100+ Free FRCEM SBA (Final) Practice Questions

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A 67-year-old man presents with a productive cough, fever and confusion. His observations show a respiratory rate of 32, BP 88/56, and his blood urea is 8 mmol/L. Using CURB-65 for community-acquired pneumonia, which scoring band would mandate consideration of intensive care assessment?

A CURB-65 score of 4–5

A CURB-65 score of 0

Presence of a productive cough

A normal chest radiograph

to track

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Sample FRCEM SBA (Final) Practice Questions

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

1A 68-year-old man attends the ED with central chest pain. ECG shows new left bundle branch block and he is haemodynamically stable. Using the Sgarbossa criteria, which ECG finding is MOST specific for acute myocardial infarction in the presence of LBBB?

A.Concordant ST elevation ≥1 mm in a lead with a positive QRS

B.Discordant ST depression ≥1 mm in lead V1 only

C.T-wave inversion in the lateral leads

D.QRS duration greater than 160 ms

Explanation: Concordant ST elevation ≥1 mm (ST deviation in the same direction as the main QRS deflection) is the most specific Sgarbossa criterion for acute MI in LBBB, scoring 5 points. It indicates ischaemic ST change that overrides the expected discordant repolarisation of LBBB.

2A 24-year-old woman presents with acute severe asthma. After initial salbutamol and ipratropium nebulisers and IV hydrocortisone she remains tachypnoeic with a PEF of 33% predicted. According to BTS/NICE/SIGN guidance, which is the MOST appropriate next pharmacological step?

A.IV aminophylline loading dose

B.Subcutaneous adrenaline 0.5 mg

C.Oral montelukast 10 mg

D.IV magnesium sulfate 1.2–2 g over 20 minutes

Explanation: A single dose of IV magnesium sulfate (1.2–2 g over 20 minutes) is recommended for acute severe or life-threatening asthma that has not responded adequately to initial inhaled bronchodilators and steroids. It is given after, or alongside, continued back-to-back nebulisers and senior/critical-care review.

3A 55-year-old man with a known history of alcohol excess presents with confusion and ataxia. You suspect Wernicke's encephalopathy. Which is the MOST appropriate initial management?

A.Oral thiamine 100 mg once daily

B.IV glucose 10% before any thiamine

C.IV high-dose B-vitamin complex (e.g. Pabrinex) before or with glucose

D.CT head before commencing any treatment

Explanation: Suspected Wernicke's encephalopathy requires prompt parenteral high-dose thiamine (as Pabrinex). Thiamine should be given before or together with glucose, because a glucose load in a thiamine-deplete patient can precipitate or worsen Wernicke's encephalopathy.

4A 30-year-old woman presents with a 3-day history of headache, photophobia and neck stiffness. She is alert with no focal neurology and no rash. CT head is normal. Lumbar puncture is performed 12 hours after symptom onset. Which CSF finding would MOST strongly support a diagnosis of subarachnoid haemorrhage rather than a traumatic tap?

A.A red cell count that falls progressively between bottle 1 and bottle 3

B.Xanthochromia on spectrophotometry

C.A clear, colourless supernatant

D.Presence of crenated red cells on microscopy

Explanation: Xanthochromia, detected by spectrophotometry of the CSF supernatant, results from breakdown of red cells to bilirubin and supports subarachnoid haemorrhage. It develops several hours after the bleed, which is why LP is recommended at least 12 hours after symptom onset.

5A 72-year-old woman on warfarin for atrial fibrillation presents after a minor fall. Her INR is 8.5 but she has no evidence of bleeding. According to BNF/BCSH guidance, what is the MOST appropriate management?

A.Give IV vitamin K 5 mg and prothrombin complex concentrate

B.Withhold warfarin and give oral vitamin K 1–5 mg

C.Continue warfarin at the same dose and recheck INR in one week

D.Give fresh frozen plasma 15 mL/kg

Explanation: For an INR above 8.0 with no bleeding, guidance recommends stopping warfarin and giving small-dose oral vitamin K (1–5 mg), then rechecking the INR. This corrects the coagulopathy without over-reversing or exposing the patient to blood-product risks.

