100+ Free MRCEM Primary Practice Questions

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The phrenic nerve, which provides the sole motor supply to the diaphragm, arises from which nerve roots?

T1, T2, T3

C1, C2, C3

C3, C4, C5

C5, C6, C7

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Sample MRCEM Primary Practice Questions

Try these sample questions to test your MRCEM 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 sustains a mid-shaft humeral fracture and is unable to extend the wrist and fingers, with sensory loss over the dorsum of the first web space. Which nerve is most likely injured?

A.Ulnar nerve

B.Median nerve

C.Radial nerve

D.Axillary nerve

Explanation: The radial nerve runs in the spiral (radial) groove of the humerus and is the nerve most commonly injured in mid-shaft humeral fractures. It supplies the wrist and finger extensors, so injury produces wrist drop and sensory loss over the dorsal first web space.

2The brachial plexus is formed by the anterior (ventral) rami of which spinal nerves?

A.C3 to C7

B.C5 to T1

C.C4 to T2

D.C6 to T1

Explanation: The brachial plexus is formed by the anterior rami of C5, C6, C7, C8 and T1. These five roots combine into three trunks, six divisions, three cords and five terminal branches.

3Following an axillary lymph node clearance, a patient develops winging of the scapula. Damage to which nerve is responsible?

A.Spinal accessory nerve

B.Thoracodorsal nerve

C.Dorsal scapular nerve

D.Long thoracic nerve

Explanation: The long thoracic nerve (C5, C6, C7) supplies serratus anterior, which holds the scapula against the chest wall. It runs superficially on serratus anterior and is vulnerable during axillary surgery, so injury produces medial winging of the scapula.

4A patient cannot abduct the arm from 15 to 90 degrees after a fall. Which muscle is most likely affected?

A.Supraspinatus

B.Infraspinatus

C.Teres minor

D.Subscapularis

Explanation: Supraspinatus initiates abduction of the arm for approximately the first 15 degrees and, with deltoid, contributes through the mid-range up to about 90 degrees. Rotator cuff tears most often involve supraspinatus, impairing this range.

5A patient presents with a 'claw hand' affecting the 4th and 5th fingers and sensory loss over the medial border of the hand after an elbow injury. Which nerve is injured?

A.Median nerve

B.Radial nerve

C.Ulnar nerve

D.Anterior interosseous nerve

Explanation: The ulnar nerve passes behind the medial epicondyle and is commonly injured at the elbow. It supplies most intrinsic hand muscles; loss produces clawing of the ring and little fingers (ulnar claw) and sensory loss over the medial 1.5 digits.

6Which structure passes through the carpal tunnel deep to the flexor retinaculum?

A.Ulnar nerve

B.Median nerve

C.Palmaris longus tendon

D.Radial artery

Explanation: The carpal tunnel transmits the median nerve and nine flexor tendons (flexor digitorum superficialis x4, flexor digitorum profundus x4, and flexor pollicis longus). Compression of the median nerve here causes carpal tunnel syndrome.

7A patient with an anterior shoulder dislocation has reduced sensation over the lateral aspect of the upper arm ('regimental badge' area) and weak abduction. Which nerve is injured?

A.Radial nerve

B.Musculocutaneous nerve

C.Suprascapular nerve

D.Axillary nerve

Explanation: The axillary nerve (C5, C6) winds around the surgical neck of the humerus and is vulnerable in anterior shoulder dislocation. It supplies deltoid and teres minor and provides 'regimental badge' sensation over the lateral upper arm.

8Which of the following is a content of the cubital fossa, lying most medially?

A.Median nerve

B.Brachial artery

C.Biceps tendon

D.Radial nerve

Explanation: From medial to lateral, the contents of the cubital fossa are the Median nerve, Brachial artery, Biceps tendon and Radial nerve (mnemonic: 'My Blood Turns Red'). The median nerve is therefore the most medial structure.

9A patient develops a foot drop and cannot dorsiflex or evert the foot after a fibular neck fracture. Which nerve is injured?

