MRCEM SBA: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Adult resuscitation and critical care — ALS, sepsis, post-arrest care
• Cardiology — ACS, arrhythmias, heart failure decompensation
• Respiratory — asthma, COPD exacerbation, PE, pneumothorax
• Trauma — major haemorrhage, ATLS, head/spinal/chest/abdominal trauma
• Paediatric emergencies — APLS algorithms, paediatric sepsis, fever in under-5s
• Neurological emergencies — stroke, status epilepticus, headache red flags
• Surgical and abdominal emergencies — appendicitis, AAA, perforation, ischaemia
• Toxicology — paracetamol, salicylate, recreational drugs, antidotes
• Mental health and self-harm — suicide risk, sectioning under MHA, capacity in ED
• Musculoskeletal and orthopaedics — fractures, dislocations, soft tissue, infection
• Sepsis and infectious diseases — bundles, antimicrobials, tropical/returning traveller
• Major incident, ethics, professional, EM administration
• Imaging and clinical procedures — ECG, ABG, CXR, US, joint aspiration

Drawn from the RCEM 2021 curriculum, RCEM clinical guidelines, Resus Council UK 2021 and item density across the iatroX bank.

• Sepsis recognition and bundles — Surviving Sepsis Campaign 2021, septic screen within 1 hour for septic shock, paediatric sepsis screen (PEWS), source control timing
• ACS management — ESC 2023 NSTEMI invasive timing (<24h GRACE-guided, <2h high-risk, immediate for ongoing ischaemia), DAPT in PCI vs medical management
• Major trauma — Major Haemorrhage Protocol activation, 1:1:1 ratio, tranexamic acid <3h from injury (CRASH-2), pelvic binders, FAST scan use
• Paediatric ALS — APLS 7th edition, recognising the deteriorating child (PEWS), paediatric sepsis recognition, weight-based drug calculations
• Toxicology — paracetamol nomogram and staggered ingestion management, salicylate dialysis criteria, sodium-channel blocker overdose (TCA, flecainide), local anaesthetic systemic toxicity (LAST) — intralipid
• Acute stroke — thrombolysis windows (4.5h standard, extended to 9h in selected patients per WAKE-UP/EXTEND), thrombectomy criteria (large vessel occlusion), posterior circulation pitfalls
• Toxicology antidotes — N-acetylcysteine for paracetamol, naloxone for opioids, flumazenil cautions, atropine + pralidoxime for organophosphate, hydroxocobalamin for cyanide, digoxin-Fab fragments
• Mental health in ED — suicide risk assessment, sectioning under MHA Sections 5(2) and 5(4) and 136, capacity assessment for refusal of care, alcohol withdrawal and Wernicke prevention

Observations from UK emergency medicine trainees and recent MRCEM SBA candidates. Verify against current RCEM, NICE and Resus Council UK guidance.

Candidate-reported observations — not official guidance.

1. Resus Council UK 2021 algorithm updates — older revision sources may teach 2015 drug doses and sequences. The 2021 update is the current standard for adult ALS, paediatric ALS and neonatal life support.
2. Toxicology nomograms — paracetamol thresholds at 4h vs staggered ingestion vs unknown timing. Salicylate level for dialysis. Sodium-channel blocker management (sodium bicarbonate). Commonly muddled under time pressure.
3. Distinguishing the acutely confused — recognising delirium vs hypoxia vs hypoglycaemia vs intoxication vs Wernicke vs head injury vs encephalitis. ABCDE plus targeted workup.
4. Paediatric drug calculations under pressure — 10 mcg/kg adrenaline IM, 20 mcg/kg atropine, suxamethonium 1-2 mg/kg, weight-based fluid resuscitation (10ml/kg in trauma, 20ml/kg in sepsis).
5. TIA vs stroke vs mimics — when to thrombolyse (eligibility criteria, exclusion criteria), the importance of NIHSS scoring, ABCD2 (now less central), recognising posterior circulation strokes.
6. Trauma triage — ATLS principles, recognising tension pneumothorax (clinical not imaging), recognising flail chest and pulmonary contusion, AAA presentation in older adults.
7. Mental Health Act — recognising when ED staff can use Section 5(2) (doctor's holding power) vs awaiting psychiatric review. Capacity for refusal of urgent treatment.
8. Statistics in EM — sensitivity/specificity of D-dimer at different pre-test probabilities, troponin thresholds, recognising the limits of imaging modalities (CT-PA, contrast-CT, US).

A pragmatic phased approach used by recent UK EM trainees passing the MRCEM SBA.

1. Weeks 1–4

   Foundation pass across all 13 blueprint topics. 30-40 questions/day with the iatroX adaptive engine. Read the RCEM Learning portal alongside weak topics. Daily ECG and image interpretation.

2. Weeks 5–8

   Targeted weak-area drilling. Map current RCEM clinical guidelines (sepsis, paediatric sepsis, major haemorrhage, ACS, stroke), Resus Council UK 2021 algorithms. Daily toxicology and drug calculation practice.

3. Weeks 9–10

   Two timed 180-question mock papers under exam conditions weekly. Review every incorrect answer in detail. Practise pacing — 60 seconds per question over a 3-hour paper requires deliberate stamina training.

4. Weeks 11–12

   Bookmark review only. Light reading on toxicology, mental health in ED and trauma protocols. Confirm Pearson VUE booking and admission documentation. Sleep, hydrate, do not learn new material.

Dedicated MRCEM SBA question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

The full MRCEM SBA question bank is free. The daily sample allowance for paid banks does not limit this free bank. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.

Three sittings per year — typically February, June and October. Application windows open ~10-12 weeks before each sitting via the RCEM exams portal. Confirm 2026 dates and application windows on the RCEM website.

180 single-best-answer items in 3 hours (~1 minute per question). Computer-based at Pearson VUE test centres worldwide. Mapped to the RCEM 2021 curriculum across the entire breadth of adult, paediatric and major-incident emergency medicine.

Most UK candidates sit during ACCS-EM CT2 or ST3 of EM specialty training. International candidates can sit at any time meeting RCEM eligibility. There is no formal minimum experience requirement.

MRCEM Primary is the basic-sciences component (separate exam). MRCEM SBA is the knowledge component (this exam). MRCEM OSCE is the clinical skills component. All three must be passed for full MRCEM. FRCEM is the higher fellowship exam taken later in training (separate SBA and SAQ components).

Approximately £350 for UK candidates and £500 for international candidates. RCEM reviews fees annually. Confirm current fees on the RCEM website.

iatroX MRCEM SBA questions are written by UK emergency physicians, mapped to the RCEM 2021 curriculum and clinical guidelines. They emphasise the FY2/ST3 EM standard. The bank is updated when RCEM publishes new clinical guidance or curriculum updates.