The SCE Respiratory Medicine covers the full breadth of the JRCPTB Respiratory curriculum, from acute asthma management through to interstitial lung disease classification, lung cancer staging, and domiciliary ventilation. The exam sits twice per year — typically February and September — giving you a fallback date if needed, but the breadth of content means starting early is essential regardless.
Topic weighting
The respiratory curriculum divides into several major domains. Based on curriculum structure and the distribution of questions in recent sittings, the approximate weighting is as follows.
Asthma accounts for roughly 12 to 15 per cent of questions, including severe asthma biologic eligibility, occupational asthma diagnosis, and acute management. COPD accounts for a similar proportion, covering GOLD classification, pharmacological management, exacerbation management, NIV, long-term oxygen therapy, and palliative approaches. These two conditions alone represent a quarter of the exam.
Interstitial lung disease — including IPF, connective tissue disease-related ILD, hypersensitivity pneumonitis, and sarcoidosis — accounts for 10 to 12 per cent and is where many candidates lose marks. The classification of ILDs has evolved significantly, and questions often test the distinction between UIP pattern and alternatives on HRCT, the role of MDT discussion, and antifibrotic eligibility criteria.
Lung cancer accounts for 8 to 10 per cent, including TNM staging, performance status-driven treatment decisions, immunotherapy eligibility (PD-L1 expression), and the lung cancer screening evidence base. Pleural disease (effusion investigation, empyema management, pneumothorax guidelines, mesothelioma) accounts for roughly 8 per cent. Pulmonary infection including community-acquired pneumonia, hospital-acquired pneumonia, aspergillosis, PJP, and tuberculosis is another 8 to 10 per cent.
The remaining questions span bronchiectasis and cystic fibrosis, pulmonary vascular disease (PE investigation and PAH classification), sleep-disordered breathing and domiciliary ventilation, occupational lung disease, respiratory physiology and lung function interpretation, and interventional pulmonology.
Guideline priorities
Respiratory medicine has a split guideline landscape. BTS and SIGN guidelines are the primary source for asthma, pneumonia, oxygen use, pleural disease, and pulmonary rehabilitation. NICE guidelines and technology appraisals govern UK-specific pathways including COPD management, IPF antifibrotic access, lung cancer investigation, and biologic eligibility for severe asthma. The GOLD report is the international reference for COPD classification. ERS and ATS guidelines cover ILD classification, pulmonary hypertension, and bronchiectasis.
The exam expects you to know which guideline applies in which context. A question about acute asthma management follows BTS/SIGN. A question about COPD pharmacotherapy follows GOLD classification with NICE-specific prescribing considerations. A question about IPF diagnosis follows the ERS/ATS framework but treatment access follows NICE technology appraisals.
The essential reading list covers BTS/SIGN British Guideline on the Management of Asthma, NICE NG115 (COPD), GOLD 2026 Report, BTS Pleural Disease Guidelines, NICE NG122 (Lung Cancer), BTS Guidelines for Home Oxygen, ERS/ATS ILD classification, and BTS/ICS Guidelines for Severe Asthma.
Blood gases and spirometry
Arterial blood gas interpretation and spirometry are tested throughout the exam rather than in a single dedicated section. Every blood gas question uses kPa (not mmHg) and expects you to identify the primary disturbance, calculate the A-a gradient where relevant, and link the findings to clinical context.
Spirometry questions test pattern recognition — obstructive versus restrictive versus mixed — and the ability to interpret flow-volume loops, gas transfer (DLCO), and lung volumes. Questions frequently present serial spirometry to assess treatment response or disease progression.
These are marks you cannot afford to lose. If your blood gas and spirometry interpretation is not automatic, practise dedicated sets before moving to clinical scenario questions.
Revision timeline
Start structured revision three to four months before your sitting. The first month should cover all major topics systematically using a question bank in untimed mode, with guideline reading for each topic as you encounter gaps. The second month should shift toward timed practice and focused revision on weak areas identified by your performance data. The third month is for mock exams, final guideline review, and consolidation.
iatroX's SCE Respiratory question bank contains over 1,500 questions mapped to the JRCPTB curriculum and aligned to BTS, NICE, GOLD, and ERS guidelines. The adaptive algorithm identifies your weakest topics — whether that is ILD classification, sleep medicine, or occupational lung disease — and prioritises them in subsequent sessions. Full mock exams simulate the two-paper format. The mobile app lets you fit revision around clinical commitments. All included at £29 per month or £99 per year alongside every other exam on the platform.
Common mistakes
Neglecting ILD is the most frequent error. Many respiratory registrars are comfortable with asthma, COPD, and pleural disease from daily clinical practice but have limited exposure to the full range of ILDs. The exam tests classification, investigation, and management at a depth that clinical experience alone does not cover.
Confusing BTS and NICE recommendations is another pitfall. Know which guideline applies to which question — the answers can differ.
Underestimating sleep medicine and ventilation is common. OSA diagnosis and management, obesity hypoventilation syndrome, and domiciliary NIV initiation criteria appear regularly and are high-yield topics that many candidates deprioritise.