A Primer for the Primary Examination

It can be difficult as a candidate without years of anaesthesia experience to appreciate the relative importance and clinical applications of different learning outcomes. One of the PLOOTD bloggers (who is of course incidentally an examiner) has therefore made this fantastic resource – A Primer for the Primary FANZCA examination. For each topic the depth of knowledge required is indicated, sources are recommended and some idea of the weighting in the exam is suggested. Many of the topics have useful musings from someone who has been an examiner for 12 years. Many of the topics also have links to some practice T/F questions with an idea of how difficult the writer feels they are.

This is going to be of most use to those who are sitting in August and beyond, but there’s a lot in there for those betwixt written and vivas too.

We think this resource is gold. Have a look and see what you think.

Carbon dioxide carriage in the blood

BT_PO 1.32   Discuss the carriage of carbon dioxide in blood, the carbon dioxide dissociation curve and their clinical significance and implications

Most of the dissolved carbon dioxide in the blood is in the erythrocytes     TRUE/FALSE

Carbonic anhydrase is found in erythrocytes   TRUE/FALSE

Carbonic anhydrase is found in pulmonary capillary endothelium   TRUE/FALSE

As temperature decreases, there is a lower pCO2 for a given mass of CO2 in the blood   TRUE/FALSE

Reduced Hb has a tenfold ability to carry CO2 over oxyhaemoglobin   TRUE/FALSE

Work of Breathing

BT_PO 1.10 Describe the Work of Breathing

1 Joule of work is done when 1 litre of gas moves in response to a pressure gradient of 1 kilopascal     TRUE/FALSE                                    This uses the SI unit of kPa, how many cm of water is that? So how many joules per breath? How many joules per minute? What is the efficiency of breathing? How many joules/calories are you expending on breathing? What % of your daily calorie use is that?

Breathing at rest is responsible for approximately 0.5% of the body’s oxygen consumption     TRUE/FALSE

Work is calculated by integrating a pressure volume curve     TRUE/FALSE

1/2 of the energy created in inspiration is stored as heat to be used for expiration      TRUE/FALSE

Bonus unexaminable question : Earth’s gravity accelerates a falling body at approximately 10 m/s/s and 1 Newton is defined as the force moving 1 kg at 1 m/s/s. Assuming that a 17th century apple had a mass of 100g, with what force would it have hit a man’s head if it fell out of a tree?


Pulmonary circulation

BT_PO 1.33 Discuss the difference between the pulmonary and systemic circulations 

The short length of the pulmonary vasculature contributes to its low resistance     TRUE/FALSE

Pulmonary endothelium synthesises prostaglandins     TRUE/FALSE

Parasympathetic stimulation constricts the pulmonary circulation     TRUE/FALSE

The pulmonary capillary bed is pulsatile     TRUE/FALSE

20% of foetal cardiac output passes through the pulmonary circulation     TRUE/FALSE

James Young Simpson



Still in holiday snap mode, but also anaesthesia history mode. Not examinable but here’s an opportunity to be sucked into the maw of wikipedia should you wish some guilt free distraction from study…

Simpson is credited with introducing chloroform as an anaesthetic agent for humans      TRUE/FALSE

Simpson made important developments in obstetric forceps      TRUE/FALSE

The first recorded use of chloroform for anaesthesia was direct injection into a dog      TRUE/FALSE

The first recorded death from chloroform was a 75 year old woman      TRUE/FALSE

Simpson removed the handle of the Broad St pump      TRUE/FALSE


Forensic pharmacokinetics

Have a look at this document – Trial of Conrad Murray  – a most fascinating read which illustrates some interesting pharmacokinetics. There are two expert witness reports in this document – read the brief letter from Paul White to Mr Flanagan first, ponder the below questions, then read the prolix submission from Steven Schafer where you’ll find a lot more detail and most of the answers.


A range of propofol concentrations (2.6-4.1 mcg/ml)  was given for the circulatory system – why would there be differing propofol concentrations in different sampling sites?

The propofol concentration in the stomach at autopsy was 1.9 mcg/ml. Why? Do you think he ingested the drug with fruit juice as Dr White speculates?

The lignocaine concentration in the femoral vein was 0.84 mcg/ml and in the stomach 23 mcg/ml. Can you explain this?






BT_PO 1.79 : Acid-base chemistry

BT_PO 1.79 : Describe acid-base chemistry using the Henderson-Hasselbach equation and strong ion difference


The SID in NaCl is 0 mmol/L        TRUE/FALSE

Normal Se Cl is approximately 100 mmol/L        TRUE/FALSE

The normal SID in plasma is approximately 40 mmol/L        TRUE/FALSE

Large volumes of NaCl as a replacement fluid can take the Se Cl to around 120 mmol/L (not that I would know as this is not routinely reported in my hospital)…

Administering large volumes of NaCl causes a metabolic acidosis by decreasing the SID    TRUE/FALSE

Administering large volumes of NaCl causes a metabolic acidosis by impairing renal bicarbonate absorption with the chloride load        TRUE/FALSE

Hypoalbuminaemia will give a metabolic acidosis        TRUE/FALSE


BT_PO 1.79 : Acid-base chemistry

Third in my series on acid base physiology, see last week’s post for the suggested reading material…

BT_PO 1.79 : Describe acid-base chemistry using the Henderson-Hasselbach equation and strong ion difference (SID)

So Stewart would look at this LO and say, yes, those 2 factors are important, but you also have to consider the dissociation of water, and the amount and dissociation of the non-volatile weak acids in the system. 

The independent variables in his model are SID, and volatile (pCO2) and non-volatile acids.

pCO2 is controlled by the lungs        TRUE/FALSE

SID is controlled by the liver        TRUE/FALSE

Albumin levels are controlled by the kidney        TRUE/FALSE

Acid-base differences across a membrane are predominantly from CO2 as it crosses membranes so easily        TRUE/FALSE

Acid-base differences across a membrane are predominantly from proteins as they cross membranes so poorly        TRUE/FALSE