100+ Free MRCEM Intermediate SBA Practice Questions

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A team is debriefing after an unsuccessful resuscitation. Which factor is the most important determinant of survival in out-of-hospital cardiac arrest and should be emphasised in community education?

Early bystander CPR and early defibrillation

The duration of post-arrest hospital stay

The brand of defibrillator used

The use of high-dose adrenaline

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Sample MRCEM Intermediate SBA Practice Questions

Try these sample questions to test your MRCEM Intermediate SBA 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 presents with central crushing chest pain. His ECG shows ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?

A.Left anterior descending artery

B.Right coronary artery

C.Left circumflex artery

D.Left main stem

Explanation: An inferior STEMI (ST elevation in II, III and aVF) is most commonly caused by occlusion of the right coronary artery, which supplies the inferior wall in the majority of people. Inferior MIs may be associated with bradyarrhythmias and right ventricular involvement.

2A 24-year-old woman presents with acute severe asthma. After initial salbutamol and ipratropium nebulisers and oral prednisolone she remains tachypnoeic with a PEF of 40% predicted. According to BTS/SIGN guidance, what is the most appropriate next pharmacological step?

A.Intravenous aminophylline loading dose

B.Subcutaneous adrenaline

C.Intravenous magnesium sulphate

D.Intravenous hydrocortisone in addition to oral prednisolone

Explanation: A single dose of intravenous magnesium sulphate (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 senior/critical care input is sought.

3A 30-year-old man is brought in after collapsing at a wedding having eaten canapes. He has facial swelling, widespread urticaria, wheeze and a blood pressure of 78/40 mmHg. What is the correct first-line treatment and route?

A.Intravenous adrenaline 1 mg (10 mL of 1:10,000)

B.Intramuscular chlorphenamine 10 mg

C.Intravenous hydrocortisone 200 mg

D.Intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000)

Explanation: Anaphylaxis is treated with intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh, repeated after 5 minutes if there is no improvement. IM adrenaline is the single most important intervention and should be given without delay.

4A 55-year-old woman with type 2 diabetes presents drowsy with a capillary glucose of 41 mmol/L, no significant ketonaemia, and a calculated serum osmolality of 340 mOsm/kg. What is the most appropriate initial intravenous fluid?

A.0.9% sodium chloride

B.5% dextrose

C.Hartmann's solution with added potassium

D.0.45% sodium chloride

Explanation: This is hyperosmolar hyperglycaemic state (HHS). The mainstay of initial treatment is 0.9% sodium chloride to restore circulating volume and gradually lower osmolality; fluid replacement alone often reduces glucose, and insulin is started cautiously only when glucose stops falling with fluid or if significant ketonaemia is present.

5A 22-year-old man presents with a sudden severe occipital headache, described as 'the worst headache of my life', that peaked within seconds. A CT head performed 4 hours after onset is reported as normal. What is the most appropriate next step?

A.Discharge with simple analgesia and safety-netting

B.Lumbar puncture at least 12 hours after symptom onset

C.Immediate CT cerebral venography

D.Commence oral nimodipine and admit

Explanation: CT is highly sensitive for subarachnoid haemorrhage in the first 6 hours but sensitivity falls thereafter. When clinical suspicion remains, a lumbar puncture performed at least 12 hours after symptom onset allows detection of xanthochromia by spectrophotometry, which distinguishes true SAH from a traumatic tap.

6A 40-year-old man presents with a painful, red, swollen first metatarsophalangeal joint. Joint aspiration shows negatively birefringent needle-shaped crystals under polarised light. Which medication is most appropriate first-line if not contraindicated?

A.Allopurinol

B.Intravenous antibiotics

C.A non-steroidal anti-inflammatory drug such as naproxen

D.Oral methotrexate

Explanation: The findings are diagnostic of acute gout (monosodium urate crystals are negatively birefringent and needle-shaped). First-line treatment of an acute flare is an NSAID such as naproxen, with colchicine or a corticosteroid as alternatives where NSAIDs are contraindicated.

7A 65-year-old man on warfarin for atrial fibrillation presents with melaena and an INR of 8.5 but no active major bleeding. What is the most appropriate management of his anticoagulation?

A.Stop warfarin and give 1-3 mg oral or slow IV vitamin K

B.Continue warfarin and recheck INR in 24 hours

C.Give fresh frozen plasma alone

D.Stop warfarin and give intravenous vitamin K plus prothrombin complex concentrate

Explanation: This patient has clinically significant (major) bleeding with melaena on a high INR. Major bleeding on warfarin is managed by stopping warfarin and giving prothrombin complex concentrate (PCC) for rapid reversal plus intravenous vitamin K, which sustains the correction once PCC has worn off.

8A 19-year-old student presents with fever, photophobia, neck stiffness and a non-blanching purpuric rash. He is alert with a blood pressure of 110/70 mmHg. After taking blood cultures, what is the most appropriate immediate antibiotic?

A.Intravenous ceftriaxone

B.Oral amoxicillin

C.Intravenous vancomycin alone

D.Intravenous metronidazole

Explanation: This presentation suggests meningococcal meningitis/septicaemia. Empirical treatment in adults is intravenous ceftriaxone (or cefotaxime), which covers Neisseria meningitidis and Streptococcus pneumoniae and should be given without delay once blood cultures are taken.

9A 70-year-old woman presents with sudden painless loss of vision in one eye. Fundoscopy reveals a pale retina with a 'cherry-red spot' at the macula. What is the most likely diagnosis?

