Ready for the FRCA Primary
Single-best-answer questions in the paper's own format, written against the RCoA primary syllabus and approved by a clinician before publication.
- Master the RCoA primary syllabus easily with over 1,200 questions covering all areas.
- Quick rounds between busy shifts, or a whole paper under examination conditions.
- The paper's own format: five options, one best answer.
The examination
The FRCA Primary is the first examination towards the Fellowship of the Royal College of Anaesthetists. The paper examines the basic sciences that underpin anaesthesia: physiology, pharmacology, physics and clinical measurement, and anatomy.
The format
90 single-best-answer questions in three hours.
The bank
Over 1,200 questions, each reviewed by a clinician. The question bank is updated continuously against the RCoA primary syllabus.
Pass rates
Overall pass rates for the FRCA Primary have ranged from 54% to 75% across the last six sittings (September 2023 to February 2026). First-attempt pass rates among UK trainees sit considerably higher, at 79–96% over the same period. Most candidates revise for three to six months.
Source: Royal College of Anaesthetists.
Preparation
Sit a full paper under examination conditions to rehearse the time pressure. Select a syllabus domain for structured revision on areas you need to work on. Take a quick round of a few questions between lists or on the train.
Syllabus
Pharmacological and Pharmacokinetic Principles
- Absorption, Distribution, Metabolism and Excretion
- Compartment Models, Context-Sensitive Half-Time and Target-Controlled Infusion
- Dose-Response, Efficacy, Potency and Therapeutic Index
- Receptor Types, Agonism, Antagonism and Signal Transduction
- Isomerism, Chirality and Structure-Activity Relationships
- Drug Interactions, Enzyme Induction and Inhibition
- Pharmacogenetics, Age, Pregnancy and Organ Failure as Sources of Variability
- Adverse Drug Reactions, Anaphylaxis and Tolerance
Anaesthetic Agents
- Intravenous Induction Agents
- Inhalational Agents, MAC and the Determinants of Uptake
- Nitrous Oxide, Xenon and the Second Gas Effect
- Total Intravenous Anaesthesia and Infusion Pharmacokinetics
- Mechanisms and Theories of Anaesthetic Action
Analgesic and Local Anaesthetic Drugs
- Opioid Agonists, Partial Agonists and Antagonists
- NSAIDs, Paracetamol and Their Mechanisms
- Local Anaesthetic Pharmacology, pKa and Differential Block
- Local Anaesthetic Systemic Toxicity, Maximum Doses and Lipid Rescue
- Analgesic Adjuvants: Ketamine, Alpha-2 Agonists, Gabapentinoids
Neuromuscular Blocking and Reversal Agents
- Suxamethonium, Phase II Block and Plasma Cholinesterase
- Non-Depolarising Agents: Onset, Duration and Elimination
- Anticholinesterases, Sugammadex and Residual Block
- Antimuscarinic Drugs and Their Autonomic Effects
Cardiovascular and Haemostatic Drugs
- Inotropes, Vasopressors and Their Receptor Selectivity
- Vasodilators and Antihypertensive Agents
- Antiarrhythmic Drugs and the Vaughan Williams Classification
- Anticoagulants, Antiplatelets, Thrombolytics and Their Reversal
- Antifibrinolytics and Procoagulant Agents
Other Drugs in Anaesthetic Practice
- Antiemetics and the Receptors They Block
- Benzodiazepines, Flumazenil and Sedative Premedication
- Bronchodilators, Steroids and Respiratory Agents
- Insulin, Oral Hypoglycaemics, Corticosteroids and Thyroid Drugs
- Antimicrobial Agents and Prophylaxis
- Antidepressants, Antipsychotics, Antiepileptics and Antiparkinsonian Drugs
- Diuretics and Their Sites of Action
Respiratory Physiology
- Lung Volumes, Capacities and Closing Capacity
- Compliance, Resistance, Work of Breathing and Surfactant
- Ventilation-Perfusion Matching, Shunt and Dead Space
- Oxygen Carriage, the Dissociation Curve and Tissue Delivery
- Carbon Dioxide Carriage and the Haldane and Bohr Effects
- Central and Peripheral Control of Ventilation
- Acid-Base Balance, Buffers and Compensation
- Altitude, Diving, Oxygen Therapy and Hypoxia
- The Effects of Anaesthesia and Positioning on Respiratory Function
Cardiovascular Physiology
- The Cardiac Cycle and Pressure-Volume Relationships
- Preload, Afterload, Contractility and Venous Return
- Cardiac Action Potentials, Conduction and the Basis of the ECG
- Blood Pressure Control, Baroreceptors and the Renin-Angiotensin System
- Microcirculation, Starling Forces and the Glycocalyx
- Coronary, Cerebral, Pulmonary, Renal, Hepatic and Uteroplacental Circulations
- The Physiological Response to Haemorrhage and Posture
Neurophysiology
- Resting Membrane Potential, Action Potentials and Conduction
- The Neuromuscular Junction and Excitation-Contraction Coupling
- Cerebrospinal Fluid, Cerebral Blood Flow and Intracranial Pressure
- Nociception, Pain Pathways and Modulation
- Autonomic Nervous System Organisation and Transmission
- Spinal Cord Organisation, Reflexes and Tracts
