The FRCA Primary MCQ is the first hurdle in the Fellowship of the Royal College of Anaesthetists examination. It tests basic sciences applied to anaesthesia — pharmacology, physiology, physics, clinical measurement, and anatomy — at a level that demands dedicated revision beyond what you absorb during clinical training. The pass rate typically sits around 55 to 60 per cent, meaning roughly two in five candidates fail at each sitting.
The exam runs three times per year — February, September, and November — and you must pass the MCQ before progressing to the OSCE and SOE.
Format
The Primary MCQ is a three-hour paper containing 90 single best answer questions. Since 2024, the exam uses SBA format exclusively — the multiple true/false (MTF) format has been removed. This is important for revision strategy because there is no negative marking in SBA format, which means you should answer every question even if you are uncertain.
Topic weighting
Pharmacology dominates the exam at approximately 40 per cent of questions. This covers general pharmacological principles (pharmacokinetics, pharmacodynamics, drug interactions), intravenous anaesthetic agents, inhalational agents (MAC values, blood-gas partition coefficients, second gas effect), analgesics (opioids, NSAIDs, local anaesthetics), neuromuscular blocking agents (suxamethonium, rocuronium, sugammadex, phase I and II block), and cardiovascular and autonomic drugs.
Physiology accounts for roughly 30 per cent, covering cardiovascular physiology (Starling's law, cardiac output, coronary blood flow), respiratory physiology (oxygen-haemoglobin dissociation curve, ventilation-perfusion matching, dead space), renal physiology, neurophysiology (pain pathways, autonomic nervous system), and GI/hepatic/endocrine physiology.
Physics and clinical measurement accounts for approximately 15 per cent, including gas laws (Boyle's, Charles', Dalton's), vaporiser function, monitoring principles (pulse oximetry, capnography, arterial line transduction), electrical safety, and defibrillation.
Anatomy accounts for the remaining 15 per cent, with focus on airway anatomy, brachial plexus (for regional anaesthesia), spinal and epidural anatomy, and surface anatomy for vascular access.
What to learn by heart
Certain facts are tested so frequently that they must be committed to memory without hesitation. MAC values for all commonly used inhalational agents (sevoflurane 2.0, desflurane 6.0, isoflurane 1.15, nitrous oxide 105). Blood-gas partition coefficients. The Henderson-Hasselbalch equation. The oxygen-haemoglobin dissociation curve and factors that shift it. pKa values for local anaesthetics. The autonomic receptor classification and the drugs acting at each receptor. Suxamethonium pharmacology (onset, duration, metabolism, side effects, contraindications). The anatomy of the brachial plexus (roots, trunks, divisions, cords, branches).
If you have to think about any of these during the exam, you are losing time. They should be automatic.
Revision strategy
Most successful candidates describe three to four months of focused revision. The pharmacology-heavy weighting means you should start with pharmacology and dedicate roughly 40 per cent of your revision time to it — matching its exam weighting.
A practical approach is to divide your revision into three phases. Phase one (weeks one to six): work through pharmacology and physiology systematically using a question bank, reading the relevant textbook sections for each topic. Phase two (weeks seven to ten): cover physics, clinical measurement, and anatomy. Phase three (weeks eleven to twelve): timed mock exams, targeted revision of weak areas, and final memorisation of key facts.
The standard textbooks are Peck, Hill, and Williams for pharmacology, Power and Kam for physiology, and Al-Shaikh and Stacey for equipment and physics. These are dense — use the question bank to guide which chapters to prioritise rather than attempting to read cover to cover.
Using iatroX for FRCA Primary
iatroX's FRCA Primary question bank contains over 1,500 SBA questions covering all five domains at the correct weighting. Questions are mapped to the RCoA Primary curriculum and reference standard anaesthetic textbooks and BNF dosing.
The adaptive algorithm is particularly useful for the FRCA Primary because the topic spread is so wide. If your cardiovascular physiology is strong but your physics is weak, the system shifts question selection toward physics without you having to manually manage your revision balance. The spaced repetition layer ensures that pharmacology facts you learned in week one are reviewed at optimal intervals rather than forgotten by exam day.
Full mock exams replicate the 90-question, three-hour format. The mobile app supports revision during on-call downtime. All included at £29 per month or £99 per year alongside every other exam on the platform.
The negative marking advantage
With the removal of MTF format, there is no penalty for incorrect answers. This changes your exam strategy fundamentally — never leave a question unanswered. If you can eliminate even one option, your expected value from guessing improves. If you can eliminate two options, you have a one-in-three chance of a correct guess. Over 90 questions, systematic elimination and educated guessing on uncertain questions can add several marks.