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RCEM FRCEM Exam Overview:
| Aspect | Details |
|---|---|
| Exam Name | RCEM FRCEM (Fellowship of the Royal College of Emergency Medicine) |
| Exam Cost | Varies by location and exam type |
| Total Time | Varies by exam type |
| Available Languages | English |
| Passing Marks | Varies by exam type |
| Eligibility | Completion of relevant training and experience |
| Exam Format | Multiple-choice questions, Objective Structured Clinical Examination (OSCE), Short Answer Questions (SAQ) |
FRCEM Primary Examination Exam Topics Breakdown
| Domain | Percentage | Description |
|---|---|---|
| Clinical | 60% | Covers clinical knowledge, diagnostic skills, management, and decision-making in emergency medicine. |
| Communication | 15% | Assesses communication skills with patients, families, and healthcare teams. |
| Professionalism | 15% | Evaluates professionalism, ethics, legal aspects, and leadership in emergency medicine. |
| Clinical Skills | 10% | Tests practical clinical skills through OSCE stations. |
Frequently Asked Questions
Question # 1
A 32 year old woman presents with dizziness She has been laking medication tor low backpain Blood tests reveal a haemolytic anaemia Which drug is most likely to be responsible?
A. Aspirin
B. Diclofenac
C. Ibuprofen
D. Mefenamic acid
E. Naproxen
Question # 2
A keen cyclist attends the ED complaining of clumsiness and tingling in his right handWhen he attempts to grip paper in his first web space he is only able to achieve this byflexing his right thumb.Innervation of which muscle is most likely compromised?
A. Abductor pollicis brevis
B. Adductor pollicis
C. Extensor pollicis brevis
D. First dorsal interosseous
E. Opponens pollicis
Question # 3
You are teaching a medical student about the knee and discuss the structures that borderthe popliteal fossa Which structure best describes the superolateral boundary of this fossa?
A. Biceps femons
B. Lateral head of gastrocnemius
C. Medial head of gastrocnemius
D. Semimembranosus
E. Semitendinosis
Question # 4
A 14 year old boy presents after a bicycle accident He has a suspected pelvic fracture andthe cremasteric reflex is absent Which nerve is most likely to be affected1?
A. Femoral
B. Genitofemoral
C. Iliohypogastric .
D. Lateral femoral cutaneous
E. Subcostal
Question # 5
You have achieved haemostasis of a wound A medical student asks you about thesubsequent inflammatory response. Which is the predominant cell type in this phase?
A. Fibroblasts
B. Lymphocytes
C. Macrophages
D. Neutrophils
E. Platelets
Question # 6
You are prescribing gentamicin for a patienl. Her serum creatinine level is raised Whichproperty of creatinine best explains why it is used as a marker of glomerular filtration rate?
A. Active secretion by the peritubular capillaries
B. Estimation of the 24 hour excretion rate
C. Free filtration by the glomerulus
D. Indicative of body muscle mass IE.
E. Steady state concentration existence in the blood
Question # 7
A 32 year old builder slips with an angle grinder causing a deep facial wound whichintersects with the inferomedial edge of the orbit and leaves exposed damaged bone.What bone is most likely affected?
A. Ethmoid
B. Maxilla
C. Nasal
D. Sphenoid
E. Zygoma
Question # 8
A 23 year old presents with episodes of a painful left arm which becomes swollen andcyanosed after they have been kayaking Obstruction of which structure is most likely tocause these symptoms'?
A. Axillary vein
B. Brachiocephalic trunk
C. Brachiocephalic vein
D. Subclavian artery
E. Subclavian vein
Question # 9
A 47 year old woman with a diagnosis of pulmonary hypertension attends the ED withbreathlessness An increase in which physiological parameter is the most likelyconsequence of this condition?
A. Left ventricular contractility
B. Pulmonary arterial blood flow
C. Pulmonary venous resistance
D. Right atrial pressure
E. Right ventricular afterload
Question # 10
A 21 year old woman is confirmed to have giardiasisWhich characteristic of this specific parasite best explains its persistent intestinalattachment?
