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100+ Free Primary FRCA Practice Questions

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Heat loss from an anaesthetised patient occurs by several mechanisms. In the operating theatre, the greatest single route of heat loss is usually:

A
B
C
D
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Sample Primary FRCA Practice Questions

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

1A drug has a hepatic extraction ratio of 0.9. Which statement best describes its clearance?
A.Clearance is independent of hepatic blood flow and limited only by enzyme activity
B.Clearance is determined mainly by the unbound fraction of drug in plasma
C.Clearance is highly dependent on hepatic blood flow (flow-limited)
D.Clearance approaches zero because so little drug escapes the liver
Explanation: A high extraction ratio (>0.7) means the liver removes almost all drug presented to it on a single pass, so hepatic clearance becomes limited by, and approximately equal to, hepatic blood flow. Such 'high-extraction' drugs (e.g. propofol, lidocaine) show large first-pass metabolism and clearance that falls when liver blood flow falls.
2Which inhalational agent has a minimum alveolar concentration (MAC) in 100% oxygen of approximately 6% in a healthy 40-year-old adult?
A.Sevoflurane
B.Isoflurane
C.Desflurane
D.Halothane
Explanation: Desflurane has the highest MAC of the modern potent volatile agents at approximately 6-6.6%, reflecting its low potency. Its low blood:gas partition coefficient (0.42) gives rapid onset and offset.
3A 70 kg patient is given an intravenous induction agent that follows a two-compartment model. The rapid fall in plasma concentration immediately after a bolus is principally explained by which process?
A.Redistribution from the central compartment to peripheral tissues
B.Hepatic metabolism of the drug
C.Renal elimination of unchanged drug
D.Plasma protein binding saturation
Explanation: After a bolus of agents such as propofol or thiopental, the rapid initial decline in plasma concentration is driven by redistribution (the alpha phase) from the well-perfused central compartment into peripheral tissues such as muscle, not by elimination. This redistribution is why a single induction dose is short-acting.
4Which neuromuscular blocking drug is metabolised by plasma (pseudo-) cholinesterase and has the shortest duration of action?
A.Rocuronium
B.Suxamethonium
C.Vecuronium
D.Atracurium
Explanation: Suxamethonium (succinylcholine) is a depolarising neuromuscular blocker rapidly hydrolysed by plasma cholinesterase, giving an onset within about 60 seconds and a duration of roughly 5-10 minutes. Atypical or deficient plasma cholinesterase prolongs its action.
5Atracurium is particularly useful in patients with combined hepatic and renal failure because its principal route of elimination is:
A.Biliary excretion of unchanged drug
B.Renal excretion of unchanged drug
C.Hofmann elimination and non-specific ester hydrolysis
D.Metabolism by plasma cholinesterase
Explanation: Atracurium undergoes Hofmann elimination (a spontaneous, temperature- and pH-dependent non-enzymatic degradation) plus non-specific ester hydrolysis, processes independent of hepatic and renal function. This makes it suitable when both organs are impaired, though it produces laudanosine.
6A patient develops prolonged paralysis after suxamethonium. The dibucaine number is reported as 20. This indicates:
A.Normal plasma cholinesterase activity
B.Homozygous atypical plasma cholinesterase
C.Heterozygous atypical plasma cholinesterase
D.Acquired cholinesterase deficiency from liver disease
Explanation: The dibucaine number reflects the percentage inhibition of plasma cholinesterase by dibucaine, not the quantity of enzyme. A number around 20 indicates homozygous atypical enzyme, associated with markedly prolonged apnoea (several hours). Normal individuals have a dibucaine number around 80.
7Which property of an opioid most directly increases its speed of onset across the blood-brain barrier?
A.High lipid solubility
B.High degree of plasma protein binding
C.Large volume of distribution
D.Low pKa relative to plasma pH
Explanation: High lipid solubility allows rapid diffusion across the blood-brain barrier, giving fast onset; this is why alfentanil and fentanyl act faster centrally than morphine. Onset also depends on the unionised fraction and effect-site equilibration.
8Remifentanil has a context-sensitive half-time that remains short (about 3-5 minutes) even after prolonged infusion. This is because it is metabolised by:
A.Hepatic cytochrome P450 enzymes
B.Non-specific plasma and tissue esterases
C.Plasma (pseudo-) cholinesterase
D.Renal tubular secretion
Explanation: Remifentanil contains an ester linkage hydrolysed by non-specific blood and tissue esterases, giving organ-independent metabolism and a context-sensitive half-time of about 3-5 minutes regardless of infusion duration. This predictable offset is its key clinical advantage.
9Which local anaesthetic is an ester and is metabolised principally by plasma cholinesterase?
A.Lidocaine
B.Bupivacaine
C.Prilocaine
D.Procaine
Explanation: Procaine is an aminoester local anaesthetic hydrolysed by plasma cholinesterase, producing para-aminobenzoic acid (PABA), which is associated with allergic reactions. Ester local anaesthetics characteristically have a single 'i' in their name.
10The maximum recommended dose of lidocaine WITH adrenaline (epinephrine) for infiltration in an adult is approximately:
A.3 mg/kg
B.7 mg/kg
C.1 mg/kg
D.12 mg/kg
Explanation: Adrenaline causes local vasoconstriction, slowing systemic absorption and allowing a higher safe dose: approximately 7 mg/kg for lidocaine with adrenaline, compared with about 3 mg/kg for plain lidocaine. These figures guide avoidance of local anaesthetic systemic toxicity.

