Top 10 High-Yield Topics for the FRCEM SBA Exam

180 questions. Three hours. A curriculum that spans virtually every system in emergency medicine.

If you're trying to revise everything, you've already lost the strategy game. The FRCEM SBA isn't designed to test encyclopaedic knowledge — it's designed to test how you think and prioritise as an emergency physician. And the questions aren't distributed evenly across topics. Some areas come up again and again, every single sitting, with predictable patterns and testable decision points.

This guide cuts through the noise. Based on the RCEM Speciality Learning Outcomes (SLOs) and what consistently appears in the 180-question paper, these are the ten topics that give you the most return on revision time. Work through them systematically and you're targeting the majority of the marks available.

How the Marks Are Distributed

Before the list, understand the structure. The FRCEM SBA paper is mapped to the RCEM 2021 curriculum SLOs. The questions aren't random — they're deliberately weighted toward:

• SLO 1 — Complex and high-risk presentations (cardiovascular, respiratory, neurological, metabolic, toxicology)

• SLO 3 — Resuscitation and peri-arrest management

• SLO 4 — Major trauma and emergency procedures

These three SLOs account for the bulk of the paper. The topics below are all drawn from within them. Revise these first, then fill gaps in the lower-weighted SLOs.

1. Acute Coronary Syndrome (STEMI vs NSTEMI)

Approximate question volume: 10–12

ACS is the single most heavily tested topic in the FRCEM SBA. Questions test ECG recognition, territory identification, management timing, and the specific decision points that separate STEMI from NSTEMI.

What you need to lock in:

• STEMI criteria: ≥1 mm in limb leads, ≥2 mm in precordial leads

• STEMI equivalents: posterior MI, de Winter's T waves, new LBBB

• Immediate PPCI target: first medical contact to balloon within 120 minutes (not door-to-balloon 90 minutes — a common exam trap)

• Prasugrel preferred over ticagrelor for patients going to PCI

• Do not pre-treat with P2Y12 inhibitor before coronary anatomy is known

• NSTEMI risk stratification: very high risk (immediate), high risk (<24 hours), intermediate (<72 hours)

• High-sensitivity troponin 0h/1h algorithm — a single normal troponin is never enough to discharge

• Oxygen only if SpO₂ <90% — routine oxygen is not recommended

NSTEMI ECG can be completely normal in approximately 30% of cases. Questions specifically test whether you know this.

For detailed ECG interpretation and full management protocols, the FRCEM STEMI vs NSTEMI guide covers this topic in full.

2. Major Trauma and ATLS Primary Survey

Approximate question volume: 8–10

Trauma questions test systematic decision-making, not anatomical knowledge. Every question is built around the xABCDE framework — and if you're still revising with the old ABCDE, you're working from outdated material.

The most important update: ABCDE is now xABCDE. The x stands for control of exsanguinating external haemorrhage — tourniquet, wound packing, pelvic binder — which takes priority before airway assessment when a patient has life-threatening external bleeding.

What you need to lock in:

• xABCDE sequence and when haemorrhage control precedes airway

• Six immediately life-threatening chest injuries: tension pneumothorax, open pneumothorax, massive haemothorax, flail chest, cardiac tamponade, airway obstruction

• Tension pneumothorax = clinical diagnosis, immediate needle decompression — never wait for CXR

• Damage control resuscitation: 1:1:1 (RBC:FFP:platelets), stop crystalloid

• TXA within 3 hours for major haemorrhage (1 g bolus + 1 g infusion)

• GCS ≤8 = intubate

• NICE NG232 CT head criteria — including anticoagulant threshold for CT within 8 hours

• Permissive hypotension (SBP 80–90 mmHg) in penetrating trauma without head injury

The FRCEM ATLS and primary survey guide covers every xABCDE step with worked scenarios.