A. Hooks
B. Intestinal mucosa penetration
C. Oral sucker
D. Sucking disc
E. Vacule formation
Question # 11
A 48 year old man presents with a flare up of gout You recommend treatment with a nonsteroidalanti-inflammatory drug (NSAID) He is concerned because his wife suffered apeptic ulcer associated with NSAID useWhich medication would be your first choice NSAID to minimise his risk of gastrointestinalside effects?
A. Diclofenac
B. Ibuprofen
C. Indomethacin
D. Naproxen
E. Piroxicam
Question # 12
You suspect cauda equina syndrome in an 85 year old man with metastatic cancer Onexamination there is loss of anal tone Which myotomes are most likely to be affected andcausing this examination finding?
A. L12
B. L3,4
C. L5
D. S1.2
E. S2, 3, 4
Question # 13
A 21 year old woman attends with an earring becoming lodged in the lobule of her ear Youdecide to perform a nerve block to allow removal of the earringWhich nerve are you most likely to need to block?
A. Auricular branch of vagus
B. Auriculotemporal
C. Greater auricular
D. Lesser occipital
E. Posterior auncular branch of facial
Question # 14
You are teaching a medical student and are discussing how fluid compartment ratios canchange in relation to age and gender You note that some population groups haveproportionally higher total body water which increases the extracellular to intracellular fluidratioWhat population group best demonstrates this?
A. Adult female
B. Adult male
C. Child
D. Elderly
E. Neonate
Question # 15
A 60 year old man with alcoholic liver cirrhosis and portal hypertension is brought to the EDbecause he has been vomiting blood Which vein is the most likely origin of hishaematemesis?
A. Azygos
B. Inferior mesenteric
C. Left gastric
D. Periumbilical
E. Superior vena cava
Question # 16
A five year old girl presents with a fever, a non-blanching rash and drowsiness. Yoususpect meningococcal infection What is most likely mode of spread for this infection?
A. Airborne
B. Blood
C. Droplet
D. Faecal-oral
E. Skin contact
Question # 17
A 21 year old man is diagnosed with diabetic ketoacidosis. A medical student asks you toassist them in calculating the patients blood pH using the Henderson-Hasselbach equation.What best describes the two required constituents for this equation?
A. Bicarbonate and PaC02
B. Bicarbonate and Pa02
C. Bicarbonate and sodium
D. Chloride and PaC02
E. Sodium and calcium
Question # 18
A two year old child presents with a barking cough You suspect croup Which virus is mostlikely to be implicated?
A. Adenovirus
B. Measles
C. Parainfluenza
D. Respiratory syncytial virus
E. Rhinovirus
Question # 19
A patient is brought into the ED unconscious Calculation from the venous blood gasconfirms a low anion gap acidosis What is the most likely cause of this abnormality?
A. Diabetic ketoacidosis
B. Hypoalbummaemia
C. Methanol
D. Rhabdomyolysis
E. Salicylates
Question # 20
A patient with severe renal impairment requires regular opioid analgesia for their pain Youare concerned about opiate accumulation Which drug in this class is most appropriate inthis patient?
A. Codeine
B. Dihydrocodeine
C. Morphine
D. Oxycodone
E. Pethidine
Question # 21
You are treating a patient with a dysrhythmia You are teaching your students about thephases of the cardiac action potential and emphasize the absolute refractory period as ameans of preventing another action potential being generatedWhich factor is most important for this period?
A. Calcium channel activation
B. Potassium channel activation
C. Potassium channel mactivation
D. Sodium channel activation
E. Sodium channel inactivation
Question # 22
An 80 year old man presents to the ED with clinical features suggestive of ischaemic bowelWhich artery is most commonly occluded in this condition?
A. Coeliac
B. Gastroduodenal
C. Inferior mesenteric
D. Left colic
E. Superior mesenteric
Question # 23
A 24 year old woman presents with an abscess over her buttock. Examination revealspalpable groin lymphadenopathy. Which group of lymph nodes are most likely to be initiallyinvolved?
A. Deep inguinal
B. External iliac
C. Inferior superficial
D. Superolateral superficial
E. Superomedial superficial
Question # 24
An 80 year old woman with an extensive cardiac history is diagnosed with aortic stenosisOn auscultation you appreciate an ejection systolic murmur.Which haemodynamic factor is most likely responsible for the audible murmur?
