100+ Free ACEM Primary Practice Questions

Pass your ACEM Primary Examination (FACEM basic sciences) exam on the first try — instant access, no signup required.

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2026 Statistics

Key Facts: ACEM Primary Exam

4 basic sciences

The Primary Examination tests Anatomy, Physiology, Pharmacology and Pathology

ACEM FACEM Curriculum

Up to 360 MCQs

Primary Written Examination has up to 360 single-best-answer questions in total

ACEM - Examinations

2 x 3-hour papers

The written exam is two 3-hour multiple-choice papers held over one day

ACEM - Examinations

About 25% each

Each of the four basic sciences forms roughly a quarter of the examination

ACEM Primary Exam Multiple Choice Subject Matrices

AUD $2,400

Primary Examination - written fee for the 2026 training year

ACEM - Fees and payments

3 attempts

Maximum number of attempts permitted at the Primary Examination

ACEM - Examinations

Angoff standard

Passing score set by Angoff criterion-referenced standard setting, no fixed cut-off

ACEM - Standard setting and results

100

Free original single-best-answer practice questions here

OpenExamPrep

The ACEM Primary Examination is the basic-sciences barrier for trainees in the Australasian College for Emergency Medicine FACEM Training Program. The Primary Written Examination is an online test of up to 360 single-best-answer multiple-choice questions, delivered as two 3-hour papers over one day, covering Anatomy, Physiology, Pharmacology and Pathology at roughly 25% each. There is no fixed pass mark; the standard is set with the Angoff method, and candidates get a maximum of three attempts. The 2026 written-exam fee is AUD $2,400. This 100-question bank provides original single-best-answer practice across all four basic sciences in an emergency-medicine context.

Sample ACEM Primary Practice Questions

Try these sample questions to test your ACEM Primary exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A patient needs emergency cricothyroidotomy. The cricothyroid membrane is bounded above and below by which two cartilages?

A.Hyoid bone above and thyroid cartilage below

B.Thyroid cartilage above and cricoid cartilage below

C.Cricoid cartilage above and first tracheal ring below

D.Epiglottis above and thyroid cartilage below

Explanation: The cricothyroid membrane lies between the thyroid cartilage superiorly and the cricoid cartilage inferiorly. It is the target for emergency surgical airway because it is relatively avascular and superficial in the anterior midline of the neck.

2During internal jugular central line insertion at the apex of the triangle formed by the two heads of sternocleidomastoid, the internal jugular vein usually lies in which relationship to the internal carotid artery?

A.Directly posterior to the artery

B.Medial to the artery

C.Lateral and slightly anterior to the artery

D.Within the carotid sheath but inferior to the artery

Explanation: At the level used for cannulation the internal jugular vein typically lies lateral and slightly anterior to the internal carotid artery within the carotid sheath. This relationship guides needle direction and explains why the artery can be punctured if the needle is angled too medially.

3A patient has a mid-shaft humeral fracture and develops wrist drop. Which nerve has most likely been injured?

A.Median nerve

B.Ulnar nerve

C.Radial nerve

D.Axillary nerve

Explanation: The radial nerve runs in the spiral (radial) groove of the humerus and is at risk with mid-shaft fractures. Injury produces wrist drop because the radial nerve supplies the wrist and finger extensors.

4Anterior shoulder dislocation classically risks injury to which nerve, tested by sensation over the 'regimental badge' area of the lateral shoulder?

A.Suprascapular nerve

B.Axillary nerve

C.Musculocutaneous nerve

D.Long thoracic nerve

Explanation: The axillary nerve winds around the surgical neck of the humerus and supplies deltoid and teres minor, plus sensation over the lateral shoulder (regimental badge area). It is at risk in anterior dislocation and surgical neck fractures.

5When performing a chest drain in the 'safe triangle', the intercostal neurovascular bundle is best avoided by inserting the drain in which position relative to the rib?

A.Just below the upper rib of the space

B.Just above the lower rib of the space

C.In the middle of the intercostal space

D.Directly over the lower rib

Explanation: The main intercostal neurovascular bundle runs in the costal groove on the underside of each rib. To avoid it, the drain is inserted just above the lower rib of the intercostal space, where the bundle is most protected.