3. Stroke and TIA

Approximate question volume: 6–8

Stroke and TIA questions are particularly high-yield right now because several guidelines have recently changed — and FRCEM reflects current practice. Candidates who have revised from older resources are at a specific disadvantage here.

The biggest change: ABCD2 scoring has been abandoned. The latest UK National Clinical Guideline for Stroke explicitly states that scoring systems like ABCD2 should not be used to triage TIA patients. All suspected TIA → immediate specialist referral with MRI within 24 hours.

What you need to lock in:

• ABCD2 is not used — all suspected TIA = immediate referral

• Thrombolysis window: 4.5 hours from known onset (alteplase or tenecteplase)

• Extended window: 4.5–9 hours for wake-up stroke with DWI-FLAIR mismatch

• No age restriction on thrombolysis

• BP before thrombolysis must be <185/110 — lower it first if needed

• Dual antiplatelet therapy (aspirin + clopidogrel for 21 days) replaces aspirin monotherapy for TIA and minor stroke

• Do NOT lower BP in ischaemic stroke unless >220/120 or thrombolysis planned

• Posterior circulation stroke — sudden vertigo + neurological signs = stroke until proven otherwise

The FRCEM stroke and TIA SBA cases guide has full worked scenarios for each of these patterns.

4. Diabetic Emergencies (DKA and HHS)

Approximate question volume: 4–6

DKA and HHS questions are protocol-driven and number-heavy. The exact thresholds and management steps are what differentiate correct from incorrect answers. There are also two specific updates from the latest JBDS guidelines that regularly catch candidates out.

What you need to lock in:

• DKA diagnostic criteria: glucose >11, ketones >3, pH <7.3

• HHS criteria: glucose ≥30, osmolality ≥320, no significant ketosis (ketones ≤3), pH >7.3

• Fluids before insulin in DKA — never start insulin without initial fluid bolus

• FRIII starting dose: 0.1 units/kg/hour

• Key update: Reduce FRIII to 0.05 units/kg/hour when glucose ≤14 mmol/L (not continue at 0.1) — add 10% glucose alongside

• Continue long-acting insulin throughout DKA treatment

• Potassium replacement protocol (K⁺ 3.5–5.5 = add 40 mmol/L; K⁺ <3.5 = senior review before starting insulin)

• DKA resolution: pH >7.3, ketones <0.6 mmol/L, bicarbonate >15 mmol/L — not glucose

• HHS: 24–72 hour correction window (not 24 hours like DKA); treatment-dose LMWH

• Euglycaemic DKA in patients on SGLT-2 inhibitors — glucose may be near normal

Full protocol details in the FRCEM DKA and HHS management guide.

5. Acute Asthma and COPD Exacerbations

Approximate question volume: 8–10 combined

Asthma and COPD are tested differently and the management principles are almost opposite in key areas. Conflating them is one of the most common sources of lost marks.

For acute asthma, questions test severity classification and escalation sequence:

• Life-threatening features include PEF <33%, SpO₂ <92%, silent chest, normal/rising CO₂ (≥4.6 kPa)

• Normal CO₂ in severe asthma = danger sign, not reassurance

• Escalation: salbutamol → ipratropium → IV magnesium sulphate (1.2–2 g over 20 minutes)

• IV aminophylline is not a routine step

For COPD exacerbations, the oxygen target is what FRCEM catches candidates on:

• Target SpO₂ 88–92% via Venturi mask — not high-flow oxygen

• NIV when pH <7.35 with rising CO₂ (type 2 respiratory failure) — start early

• Antibiotics only if bacterial features (purulent sputum + other cardinal symptoms)

• Prednisolone 30–40 mg for 5 days

The FRCEM asthma and COPD exacerbations guide has the full severity tables and worked scenarios.

6. Paracetamol and TCA Overdose

Approximate question volume: 6–8 combined

Toxicology questions are among the most protocol-specific in the paper — the right answer depends on knowing exact thresholds and which treatments are contraindicated.

