Exam guide
The MRCEM Primary and MRCEM SBA, explained
Primary is basic science in a clinical shell; SBA tests emergency decision-making against the RCEM curriculum's own outcomes. Set by the Royal College of Emergency Medicine.
Last checked 15 August 2026. Confirm current fees, dates and the live syllabus on the RCEM's own site before booking.
How the exam is structured
MRCEM is sat as 2 separate stages, each its own sitting — not one combined exam.
MRCEM Primary
| Papers | MRCEM Primary |
|---|---|
| Questions | 180 across 1 paper |
| Time | 180 minutes total (180 min for MRCEM Primary) |
| Question types | 180 SBA |
MRCEM SBA
| Papers | Paper 1; Paper 2 |
|---|---|
| Questions | 180 across 2 papers |
| Time | 240 minutes total (120 min for Paper 1, 120 min for Paper 2) |
| Question types | 90 SBA; 90 SBA |
| Options per SBA/MCQ | 5 (A–E) |
|---|---|
| Sittings per year | 2 |
| Set by | Royal College of Emergency Medicine |
Where the marks are
Most candidates revise every domain evenly by accident, which spends most of their time on a fraction of the paper. A SpecialityMCQ session is built to the weights below, then tilted toward whichever domain is currently costing you marks.
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Anatomy (Primary)
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Physiology (Primary)
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Complex or Stable Patient (SLO1)
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Resuscitate (SLO3)
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Injured Patient (SLO4)
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Paediatric Emergency Medicine (SLO5)
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Pharmacology (Primary)
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Procedural Skills (SLO6)
These are RCEM's own published category-level (Primary) and Specialty Learning Outcome-level (SBA) question counts, from RCEM's regulations and information packs, not an estimate.
A sample question
Written in-house to the MRCEM style and answered against a named, current source — not claimed to be from a past paper. It plays exactly as it would in the app.
A 24-year-old man presents to the emergency department with widespread urticaria, facial and lip swelling, and audible stridor within minutes of eating a meal containing peanuts. His blood pressure is 82/50 mmHg and he appears increasingly drowsy. What is the most appropriate immediate management?
- Source
- Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers (Resuscitation Council UK, 2021) — Adult algorithm: adrenaline dose and route
- Checked
- Read against this source on 12 Aug 2026. If the guidance changes, the question comes back for another read before it is shown again.
Where this answer comes from
TAKEAWAY
Intramuscular adrenaline, 500 micrograms of 1:1000 (0.5 mL), given into the anterolateral thigh, is the first-line treatment for anaphylaxis in an adult and should not be delayed for other measures — it can be repeated after 5 minutes if there is no improvement.
Why A is right
This is the Resuscitation Council UK first-line adult dose, route and site for anaphylaxis, and should be given immediately once the diagnosis is suspected.
IV adrenaline at this concentration and dose is for use only by those experienced in its titration, typically in a peri-arrest setting — it is not the first-line route and carries a real risk of dangerous arrhythmia if given incorrectly.
300 micrograms is the auto-injector dose used in community anaphylaxis kits for adults, not the in-hospital adult treatment dose, which is 500 micrograms IM.
Nebulised bronchodilator can help wheeze as an adjunct, but it does not treat the airway swelling or hypotension driving this presentation, and must never substitute for adrenaline.
Steroids have a delayed onset of action and are no longer given routinely first-line in UK anaphylaxis algorithms — adrenaline is the immediate, first-line treatment.
You just answered one. Five a day are free.
Start freeA real question, written in-house to this exam's style, shown exactly as it would play in the app.
Where SpecialityMCQ fits
SpecialityMCQ's MRCEM bank grows toward the weights above, written as single best answer items set in UK NHS practice. Sessions balance every domain, then tilt toward whichever is currently costing you marks. Anything you miss returns on a spacing curve until it sticks, and every answer names the source it rests on and the date that source was last read.
New questions a day are free, with no card required, and the review deck is free for good.
Questions about the MRCEM exam
What is the MRCEM Primary and MRCEM SBA?
MRCEM Primary and MRCEM SBA is set by the Royal College of Emergency Medicine. Primary is basic science in a clinical shell; SBA tests emergency decision-making against the RCEM curriculum's own outcomes.
How is the MRCEM exam structured across its stages?
MRCEM is sat as 2 separate stages, not one combined exam: MRCEM Primary: 180 questions across 1 paper (180 minutes); MRCEM SBA: 180 questions across 2 papers (240 minutes). Each with 5 options per single-best-answer item.
What does the MRCEM blueprint cover?
The chart on this page shows the highest-weighted domains. These are RCEM's own published category-level (Primary) and Specialty Learning Outcome-level (SBA) question counts, from RCEM's regulations and information packs, not an estimate.
How many times a year can I sit MRCEM?
2 sittings a year, per the RCEM's own published exam calendar. Confirm current dates and fees on the college's own site before booking.
Is SpecialityMCQ affiliated with the RCEM?
No. SpecialityMCQ is an independent revision tool and is not affiliated with, endorsed by, or accredited by the Royal College of Emergency Medicine.
Sitting a different exam? SpecialityMCQ also covers MRCS Part A , MRCOG Part 1 and Part 2 , MRCPCH Foundation of Practice and Theory and Science and MRCPsych Paper A and Paper B , each with its own guide.
SpecialityMCQ is an independent revision tool. It is not affiliated with, endorsed by, or accredited by the Royal College of Emergency Medicine, or any other exam authority. This page summarises the college's own published exam information for candidates and is not a substitute for it. Always confirm current syllabus, fees and dates on the college's own site before applying.