100+ Free MRCEM Intermediate SBA Practice Questions
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A 22-year-old man sustains a stab wound to the left chest and is hypotensive with distended neck veins and muffled heart sounds. FAST shows pericardial fluid. What is the most likely diagnosis?
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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 58-year-old man presents with central crushing chest pain for 40 minutes. His ECG shows 2 mm ST elevation in leads II, III and aVF. Which additional ECG leads should be recorded to assess for right ventricular involvement?
2A 24-year-old woman with known asthma presents with breathlessness. She is too breathless to complete sentences, her respiratory rate is 28/min, heart rate 120/min and peak flow is 40% of predicted. According to BTS/SIGN classification, how is this acute asthma attack best categorised?
3A 70-year-old man with a known abdominal aortic aneurysm presents with sudden severe back pain and is hypotensive. He is haemodynamically borderline. What blood pressure target best describes the principle of permissive hypotension while awaiting surgery?
4A 30-year-old woman presents with a unilateral painful red eye, photophobia and blurred vision. Examination shows ciliary flush and an irregular, small pupil. Slit-lamp examination reveals cells and flare in the anterior chamber. What is the most likely diagnosis?
5A 65-year-old man presents with a swollen, hot, tender left first metatarsophalangeal joint. Joint aspiration shows negatively birefringent needle-shaped crystals under polarised light microscopy. Which is the most appropriate first-line treatment if he has stable chronic kidney disease (eGFR 35)?
6A 45-year-old man with type 1 diabetes presents unwell. Capillary blood glucose is 28 mmol/L, capillary ketones 4.5 mmol/L and venous pH 7.18 with bicarbonate 12 mmol/L. After starting 0.9% sodium chloride, what is the recommended fixed-rate intravenous insulin infusion rate for diabetic ketoacidosis in adults?
7A 22-year-old man presents with a 2-day history of severe sore throat, trismus and a muffled hot-potato voice. Examination shows unilateral peritonsillar swelling with deviation of the uvula to the opposite side. What is the most appropriate immediate management?
8A 35-year-old woman presents with a sudden severe occipital headache that reached maximum intensity within seconds (thunderclap). CT head performed 4 hours after onset is reported as normal. What is the most appropriate next step to exclude subarachnoid haemorrhage?
9A 28-year-old woman presents 6 weeks after her last menstrual period with lower abdominal pain and light vaginal bleeding. A urine pregnancy test is positive. Transvaginal ultrasound shows an empty uterus and a small adnexal mass with no fetal heartbeat; serum beta-hCG is 1800 IU/L. What is the most likely diagnosis?
10A 60-year-old man with metastatic prostate cancer presents with progressive bilateral leg weakness, urinary retention and a sensory level at the umbilicus. Which investigation and treatment combination is most appropriate?
About the MRCEM Intermediate SBA Exam
The MRCEM Intermediate SBA is the second of the three MRCEM components, assessing applied emergency medicine knowledge through 180 single best answer questions across two papers. It is blueprinted to Year 1-3 Specialty Learning Outcomes (SLOs) of the RCEM 2021 Emergency Medicine curriculum and replaced the FRCEM Intermediate SAQ in August 2021.
Assessment
180 single best answer questions in two 90-question papers (2 hours each) sat on the same day, with a 1-hour break. Mapped to Year 1-3 Specialty Learning Outcomes of the RCEM 2021 EM curriculum.
Time Limit
4 hours total (two 2-hour papers plus a 1-hour break)
Passing Score
Variable pass mark set by modified Angoff plus one standard error of measurement; e.g. 117/180 in January 2025. No negative marking.
Exam Fee
2026: approx GBP 429 (Member UK) to GBP 609 (Non-member International), depending on membership and location. Check the RCEM exam calendar for current fees. (Royal College of Emergency Medicine (RCEM))
MRCEM Intermediate SBA Exam Content Outline
SLO1 Complex stable patient
~60/180 questions covering cardiology, respiratory, neurology, endocrine, GI, toxicology, environmental, ENT, ophthalmology, O&G and oncological emergencies in the stable but complex patient.
SLO3 Resuscitate
~40/180 questions on ALS and peri-arrest care, sepsis, organ failure (excluding major trauma) and palliative/end-of-life care.
SLO4 Injured patient
~30/180 questions on major trauma and other injury presentations, including pain and sedation and major and minor injury management.
SLO5 Paediatric Emergency Medicine
~25/180 questions across paediatric clinical categories plus neonatal emergencies and safeguarding.
SLO6 Procedural skills
~10/180 questions on procedural skills and basic anaesthetic care: airway, chest drain, pacing, sedation, POCUS, vascular access and wound management.
SLO7 Complex or challenging situations
~15/180 questions on legislation, organ/tissue donation, information governance, safeguarding, and evidence and guidelines.
How to Pass the MRCEM Intermediate SBA Exam
What You Need to Know
- Passing score: Variable pass mark set by modified Angoff plus one standard error of measurement; e.g. 117/180 in January 2025. No negative marking.
- Assessment: 180 single best answer questions in two 90-question papers (2 hours each) sat on the same day, with a 1-hour break. Mapped to Year 1-3 Specialty Learning Outcomes of the RCEM 2021 EM curriculum.
- Time limit: 4 hours total (two 2-hour papers plus a 1-hour break)
- Exam fee: 2026: approx GBP 429 (Member UK) to GBP 609 (Non-member International), depending on membership and location. Check the RCEM exam calendar for current fees.
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
Frequently Asked Questions
How many questions are on the MRCEM Intermediate SBA and how long is it?
The exam has 180 single best answer (SBA) questions delivered as two 2-hour papers of 90 questions each, sat on the same day with a 1-hour break, giving 4 hours of testing time.
What is the pass mark for the MRCEM Intermediate SBA?
There is no fixed pass mark. RCEM uses a modified Angoff standard-setting method plus one standard error of measurement, so the pass mark changes each diet (for example it was 117 out of 180 in January 2025). There is no negative marking.
What is the MRCEM Intermediate SBA blueprint?
Questions are blueprinted to six Specialty Learning Outcomes from the RCEM 2021 curriculum: SLO1 complex stable patient (~60), SLO3 resuscitate (~40), SLO4 injured patient (~30), SLO5 paediatric EM (~25), SLO6 procedural skills (~10) and SLO7 complex/challenging situations (~15).
Who runs the exam and how is it delivered?
The Royal College of Emergency Medicine (RCEM) runs the MRCEM Intermediate SBA. It is a computer-based theory exam; from 2026 RCEM delivers its written exams through Surpass Assessment test centres worldwide (previously via Pearson VUE).