FRCA past paper questions

If you’re preparing for the final Fellowship of the Royal College of Anaesthetists (FRCA) written exam, you will find that many questions can be predicted by past papers, recent publications and 'hot' topics.

You'll find recent FRCA past papers on the Royal College of Anaesthetists Society website and chairman’s reports which will help you understand the type of questions asked and to help guide your revision.

Exam questions take considerable time to write and check. As the exam paper is set three months before to the exam, the questions will have been written several months before this, so focus your revision on resources available before that time.

As of March 2020, the paper changed to consist entirely of CRQs. Questions are marked out of 20 and you will have threee hours to complete the paper (15 minutes per question).

Below are details of the obstetric questions in the exam over the past 10 years, along with a summary of the chairman’s reports and some suggested resources to help you answer the questions.

These have been sourced from the RCOA website with their permission. While the full exam questions cannot be copied, there is a summary of what was asked and which exam they appeared in.

Recent topics covered

Updated June 2021

Analgesia	Conditions affecting pregnancy	Anaesthesia
Anatomy of labour pain	Pre-eclampsia	GA in pregnant patient
Remifentanil PCA	IUFD	Assess block for C/S
PDPH	Obesity	GA for LSCS
	Cardiac disease	Post LSCS analgesia
	Placenta praevia
	Amniotic fluid embolism
	PPH

Exam resources

Anatomy of labour pain

When was it asked?

April 2009 Question 3

What was asked?

Pain pathways in 1st and 2nd stages of labour
How & why nature of pain changes as labour progresses
Why you need a higher level of block for LSCS than you do for labour analgesia
Why do women sometimes get bradycardia during LSCS under regional

Summary of Chairman’s Report

Poor knowledge of anatomy of pain pathways

Suggested Resources

BJA Education Article: Neuraxial Analgesia for Labour. Jan 2020.
Bonica J. Peripheral Mechanisms and Pathways of Partutrition Pain. Br J Anaesth. 1979;51:3S-9S
Labor S, Maguire S. The Pain of Labour. Rev Pain. 2008;2(2):15–19. doi:10.1177/204946370800200205

Causes of bradycardia during LSCS under regional:

High spinal blocking cardiac sympathetic stimulation
Reduced venous return to the heart = vasovagal
Surgical manipulation increasing vagal tone
Treatment with alpha agonists causing reflex bradycardia

Remifentanil PCA

When was it asked?

September 2020 – pass rate 29%

What was asked?

Patient not consenting to an epidural - how would you approach her?
Alternative options for labour analgesia
Remifentanil PCA Settings
Monitoring required during remifentanil PCA

Summary of Chairman’s Report

Candidates seemed to have little knowledge or experience of Remifentanil PCA. Poor knowledge of dose, optimal timing and necessary protocols to ensure safety

Suggested Resources

BJA Education Article: Non-regional analgesia for labour: remifentanil in obstetrics. 2019.
BJA Education Article: Neuraxial analgesia for labour. 2020.
Murray H, Hodgkinson P, Hughes D. Remifentanil patient-controlled intravenous
analgesia during labour: a retrospective observational study of 10 years' experience. Int J Obstet Anesth. 2019 Aug;39:29-34
Van de Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-
based narrative review. Int J Obstet Anesth. 2016 Feb;25:66-74
Melber AA, Jelting Y, Huber M, Keller D, Dullenkopf A, Girard T, Kranke P.
Remifentanil patient-controlled analgesia in labour: six-year audit of outcome
data of the RemiPCA SAFE Network (2010-2015). Int J Obstet Anesth. 2019
Aug;39:12-21
RCOA Guideline: Best practice in the management of epidural analgesia in the hospital setting. Nov 2010.

Post dural puncture headache

When was it asked?

March 2017 – Pass rate 81.3%

March 2013 Question 12

What was asked?

Clinical features of a PDPH
Differential diagnosis of post partum headache
Features that would make you concerned about a serious underlying cause
Risk of an epidural blood patch
Conservative treatment options for PDPH
How an epidural blood patch is performed

Highlights from Chairman’s Report

Well answered

Suggested resources

OAA PDPH Guideline. Published May 2019
Turnbull, D. and Shepherd, D., 2003. Post-dural puncture headache: pathogenesis, prevention and treatment, British Journal of Anaesthesia, 91(5),pp.718-729
Up to Date: Post Dural Puncture Headache

Pre-eclampsia

When was it asked?