A.Tibial nerve

B.Femoral nerve

C.Common fibular (peroneal) nerve

D.Sural nerve

Explanation: The common fibular (peroneal) nerve winds around the neck of the fibula where it is superficial and easily injured. It supplies the anterior and lateral compartments of the leg, so injury causes foot drop with loss of dorsiflexion and eversion.

10The femoral nerve, artery and vein pass beneath the inguinal ligament. From lateral to medial, what is their correct order?

A.Vein, artery, nerve

B.Nerve, artery, vein

C.Artery, vein, nerve

D.Nerve, vein, artery

Explanation: From lateral to medial in the femoral triangle, the order is Nerve, Artery, Vein, Empty space, Lymphatics (mnemonic NAVEL). The femoral nerve lies most laterally and is outside the femoral sheath.

About the MRCEM Primary Exam

The MRCEM Primary is the first written examination of the Royal College of Emergency Medicine's MRCEM pathway. It is a 3-hour, 180-question single best answer paper testing basic sciences (anatomy, physiology, pharmacology, microbiology, pathology and evidence-based medicine) mapped to the RCEM Basic Sciences curriculum and the 2021 Emergency Medicine curriculum.

Assessment

A single 3-hour paper of 180 single best answer (SBA) questions covering basic sciences mapped to the RCEM Basic Sciences curriculum.

Time Limit

3 hours

Passing Score

No fixed pass mark; set per diet by the Angoff method. Marking is 1 point per correct answer with no negative marking.

Exam Fee

2026 RCEM fees: Member UK GBP 415, Member International GBP 460, Non-member UK GBP 498, Non-member International GBP 554. Confirm current fees on the RCEM exam calendar. (Royal College of Emergency Medicine (RCEM))

MRCEM Primary Exam Content Outline

33%

Anatomy

Upper limb, lower limb, thorax, abdomen, head and neck, central nervous system and cranial nerves.

33%

Physiology

Cardiovascular, respiratory, renal, endocrine, gastrointestinal, neuromuscular and haematological/immune physiology.

14%

Pharmacology

Pharmacokinetics, pharmacodynamics, drug mechanisms, emergency drugs and toxicology/antidotes per UK BNF practice.

10%

Microbiology

Bacteriology, virology, common emergency infections, antimicrobials and resistance mechanisms.

Pathology

Cellular injury and necrosis, inflammation, thrombosis and atherosclerosis.

Evidence-Based Medicine

Study design, diagnostic test accuracy, basic statistics and critical appraisal.

How to Pass the MRCEM Primary Exam

What You Need to Know

Passing score: No fixed pass mark; set per diet by the Angoff method. Marking is 1 point per correct answer with no negative marking.
Assessment: A single 3-hour paper of 180 single best answer (SBA) questions covering basic sciences mapped to the RCEM Basic Sciences curriculum.
Time limit: 3 hours
Exam fee: 2026 RCEM fees: Member UK GBP 415, Member International GBP 460, Non-member UK GBP 498, Non-member International GBP 554. 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 Primary Study Tips from Top Performers

1Prioritise anatomy and physiology: together they make up roughly two-thirds of the paper, so master the upper limb, lower limb and core organ-system physiology first.

2Use the RCEM Basic Sciences curriculum as your blueprint and practise large volumes of single-best-answer questions under timed conditions (180 questions in 3 hours is about one minute per question).

3Because there is no negative marking, never leave a question blank; make your best-supported choice on every item.

Frequently Asked Questions

How many questions are on the MRCEM Primary exam and how long is it?

The MRCEM Primary is a single 3-hour paper of 180 single best answer (SBA) questions. There is no negative marking; each correct answer scores one mark.

What is the pass mark for MRCEM Primary?

There is no fixed pass mark. RCEM sets the pass mark for each exam diet using the Angoff standard-setting method, so the threshold varies slightly between sittings depending on question difficulty.

Which subjects does MRCEM Primary cover?

It tests basic sciences mapped to the RCEM Basic Sciences curriculum: anatomy and physiology (about one-third each), plus pharmacology, microbiology, pathology and evidence-based medicine.

Who delivers the MRCEM Primary exam?

RCEM delivers its theory exams electronically. From January 2026, Surpass Assessment delivers all RCEM theory exams worldwide, offering both a test-centre network and online invigilation.