physiological changes of pregnancy, aortocaval compression, preeclampsia and eclampsia, labour epidural analgesia, spinal anaesthesia for caesarean section, postpartum haemorrhage, amniotic fluid embolism, and obstetric failed intubation.

10%

Paediatric Anaesthesia

Paediatric airway anatomy, weight-based fluid/drug dosing, laryngospasm, caudal blocks, neonatal circulatory transition, PONV prophylaxis, inhalational induction, croup versus epiglottitis, and neonatal surgical emergencies.

10%

Intensive Care Medicine and Crisis Management

Sepsis and septic shock, ARDS lung-protective ventilation, anaphylaxis, gas embolism, cardiac arrest algorithms, LAST-related arrest, operating theatre fires, CICO front-of-neck access, and transfusion reactions (TRALI/TACO).

9%

Neuroanaesthesia

Intracranial pressure and cerebral perfusion pressure management, venous air embolism in the sitting position, awake craniotomy, neuromonitoring, autonomic dysreflexia, traumatic brain injury targets, aneurysm surgery, and cerebral autoregulation.

8%

Acute and Chronic Pain Medicine

Multimodal analgesia, PCA safety features, opioid-induced respiratory depression, neuropathic pain pharmacology, opioid-induced hyperalgesia, the biopsychosocial pain model, and ketamine as an analgesic adjunct.

7%

Applied Pharmacology and Physiology

Volatile anaesthetic blood-gas partition coefficients, propofol/remifentanil pharmacokinetics, neuromuscular blocker onset/offset and organ-independent elimination, acid-base interpretation, and the oxygen-haemoglobin dissociation curve.

6%

Professionalism, Ethics and Patient Safety

Informed consent and capacity assessment, the WHO Surgical Safety Checklist, open disclosure after adverse events, crisis resource management, and incident reporting/just culture.

How to Pass the ANZCA Final Exam Exam

What You Need to Know

  • Passing score: Candidates need at least 40% in both the MCQ and SAQ to be invited to vivas, then an overall mark of at least 50%, a pass in the anaesthesia viva section, a pass in at least one other section, and a pass (5/10 or higher) in at least 4 of the 8 anaesthesia vivas.
  • Assessment: A single written exam day with 150 single-best-answer MCQs (150 minutes) and 15 short-answer questions (150 minutes), followed months later by a 3-day viva schedule comprising 8 anaesthesia vivas and 2 medical vivas (15 minutes each). This bank provides original MCQ-style practice items in the same advanced-anaesthesia style.
  • Time limit: 150 minutes for the MCQ paper and 150 minutes for the SAQ paper on the written exam day; each viva is 15 minutes, with anaesthesia and medical vivas held across 3 separate days.
  • Exam fee: The 2026 Final Examination fee is A$7,330.00 (tax free) in Australia and NZ$9,195.00 (plus GST) in New Zealand; a withdrawal fee of A$870.00 / NZ$1,095.00 applies if the candidate withdraws.

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 Final Exam Study Tips from Top Performers

1Work systematically through the ANZCA anaesthesia training program curriculum's Clinical Fundamentals and all 12 Specialised Study Units (cardiac, general/urological/gynaecological, head and neck, intensive care, neurosurgery, obstetrics, ophthalmic, orthopaedic, paediatric, plastics, thoracic, vascular) rather than relying on primary-exam-level basic sciences alone.
2Practise integrating physiology, pharmacology, and clinical judgement into applied scenarios, since the Final Exam tests advanced clinical decision-making rather than isolated factual recall.
3Review past FEx written and viva reports published by ANZCA to understand recurring themes, common pitfalls, and examiner expectations for both the SAQ and viva components.
4Build fluency in structured emergency algorithms (difficult airway/CICO, anaphylaxis, LAST, malignant hyperthermia, cardiac arrest) since crisis management is heavily weighted across both the written and viva components.
5Rehearse viva technique with peers or a study group using realistic time pressure, since the anaesthesia and medical vivas make up the majority of the final mark allocation.
6Keep perioperative medicine knowledge current (anticoagulant bridging, SGLT2 inhibitor management, ERAS, VTE prophylaxis) as guidelines in this area change frequently and are commonly examined.

Frequently Asked Questions

How many questions are on the ANZCA Final Examination?

The written component has 150 single-best-answer MCQs (150 minutes) and 15 short-answer questions (150 minutes) on the same day, followed by 8 anaesthesia vivas and 2 medical vivas of 15 minutes each on a separate viva schedule.

What mark do I need to pass the ANZCA Final Exam?

You need at least 40% in the MCQ and 40% in the SAQ to be invited to vivas. To pass overall you need at least 50% overall, a pass in the anaesthesia viva section, a pass in at least one other section, and a pass (5/10 or higher) in at least 4 of the 8 anaesthesia vivas.

How much does the ANZCA Final Examination cost?

The 2026 Final Examination fee is A$7,330.00 (tax free) in Australia and NZ$9,195.00 (plus GST) in New Zealand. A withdrawal fee of A$870.00 / NZ$1,095.00 applies if you withdraw after applying.

Who is eligible to sit the ANZCA Final Exam?

Trainees must have completed introductory and basic training, at least 26 weeks FTE of advanced training, and at least 88 weeks FTE of clinical anaesthesia time, with a satisfactory Clinical Progress Assessment report and all fees paid.

Do SIMGs sitting the ANZCA exam need to do the written component?

Specialist international medical graduates (SIMGs) required to sit the Final Exam generally only need to complete the medical and anaesthesia viva sections, not the written MCQ/SAQ components.

Are these official ANZCA practice questions?

No. These are original OpenExamPrep questions modelled on the ANZCA anaesthesia training program curriculum's Clinical Fundamentals and Specialised Study Units. ANZCA provides its own curriculum, past FEx reports, and preparation resources separately.