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FRCR Part 2A (Radiology) - CR2A - understanding the SBA format

The following guidance is intended to help you understand the single best answer (SBA) format used in the Final FRCR Part A examination. It will also provide advice on how to approach individual questions and how best to prepare for this examination.
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1 The SBA question

1.1 Structure

Each question consists of the following 3 components:

  • Stem or clinical vignette
  • Question
  • 5 options (A – E): all of which may be plausible in varying degrees but one is clearly the single best answer and the other four are distractors.

1.2 How to read the stem

  • The information in the stem is relevant and not there to mislead.
  • Information should be interpreted in the same way that you would in your every day practice. For example, if it is stated that a patient with a liver or bone or brain lesion has no history of malignancy, it does not exclude metastasis as a cause for the lesion but the likelihood of the lesion being a metastasis would depend on the other information provided for example the age of the patient, smoking history etc.
  • The information provided is relatively brief and you should realise that some information may not be available to you – much like in your day to day work.
  • Pay attention to the age and sex of the patient and the information provided about the clinical setting, including the presenting symptom, length of the history, family history,
    immune status etc.
  • Pay attention to the imaging findings and any anatomical information provided.
  • If it helps, underline the key words in the stem to help you focus on the pertinent information.

1.3 How to read the question

Common formats include:

  • What is the most likely diagnosis?
  • What is the LEAST likely diagnosis?
  • What is the most appropriate next imaging investigation?

To avoid confusion, the word LEAST will be capitalised if it appears in the question to draw your attention to it.

Underline part of the question if that helps reinforce exactly what is being asked:

  • What is the most likely diagnosis?
  • What is the LEAST likely diagnosis?
  • What is the most appropriate next imaging investigation?

1.4 How to read the options (best answer + four distractors)

Each option is usually a single line of text but occasionally longer or in table format.

Don’t pick the first plausible answer you see.

You are not only looking for an answer that is plausible you are looking for the answer that is most correct in the particular clinical context provided in the stem. Always consider carefully all the information provided which is likely to include some of the following:

  • Age and sex of the patient
  • Presentation including length of history
  • Past medical history
  • Family history
  • Imaging findings
  • Results of other examinations
  • Immune status etc.

Don’t worry if the answer that comes to mind when you first read the question is not in the list of options – you need to pick the best of the available options.

2 How to prepare for the examination

  • Use good radiology text books and radiology web-resources including R-ITI.
  • Read review articles.
  • When possible, take modules for which you have already done the clinical attachment.
  • Attend MDTs.
  • Don’t rely on Final FRCR Part A examination question books. These books are not generally written by people involved with the examination and the standard of the questions is unlikely
    to be a good indication of what you will encounter.
  • Don’t use ‘past papers’ handed down by other trainees. The individuals who wrote down the questions broke examination regulations and may have misremembered the questions.
  • Questions are not reused for some time after appearing in a paper and are very often altered before being reused. The topics need to be learnt but the ‘past paper’ questions and answers
    are very unlikely to appear in the real examination.

3 Examples of questions and how to go about answering them

A number of example questions are provided. All these questions have previously appeared in the Final FRCR Part A but have now been withdrawn. Each question is followed by an explanation — written by an examiner — of how the question should be approached/considered.