100+ Free Final FRCA Practice Questions

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A 6-year-old child (20 kg) presents for emergency appendicectomy. Which estimated endotracheal tube internal diameter and length at the lips are most appropriate using standard paediatric formulae?

Size 6.5 cuffed, 19 cm at the lips

Size 4.0 cuffed, 13 cm at the lips

Size 5.0 cuffed, 15 cm at the lips

Size 5.5 cuffed, 17 cm at the lips

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Sample Final FRCA Practice Questions

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1A 28-year-old woman at 39 weeks gestation requires a category 1 emergency caesarean section for placental abruption with fetal bradycardia. She has no functioning epidural in situ. Which anaesthetic technique is most appropriate?

A.Slow-titrated spinal anaesthesia

B.Combined spinal-epidural with incremental dosing

C.General anaesthesia with rapid sequence induction

D.Awaiting a single-shot spinal to establish a T4 block over 15 minutes

Explanation: A category 1 caesarean implies an immediate threat to the life of the woman or fetus, with a target decision-to-delivery interval of 30 minutes. With no working epidural and active abruption causing fetal bradycardia, general anaesthesia with rapid sequence induction provides the fastest, most reliable surgical anaesthesia.

2During a difficult intubation in an obese patient, you cannot intubate and cannot adequately oxygenate via facemask or supraglottic airway. According to the 2015 Difficult Airway Society guidelines, what is the next step?

A.Repeated attempts at laryngoscopy with a bougie

B.Emergency front-of-neck access by scalpel cricothyroidotomy

C.Wake the patient up and reschedule

D.Insertion of a second-generation supraglottic airway device

Explanation: A 'cannot intubate, cannot oxygenate' (CICO) situation that has progressed through DAS plans A-C mandates plan D: emergency front-of-neck access. The DAS 2015 guideline recommends a scalpel-bougie-tube cricothyroidotomy as the rescue technique of choice.

3A 6-year-old child (20 kg) presents for emergency appendicectomy. Which estimated endotracheal tube internal diameter and length at the lips are most appropriate using standard paediatric formulae?

A.Size 4.0 cuffed, 13 cm at the lips

B.Size 5.5 cuffed, 17 cm at the lips

C.Size 6.5 cuffed, 19 cm at the lips

D.Size 5.0 cuffed, 15 cm at the lips

Explanation: For a 6-year-old, the cuffed tube size by the formula (age/4 + 3.5) is 5.0 mm, and oral length is approximately (age/2 + 12) = 15 cm. Modern practice favours cuffed tubes in children over uncuffed due to better seal and reduced air leak.

4A patient undergoing carotid endarterectomy under general anaesthesia develops a sudden fall in cerebral oximetry (NIRS) values on the operative side after carotid cross-clamping. What is the most appropriate immediate management?

A.Insert a carotid shunt to restore cerebral perfusion

B.Deepen anaesthesia to reduce cerebral metabolic rate

C.Administer a bolus of mannitol

D.Lower the mean arterial pressure to reduce embolic risk

Explanation: A fall in NIRS after cross-clamping suggests inadequate collateral cerebral perfusion through the circle of Willis. The definitive response is insertion of a carotid shunt to bypass the clamped segment and restore ipsilateral cerebral blood flow.

5A 70-year-old man for elective total knee replacement has aortic stenosis with a valve area of 0.7 cm2 and a mean gradient of 45 mmHg. Which haemodynamic goal is most important during anaesthesia?

A.Maintain a fast heart rate to improve cardiac output

B.Allow permissive hypotension to reduce afterload

C.Maintain systemic vascular resistance and avoid hypotension

D.Encourage vasodilation to reduce left ventricular work

Explanation: Severe aortic stenosis produces a fixed obstruction to left ventricular outflow. Coronary perfusion of the hypertrophied ventricle depends on adequate diastolic blood pressure, so maintaining systemic vascular resistance and avoiding hypotension is critical to prevent ischaemia and a downward spiral.

6A patient develops malignant hyperthermia during a sevoflurane anaesthetic. After stopping the trigger and hyperventilating with 100% oxygen, what is the recommended initial dose of dantrolene?

A.1 mg/kg IV, repeated to a maximum of 10 mg/kg

B.2.5 mg/kg IV, repeated as needed

C.0.5 mg/kg IV every 5 minutes

D.5 mg/kg IV as a single dose

Explanation: The Association of Anaesthetists guideline recommends an initial dantrolene dose of 2.5 mg/kg IV, repeated every 5 minutes as needed (often to around 10 mg/kg or more) until the hypermetabolic crisis resolves. Dantrolene inhibits ryanodine receptor calcium release in skeletal muscle.

7A patient for laparoscopic cholecystectomy develops a sudden fall in end-tidal CO2 to near zero, loss of the capnograph trace, and a fall in oxygen saturation shortly after pneumoperitoneum insufflation. The most likely diagnosis is:

A.Endobronchial intubation

B.Bronchospasm

C.Light anaesthesia with breath-holding

D.Gas (CO2) embolism

Explanation: A sudden, profound fall in end-tidal CO2 with cardiovascular compromise during laparoscopic insufflation is the classic presentation of CO2 gas embolism, caused by inadvertent intravascular insufflation. Management includes stopping insufflation, releasing pneumoperitoneum, 100% oxygen, and left lateral head-down positioning.

8A 45-year-old undergoing functional endoscopic sinus surgery requires controlled hypotension to reduce surgical bleeding. Which target and approach best balance surgical field quality and patient safety in a healthy adult?

