FRCEM SBA Sample Questions

1. A patient with diagnosed mental health problems has escaped from a

psychiatric hospital and been found by the police running on the street naked.
Police have brought the patient to the ED to assess the wounds on her feet.
She is initially restrained by two police officers in a private cubicle. However,
she manages to push the officers’ away and started repeatedly hitting her
head off the sink. She is uncooperative.

Which immediate action you should take?

A) Apply required force to restrain and sedate her if necessary

B) Call security to help the police restrain and request police apply hand cuffs
C) Inform the psychiatric hospital and restrain her until the psychiatric team
arrive
D) Refer her to the on-call mental health team to complete a mental capacity
assessment
E) Verbal calming and de-escalation techniques may be used

2. A 40 year old woman presents with several days history of intermittent

dizziness and feeling the room spinning at times. This came on suddenly
when she was getting out of bed and is brought on by turning her head
or looking up. She is normally fit and well. She is not on any medications.

Which is the most appropriate test to confirm the diagnosis?

A) Dix-Hallpike
B) Epley
C) Froment’s
D) Head Impulse Nystagmus Test of Skew (HINTS)
E) Romberg

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FRCEM SBA Sample Questions

3. A 85 year old woman is brought to the ED after a collapse.

She is now GCS 15 and has had a CT head scan performed within three hours
of her collapse.

What is the most likely diagnosis?

A) Cerebral tumour
B) Infarct of the anterior communicating artery territory
C) Infarct of the left middle cerebral artery territory
D) Infarct of the right middle cerebral artery territory
E) Intracerebral haemorrhage

4. A 78 year old woman is brought to the ED after collapsing. She had a brief loss
of consciousness. She now feels light-headed. Her ECG confirms bradycardia
with a HR of 50 beats per minute.

Which is the most pressing indication for transcutaneous pacing?

A) History of syncope
B) Ongoing chest pain
C) Persistent hypotension
D) Ventricular pause of greater than three seconds
E) Worsening breathlessness

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FRCEM SBA Sample Questions

5. The triage nurse asks you for advice about what to do with a patient who has
presented with superficial self-harm wounds. She is concerned the patient will
leave the department.

What is the most important action to take next?

A) Call the patient's next of kin

B) Call security to observe the patient
C) Document the patient’s physical appearance
D) Perform a capacity assessment
E) Place in a location where they can be observed

6. A 20 year old man brought in by the police. He is under arrest and he has
swallowed drugs in a small plastic bag in an attempt to conceal them. His
observations are normal at triage and he has no symptoms when you assess
him.

Which is the most appropriate investigation?

A) CT scan with contrast

B) Drug screening undertaken by the police
C) Laxatives and whole bowel irrigation
D) Low dose CT scan of the abdomen and pelvis
E) Observation for eight hours

7. A 33 year old woman has sustained a head injury. She has a GCS of 15 and has
full capacity to make decisions about her care.

She meets the NICE criteria for a CT scan of her brain.

She is 25 weeks pregnant and wants more information about the risk of
radiation to her unborn child from the CT brain.

Which best describes what you will tell her about the risk to the foetus from the
CT?

A) <1 in 1,000,000 risk of childhood cancer

B) 1 in 10,000 risk of impaired mental development
C) 1 in 100,000 risk of growth restriction
D) 1 in 250,000 risk of miscarriage
E) 1 in 1,000,000 risk of foetal malformation

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FRCEM SBA Sample Questions

8. A 50 year old man presents to your ED. He reports that his implantable
cardioverter-defibrillator (ICD) has shocked him five times in the last two hours.

The ICD had been inserted two months ago after the patient was investigated
for recurrent episodes of palpitations and had monitored runs of VT and VF. This
is the first time the device has fired since insertion.

He is attached to a cardiac monitor in resus, and the rhythm shows atrial flutter
with a rate of 160 beats per minute. While the monitor continues to show atrial
flutter the patient has two further ICD shocks, which cause him considerable
distress.

Which is the best way to manage this patient’s ICD discharge in the ED?

A) Apply a magnet to the ICD

B) Intravenous flecainide infusion
C) Intravenous metoprolol bolus
D) Sedation and DC cardioversion
E) Urgent referral to cardiology for device interrogation and adjustment