Free FRCEM SBA Practice Questions

Sample Practice Questions

Try these 10 sample questions from the FRCEM SBA practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A stable adult with asthma and renal colic has previously developed bronchospasm after taking ibuprofen. Which of these analgesics avoids the drug class that triggered that reaction?

   1. A.Naproxen
   2. B.ParacetamolCorrect answer: B
   3. C.Diclofenac
   4. D.Ibuprofen

   Explanation: The guideline states: "Avoid NSAIDS in asthmatics who are known to get worsening bronchospasm with NSAIDS" The recorded NSAID reaction excludes the three NSAIDs offered. Paracetamol belongs to a different analgesic class.

   Reference: RCEM Management of Acute Pain in Adults — p. 10, NSAIDs

2. 2A shock is delivered for ventricular fibrillation during adult ALS. The patient has no clinical or physiological signs of return of spontaneous circulation. What should the team do immediately?

   1. A.Resume chest compressionsCorrect answer: A
   2. B.Perform a carotid pulse check
   3. C.Record a twelve-lead ECG
   4. D.Reanalyse the cardiac rhythm

   Explanation: RCUK states: "Immediately resume chest compressions after shock delivery." Without signs suggesting ROSC, immediate compressions take priority over an extra rhythm or pulse check.

   Reference: Resuscitation Council UK Adult Advanced Life Support Guidelines — Defibrillation strategy

3. 3An adult presents immediately after sustaining an open tibial shaft fracture. Within what interval after injury should IV prophylactic antibiotics ideally be administered?

   1. A.1 hourCorrect answer: A
   2. B.3 hours
   3. C.6 hours
   4. D.12 hours

   Explanation: The source states: "Intravenous prophylactic antibiotics should be administered as soon as possible, ideally within 1 hour of injury." The ideal boundary is one hour after injury, not after arrival, imaging or theatre transfer. Administration should be as soon as possible.

   Reference: BOASt Open Fractures — Standards for Practice, prophylactic antibiotics

4. 4A 20 kg child has symptomatic hypoglycaemia and cannot safely swallow. Using the recommended 0.2 g/kg IV glucose dose, how much 10% glucose should be given?

   1. A.4 mL
   2. B.20 mL
   3. C.40 mLCorrect answer: C
   4. D.200 mL

   Explanation: The source states: "give an IV bolus of 0.2 g kg-1 glucose (2 mL kg-1 10% glucose)" 0.2 × 20 = 4 g glucose. A 10% solution contains 0.1 g/mL, so 4 ÷ 0.1 = 40 mL. Four mL treats grams as mL; 20 mL halves the prescribed dose; 200 mL uses 1 g/kg.

   Reference: Resuscitation Council UK Paediatric Life Support — Disability, treatment of hypoglycaemia

5. 5An ED clinician is considering ketamine procedural sedation for an infant. Below what age does RCEM recommend that ketamine should not be used for ED sedation?

   1. A.3 months
   2. B.6 months
   3. C.12 monthsCorrect answer: C
   4. D.24 months

   Explanation: The source states: "Ketamine should not be used for sedation in the Emergency Department for children under the age of 1 year." The exclusion is children younger than one year, equivalent to 12 months. This is not a statement that every child older than one year is automatically suitable.

   Reference: RCEM Ketamine Procedural Sedation for Children in the ED — p. 2, recommendation 2

6. 6An adult in an English ED understands and weighs the material risks, retains the information and communicates a refusal of recommended treatment. The clinician considers the choice very unwise. Which assessment should determine whether the patient can make this decision?

   1. A.The patient's agreement with the clinical recommendation
   2. B.The patient's functional ability to make this decisionCorrect answer: B
   3. C.The family's agreement with the patient's preference
   4. D.The patient's agreement to undergo psychiatric assessment

   Explanation: The source states: "A person is not to be treated as unable to make a decision merely because he makes an unwise decision." An unwise refusal alone does not demonstrate incapacity. The scenario supplies the relevant decision-making abilities; agreement with clinicians or relatives is not the statutory test.

   Reference: Mental Capacity Act 2005, section 1 — section 1(4)

7. 7During a major-incident exercise, an ED consultant receives an initial scene report covering declaration of a major incident, exact location, incident type, hazards, access, casualty numbers and emergency services. Which communication framework structures this report?

   1. A.ATMIST
   2. B.SBAR
   3. C.METHANECorrect answer: C
   4. D.AMPLE

   Explanation: The source states: "The tool then sets out the METHANE model – which brings structure and clarity to the initial stages of managing any multi-agency or major incident." The seven components in the scenario correspond to METHANE. The other mnemonics structure different clinical histories or handovers.

   Reference: NHS England Ten Second Triage Tool — Ten Second Triage tool, METHANE model

8. 8An ED journal club reviews a randomised trial of treatment after an acute illness. The one-year adverse-event risk is 20% with standard care and 15% with the new treatment. Using these point estimates, how many patients need the new treatment rather than standard care to prevent one additional event over one year?

   1. A.4
   2. B.5
   3. C.7
   4. D.20Correct answer: D

   Explanation: The source states: "Is the reciprocal of the absolute risk reduction, to say 1 / {(Event Rate A) – (Event Rate B)}." Absolute risk reduction = 0.20 − 0.15 = 0.05; NNT = 1/0.05 = 20 patients over one year. The alternatives follow errors: 4 is 1/relative risk reduction (1/0.25); 5 reports the percentage-point reduction instead of its reciprocal; 7 rounds up 1/0.15 and incorrectly uses the treated-group risk alone.

   Reference: Cochrane Glossary of Key Terms in Health Technology Assessment — p. 38, Number (Needed) to Treat (NNT)

9. 9An adult reports very little pain relief from correctly taken codeine. A metabolic variant is suspected. Which property of codeine explains why genetic variation can reduce its analgesic efficacy?

   1. A.It is a prodrug requiring metabolic activation.Correct answer: A
   2. B.It is an active drug eliminated without metabolism.
   3. C.It is a local anaesthetic blocking sodium channels.
   4. D.It is an NSAID inhibiting cyclo-oxygenase activity.

   Explanation: The guideline states: "Codeine is a prodrug and as such its efficacy is subject to genetic polymorphism." Variable activation can reduce codeine's effect. The alternatives describe different analgesic mechanisms or dispositions, rather than codeine.

   Reference: RCEM Management of Acute Pain in Adults — p. 10, Opioids

10. 10During resuscitation of an adult, the team uses the standard anterolateral defibrillator-pad arrangement. Where should the lateral (apical) pad be placed?

    1. A.Directly below the left armpit in the mid-axillary lineCorrect answer: A
    2. B.Directly to the left of the sternum on the anterior chest
    3. C.At the same height just medial to the left scapula
    4. D.Below the right clavicle to the right of the sternum

    Explanation: RCUK states: "ensure that the lateral (apical) pad is positioned correctly (i.e. directly below the armpit in the mid-axillary line)." This identifies the lateral pad in standard anterolateral placement. The left parasternal and left posterior positions belong to anteroposterior placement; the right infraclavicular position is the other pad in standard anterolateral placement.

    Reference: Resuscitation Council UK Adult Advanced Life Support Guidelines — Defibrillation, Pad position