A. Decreased viscosity
B. High blood volume
C. Increased viscosity
D. Laminar flow
E. Turbulent flow
Question # 25
A 32 year old man presents with suspected acute appendicitis A medical student asks youwhat the commonest anatomical position of the appendix isWhat is the most likely position?
A. Paracaecal
B. Postileal
C. Preileal
D. Retrocaecal
E. Subileal
Question # 26
You are conducting a study of children presenting with febrile convulsions. As pari of yourdata collection you record their temperature in degrees Celsius on arrival Which is the best description of this type of data?
A. Discrete
B. Interval
C. Nominal
D. Ordinal
E. Ratio
Question # 27
A four year old boy presents with a cough and fever for the last few weeks which becameworse in the last 24 hours. There is no record of his vaccination history His temperature is38.5°C, heart rate 135 beats per minute, and oxygen saturations are 97% He is coughingfrequently and has bilateral subconjunctival haemorrhages.Which organism is most likely to have caused his condition?
A. Bordetella pertussis
B. Cornebactenum diphthenae
C. Haemophilus influenzae
D. Mycobacterium tuberculosis
E. Respiratory syncytial virus
Question # 28
A 56 year old presents unwell They are diagnosed with a hypertensive crisis. You decide tostart sodium nitroprusside What best describes the mechanism of action of this drug?
A. Antagonises the renm-angiotensm-aldosterone system
B. Decreases angiotensin II
C. Decreases the breakdown of bradykmin
D. Inhibits angiotensin converting enzyme
E. Releases nitric oxide
Question # 29
A 56 year old woman with severe ascites attends the ED with breathlessness Chestauscultation is normal What findings would you expect on spirometry?
A. Increased FEV,/FVC ratio
B. Increased FVC
C. Increased inspiratory capacity
D. Increased total lung capacity
E. Increased vital capacity
Question # 30
A 20 year old woman with known diabetes presents with hypoglycaemia She was givenglucagon with good recovery. Which cells ot the pancreas normally secrete this hormone?
A. Alpha
B. Beta
C. Delta
D. Exocrine
E. Gamma
Question # 31
A 24 year old woman is admitted to your observation ward with a sudden onset headache.Her CT showed no abnormality and you decide to perform a lumbar punctureWhat is the next structure the needle will puncture after going through the skin andsubcutaneous fat?
A. Dura
B. Epidural space
C. Interspmous ligament
D. Ligamentum flavum
E. Supraspinous ligament
Question # 32
A 28 year old woman has an expanding skin rash: lethargy and body ache You suspectLyme disease Which microorganism is most likely to be the cause?
A. Anaplasma phagocytophilum
B. Bartonella qumtana .
C. Borrelia burgdorferi
D. Brucella abortus
E. Theilena microti
Question # 33
A 40 year old man attends with a fracture of the shaft of femur and you performed afemoral nerve block for pain relief. Which structure lies immediately medial to your needleinsertion in the groins A
A. Femoral artery
B. Femoral vein
C. Iliacus muscle
D. Inguinal ligament
E. Psoas muscle
Question # 34
You are considering procedural sedation for a patient with vascular compromise due to afracture They ate a meal two hours ago You are trying to remember the factors that affectgastric emptytng in healthy patientsWhat factor will delay gastric emptying?
A. Decreased duodenal luminal pH
B. Increased gastric distention
C. Low fat content of chyme
D. More liquids than solids in the stomach
E. Release of gastrin
Question # 35
A patient presents to the ED a few days after a significant head injury He is polyuric withhypernatremia and high plasma osmolality Which hormone is most likely to cause thispicture?
A. Adrenocorticotropic
B. Corticotropm-releasing
C. Dopamine
D. Somatostatin
E. Vasopressin
Question # 36
A 67 year old woman is being treated for haematemesis Within a few minutes of startingtransfusion of packed red cells she reports dizziness, breathlessness, tingling of her lipsand develops a maculopapular rashWhat type of hypersensitivity reaction is most likely to be occurring?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
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