For paracetamol overdose:

• Single treatment nomogram line at 100 mg/L at 4 hours — the old two-line risk-factor system is obsolete

• Staggered overdose or unknown timing = give NAC immediately, no nomogram

• 8-hour window for near-100% NAC efficacy

• NAC hypersensitivity reaction = pause, treat, restart — not a contraindication to continuing

• SNAP regime (12-hour protocol) is RCEM-endorsed and increasingly standard

For TCA overdose:

• ECG is the critical investigation: QRS >100 ms = give sodium bicarbonate

• Terminal R wave in aVR — highly specific for TCA toxicity

• Sodium bicarbonate: target pH 7.45–7.55 regardless of baseline pH

• Phenytoin is contraindicated in TCA seizures — benzodiazepines only

• Flumazenil is contraindicated if TCA co-ingested — will precipitate seizures

• 6-hour observation for all TCA presentations

The FRCEM paracetamol and TCA overdose guide has full management protocols and worked scenarios.

7. Resuscitation and ALS

Approximate question volume: 6–8

Resuscitation questions are mapped to SLO 3 and test knowledge of the ALS algorithm, reversible causes, and peri-arrest arrhythmia management. These should be easy marks — the protocols are fixed and the scenarios are predictable.

What you need to lock in:

• Shockable rhythms: VF and pulseless VT → defibrillation + CPR

• Non-shockable: PEA and asystole → CPR + adrenaline 1 mg every 3–5 minutes

• 4Hs and 4Ts (reversible causes): Hypoxia, Hypovolaemia, Hypo/hyperkalaemia, Hypothermia | Tension pneumothorax, Tamponade, Toxins, Thromboembolism

• Adrenaline in non-shockable arrest: as soon as IV/IO access

• Adrenaline in shockable arrest: after 3rd shock

• Amiodarone 300 mg after 3rd shock in shockable rhythm

• ROSC post-resuscitation: targeted temperature management, 12-lead ECG, PCI if STEMI

• Airway during CPR: advanced airway (intubation or supraglottic) — continuous compressions once in place, 10 breaths/minute

Peri-arrest arrhythmias are also tested — SVT, AF with haemodynamic compromise, complete heart block, and when to cardiovert versus rate control.

8. Sepsis and Septic Shock

Approximate question volume: 4–6

Sepsis questions test recognition, the Sepsis-6, and the specific management steps that improve outcome. The Surviving Sepsis Campaign and NICE NG51 guidance underpin what FRCEM tests.

What you need to lock in:

• Sepsis-3 definition: life-threatening organ dysfunction caused by dysregulated host response to infection. SOFA score ≥2 from baseline.

• Septic shock: sepsis + vasopressor requirement to maintain MAP ≥65 mmHg + serum lactate >2 mmol/L despite adequate fluid resuscitation

• Sepsis-6 bundle (within 1 hour):

  1. Blood cultures (before antibiotics)

  2. IV antibiotics — broad-spectrum, within 1 hour of recognition

  3. IV fluid bolus — 500 ml crystalloid (cautious approach now; reassess after each bolus)

  4. Measure serum lactate

  5. Urine output monitoring (catheterise)

  6. High-flow oxygen to target SpO₂ ≥94%

• Lactate >4 mmol/L = septic shock regardless of BP — aggressive resuscitation

• Noradrenaline is the vasopressor of choice in septic shock

• Do not delay antibiotics waiting for imaging or further investigations

Antibiotic timing is a frequently tested decision point — blood cultures first, then antibiotics without delay. Imaging and further workup come after, not before.

9. ECG Interpretation

Approximate question volume: 8–10 (embedded across topics)

ECG interpretation is not a standalone topic — it runs through ACS, arrhythmia, TCA overdose, hyperkalaemia, and resuscitation questions. Getting ECG recognition wrong is therefore a multiplier error: one knowledge gap affects multiple question categories.

