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The Primary Examination Sub-committee and all primary examiners strive to conduct an examination which is
fair, valid, and reliable, and that continues to assess the basic sciences with a relevance to safe conduct of
anaesthesia. We hope this information will be of benefit to both trainees and those who are helping trainees
prepare for the coming examination.
The broad aim of the primary examination is to provide an integrated approach to learning. While the candidate
will be learning about individual topics via the reference texts, the examination process, especially with regard
to the oral examination, will not examine individual subject areas in isolation. Rather the examination will aim to
present candidates with a broad range of questions covering the scope of the major topics.
Below is a brief outline on the MCQ, SAQ and Viva examination process to provide you with an understanding of
how the examination is managed and operates.
The multiple choice question (MCQ) paper consists of 150 Type A (select the best answer) questions, to be
answered in 150 minutes.
Question selection
The College maintains a question bank that contains several thousand multiple choice questions. All questions
must be related back to a learning outcome, and have a reference to a textbook or reference on the reading list
in its most up to date edition. Prior to setting a question in the exam, the reference from which it is written is
If a question has been asked previously, it will have been analysed to determine a correlation calculated
between the scores on the individual question and the scores obtained on all the other questions (the r-biserial
number). Only questions which have been demonstrated to have a high r-biserial number are maintained in the
bank for future use. Questions which have a low or negative r-biserial number are removed from the bank, or
reviewed and rewritten.
Certain questions are designated marker questions, which when repeated enables each group of candidates to
be compared to previous groups of candidates. These questions have high r-biserial numbers.
When setting the MCQ paper, the examiners work to a template to ensure that questions cover a large
proportion of the learning outcomes. Examination reports document the allocation of questions to topics.
The questions are marked and summary statistics are produced for each question in the examination, detailing
the response rates for each of the five possible answers (A to E), and the r-biserial correlation calculated
between the scores on the individual question and the scores obtained on all the other questions. The
questions are then reviewed for inclusion. Further analysis may include comparing the marker questions against
the marks for the marker questions of the last exam, and a correction being applied to all candidates scores.
A score out of 25 is then determined.


The short answer paper consists of 15 questions.
Question selection

Similar to the MCQ bank, the college has a bank of short answer questions (SAQ). Prior to being selected for an
examination, the question will be checked back against the learning outcome and the most current prescribed
reference texts.
There is no set template for selecting SAQs by topic. The SAQ paper consists of both old and new questions.
When a question is entered into the SAQ base, a marking scheme/grid is prepared for that question, based on
the current textbook references. The grid is generally produced by the examiner who wrote the question. The
examiner who is marking the question, who is almost always different from the examiner who set the question,
can discuss the marking grid before hand and make changes if considered necessary.
An example of a short answer question with its marking grid is in Appendix A.
Each SAQ is marked out of 25 marks. All marks are collated and a total mark out of 25 is awarded.
Candidates need to score 40% or more in each of the MCQ and SAQ papers to be invited to the oral
The oral section of the exam consists of three viva sessions of 20 minutes each. There are two examiners at
each session. Each viva session consists of four topics (two asked by each examiner) during a 20 minute period.
Appendix B has an example of a sample viva.
Each examiner will have their own bank of oral examination questions. Prior to each oral examination, an
examiner will submit their questions to the court of examiners for that examination. For an oral question to be
approved for an examination, it must not relate to a topic that has already been significantly assessed in the SAQ
paper, it must be directly related to a learning outcome, and the answers that are required must be found in a
textbook from the reading list. When presented, the examiners will discuss what standard is required to achieve
a pass. There will also be discussion as to the content of the opening question for each oral examination topic.
There is a controller who will assess all the oral questions that will be asked of a candidate to ensure that there
is an appropriate spread of topics, and that a candidate is not assessed on the same material more than once.
Candidates are marked out of 25 independently by each examiner without conferring. In most circumstances,
examiner marks usually differ by no more than one to two marks. It should be noted that examiners have no
knowledge of a candidates performance in the written examination. The scores of all three vivas are added up
to give a final mark out of 50 for the oral component of the examination.
After verification, marks are entered into a computer program, and a combined score for the whole examination
is determined. A score of equal to or greater than 50.0 is a pass, and a score of less than 50.0 is a fail. Marks
are not altered or scaled in anyway.

Examiners are also being constantly assessed for fairness and performance, and as such there may be a senior
examiner who may be present during the oral examination. Examiners are given feedback as to their
performance with suggestions as to how they could improve their technique. As mentioned at the beginning of
this note, The Primary Examination Sub-committee strives to conduct an examination which is fair, valid, and
reliable, and that continues to assess the basic sciences with a relevance to safe conduct of anaesthesia.