A.MAP of 60-70 mmHg using total intravenous anaesthesia with remifentanil

B.MAP of 50 mmHg using deep volatile anaesthesia alone

C.Systolic of 70 mmHg with sodium nitroprusside infusion

D.Reverse Trendelenburg position only, with no pharmacological control

Explanation: A modest reduction to a MAP of 60-70 mmHg using TIVA with remifentanil provides a good surgical field while staying within cerebral autoregulation limits in a healthy patient. Remifentanil blunts sympathetic responses and TIVA with propofol provides additional bleeding reduction in sinus surgery.

9During a posterior fossa craniotomy in the sitting position, the patient develops a sudden 'mill-wheel' murmur, hypotension and a fall in end-tidal CO2. What is the priority intervention?

A.Administer intravenous fluids and vasopressors only

B.Place the patient head-up to reduce intracranial pressure

C.Flood the surgical field with saline and apply bone wax

D.Increase the inspired oxygen and continue surgery

Explanation: These signs indicate venous air embolism, a recognised risk of the sitting position. The first priority is to prevent further air entrainment by flooding the surgical field with saline and asking the surgeon to identify and occlude the open vein (e.g. with bone wax), along with jugular venous compression and 100% oxygen.

10A patient with a known history of suxamethonium apnoea (homozygous atypical plasma cholinesterase) needs general anaesthesia. Which neuromuscular blocking strategy is most appropriate?

A.Use suxamethonium at a reduced dose

B.Use a non-depolarising agent such as rocuronium with neuromuscular monitoring

C.Avoid all neuromuscular blockers and use deep volatile anaesthesia

D.Use mivacurium as it is metabolised by a different pathway

Explanation: Patients with plasma cholinesterase deficiency have markedly prolonged paralysis from suxamethonium. A non-depolarising agent such as rocuronium, with quantitative neuromuscular monitoring and reversal (neostigmine or sugammadex), is the safe choice.

About the Final FRCA Exam

The Final FRCA is the second part of the Fellowship of the Royal College of Anaesthetists, taken by UK anaesthetists in stage 2 (intermediate) training. The Written examination comprises a 90-question Single Best Answer MCQ paper and a 12-question Constructed Response Question paper, both 3 hours long, with no negative marking. Passing the Written is the gateway to the Structured Oral Examination (SOE).

Assessment

Written: 90 Single Best Answer MCQs plus 12 Constructed Response Questions (102 written items total), followed by the Structured Oral Examination (SOE).

Time Limit

3 hours for the SBA MCQ paper and 3 hours for the CRQ paper, sat on separate days, plus the timed SOE.

Passing Score

No fixed percentage; the pass mark is set for each sitting using a modified Angoff method for the MCQ and CRQ and borderline regression for the SOE.

Exam Fee

GBP 620 for the Final FRCA Written examination (2025-2026 RCoA fee); the SOE is charged separately. (Royal College of Anaesthetists (RCoA))

Final FRCA Exam Content Outline

47%

Clinical anaesthesia

Applied general and subspecialty anaesthesia including obstetric, paediatric, neuro, cardiac, thoracic, vascular, trauma, ENT, day surgery and airway management.

10%

Perioperative medicine

Preoperative assessment, risk stratification, comorbidity optimisation, enhanced recovery and shared decision-making.

10%

Regional and local anaesthesia

Neuraxial and peripheral nerve blocks, abdominal wall blocks, and complications such as LAST and post-dural puncture headache.

12%

Intensive care medicine

Sepsis, ARDS, organ support, sedation, brainstem death and post-cardiac-arrest care for the critically ill patient.

Pain medicine

Acute, chronic, cancer and neuropathic pain, opioid prescribing and conversion, and complex pain syndromes.

13%

Applied basic sciences

Applied pharmacology, physiology, physics, clinical measurement, equipment and statistics underpinning anaesthesia.

How to Pass the Final FRCA Exam

What You Need to Know

Passing score: No fixed percentage; the pass mark is set for each sitting using a modified Angoff method for the MCQ and CRQ and borderline regression for the SOE.
Assessment: Written: 90 Single Best Answer MCQs plus 12 Constructed Response Questions (102 written items total), followed by the Structured Oral Examination (SOE).
Time limit: 3 hours for the SBA MCQ paper and 3 hours for the CRQ paper, sat on separate days, plus the timed SOE.
Exam fee: GBP 620 for the Final FRCA Written examination (2025-2026 RCoA fee); the SOE is charged separately.

Keys to Passing

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

Final FRCA Study Tips from Top Performers

1Map your revision to the RCoA stage 2 (intermediate) curriculum and Annex C, as the whole syllabus is fair game across the MCQ, CRQ and SOE.

2Practise applied SBA scenarios under timed conditions (90 questions in 3 hours), focusing on clinical decision-making rather than pure recall, since the MCQ rewards judgement.

3Rehearse structured spoken answers for the SOE by linking clinical management to the underlying applied basic science, mirroring the linked clinical-science questions.

Frequently Asked Questions

How many questions are in the Final FRCA Written examination?

The Final FRCA Written examination has 90 Single Best Answer MCQs (3 hours) and 12 Constructed Response Questions (3 hours), sat on separate days. The MCQ paper has no negative marking and a maximum of 90 marks.

How is the Final FRCA pass mark set?

There is no fixed percentage pass mark. The MCQ and CRQ pass marks are set for each sitting using a modified Angoff standard-setting method approved by the GMC, while the SOE uses borderline regression.

What does the Final FRCA cost?

The Final FRCA Written examination fee is GBP 620 under the 2025-2026 RCoA schedule, with the Structured Oral Examination charged separately. Candidates should confirm current fees on the RCoA website.

Is the Final FRCA changing?

Following an independent review, the RCoA is introducing a new assessment system. The Final SOE is due to be replaced by a Final Clinical Performance Exam (FCPE) station, with changes being phased in around 2027; candidates should check the RCoA site for the latest format.