Free MRCEM SBA Practice Questions

Sample Practice Questions

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

1. 1An otherwise healthy, non-pregnant adult has suspected renal colic and severe loin-to-groin pain. Renal function is normal, and there is no contraindication to an NSAID. Which drug class should be offered first for analgesia?

   1. A.An opioid analgesic
   2. B.A benzodiazepine
   3. C.An NSAID analgesicCorrect answer: C
   4. D.An antispasmodic

   Explanation: RCEMLearning states: "Offer an NSAID by any route as first-line treatment for adults, children and young people with suspected renal colic.". The patient can receive an NSAID, so it is the recommended initial analgesic class. Opioids are rescue treatment; benzodiazepines and antispasmodics do not replace this first-line approach.

   Reference: RCEMLearning — Renal Colic in Emergency Medicine — Management — Analgesia

2. 2An adult in cardiac arrest has pulseless electrical activity. High-quality CPR is underway and IV access has been obtained. Which medication should be given as soon as possible?

   1. A.Amiodarone 300 mg IV
   2. B.Lidocaine 100 mg IV
   3. C.Adrenaline 1 mg IVCorrect answer: C
   4. D.Atropine 500 micrograms IV

   Explanation: The guidance states: "Give adrenaline 1 mg as soon as possible for adult patients in cardiac arrest with a non-shockable rhythm.". PEA is a non-shockable arrest rhythm. Adrenaline is indicated promptly; amiodarone and lidocaine address shock-refractory VF/pVT, and atropine addresses selected bradycardias with a pulse.

   Reference: Resuscitation Council UK — Adult Advanced Life Support — Drugs and fluids — Vasopressor drugs

3. 3A pelvic binder is being applied to an adult after a high-energy collision with a suspected unstable pelvic fracture. At which anatomical level should it be centred?

   1. A.The iliac crests
   2. B.The anterior superior iliac spines
   3. C.The greater trochantersCorrect answer: C
   4. D.The upper lumbar spine

   Explanation: The guidance states: "It is important to identify the correct landmark of the greater trochanters to apply the pelvic binder, otherwise it is ineffective.". The binder must compress at the greater trochanters, rather than the waist or iliac crests. The other levels do not provide the intended pelvic-ring compression.

   Reference: RCEMLearning — Pelvic Injuries — Management — Pelvic binder

4. 4A trained paediatric resuscitation team is performing chest compressions on a young child. What minimum proportion of the chest's anteroposterior dimension should be compressed?

   1. A.One quarter
   2. B.One thirdCorrect answer: B
   3. C.One half
   4. D.Two thirds

   Explanation: The guidance states: "Depress the chest by at least one third of the anteroposterior dimension.". One third is the recommended minimum proportional depth, with an absolute maximum of 6 cm. Larger fractions are not the minimum asked for, and one quarter is too shallow.

   Reference: Resuscitation Council UK — Paediatric Life Support — Paediatric basic life support — Chest compressions

5. 5Following tracheal intubation during adult CPR, the team needs to exclude oesophageal tube placement. Which finding must be used?

   1. A.A sustained waveform end-tidal CO2 traceCorrect answer: A
   2. B.Symmetrical visible chest-wall movement
   3. C.Bilateral breath sounds on auscultation
   4. D.Condensation visible inside the tracheal tube

   Explanation: The guidance states: "A sustained ETCO2 trace on waveform capnography must be used to exclude oesophageal placement of the tracheal tube.". A sustained capnography trace is required to exclude oesophageal intubation. Chest movement, auscultation and condensation are useful observations but are not sufficiently reliable substitutes.

   Reference: Resuscitation Council UK — Adult Advanced Life Support — Airway and ventilation — Confirmation of tracheal tube placement

6. 6An unconscious adult requires immediate treatment to prevent death. There is no indication of an applicable prior refusal, and it is not possible to discover the patient's wishes in time. On what basis may the doctor proceed?

   1. A.Emergency treatment immediately necessary to save lifeCorrect answer: A
   2. B.Prior authorisation from the patient's nearest relative
   3. C.A prior court order authorising the proposed treatment
   4. D.Prior authorisation by an appointed health attorney

   Explanation: The guidance states: "In an emergency, if a patient is unconscious or you otherwise conclude that they lack capacity and it’s not possible to find out their wishes, you can provide treatment that is immediately necessary to save their life or to prevent a serious deterioration of their condition.". The emergency conditions permit immediately necessary life-saving treatment while wishes cannot be discovered. The other options describe substitute or court decision processes, which cannot be required before treatment in this emergency; nearest-relative status alone does not confer treatment-consent authority.

   Reference: GMC — Decision Making and Consent — Treatment in emergencies, paragraph 63

7. 7A woman at 20 weeks of pregnancy is stable but has unilateral colicky flank pain and suspected ureteric obstruction. Which imaging investigation should be selected first?

   1. A.Renal tract ultrasoundCorrect answer: A
   2. B.Non-contrast CT KUB
   3. C.Intravenous urography
   4. D.Abdominal radiography

   Explanation: RCEMLearning states: "Ultrasound remains the investigation of choice in this group of patients.". This section specifically concerns pregnancy. Ultrasound avoids ionising radiation and is the initial investigation; CT may be considered if uncertainty remains, rather than replacing the first investigation.

   Reference: RCEMLearning — Renal Colic in Emergency Medicine — Clinical Assessment — Imaging in Pregnancy

8. 8An adult remains in ventricular fibrillation after three shocks during standard ALS. What is the recommended first IV amiodarone dose?

   1. A.150 mg
   2. B.300 mgCorrect answer: B
   3. C.450 mg
   4. D.900 mg

   Explanation: The guidance states: "Give amiodarone 300 mg IV for adult patients in cardiac arrest who are in VF/pVT after a total of three shocks have been given.". The first dose after three shocks is 300 mg. A further 150 mg may follow after five shocks; 450 mg is the combined total and 900 mg is an infusion quantity used in another arrhythmia context.

   Reference: Resuscitation Council UK — Adult Advanced Life Support — Drugs and fluids — Antiarrhythmic drugs

9. 9A man with a pelvic fracture has blood at the urethral meatus and a perineal haematoma. He is currently stable and bladder drainage is being considered. Which investigation should precede routine urethral catheterisation?

   1. A.Retrograde urethrographyCorrect answer: A
   2. B.Renal tract ultrasonography
   3. C.Intravenous urography
   4. D.Plain abdominal radiography

   Explanation: The guidance states: "Presence of any of the above findings MANDATES a catheter retrograde cystogram/ urethrogram to investigate for GU injuries.". Blood at the meatus and perineal haematoma are among the preceding signs of possible urethral injury. Retrograde urethrography assesses urethral integrity before a routine catheter attempt; urological advice should be obtained. Renal ultrasound, IV urography and plain abdominal radiography do not provide the required urethral assessment.

   Reference: RCEMLearning — Pelvic Injuries — Associated injuries — Genitourinary injuries

10. 10A child has ventricular fibrillation and needs the first defibrillation shock. What standard weight-based energy dose is recommended for the initial shocks?

    1. A.1 J/kg
    2. B.2 J/kg
    3. C.4 J/kgCorrect answer: C
    4. D.8 J/kg

    Explanation: The guidance states: "Use 4 J kg-1 as the standard energy dose for the initial shocks.". Initial shocks use 4 J/kg, within the adult maximum suggested by the guideline. One J/kg is an initial synchronised cardioversion dose, and escalation towards 8 J/kg is reserved for refractory VF/pVT.

    Reference: Resuscitation Council UK — Paediatric Life Support — Paediatric advanced life support — Defibrillation