2013 Curriculum and Learning Objectives
Reading list
Candidate information sheet

SAQ Question Marking Grid
Question Number
Nutrition and Metabolism

Outline the components of parenteral nutrition and explain the rationale for the use of each

Suggested Answer:
Definition: providing partial or total nutritional support either to
increase caloric intake, or to provide total nutritional and fluid support to
prevent complications of prolonged fasting


Water approx 2.5 Litres per day


Caloric approx 8000 kJ or 2000 kCal or 100kJ/kg or 25 kCal/kg per day


provided as CHO glucose solution




- to include essential fatty acids

Protein to include essential and non essential AA


(prevents catabolism of muscles)


Different amounts of protein according to reason for TPN e.g. different

states of catabolism postop, burns etc


Ratios may be adjusted to change RQ value in certain disease states


Electrolytes and minerals to replace obligatory losses


Na approx 1.5 mMol/Kg/Day (note: different references different have

values any reference value acceptable)


K approx 1 mMol/Kg/day


Ca and Mg


allow normal nerve and cellular function


Vitamins and trace elements for normal body processes


Insulin also given, adjusted to the glucose tolerance state of the patient
(e.g. may be altered in critically ill).


Altered caloric requirements with physiology (age, gender, pregnancy)

and pathology (sepsis, trauma and burns).


Global marks


Syllabus Reference:

Section K; 2.d To explain the physiological principles of parenteral nutrition

Textbook References:
Oh, edition p

Guyton, edition pp

A number of vivas, written by members of the Primary Examination Sub-Committee have been designed to
give candidates some practise in the type of vivas that will be used in the primary examination.
In order to gain maximum benefit from these vivas, it is suggested that they be used under examination
conditions, with questions being asked by a consultant or other suitable member, after they have given some
thought to the appropriate level of response for each question. The vivas have been constructed to allow or
practise of technique. They are not designed to be given over a six-minute period; some may take longer.
Sample viva 1
1. Let us assume you are passing a spinal needle in order to undertake a spinal anaesthetic what layers of
tissue do you pass through?
2. You enter the CSF, and note that CSF flows from the end of the needle. Why?
3. What is normal CSF pressure?
4. How is CSF manufactured?
5. Local anaesthetic is injected into the CSF. What is the mechanism of action of local anaesthetic drugs?
6. Immediately afterwards you notice that the blood pressure has fallen to 80/50. What are the
mechanisms for this response?
7. Where do these sympathetic nerves arise from?
8. What drugs could you use to treat this response?
9. If you choose metaraminol, what is its mechanism of action? Why is its administration accompanied by a
10. The patient feels no pain, but still has a small amount of movement in his toes. Why is that?
11. What types of nerves are affected by the local anaesthetic? Why do they have different sensitives?
Sample viva 2
1. You see a patient preoperatively and wish to assess his renal function. What tests will you order?
2. Why are these tests used to assess renal function?
3. Can they be used in an equation to better estimate GFR?
4. What are the variables in the Cobcroft Gault equation?
5. The surgery requires that a muscle relaxant is used. How do you classify non-depolarising muscle
6. Which relaxant might be suitable for a person with renal failure?
7. Let us say mivacurium is selected (but viva could be modified for any agent). Why is this drug suitable?
8. How is it metabolised?
9. Mivacurium is presented as a number of isomers. What is an isomer?
10. What is the significance if the isomers that go to make up mivacurium?
Sample viva 3
1. What is your usual fluid of choice in adults?
2. What are the components of Hartmann's solution?
3. Why is this fluid ideal?
4. What is the value of calcium in this fluid? In plasma?
5. When we measure serum calcium we also measure something else? Why do we measure albumin?
6. What determines the plasma concentration of calcium in the blood?
7. What is the role of calcium in the body (outline)?
8. We can also give calcium as a drug. In what forms do we give it? When might we give it?
9. If we give it for hyperkalaemia, have does it exert its effects
10. How do calcium channel blockers exert their effects?
11. What are the effects of calcium channel blockers?
12. In what way do nimodipine and verapamil differ?
13. What are the clinically important side effects of calcium channel blockers?
14. How do we treat an overdose of calcium channel blockers?

Sample viva 4

What are the properties of the ideal drug to administer as a pre-operative anxiolytic medication?
What is an example of a drug used for premedication?
If a benzodiazepine is used as an example, what is margin of safety?
Draw a dose response curve explaining concepts of margin of safety with both wide and narrow margins
What effects do benzodiazepines have on the control of ventilation?
How is ventilation normally controlled?
What effect may benzodiazepines have on MAC?
What changes in the EEG do you see with increasing MAC?
How can we measure depth of anesthesia in the operating theatre?
What is the principle of operation of these machines?
What other drugs may cause a MAC sparing effect?