Updated June 2020
Final FRCA Written
Obstetric Past Questions
If you’re preparing for the Final FRCA written exam, you will hopefully be
aware that many questions can be predicted by past papers, recent
publications and “hot topics”. The RCOA website contains recent past papers
and Chairman’s reports which are extremely useful to help understand the
type of question asked and guide your revision accordingly. Exam questions
take considerable time to write and check. As the exam paper is set 3 months
prior to the exam, the questions will have been written several months before
this so focus your revision on resources prior to then.
In March 2020 the paper changed to consist entirely of CRQs. Questions are
still be marked out of 20 and you will have 3 hours to complete the paper (15
minutes per question).
This document contains all the obstetric SAQs 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 kind permission. I am not permitted to share the
full exam questions or Chairman’s reports but have summarised what was
asked and referenced the exam they appeared in.
I hope you find the resources helpful and wish you good luck with the exam!
Fiona Pearson
OAA Trainee Rep.
Final FRCA Written Resource v1.2
Updated June 2020
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 (& 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
Highlights from 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:
• The diagnosis and management of pre-eclampsia. BJA CEPD Reviews.
2003;3(2):38-42. Available at:
[Link]
• Hypertension in pregnancy. BJA Education. 2016;16(1):33-37
[Link]
• Up to Date: Anaesthesia for the Patient with Pre-eclampsia
[Link]
preeclampsia
• Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section.
Current Opinion in Anaesthesiology. 2015;28(3):240-246.
• McGlennan A, Mustafa A. General anaesthesia for Caesarean section.
Continuing Education in Anaesthesia Critical Care & Pain. 2009;9(5):148-151.
Final FRCA Written Resource v1.2
Updated June 2020
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
Highlights from 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. Available at:
[Link]
• 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. Available
at: [Link]
patient-at-delivery
Final FRCA Written Resource v1.2
Updated June 2020
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. Available at:
[Link]
• Brown J. Anaesthesia for Caesarean Section. 2008. Available at:
[Link]
[Link]
• Newman B. Complete Spinal Block Following Spinal Anaesthesia. Available at
[Link]
%20spinal%[Link]
• Bogod D. Pain during caesarean section. BJOG: An International Journal of
Obstetrics & Gynaecology. 2016;123(5):753-753.
Final FRCA Written Resource v1.2
Updated June 2020
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 Available at: [Link]
[Link]/assets/_managed/cms/files/Clinical%20Guidelines/PDPH_Stevenag
e_2014.pdf
• Turnbull, D. and Shepherd, D., 2003. Post-dural puncture headache:
pathogenesis, prevention and treatment. British Journal of Anaesthesia, 91(5),
pp.718-729. Available at:
[Link]
• Up to Date: Post Dural Puncture Headache
[Link]
Final FRCA Written Resource v1.2
Updated June 2020
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
Highlights from 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:
[Link]
• [Link]
Uterine%20Foetal%20Demise/IUFD%20Guideline%20Basildon%20and%20Thurrock.p
df
Final FRCA Written Resource v1.2
Updated June 2020
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
Highlights from Chairman’s Report
Generally well answered. Points lost in communication question due to vague answers.
Suggested Resources
• CEACCP Article on Obesity in Pregnancy. 2011;11(4):143-146 :
[Link]
• Care of Women with Obesity in Pregnancy (Green-top Guideline No. 72)
Published: Nov 2018:
[Link]
Final FRCA Written Resource v1.2
Updated June 2020
Cardiac Disease in Pregnancy
When was it asked?
March 2014 Question 9 – Pass Rate 65.5%
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. Available at:
[Link]
• Elkayam U, Goland S, Pieper P, Silversides C. High-Risk Cardiac Disease in
Pregnancy. J Am Coll Cardiol. 2016;68(5):502-516. Available at:
[Link]
Final FRCA Written Resource v1.2
Updated June 2020
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
• 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
• Lin ES, Kaye AD, Baluch AR. Preanesthetic Assessment of the Jehovah's Witness
Patient. Ochsner J. 2012;12(1):61–69.
• Smith C, Shippam W. Intraopearitve Cell Salvage in Obstetrics. WFASHQ Tutorial
of the Week, May 2018. Available at:
[Link]
[Link]
Final FRCA Written Resource v1.2
Updated June 2020
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
Jatin D. Dedhia, Mary C. Mushambi, Amniotic fluid embolism, Continuing Education in
Anaesthesia Critical Care & Pain, Volume 7, Issue 5, October 2007, Pages 152–
156, Available at: [Link]
Final FRCA Written Resource v1.2
Updated June 2020
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
• NAP5: Accidental awareness under General Anaesthesia in the United Kingdom
& Ireland. Available at: [Link]
Final FRCA Written Resource v1.2
Updated June 2020
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 & how to manage them
Suggested Resources
• 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
• Best practice in the management of epidural analgesia in the hospital
[Link] Guideline. Nov 2010. Available at:
[Link]
ce_management_epidural_analgesia_2011_final.pdf?ver=2018-07-11-163752-
770&ver=2018-07-11-163752-770
• Chaney M, Sevarino F. Side Effects of Intrathecal and Epidural Opioids. Survey of
Anesthesiology. 1996;40(6):383. doi:10.1097/00132586-199612000-00055
Final FRCA Written Resource v1.2
Updated June 2020
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
• F Plaat, A Shonfeld, Major obstetric haemorrhage, Continuing Education in
Anaesthesia Critical Care & Pain, Volume 15, Issue 4, August 2015, Pages 190–193
Available at: [Link]
• RCOG Green-Top Guideline No 52. Postpartum Haemorrhage, Prevention and
Management. Available at:
[Link]
Final FRCA Written Resource v1.2
Updated June 2020
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
• Bonica J. Peripheral Mechanisms and Pathways of Parturition Pain. Br J Anaesth.
1979;51:3S-9S.
Available at: [Link]
• 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
Final FRCA Written Resource v1.2