- Vision, Hearing, Balance and the Physiology of Consciousness and Sleep
Renal Physiology, Body Fluids and Electrolytes
- Renal Blood Flow, Glomerular Filtration and Autoregulation
- Tubular Reabsorption, Secretion and the Countercurrent Mechanism
- Body Fluid Compartments, Osmolality and Water Balance
- Sodium, Potassium, Calcium and Magnesium Homeostasis
- The Renal Contribution to Acid-Base Regulation
- Bladder Function and Micturition
Hepatic, Gastrointestinal, Endocrine, Metabolic and Haematological Physiology
- Liver Function, Blood Supply and Bilirubin Metabolism
- Gastric Function, Motility, Secretion and Swallowing
- Pituitary, Thyroid, Adrenal and Pancreatic Endocrine Function
- Energy Metabolism, Starvation, the Stress Response and Nutrition
- Haemoglobin, Red Cells, Blood Groups and Transfusion
- Coagulation, Fibrinolysis and Their Regulation
- Immune Function, Inflammation and Hypersensitivity
- Skeletal, Cardiac and Smooth Muscle Physiology
- Temperature Regulation and the Physiology of Hypothermia
Maternal, Fetal, Neonatal and Paediatric Physiology
- Maternal Physiological Changes in Pregnancy
- Placental Structure, Transfer and Uteroplacental Blood Flow
- Fetal Circulation and the Changes at Birth
- Paediatric Respiratory, Cardiovascular and Thermal Differences
- The Physiology of Ageing
Anatomy Applied to Anaesthesia
- Upper Airway, Larynx and Trachea
- Thoracic Wall, Pleura, Lungs and Bronchial Tree
- Heart, Great Vessels and Sites of Central Venous Access
- Vertebral Column, Meninges and the Neuraxial Space
- Brachial and Lumbosacral Plexuses and Peripheral Nerve Blocks
- Cranial Nerves, Base of Skull and the Orbit
- Abdominal Wall, Inguinal Region and Pelvic Anatomy
- Sympathetic Chain, Coeliac Plexus and Autonomic Anatomy
Physical Principles
- Gas Laws, Critical Temperature and the Behaviour of Vapours
- Laminar and Turbulent Flow, Viscosity, Reynolds Number and the Venturi Effect
- Pressure, Force, Surface Tension and the Law of Laplace
- Solubility, Partition Coefficients, Diffusion and Osmosis
- Heat, Latent Heat, Humidity and Their Measurement
- SI Units, Dimensional Analysis and Exponential Functions
- Electrical Principles, Impedance, Amplifiers and Signal Processing
- Ultrasound, Doppler, Lasers and Electromagnetic Radiation
Clinical Measurement and Monitoring
- Accuracy, Precision, Drift, Calibration, Resonance and Damping
- Invasive and Non-Invasive Blood Pressure Measurement
- Cardiac Output Measurement and Its Assumptions
- Pulse Oximetry: Principle, Limitations and Sources of Error
- Capnography and the Interpretation of the Waveform
- Anaesthetic Gas and Oxygen Analysis
- Measurement of Gas Flow, Volume and Lung Function
- Temperature Measurement and Its Sites
- Peripheral Nerve Stimulation and Quantitative Monitoring
- Depth of Anaesthesia Monitoring and Processed EEG
- ECG Monitoring, Lead Systems and Artefact
- Blood Gas Electrodes, Co-Oximetry and Point-of-Care Testing
Anaesthetic Equipment
- Cylinders, Pipelines, Manifolds and Their Safety Features
- The Anaesthetic Machine, Flowmeters and Pressure Regulation
- Vaporisers: Design, Compensation and Filling Hazards
- Breathing Systems, Their Classification and Fresh Gas Requirements
- Carbon Dioxide Absorption and Its Degradation Products
- Ventilators, Modes and Their Delivered Waveforms
- Tracheal Tubes, Supraglottic Airways and Laryngoscopes
- Humidification, Filters and Heat-Moisture Exchangers
- Infusion Pumps, Syringe Drivers and Their Failure Modes
- Scavenging Systems and Theatre Pollution
- Regional Anaesthesia and Vascular Access Equipment
Safety, Hazards and Human Factors
- Electrical Safety, Leakage Current, Diathermy and Equipment Classification
- Fire, Laser and Airway Fire Risk
- Pressure, Cylinder and Gas Supply Hazards
- The MRI Environment and Anaesthesia at Remote Sites
- Machine Checking, Alarms and Their Limits
- Decontamination, Sterilisation and Infection Control
- Human Factors, Error, Checklists and Incident Reporting
Statistical Methods and Data Interpretation
- Types of Data, Distributions and Their Description
- Measures of Central Tendency, Spread and the Standard Error
- Null Hypothesis, p Values, Confidence Intervals and Choice of Test
- Type I and Type II Error, Power and Sample Size
- Sensitivity, Specificity, Predictive Values and Likelihood Ratios
- Trial Design, Randomisation, Blinding, Bias and Confounding
- Systematic Review, Meta-Analysis and Levels of Evidence
- Graphical Presentation and the Interpretation of Plots
- Agreement, Repeatability and Bland-Altman Analysis
Sample questions
Local Anaesthetic Pharmacology, pKa and Differential Block
Lidocaine has a pKa of 7.9 and bupivacaine has a pKa of 8.1. Both are injected into tissue at pH 7.4. Which statement best explains the faster clinical onset of lidocaine compared with bupivacaine?