March 2018 question 10 – Pass rate 59.8%

September 2015 question 3

September 2011 Question 7

What was asked

Definition of pre-eclampsia
Symptoms of pre-eclampsia (and severe symptoms)
How to manage following admission to delivery suite
How to alter general anaesthetic technique if requiring a LSCS under GA
Indication for magnesium therapy and how to administer it
Symptoms, signs and management of magnesium toxicity

Summary of Chairman’s Reports

Poor understanding of difference between pre-eclampsia and eclampsia.
Failure to understand importance of controlling systolic BP to prevent intracerebral bleed.

Suggested Resources

BJA Education Article: Update on Hypertensive Disorders of pregnancy, 2020;20(12): 411-416
BJA Education Article: Hypertension in pregnancy. 2016;16(1):33-37
The diagnosis and management of pre‐eclampsia. BJA CEPD Reviews. 2003;3(2):38-42
Up to Date: Anaesthesia for the Patient with Pre-eclampsia

Intrauterine fetal death

When was it asked?

September 2017 – Pass rate N/A (removed from exam, see chairman’s report)

September 2012 Question 3

What was asked?

Non-clinical aspects of management of a woman with IUFD at 36/40
Considerations when providing pain relief for a woman with IUFD at 36/40
Advantages of using regional anaesthesia if requiring LSCS for IUFD at 36/40
Which abnormal haem results would contradict epidural analgesia

Summary of Chairman’s Report

Removed due to ambiguity about whether IUFD was in current or previous pregnancy. Pass rate poor, most marks lost in pain relief question. Should outline advantages and disadvantages of each mode of analgesia.

Suggested Resources

Late Intrauterine Fetal Death and Stillbirth. RCOG Green Top Guideline 55. Published Oct 2010
Anaesthetic Management of Intra-Uterine Foetal Demise

Obesity in pregnancy

When was it asked?

September 2018 – Pass rate 71.4%

September 2013 Question 2

What was asked?

Questions related to seeing a lady with a BMI 55 in the antenatal clinic at 32/40
What to elicit in the history and exam
Specific obstetric risks associated with high BMI
What you need to communicate to the patient
What the plan for her management on the delivery suite should be

Summary of Chairman’s Report

Generally well answered. Points lost in communication question due to vague answers.

Suggested Resources

BJA Education Article: Anaesthesia for the obese patient.
BJA Education Article: Nov 2019. The peripartum management of diabetes.
Care of Women with Obesity in Pregnancy (Green-top Guideline No. 72) Published: Nov 2018

Cardiac disease in pregnancy

When was it asked?

March 2014 Question 9 – Pass Rate 65.5%

March 2021 Question 4 – Pass Rate 59.8%

What was asked?

Causes of mitral stenosis
How the cardiovascular changes of pregnancy exacerbate the pathophysiology of mitral stenosis
How to manage a woman with mod-severe mitral stenosis when she is in labour

Summary of Chairman's report

Pathology of MS poorly understood.

Suggested Resources

Bishop L, Lansbury A, English K. Adult congenital heart disease and
pregnancy. BJA Education. 2018;18(1):23-29.
Elkayam U, Goland S, Pieper P, Silversides C. High-Risk Cardiac Disease in
Pregnancy. J Am Coll Cardiol. 2016;68(5):502-516.

Jehovah’s Witness with low lying placenta

When was it asked?

March 2015 – Question 6

What was asked?

Seeing a Jehovah’s Witness in antenatal clinic who is 30/40 pregnant booked for elective LSCS for low lying placenta– what should you discuss?
Advantages and disadvantages of intraop cell salvage during the LSCS
Suggested Resources

Suggested resources
Currie J, Hogg M, Patel N, Madgwick K, Yoong W. Management of women who
decline blood and blood products in pregnancy. The Obstetrician & Gynaecologist. 2010;12(1):13-20. doi:10.1576/toag.12.1.013.27553
Lawson T, Ralph C. Perioperative Jehovah's Witnesses: a review. Br J Anaesth.
2015;115(5):676-687. doi:10.1093/bja/aev161
Smith C, Shippam W. intraoperative Cell Salvage in Obstetrics. WFASHQ Tutorial of the Week, May 2018.

