Free Specialty Certificate Examination in Acute Medicine Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Specialty Certificate Examination in Acute Medicine practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A man with prostate cancer develops progressive thoracic back pain, leg weakness and urinary retention. Metastatic spinal cord compression is suspected. Which imaging plan best follows the NHS GGC pathway?

   1. A.MRI of the whole spine within 24 hoursCorrect answer: A
   2. B.CT of the lumbar spine within 24 hours
   3. C.MRI of the whole spine within one week
   4. D.Plain spinal radiographs within one week

   Explanation: The guideline requires "Urgent MRI of the whole spine (within 24 hours)." New motor and bladder symptoms make this suspected cord compression. Whole-spine MRI urgently defines the extent; lumbar-only CT, delayed MRI and plain radiographs do not meet this requirement.

   Reference: GGC Medicines: Malignant Spinal Cord Compression — Assessment / Monitoring

2. 2A patient in an NHS GGC emergency department has a convincing history of acute coronary ischaemia, but the initial ECG shows no ischaemic changes. Which blood test is indicated to assess myocardial injury?

   1. A.Serum troponinCorrect answer: A
   2. B.Plasma D-dimer
   3. C.Serum myoglobin
   4. D.Total creatine kinase

   Explanation: The guideline says "Test for troponin if acute coronary syndrome is suspected with a suggestive history (even if no ECG changes)". A normal initial ECG does not remove the indication. D-dimer evaluates fibrin breakdown, while myoglobin and total CK lack the specificity of troponin for this assessment.

   Reference: GGC Medicines: Suspected Acute Coronary Syndrome — Assessment / monitoring

3. 3An adult on a general ward has cardiac arrest with pulseless electrical activity. CPR is in progress and IV access is available. According to RCUK 2025, when should the first 1 mg dose of adrenaline be given?

   1. A.As soon as possibleCorrect answer: A
   2. B.After the first two-minute CPR cycle
   3. C.After the third rhythm assessment
   4. D.After five two-minute CPR cycles

   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 rhythm. Adrenaline should not wait for the later cycle or rhythm-assessment milestones offered in the other options.

   Reference: Resuscitation Council UK: Adult ALS 2025 — Vasopressor drugs

4. 4An adult with type 1 diabetes uses once-daily glargine and presents with DKA. A fixed-rate IV insulin infusion is started in an NHS GGC unit. How should the established basal glargine be managed?

   1. A.Continue the scheduled basal glargineCorrect answer: A
   2. B.Omit basal glargine until ketones clear
   3. C.Replace basal glargine with rapid-acting SC insulin
   4. D.Reduce basal glargine to correction-only dosing

   Explanation: The guidance states "Continue background SC insulin (glargine, levemir, degludec, isophane insulin) while on fixed rate intravenous insulin.". Basal insulin continues alongside IV insulin. Omitting or replacing the background component is not this pathway's approach; correction-only dosing does not provide basal cover.

   Reference: GGC Medicines: Diabetic Ketoacidosis — Supplementary notes, 0–4 hours

5. 5A patient taking a proton pump inhibitor is scheduled for an H. pylori stool antigen test. What minimum PPI-free interval does the NHS GGC guideline specify to reduce false-negative results?

   1. A.48 hours
   2. B.1 week
   3. C.2 weeksCorrect answer: C
   4. D.4 weeks

   Explanation: The guideline states "Ensure that PPI is stopped at least two weeks before C13 urea breath testing and stool antigen testing to prevent false negative results.". Two weeks is the minimum PPI washout. The question asks the minimum interval, so a longer interval is not an alternative minimum; the shorter intervals do not meet it.

   Reference: GGC Medicines: Helicobacter pylori — Assessment

6. 6An older inpatient who was cognitively stable at home becomes inattentive and disoriented over two days. Alertness fluctuates markedly during the day. Which syndrome best fits this change?

   1. A.Alzheimer-type dementia
   2. B.DeliriumCorrect answer: B
   3. C.Frontotemporal dementia
   4. D.Depressive pseudodementia

   Explanation: The source states "Delirium is characterised by an acute and fluctuating change in alertness and cognition, usually with evidence of an underlying trigger.". The acute onset and fluctuation are characteristic of delirium and require prompt investigation for triggers. The other cognitive syndromes usually have a different time course and do not explain the abrupt fluctuating alertness.

   Reference: GGC Medicines: Acutely Disturbed Patients including Delirium — Introduction

7. 7An adult has a clinical presentation strongly suggestive of acute gout, but serum urate measured during the attack is normal. What interpretation follows the NHS GGC guidance?

   1. A.A normal result excludes gout permanently
   2. B.Urate should be repeated after the attack resolvesCorrect answer: B
   3. C.Urate must be repeated during the same painful episode
   4. D.The result establishes calcium pyrophosphate arthritis

   Explanation: The source states "This can sometimes fall during an acute attack, so if the level is normal, then repeat once the acute attack has resolved.". An acute flare can lower serum urate, so the normal result does not exclude gout. It also does not identify another crystal arthritis; repeat outside the acute attack.

   Reference: GGC Medicines: Gout — Assessment / Monitoring

8. 8A patient has a witnessed onset of disabling focal neurological symptoms and is referred immediately to the NHS GGC acute stroke service. What is the upper time limit from onset or last known well in the cited standard IV thrombolysis pathway?

   1. A.3 hours
   2. B.4.5 hoursCorrect answer: B
   3. C.6 hours
   4. D.12 hours

   Explanation: The source states "within 4.5 hours of the onset of symptoms or when last known to be well.". The specified standard window is 4.5 hours. Earlier treatment is preferable; three hours is not its upper limit. This question does not address imaging-selected extended-window treatment.

   Reference: GGC Medicines: Acute Stroke 1 — Stroke Unit care

9. 9An adult with an acute COPD exacerbation is at risk of hypercapnic respiratory failure and needs supplemental oxygen. What initial saturation target follows the cited NHS GGC guidance while blood gases guide further treatment?

   1. A.85–89%
   2. B.88–92%Correct answer: B
   3. C.92–96%
   4. D.94–98%

   Explanation: The guideline states "maintain oxygen saturation 88-92%". Controlled oxygen targets 88–92% in this setting. The higher ranges risk excessive oxygen delivery in a susceptible patient; the lower range permits more hypoxaemia than this target.

   Reference: GGC Medicines: Acute Exacerbation of COPD — Bronchodilators and oxygen

10. 10An adult admitted to an acute ward receives specialist medicines that may be absent from the GP medication list. Under NHS GGC reconciliation guidance, what minimum number of information sources should verify the medication history?

    1. A.1 source
    2. B.2 sourcesCorrect answer: B
    3. C.3 sources
    4. D.4 sources

    Explanation: The source states "more than one source should always be used to verify the medication history." The smallest number greater than one is two. One source falls short; three and four may be useful but are not the minimum asked for.

    Reference: GGC Medicines: Assessing Medicines on Admission — Introduction