- Lidocaine has a lower molecular weight, allowing faster diffusion through connective tissue barriers
- Lidocaine has a higher lipid solubility than bupivacaine, increasing the rate of membrane penetration
- A greater proportion of lidocaine is unionised at tissue pH, so more crosses the nerve membrane to reach the intracellular binding site
- Lidocaine produces less vasodilatation than bupivacaine, so more drug remains at the injection site
- Lidocaine binds the sodium channel in its ionised form, which is present in greater proportion at tissue pH
The Cardiac Cycle and Pressure-Volume Relationships
A parturient at term undergoes emergency Caesarean section under spinal anaesthesia. Immediately after delivery of the baby, her blood pressure rises sharply. Which physiological mechanism best explains this transient hypertension?
- Relief of aortocaval compression increases venous return and therefore cardiac output
- Uterine contraction after delivery releases catecholamines from the adrenal medulla
- Spinal anaesthesia wears off rapidly after delivery, restoring sympathetic tone
- Oxytocin given at delivery causes direct arterial vasoconstriction
- Removal of the placental circulation eliminates a low-resistance vascular bed
Accuracy, Precision, Drift, Calibration, Resonance and Damping
An invasive arterial pressure monitoring system is overdamped. Which change in the displayed pressure is most likely?
- Systolic and diastolic pressures increase equally
- Systolic pressure decreases and pulse pressure narrows
- Diastolic pressure decreases and pulse pressure widens
- Mean pressure increases substantially
- Systolic pressure increases and pulse pressure widens
Common questions
Where can I find FRCA Primary practice questions?
ClinicalGrit has a bank of over 1,200 single-best-answer questions written against the RCoA primary syllabus. Every question is reviewed by a clinician before publication, and each answer comes with a detailed explanation. You can try several rounds free before buying access.
Are there free FRCA Primary mock questions available?
Yes. ClinicalGrit gives you free trial rounds of FRCA Primary questions — no card required. Create an account, start a round, and the questions are in the paper’s own format: a stem, five options, one best answer. The trial lets you see how the bank works before committing.
What format is the FRCA Primary examination?
The FRCA Primary is a written paper of 90 single-best-answer (SBA) questions in three hours. It examines the basic sciences that underpin anaesthesia: physiology, pharmacology, physics and clinical measurement, and anatomy. The questions on ClinicalGrit use the same SBA format.
What are the FRCA Primary pass rates?
Overall pass rates for the FRCA Primary have ranged from 54% to 75% across the last six sittings (September 2023 to February 2026). First-attempt pass rates among UK trainees are considerably higher, at 79–96% over the same period. Most candidates revise for three to six months.
How should I prepare for the FRCA Primary?
Sit full mock papers under timed conditions to rehearse the time pressure — three hours for 90 questions is two minutes each. Between papers, select a syllabus domain and work through questions on that area. Short rounds between theatre lists or on the train keep the revision going without a long session.
What topics does the FRCA Primary cover?
The RCoA primary syllabus covers pharmacology (including anaesthetic agents, analgesics, neuromuscular drugs and cardiovascular drugs), physiology (respiratory, cardiovascular, neurophysiology, renal, hepatic, endocrine and maternal/fetal), anatomy applied to anaesthesia, physics and clinical measurement, anaesthetic equipment, safety and human factors, and statistics.
Can I sit a full FRCA Primary mock exam online?
Yes. ClinicalGrit lets you sit a full 90-question mock paper under timed conditions that mirror the real examination. You can also run shorter rounds — a quick five questions between cases, or a focused session on one syllabus area — and the bank tracks your progress across the whole syllabus.
What revision tips help for the FRCA Primary?
Work steadily over three to six months rather than cramming. Alternate between full timed papers (to learn the pace) and focused domain work (to close gaps). Use the syllabus map to see which areas are weakest and direct revision there. Every question you answer is tracked, so you can see your coverage growing.
Can I trust the clinical accuracy of the contents of the question bank?
Yes. All questions are reviewed by a clinician before publication. We take great care over clinical accuracy, but some questions are open to debate and mistakes can happen. If anything raises a question, write to support@clinicalgrit.com.
Will you guarantee that I pass?
No, but we will give you the best chance to pass. If you don't pass, write to support@clinicalgrit.com for another access period at no cost.
Do you publish, store, or send my performance details anywhere?
Your answers and results are stored with your account so that you can follow your own progress. We do not publish them, sell them or pass them to anyone for marketing, and we do not use them to train language models. The privacy statement lists every service that processes them.
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