ANZCA FINALS PAST MCQ QUESTIONS AND
ANSWERS LATEST 2025-2026 EXAM UPDATE
What is NOT true for PDPH following puncture
A: Prophylactic bed rest
B: Decreased incidence when catheter is inserted intrathecally
C: Decreased incidence in elderly
D: Caffeine is not effective
E: Epidural blood patch is 80% effective - Answer-ANSWER A
in Section 9.6.5 Acute Pain Management: Scientific Evidence (2005)
and Update (2007)
Incidence of headache following dural puncture 0.4-24%
* postural in nature
* commoner in patients under 50 yrs
* commoner in parturients
* significanntly less common in males than non-pregnant females (level
1 evidence - 2007 update)
,* 90% resolve spontaneously within 10 days
Incidence may be reduced by using: (level I)
* 26 gauge or smaller needle (NNT=13)
* use of needle with a non-cutting bevel (NNT=27)
No evidence that bed rest is beneficial in preventing PDPH (Level I)
* PDPH may causes difficulty mobilising, and headache may then
subside with bed rest
* Non-opioid and opioid analgesics may provide temoporary relief
* Preventive role of fluid therapy unclear (Level I)
NO evidence to support the use of:
* Sumatriptan (Level II)
* ACTH
* Epidurally administered saline, dextran, fibrin glue or neuraxial
opioids
IV and oral caffeine (both level II) are:
* effective in treating PDPH
,* do not reduce blood patch rate
Epidural blood patches:
* are common practice but further high quality trials are required to
determine efficacy (level I)
* significant symptomatic relief obtained in 75-95% of patients given a
15 mL blood patch (level IV, three studies)
* conflicting evidence regarding use of prophylactic blood patches - one
trial showed decreased incidence of PDPH (level III)
Autologous epidural blood patches may be contra-indicated in:
* leukaemia
* coagulopathy
* infection, including HIV
Autonomic dysreflexia. Which ONE is true?
A: 50% of patients with a level below T6
B: Unlikely if below T10
C: Can be prevented??
D: Can be precipitated by light touch
E. ? - Answer-ANSWER B
, Ageing (adult) causes:
A: Decreased FRC
B: Decreased Cardiac output
C: Diastolic dysfunction
D: Increased creatinine - Answer-ANSWER C
TEG tracing given, post cardiac surgery. Had quite slim tail (ie
fibrinolysis) but broader 'shoulders'.
A: Fibrinolysis
B: Hypofibrinogenaemia
C: Platelet dysfunction
D: Heparin effect
E: Surgical bleeding - Answer-ANSWER A
Post scoliosis repair, decreased movement bilaterally in the legs with
decreased pain and temperature sensation but spared joint position sense
and vibration. What is at fault?
A: Posterior spinal arteries
B: Anterior spinal arteries
C: Epidural haematoma
ANSWERS LATEST 2025-2026 EXAM UPDATE
What is NOT true for PDPH following puncture
A: Prophylactic bed rest
B: Decreased incidence when catheter is inserted intrathecally
C: Decreased incidence in elderly
D: Caffeine is not effective
E: Epidural blood patch is 80% effective - Answer-ANSWER A
in Section 9.6.5 Acute Pain Management: Scientific Evidence (2005)
and Update (2007)
Incidence of headache following dural puncture 0.4-24%
* postural in nature
* commoner in patients under 50 yrs
* commoner in parturients
* significanntly less common in males than non-pregnant females (level
1 evidence - 2007 update)
,* 90% resolve spontaneously within 10 days
Incidence may be reduced by using: (level I)
* 26 gauge or smaller needle (NNT=13)
* use of needle with a non-cutting bevel (NNT=27)
No evidence that bed rest is beneficial in preventing PDPH (Level I)
* PDPH may causes difficulty mobilising, and headache may then
subside with bed rest
* Non-opioid and opioid analgesics may provide temoporary relief
* Preventive role of fluid therapy unclear (Level I)
NO evidence to support the use of:
* Sumatriptan (Level II)
* ACTH
* Epidurally administered saline, dextran, fibrin glue or neuraxial
opioids
IV and oral caffeine (both level II) are:
* effective in treating PDPH
,* do not reduce blood patch rate
Epidural blood patches:
* are common practice but further high quality trials are required to
determine efficacy (level I)
* significant symptomatic relief obtained in 75-95% of patients given a
15 mL blood patch (level IV, three studies)
* conflicting evidence regarding use of prophylactic blood patches - one
trial showed decreased incidence of PDPH (level III)
Autologous epidural blood patches may be contra-indicated in:
* leukaemia
* coagulopathy
* infection, including HIV
Autonomic dysreflexia. Which ONE is true?
A: 50% of patients with a level below T6
B: Unlikely if below T10
C: Can be prevented??
D: Can be precipitated by light touch
E. ? - Answer-ANSWER B
, Ageing (adult) causes:
A: Decreased FRC
B: Decreased Cardiac output
C: Diastolic dysfunction
D: Increased creatinine - Answer-ANSWER C
TEG tracing given, post cardiac surgery. Had quite slim tail (ie
fibrinolysis) but broader 'shoulders'.
A: Fibrinolysis
B: Hypofibrinogenaemia
C: Platelet dysfunction
D: Heparin effect
E: Surgical bleeding - Answer-ANSWER A
Post scoliosis repair, decreased movement bilaterally in the legs with
decreased pain and temperature sensation but spared joint position sense
and vibration. What is at fault?
A: Posterior spinal arteries
B: Anterior spinal arteries
C: Epidural haematoma
