Free Practice Questions for FRCR Part 2A

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Sample FRCR Part 2A Practice Questions

Try these sample questions to review concepts for the FRCR Part 2A exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 55-year-old smoker has a solitary pulmonary nodule found incidentally on CT. The nodule is 7 mm, solid, smooth, and located in the right lower lobe. According to current British Thoracic Society guidance, which is the most appropriate next step?

A.CT surveillance, typically at 3 months and 12 months

B.Immediate CT-guided biopsy

C.PET-CT followed by lobectomy

D.No further follow-up required

Explanation: For a solid nodule of 5-8 mm (or 80-300 mm3), BTS guidelines recommend CT surveillance to assess for growth, with volumetry where available. A nodule of this size is below the threshold for immediate biopsy or PET-CT, which are reserved for nodules 8 mm or larger.

2On a chest radiograph, which finding most specifically indicates a left lower lobe collapse?

A.Elevation of the right hemidiaphragm with mediastinal shift to the right

B.A 'sail sign' triangular opacity behind the heart with loss of the medial left hemidiaphragm

C.A wedge-shaped opacity in the right cardiophrenic angle

D.Hyperexpansion of the left lung with flattened diaphragm

Explanation: Left lower lobe collapse produces a retrocardiac triangular opacity (the 'sail sign') with loss of the medial part of the left hemidiaphragm silhouette. The collapsed lobe rotates posteromedially behind the heart.

3A 30-year-old woman presents with acute pleuritic chest pain and dyspnoea. A CT pulmonary angiogram shows a filling defect in the right main pulmonary artery. Which CT sign is the most reliable indicator of associated right heart strain?

A.Mosaic attenuation of the lung parenchyma

B.A wedge-shaped peripheral consolidation

C.Right ventricle to left ventricle short-axis diameter ratio greater than 1

D.Enlargement of the bronchial arteries

Explanation: An RV:LV short-axis diameter ratio greater than 1 on axial CT is a validated marker of right heart strain in acute pulmonary embolism and is associated with adverse outcomes. It reflects acute pressure overload of the right ventricle.

4A high-resolution CT of the chest shows bilateral lower-zone predominant subpleural reticulation, traction bronchiectasis, and honeycombing, without significant ground-glass opacity. This pattern is most consistent with which diagnosis?

A.Non-specific interstitial pneumonia (NSIP)

B.Hypersensitivity pneumonitis

C.Sarcoidosis

D.Usual interstitial pneumonia (UIP)

Explanation: Basal, subpleural reticulation with honeycombing and traction bronchiectasis and minimal ground-glass is the typical UIP pattern, the hallmark of idiopathic pulmonary fibrosis. Honeycombing is the key discriminator that supports a definite UIP diagnosis.

5Which radiographic feature best distinguishes a tension pneumothorax requiring immediate decompression from a simple pneumothorax?

A.A visible visceral pleural line at the apex

B.Absence of lung markings peripheral to the pleural line

C.A small apical lucency without mediastinal change

D.Contralateral mediastinal shift with depression of the ipsilateral hemidiaphragm

Explanation: Tension pneumothorax is a clinical diagnosis but on imaging shows mediastinal shift away from the affected side and ipsilateral hemidiaphragm depression due to positive intrapleural pressure. These signs indicate cardiovascular compromise requiring urgent decompression.

6A 65-year-old presents with sudden interscapular pain. CT angiography shows an intimal flap in the ascending and descending thoracic aorta extending to the iliac arteries. According to the Stanford classification, which type is this and what is the typical management?

A.Stanford type B, managed medically in the first instance

B.Stanford type A, managed conservatively

C.Stanford type A, requiring emergency surgical repair

D.Stanford type B, requiring emergency surgical repair

Explanation: Any aortic dissection involving the ascending aorta is Stanford type A regardless of distal extent, and these require emergency surgical repair owing to risks of tamponade, coronary occlusion, and aortic rupture. Stanford type B spares the ascending aorta.

7A chest radiograph in a patient with chronic dyspnoea shows enlarged central pulmonary arteries with rapid peripheral tapering ('pruning'). This vascular pattern most strongly suggests which condition?

A.Pulmonary venous congestion from left heart failure

B.Pulmonary arterial hypertension

C.Pulmonary oligaemia from acute embolism

D.Normal vascular anatomy

Explanation: Enlarged proximal pulmonary arteries with peripheral 'pruning' of vessels is the classic plain film appearance of pulmonary arterial hypertension. A main pulmonary artery diameter exceeding the adjacent ascending aorta supports the diagnosis.

8On CT, an anterior mediastinal mass in a 28-year-old man contains macroscopic fat, fluid, and a focus of calcification. Which diagnosis is most likely?

A.Mature teratoma

B.Thymoma

C.Lymphoma

D.Substernal goitre

Explanation: A mature (cystic) teratoma classically contains a heterogeneous mix of fat, fluid, soft tissue, and calcification or even teeth within the anterior mediastinum of a young adult. The presence of macroscopic fat is highly suggestive of a germ cell tumour.