6The 'safe triangle' for intercostal catheter insertion is bordered anteriorly by the lateral edge of which muscle?

A.Latissimus dorsi

B.Pectoralis major

C.Serratus anterior

D.Trapezius

Explanation: The safe triangle is bounded anteriorly by the lateral border of pectoralis major, posteriorly by the lateral border of latissimus dorsi, inferiorly by a line at the level of the nipple/5th intercostal space, with the apex below the axilla. This avoids major vessels, the heart and the diaphragm.

7On a supine trauma CT, free fluid from a ruptured spleen in an adult most commonly first collects in which dependent recess?

A.Subphrenic space

B.Hepatorenal recess (Morrison's pouch)

C.Rectovesical pouch

D.Lesser sac

Explanation: In the supine patient the hepatorenal recess (Morrison's pouch) is the most dependent part of the upper abdominal peritoneal cavity, so free fluid tends to collect there. This is the classic FAST window for detecting haemoperitoneum.

8A femoral nerve block is performed for a fractured neck of femur. At the groin, the femoral nerve lies in which position relative to the femoral artery?

A.Medial to the artery

B.Lateral to the artery

C.Directly anterior to the artery

D.Posterior to the femoral vein

Explanation: From medial to lateral the femoral structures are arranged Vein, Artery, Nerve (mnemonic VAN). The femoral nerve therefore lies lateral to the femoral artery, outside the femoral sheath, which is the target for a femoral nerve block.

9A knee dislocation is reduced in the emergency department. Which artery is most at risk of injury and mandates assessment of distal perfusion?

A.Femoral artery

B.Popliteal artery

C.Anterior tibial artery

D.Peroneal artery

Explanation: The popliteal artery is relatively tethered at the adductor hiatus proximally and the soleal arch distally, so it is at high risk of intimal tear or occlusion with knee dislocation. Distal pulses and ankle-brachial index should be assessed and arterial injury actively excluded.

10A patient cannot dorsiflex the foot or extend the toes and has sensory loss in the first dorsal web space after a fibular neck injury. Which nerve is injured?

A.Tibial nerve

B.Common fibular (peroneal) nerve

C.Superficial fibular nerve

D.Sural nerve

Explanation: The common fibular (peroneal) nerve winds around the neck of the fibula and is easily injured there. Injury causes foot drop (loss of dorsiflexion and toe extension) and sensory loss including the first dorsal web space, which is the autonomous zone of the deep fibular branch.

About the ACEM Primary Exam

The ACEM Primary Examination is the basic-sciences barrier examination of the FACEM Training Program run by the Australasian College for Emergency Medicine. Its objective is to confirm that emergency medicine trainees possess the required knowledge of the four basic medical sciences - Anatomy, Pathology, Physiology and Pharmacology - that underpin the practice of emergency medicine. The Primary Written Examination is conducted online as two 3-hour multiple-choice (single-best-answer) papers totalling up to 360 questions, with each of the four subjects making up approximately a quarter of the examination. Trainees who pass the written paper progress to the separately assessed integrated viva. The passing standard is set using the Angoff method rather than a fixed percentage, and candidates are allowed a maximum of three attempts.

Assessment

Online integrated written examination of up to 360 single-best-answer multiple-choice questions, delivered as two 3-hour papers of up to 180 questions each, covering Anatomy, Physiology, Pharmacology and Pathology (each about 25%).

Time Limit

6 hours of written examination in total: two 3-hour papers held over the course of one day.

Passing Score

No fixed percentage cut-off. The passing standard is determined by the Angoff criterion-referenced standard-setting method based on the minimum competency required for safe emergency-medicine practice.

Exam Fee

Primary Examination - written: AUD $2,400 for the 2026 training year (the integrated viva is charged separately at AUD $2,660). (Australasian College for Emergency Medicine (ACEM))

ACEM Primary Exam Content Outline

25%

Anatomy

Applied anatomy with a strong emphasis on the upper and lower limbs, plus head, neck and CNS, thorax and abdomen/pelvis. Candidates need surface and clinical anatomy relevant to procedures, injury patterns and the interpretation of emergency X-ray and CT imaging.