6A 19-year-old man presents with a painful, swollen left testicle for 4 hours. The pain began suddenly and he has vomited. On examination the testis is high-riding with an absent cremasteric reflex. What is the MOST appropriate immediate action?

A.Arrange an urgent outpatient ultrasound and discharge with analgesia

B.Prescribe oral antibiotics for suspected epididymo-orchitis

C.Attempt manual detorsion and reassess in 24 hours

D.Refer urgently to urology for emergency surgical exploration

Explanation: This is a classic presentation of testicular torsion, which is a surgical emergency. Immediate urology referral for scrotal exploration is required because testicular viability falls rapidly after about 6 hours; imaging must not delay surgery when clinical suspicion is high.

7A 45-year-old man presents with a severe, unilateral, retro-orbital headache lasting 45 minutes with ipsilateral lacrimation, nasal congestion and restlessness. He has had several similar attacks daily for two weeks. Which is the MOST appropriate acute treatment?

A.Oral sumatriptan 50 mg

B.High-flow oxygen 12–15 L/min via non-rebreathe mask

C.Oral propranolol 80 mg

D.Intramuscular chlorpromazine

Explanation: This is cluster headache. High-flow 100% oxygen (12–15 L/min via a non-rebreathe mask) is a first-line acute abortive treatment and aborts attacks in many patients within 15–20 minutes. Subcutaneous or intranasal triptans are the other first-line options.

8A 62-year-old man with type 2 diabetes presents with confusion and a capillary glucose of 38 mmol/L. He is profoundly dehydrated. Blood gas shows pH 7.34, bicarbonate 20 mmol/L and only trace ketones. Calculated serum osmolality is 340 mosmol/kg. What is the MOST important initial fluid management priority?

A.Rapid IV insulin infusion at 0.1 units/kg/hour

B.IV 0.9% sodium chloride to replace fluid deficit gradually

C.IV 8.4% sodium bicarbonate to correct acidosis

D.IV 5% glucose to prevent hypoglycaemia

Explanation: This is hyperosmolar hyperglycaemic state (HHS): marked hyperglycaemia, raised osmolality, minimal ketosis and near-normal pH. The priority is gradual rehydration with 0.9% sodium chloride to restore circulating volume and lower osmolality slowly; insulin is introduced cautiously (often only once glucose stops falling with fluids alone).

9A 78-year-old woman presents with sudden painless loss of vision in her right eye. Fundoscopy shows a pale retina with a cherry-red spot at the macula. Which is the MOST likely diagnosis?

A.Central retinal vein occlusion

B.Acute angle-closure glaucoma

C.Vitreous haemorrhage

D.Central retinal artery occlusion

Explanation: A pale oedematous retina with a cherry-red spot at the macula and sudden painless monocular visual loss is characteristic of central retinal artery occlusion. It is an ocular emergency analogous to a stroke and warrants urgent ophthalmology referral and vascular risk assessment.

10A 50-year-old man presents with epigastric pain radiating to the back and vomiting. Serum amylase is markedly raised and a diagnosis of acute pancreatitis is made. Which scoring tool is specifically recommended in UK practice to stratify severity at admission and at 48 hours in acute pancreatitis?

A.CURB-65 score

B.Wells score

C.Glasgow-Imrie score

D.Alvarado score

Explanation: The Glasgow-Imrie score is a validated tool to assess the severity of acute pancreatitis, applied at admission and at 48 hours. A score of 3 or more indicates severe pancreatitis warranting consideration of high-dependency or critical care.

About the FRCEM SBA (Final) Exam

The FRCEM SBA (Final) is the theory component of Fellowship of the Royal College of Emergency Medicine, taken alongside the FRCEM OSCE. It consists of 180 single best answer questions across two papers and is blueprinted to the full RCEM Emergency Medicine 2021 curriculum, including research, management and quality improvement.