About the Primary FRCA Exam

The Primary FRCA is the first part of the Fellowship of the Royal College of Anaesthetists, sat by UK anaesthetics trainees. Its MCQ component is a 3-hour paper of 90 single best answer questions split roughly equally across pharmacology, physiology/biochemistry/anatomy, and physics/clinical measurement/data interpretation, delivered online with remote invigilation via TestReach.

Assessment

MCQ of 90 single best answer (SBA) questions, followed (once passed) by an OSCE of 16 stations and a Structured Oral Examination (SOE).

Time Limit

3 hours for the MCQ component

Passing Score

Pass mark set per sitting by modified Angoff standard setting; one mark per correct answer (max 90), no negative marking.

Exam Fee

MCQ £410; OSCE/SOE £755 together (OSCE £410, SOE £370) for 2025-26. (Royal College of Anaesthetists (RCoA))

Primary FRCA Exam Content Outline

33%

Pharmacology

Pharmacokinetics and pharmacodynamics, intravenous and inhalational anaesthetics, neuromuscular blockers and reversal, local anaesthetics, analgesics, and autonomic and cardiovascular drugs (about 30 MCQ questions).

33%

Physiology, Biochemistry and Anatomy

Cardiovascular, respiratory, renal, neuro, endocrine and cellular physiology, acid-base and biochemistry, and applied airway, neuraxial and regional anatomy (about 30 MCQ questions).

33%

Physics, Clinical Measurement and Data Interpretation

Physical principles, anaesthetic equipment and medical gases, monitoring, electrical safety, statistics and interpretation of waveforms and data (about 30 MCQ questions).

How to Pass the Primary FRCA Exam

What You Need to Know

  • Passing score: Pass mark set per sitting by modified Angoff standard setting; one mark per correct answer (max 90), no negative marking.
  • Assessment: MCQ of 90 single best answer (SBA) questions, followed (once passed) by an OSCE of 16 stations and a Structured Oral Examination (SOE).
  • Time limit: 3 hours for the MCQ component
  • Exam fee: MCQ £410; OSCE/SOE £755 together (OSCE £410, SOE £370) for 2025-26.

Keys to Passing

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

Primary FRCA Study Tips from Top Performers

1Use the official RCoA Primary FRCA syllabus to weight your revision evenly across the three roughly equal domains: pharmacology, physiology/biochemistry/anatomy, and physics/clinical measurement.
2Drill single best answer technique under timed conditions: 90 questions in 3 hours is about 2 minutes each, so practise eliminating distractors quickly.
3Master the core equations and applied physics (alveolar gas equation, Bohr/dead-space, Hagen-Poiseuille, Laplace, electrical safety) because they recur and are high-yield in the measurement domain.

Frequently Asked Questions

How many questions are on the Primary FRCA MCQ and how long is it?

The Primary FRCA MCQ is a 3-hour exam of 90 single best answer (SBA) questions, with roughly 30 in pharmacology, 30 in physiology/biochemistry/anatomy, and 30 in physics, clinical measurement and data interpretation.

Is there negative marking in the Primary FRCA MCQ?

No. One mark is awarded for each correct answer, up to a maximum of 90 marks, and incorrect answers are not penalised. The pass mark for each sitting is set by examiners using a modified Angoff method.

How is the Primary FRCA MCQ delivered?

The MCQ is delivered online at a location of your choosing with remote invigilation through the RCoA's supplier, TestReach. Candidates must pass the MCQ before sitting the OSCE and SOE components.

What does the Primary FRCA cost?

For 2025-26 the MCQ fee is £410. The OSCE and SOE are usually sat together at £755 (OSCE £410, SOE £370). Always check the current RCoA examinations calendar for up-to-date fees.