25%

Physiology

Integrated physiology weighted toward the heart and circulation, respiratory and renal systems, with cellular function, nervous, endocrine and body-fluid physiology. Practice emphasises shock, oxygen delivery, acid-base balance and compensatory responses seen in emergency patients.

25%

Pharmacology

General pharmacology (pharmacokinetics and pharmacodynamics) plus cardiovascular, nervous-system, antimicrobial and analgesic/anti-inflammatory agents. Practice focuses on resuscitation drugs, analgesia and sedation, antiarrhythmics, vasoactive agents and toxicology-relevant pharmacology.

25%

Pathology

General pathology covering cellular injury, tissue response to injury and inflammation, fluid and haemodynamic disorders, immunity, neoplasia, infectious diseases, haematology and systemic pathology of conditions commonly seen in emergency medicine.

How to Pass the ACEM Primary Exam

What You Need to Know

Passing score: No fixed percentage cut-off. The passing standard is determined by the Angoff criterion-referenced standard-setting method based on the minimum competency required for safe emergency-medicine practice.
Assessment: Online integrated written examination of up to 360 single-best-answer multiple-choice questions, delivered as two 3-hour papers of up to 180 questions each, covering Anatomy, Physiology, Pharmacology and Pathology (each about 25%).
Time limit: 6 hours of written examination in total: two 3-hour papers held over the course of one day.
Exam fee: Primary Examination - written: AUD $2,400 for the 2026 training year (the integrated viva is charged separately at AUD $2,660).

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ACEM Primary Study Tips from Top Performers

1Map your study to the official MCQ subject matrices: anatomy is dominated by upper and lower limb, physiology by heart/circulation and respiratory, pharmacology by cardiovascular and nervous-system drugs, and pathology by tissue response, infection and haemodynamic disorders.

2Drill applied anatomy with imaging: practise identifying structures on plain X-rays and CT of the head, thorax and abdomen, because the exam emphasises anatomy needed for emergency imaging and procedures.

3Build a strong physiology core around oxygen delivery, acid-base balance and shock, then layer renal, cardiac and respiratory regulation on top so you can reason through integrated emergency scenarios.

4Learn pharmacology by drug class and mechanism rather than rote lists; concentrate on resuscitation drugs, analgesia and sedation, antiarrhythmics, vasoactive agents and common toxicology antidotes.

5For pathology, master the general principles first - cellular injury, inflammation, healing, immunity and neoplasia - before applying them to specific emergency-relevant diseases.

6Sit timed single-best-answer questions across all four subjects so you can keep pace with up to 180 questions per 3-hour paper and avoid spending too long on any one item.

Frequently Asked Questions

What does the ACEM Primary Examination test?

It tests the four basic medical sciences that underpin emergency medicine: Anatomy, Physiology, Pharmacology and Pathology. Each subject makes up approximately 25% of the examination. Clinical and viva components belong to later exams, not the Primary written paper.

How is the Primary Written Examination structured?

It is an online integrated written examination of up to 360 single-best-answer multiple-choice questions, delivered as two 3-hour papers of up to 180 questions each, held over the course of one day.

Is there a fixed pass mark for the ACEM Primary Examination?

No. The passing standard is set using the Angoff criterion-referenced standard-setting method, based on the minimum competency required for safe practice rather than a fixed percentage cut-off.

How much does the ACEM Primary written examination cost?

For the 2026 training year the Primary Examination - written fee is AUD $2,400, the same in Australia and Aotearoa New Zealand/overseas. The integrated viva is charged separately.

How many times can I attempt the ACEM Primary Examination?

Candidates are allowed a maximum of three attempts at the Primary Examination. It is held at centres in Adelaide, Auckland, Brisbane, Melbourne, Perth and Sydney.

Are these official ACEM practice questions?

No. These are original OpenExamPrep questions modelled on the four-subject matrix of the Primary Written Examination. ACEM publishes the official syllabus, MCQ subject matrices and Guide to the Primary Examination separately.