A.Central retinal vein occlusion

B.Central retinal artery occlusion

C.Vitreous haemorrhage

D.Acute angle-closure glaucoma

Explanation: A pale oedematous retina with a cherry-red spot at the fovea is the classic appearance of central retinal artery occlusion. It causes sudden, painless, profound monocular visual loss and is an ophthalmological emergency.

10A 45-year-old man presents with severe colicky left loin-to-groin pain and microscopic haematuria. A non-contrast CT KUB confirms a 4 mm stone at the vesicoureteric junction with no obstruction or infection. He is haemodynamically stable. What is the most appropriate management?

A.Immediate referral for emergency ureteroscopy

B.Urgent percutaneous nephrostomy

C.Analgesia (e.g. a NSAID) and conservative management with likely spontaneous passage

D.Commence intravenous antibiotics and admit

Explanation: Stones less than 5 mm usually pass spontaneously. With no infection or obstruction, management is effective analgesia (a NSAID such as diclofenac is first-line) and conservative outpatient follow-up, with advice to return if fever or uncontrolled pain develops.

About the MRCEM Intermediate SBA Exam

The MRCEM Intermediate SBA is the second of three MRCEM components and replaced the FRCEM Intermediate SAQ in 2021. It is a 180-question single-best-answer theory paper mapped to the RCEM 2021 Emergency Medicine curriculum, testing applied clinical decision-making across resuscitation, acute presentations, trauma, paediatrics and EM specialty areas.

Assessment

180 Single Best Answer (SBA) questions in two papers of 90 questions, sat on the same day with a 1-hour break. Mapped to SLO 1 and SLO 3-7 of the RCEM 2021 curriculum.

Time Limit

4 hours total (two 2-hour papers plus a 1-hour break)

Passing Score

Variable pass mark set per diet using the Angoff method plus one standard error of measurement (e.g. 106/180 in Feb 2022, 117/180 in Jan 2025). No negative marking.

Exam Fee

2026 approx GBP 429 (Member UK), GBP 485 (Member International), GBP 525 (Non-member UK), GBP 609 (Non-member International); confirm current fees on the RCEM exam calendar. (Royal College of Emergency Medicine (RCEM))

MRCEM Intermediate SBA Exam Content Outline

31%

SLO 1: Complex stable patient

Undifferentiated medical presentations spanning cardiology, respiratory, neurology, endocrinology, toxicology, infectious diseases and other specialty areas (55 of 180 questions).

22%

SLO 3: Resuscitation

Adult resuscitation and the critically ill patient, shock, reversible causes of arrest, and palliative and end-of-life care, excluding major trauma (40 of 180 questions).

17%

SLO 4: Injured patient

Major and minor trauma, head and spinal injury, fractures, burns and analgesia in the injured patient (30 of 180 questions).

14%

SLO 5: Paediatric emergency medicine

Acutely unwell and injured children, neonatal emergencies and safeguarding in children (25 of 180 questions).

11%

SLO 6: Procedural skills

Airway management, chest drains, pacing, lumbar puncture, joint reduction, POCUS, vascular access, wound care and procedural sedation (20 of 180 questions).

SLO 7: Complex or challenging situations

Capacity and consent, legislation, safeguarding, information governance and organ donation (10 of 180 questions).

How to Pass the MRCEM Intermediate SBA Exam

What You Need to Know

Passing score: Variable pass mark set per diet using the Angoff method plus one standard error of measurement (e.g. 106/180 in Feb 2022, 117/180 in Jan 2025). No negative marking.
Assessment: 180 Single Best Answer (SBA) questions in two papers of 90 questions, sat on the same day with a 1-hour break. Mapped to SLO 1 and SLO 3-7 of the RCEM 2021 curriculum.
Time limit: 4 hours total (two 2-hour papers plus a 1-hour break)
Exam fee: 2026 approx GBP 429 (Member UK), GBP 485 (Member International), GBP 525 (Non-member UK), GBP 609 (Non-member International); confirm current fees on the RCEM exam calendar.

Keys to Passing

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

MRCEM Intermediate SBA Study Tips from Top Performers

1Study by SLO rather than by textbook chapter, and allocate revision time in proportion to the blueprint weightings (the complex stable patient and resuscitation domains together make up more than half the paper).

2Align your knowledge with current UK guidance such as NICE, the BNF and Resuscitation Council UK, since SBA stems test applied management decisions, not pure recall.

3Practise large volumes of timed single-best-answer questions and analyse every incorrect answer, then sit full-length 180-question mocks to build exam stamina across the two papers.

Frequently Asked Questions

Is the MRCEM Intermediate SBA the same as the FRCEM Intermediate?

Yes. The MRCEM Intermediate SBA replaced the FRCEM Intermediate SAQ in the second half of 2021 and is the current name. It is mapped to the RCEM 2021 Emergency Medicine curriculum (Specialty Learning Outcomes SLO 1 and SLO 3-7).

How many questions are on the MRCEM Intermediate SBA and how long is it?

The exam has 180 single-best-answer questions delivered as two 90-question papers, each lasting 2 hours, sat on the same day with a 1-hour break, for a total of about 4 hours of testing.

What is the pass mark for the MRCEM Intermediate SBA?

There is no fixed pass mark. It is set for each diet using the Angoff method plus one standard error of measurement, so it varies with question difficulty. Recent pass marks have been around 106/180 (Feb 2022) and 117/180 (Jan 2025), with no negative marking.

How is the exam blueprinted across the curriculum?

Questions are distributed across SLOs: SLO 1 complex stable patient (55), SLO 3 resuscitation (40), SLO 4 injured patient (30), SLO 5 paediatric emergency medicine (25), SLO 6 procedural skills (20) and SLO 7 complex or challenging situations (10), totalling 180 questions.