9A patient with known sarcoidosis has a chest radiograph. Which combination of findings represents the classic Garland triad (1-2-3 sign)?

A.Bilateral hilar adenopathy with pleural effusions

B.Unilateral hilar adenopathy with cavitation

C.Bilateral hilar and right paratracheal lymphadenopathy

D.Mediastinal adenopathy with a pericardial effusion

Explanation: The Garland triad (1-2-3 sign) describes symmetrical bilateral hilar and right paratracheal lymphadenopathy, the most characteristic thoracic nodal pattern of sarcoidosis. The symmetry helps distinguish it from lymphoma or tuberculosis.

10A 40-year-old with acute chest pain has a coronary CT angiogram showing a coronary calcium score (Agatston) of 0. What is the most appropriate clinical implication?

A.Confirmed three-vessel coronary disease requiring bypass

B.An immediate indication for thrombolysis

C.An unreliable result requiring invasive angiography in all cases

D.A very low likelihood of significant obstructive coronary artery disease

Explanation: An Agatston calcium score of zero carries a very low risk of obstructive coronary artery disease and an excellent negative predictive value for cardiac events. It is a strong negative test in stable, low-to-intermediate risk patients.

About the FRCR Part 2A Exam

The Final FRCR Part A (CR2A) is the written knowledge examination of the Royal College of Radiologists for UK clinical radiology trainees and overseas candidates. It comprises two single-best-answer papers totalling 240 questions, sat over two days, and tests all aspects of clinical radiology and the basic sciences against the Specialty Training Curriculum for Clinical Radiology.

Exam sponsor: Royal College of Radiologists (RCR). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two single-best-answer papers of 120 questions each (240 total), assessed as one combined examination across six clinical radiology modules.

Time Limit

3 hours per paper (two papers)

Passing Score

No fixed percentage; a standard-set pass mark is applied to the whole 240-question assessment for each sitting.

Exam / Certification Fees

Varies by RCR membership status and venue (UK fees approximately GBP 535-830 per sitting); confirm current fees on the RCR website.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

17%

Cardiothoracic and Vascular

Chest, cardiac, mediastinal and vascular imaging including lung nodules, interstitial lung disease, pulmonary embolism, aortic syndromes and pulmonary hypertension.

17%

Musculoskeletal and Trauma

Bone tumours, arthropathies, metabolic bone disease, fractures, internal joint derangement and acute trauma imaging.

17%

Gastro-intestinal

Luminal GI tract, hepatobiliary, pancreatic and peritoneal pathology across fluoroscopy, ultrasound, CT and MRI.

17%

Genito-urinary, Adrenal, O&G and Breast

Renal, adrenal, urological, gynaecological, obstetric and breast imaging including lesion characterisation and staging.

16%

Paediatric

Neonatal and childhood imaging including congenital anomalies, paediatric tumours, non-accidental injury and developmental conditions.

16%

Central Nervous System and Head & Neck

Brain, spine, head and neck imaging including stroke, haemorrhage, tumours, infection, ENT and orbital pathology.

Preparing for the FRCR Part 2A Exam

What You Need to Know

Passing score: No fixed percentage; a standard-set pass mark is applied to the whole 240-question assessment for each sitting.
Assessment: Two single-best-answer papers of 120 questions each (240 total), assessed as one combined examination across six clinical radiology modules.
Time limit: 3 hours per paper (two papers)
Exam / certification fees: Varies by RCR membership status and venue (UK fees approximately GBP 535-830 per sitting); confirm current fees on the RCR website. Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
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FRCR Part 2A: Suggested Study Strategy

1Revise systematically by module, using a question bank to cover the six equally weighted subspecialties so no system is neglected.

2Practise pattern recognition and discriminating features (e.g. silhouette sign, washout characteristics, classic signs) under timed conditions of about 90 seconds per question.

3Anchor revision in UK practice, referencing RCR guidance, NICE and society guidelines, and use the official RCR sample questions to calibrate exam style.

Frequently Asked Questions

How is the FRCR Part 2A exam structured?

It consists of two single-best-answer papers, each with 120 questions, giving 240 questions in total. Each paper lasts 3 hours and the two papers are assessed together as one examination.

What subspecialties does FRCR Part 2A cover?

Questions are drawn from six modules: cardiothoracic and vascular, musculoskeletal and trauma, gastro-intestinal, genito-urinary/adrenal/obstetrics & gynaecology/breast, paediatric, and central nervous system and head & neck.

Is there a fixed pass mark for FRCR Part 2A?

No. The RCR applies a standard-set pass mark to the combined 240-question assessment, so the threshold can vary slightly between sittings based on paper difficulty.

How often is the FRCR Part 2A exam held?

It is normally held twice a year, in April and November, and is delivered by the RCR on the Speedwell digital examination platform.