The patterns FRCEM tests most frequently:

Arrhythmias:

• AF: rate vs rhythm control decision, anticoagulation when to start

• SVT: vagal manoeuvres first, adenosine 6 mg if unsuccessful

• Complete heart block: atropine, isoprenaline, transvenous pacing

• VT with pulse: amiodarone if stable, synchronised DC cardioversion if unstable

• Torsades de pointes: IV magnesium sulphate 2 g

Ischaemia patterns:

• Anterior, inferior, lateral, posterior STEMI territories

• De Winter's T waves (anterior STEMI equivalent)

• Wellens' syndrome (proximal LAD stenosis — urgent referral despite near-normal troponin)

Metabolic patterns:

• Hyperkalaemia: tall peaked T waves → PR prolongation → wide QRS → sine wave → arrest

• Hypokalaemia: U waves, flattened T waves, QTc prolongation

• Hyponatraemia: broad non-specific changes

TCA toxicity: QRS >100 ms, terminal R wave in aVR — treated with sodium bicarbonate

The more ECG practice you do, the faster and more automatic pattern recognition becomes. Build it into your daily revision.

10. Electrolyte Disturbances

Approximate question volume: 4–6

Electrolyte questions feel niche but are reliably present in every sitting — and they're often tied to ECG changes, arrhythmias, or clinical presentations that bridge multiple topics.

Hyperkalaemia is the highest-yield electrolyte topic in FRCEM:

• ECG changes in order: peaked T waves → PR lengthening → wide QRS → sine wave → arrest

• Immediate cardiac membrane stabilisation: IV calcium gluconate 10 ml 10% (does not lower potassium, protects the heart)

• Shift potassium into cells: insulin + dextrose, salbutamol nebuliser, sodium bicarbonate (if acidotic)

• Remove potassium: dialysis (definitive), calcium resonium (slow, not acute)

• Causes to identify: AKI, ACE inhibitor/potassium-sparing diuretic use, Addison's disease, rhabdomyolysis

Hyponatraemia:

• Severity drives management: mild/moderate = fluid restrict or treat cause; severe (symptomatic, <120 mmol/L) = hypertonic saline

• Correct slowly — max 10 mmol/L per 24 hours to prevent osmotic demyelination syndrome

Hypocalcaemia:

• Symptoms: tetany, Trousseau's sign, Chvostek's sign, prolonged QTc

• Management: IV calcium gluconate (not chloride peripherally — caustic)

• Look for: pancreatitis, rhabdomyolysis, massive transfusion, parathyroid disease

How to Use This List

The topics above are not equally weighted — ACS, trauma, and respiratory conditions together account for roughly 30–35 questions, which is nearly 20% of the entire paper. That's where the bulk of your revision time should go.

A practical revision structure:

First pass (weeks 1–3): Work through topics 1–5 with dedicated question sessions after each. Aim for 30–50 questions per topic.

Second pass (weeks 4–5): Cover topics 6–10. These are slightly lower volume but the patterns are equally predictable.

Final two weeks: Full mixed-topic mock papers under timed conditions. Identify the topics where you're still losing marks and revisit them specifically.

The exam rewards candidates who can move quickly through familiar patterns. That speed only comes from doing enough questions that the recognition becomes automatic — not from reading notes repeatedly.

For a complete pass strategy built around the RCEM SLO structure, the guide to passing FRCEM on your first attempt covers exam technique, time management, and how to approach unfamiliar questions.

The FRCEM SBA rewards structured, targeted preparation over broad coverage. These ten topics, revised systematically with adequate question practice, cover the majority of the marks available in the paper.

Start with ACS and trauma — they account for almost a quarter of the questions between them. Build the ECG recognition and management protocols until they're second nature. And never stop practising under timed conditions.

Looking for SLO-mapped SBA questions across all ten of these topics? Register with StudyFRCEM for comprehensive question bank access with detailed guideline-based explanations.