Amniotic fluid embolism

When was it asked?

Sept 2011 Question 5

What was asked?

What were the direct causes of maternal mortality in the CEMACE report?
Clinical presentation of AFE
Differential diagnoses of AFE
Describe 2 pathophysiological theories of AFE

Suggested resources

BJA Education Article: Amniotic fluid embolism. June 2018.

Post-partum haemorrhage

When was it asked?

March 2010 Question 7

What was asked?

Which factors contribute to development of PPH
List 4 uterotonic drugs and give their dosage, mechanism of action and major side effects

Suggested Resources

BJA Education Article: Major obstetric haemorrhage, August 2015
RCOG Green-Top Guideline No 52. Postpartum Haemorrhage, Prevention and Management.

General anaesthesia for non-obs surgery

When was it asked?

March 2019 question 4 – Pass rate 32.4%
March 2016 question 7 – Pass rate 57.6%
September 2014 Question 3 – Pass rate 33%

What was asked?

NAP4 recommendations regarding airway management in pregnant women
Questions related to a patient requiring emergency surgery in the 2nd trimester
o Risks to the fetus during anaesthesia
o How to minimise risks to the fetus
o Pre and intraop steps you could take to ensure fetal safety if 27/40 pregnant
Factors contributing to difficult airway in pregnant patient
How to reduce airway related morbidity & mortality associated with GA in pregnancy

Summary of Chairman's Reports

Candidates ignored emphasis on the fetus
No point discussing teratogenesis in the 2nd trimester
Recommendations from NAP4 poorly known

Suggested resources

National Audit Project 4. Obstetrics. Chapter 22 page 15.
Rucklidge M, Hinton C. Difficult and failed intubation in obstetrics. Continuing
Education in Anaesthesia Critical Care & Pain. 2012;12(2):86-91.
Up to Date: Airway management of the pregnant patient at delivery.

Assessing block for LSCS

When was it asked?

March 2012 Question 3
September 2016 question 4 – Pass rate 77.5%

What was asked?

Which dermatomes should be blocked for elective LSCS
Methods of testing to confirm adequacy of spinal
Actions to take if spinal block inadequate prior to starting elective LSCS
Symptoms and signs of high spinal
How to manage pain during elective LSCS under spinal

Highlights from Chairman’s Report

Well answered.

Suggested Resources

Hockin G. Assessment of Spinal Anaesthetic Block.
Brown J. Anaesthesia for Caesarean Section. 2008.
Newman B. Complete Spinal Block Following Spinal Anaesthesia.
Bogod D. Pain during caesarean section. BJOG: An International Journal of
Obstetrics & Gynaecology. 2016;123(5):753-753.

General anaesthesia for LSCS

When was it asked?

March 2020 ( the first CRQ) question 6 – Pass rate 59.5%

What was asked?

Reasons for accidental awareness under caesarean section
Conduct of general anaesthesia for LSCS

Highlights from Chairman’s Reports

Poor familiarity with NAP5 findings. Answers generalised and not specific.

Suggested resources

BJA Education Article: General Anaesthesia in Obstetrics, June 2020
NAP5: Accidental awareness under General Anaesthesia in the United Kingdom & Ireland.
Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Current Opinion in Anaesthesiology. 2015;28(3):240-246

Post LSCS pain management

When was it asked?

March 2011 Question 1

What was asked?

Management of pain after LSCS under general anaesthesia
Use of neuraxial techniques to provide postop analgesia following LSCS (including doses)
Monitoring requirements after LSCS under spinal or epidural
Side effects of neuraxially administered opioids and how to manage them

Suggested resources

BJA Education Article: Enhanced recovery for elective Caesarean section.
Kerai S, Saxena KN, Taneja B. Post-caesarean analgesia: What is new? Indian J Anaesth. 2017;61(3):200–214. doi:10.4103/ija.IJA_313_16
Chaney M, Sevarino F. Side Effects of Intrathecal and Epidural Opioids. Survey of Anesthesiology. 1996;40(6):383. doi:10.1097/00132586-199612000-00055