Assessment

180 single best answer (SBA) questions delivered as two 90-question papers, blueprinted to the RCEM Emergency Medicine 2021 curriculum across SLOs 1, 3-8 and 10-12.

Time Limit

Two 2-hour papers (4 hours total) on the same day with a one-hour break in between.

Passing Score

Standard set by modified Angoff method plus one standard error of measurement; no negative marking. The October 2024 pass mark was 108 of 180.

Exam Fee

2026: UK member GBP 429, international member GBP 485, UK non-member GBP 525, international non-member GBP 609. (Royal College of Emergency Medicine (RCEM))

FRCEM SBA (Final) Exam Content Outline

19%

SLO1 - Stable complex patients

Acute medical and surgical presentations in stable ED patients across cardiology, respiratory, neurology, toxicology, endocrine and more.

22%

SLO3 - Resuscitation (excluding major trauma)

Adult resuscitation, ALS algorithms, shock, sepsis, anaphylaxis, arrhythmia and end-of-life care.

19%

SLO4 - Injured patients

Major trauma, ATLS, burns, fractures, head injury and wound management.

17%

SLO5 - Paediatric emergency medicine

Children of all ages, neonatal emergencies, paediatric resuscitation and safeguarding.

SLO6 - Procedural skills

Advanced airway, RSI, procedural sedation, chest drains, pacing, vascular access and POCUS.

SLO7 - Complex situations

Legal frameworks, capacity, consent, confidentiality, safeguarding and organ donation.

SLO8/SLO12 - Leadership and management

Leading the ED shift, major incidents, human factors and managing department flow.

SLO10/SLO11 - Research, quality and safety

Research methods, statistics, quality improvement and patient safety/governance.

How to Pass the FRCEM SBA (Final) Exam

What You Need to Know

Passing score: Standard set by modified Angoff method plus one standard error of measurement; no negative marking. The October 2024 pass mark was 108 of 180.
Assessment: 180 single best answer (SBA) questions delivered as two 90-question papers, blueprinted to the RCEM Emergency Medicine 2021 curriculum across SLOs 1, 3-8 and 10-12.
Time limit: Two 2-hour papers (4 hours total) on the same day with a one-hour break in between.
Exam fee: 2026: UK member GBP 429, international member GBP 485, UK non-member GBP 525, international non-member GBP 609.

Keys to Passing

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

FRCEM SBA (Final) Study Tips from Top Performers

1Study by SLO weighting, not by textbook: resuscitation (SLO3), stable complex patients (SLO1) and trauma (SLO4) carry the most questions, but do not neglect the smaller research, QI and management domains that many candidates overlook.

2Ground revision in current UK standards (NICE, BNF, Resuscitation Council UK, BTS and college guidelines), as the exam tests consultant-level application of UK best practice rather than pure recall.

3Practise under timed conditions (roughly 80 seconds per question) using full-length SBA papers to build the stamina needed for two consecutive 90-question papers.

Frequently Asked Questions

How many questions are on the FRCEM SBA (Final) exam?

The FRCEM SBA consists of 180 single best answer questions, presented as two papers of 90 questions, each lasting two hours, with a one-hour break in between.

What is the pass mark for the FRCEM SBA?

There is no predetermined pass mark. The cut score is set using a modified Angoff method, with one standard error of measurement added to create the final pass mark. The October 2024 pass mark was 108 out of 180, and there is no negative marking.

How much does the FRCEM SBA cost in 2026?

In 2026 the fee is GBP 429 for UK members, GBP 485 for international members, GBP 525 for UK non-members and GBP 609 for international non-members.

What curriculum does the FRCEM SBA cover?

It is blueprinted to the full RCEM Emergency Medicine 2021 curriculum, sampling across Specialty Learning Outcomes including resuscitation, trauma, paediatrics, procedural skills, complex situations, leadership and management, and research, quality and safety.