Acute Medicine

1,080 best-of-five questions for the Specialty Certificate Examination in Acute Medicine, written by a UK consultant physician and mapped to the current SCE blueprint. This is the largest Acute Medicine SCE bank we know of, and every answer explains the decision you would make on the take.

The Acute Medicine SCE is about the first 24 hours: who needs escalating, what to give first, which result changes the plan. The questions are written the same way. Sat the SCE before and missed the pass mark, or preparing for the first time? Start with the free sample questions and judge the explanations for yourself.

What you get

• 1,080 SCE-style questions. Longer stems with observations, blood results, gases and ECG findings, one lead-in, five options, one best answer.
• Decision-based explanations. Each answer says why the diagnosis fits, what the next step is under current UK guidance, and why the other four options would be the wrong call on the take. Every explanation ends with a Clinical Tip.
• Full blueprint coverage. Sepsis and infection, cardiology on the take, respiratory failure and ventilation, GI bleeding and liver failure, renal and electrolyte emergencies, endocrine emergencies, acute neurology, toxicology, haematology and oncology complications, frailty and geriatrics, peri-operative medicine and prescribing safety.
• Revision notes. Topic notes sit beside the questions, so a wrong answer links straight to the reading you need.
• Progress by topic. See your score in each blueprint area, revisit flagged questions and reset the bank for a second pass.
• Website and app. Revise at home or on the License Medical app between patients; progress syncs. New questions are added free during your subscription.

Which plan?

• 1 month. Used another bank and did not get through? One focused month to close the gaps before you resit.
• 3 months. The plan most first-time passers use: one full pass of the bank and a second pass of your weakest topics.
• 6 or 12 months. On a busy rota? Spread it out at under an hour a day and still finish the bank twice before the sitting.

Sample question

A 72-year-old woman is brought to the acute medical unit with two days of vomiting and confusion. She has type 2 diabetes treated with metformin and takes bendroflumethiazide for hypertension. Observations: temperature 37.2 °C, heart rate 112/min, blood pressure 96/58 mmHg, respiratory rate 22/min, oxygen saturation 96% on air. Blood results: sodium 148 mmol/L, potassium 4.9 mmol/L, urea 24 mmol/L, creatinine 210 µmol/L, glucose 42 mmol/L, bicarbonate 20 mmol/L, serum osmolality 348 mOsm/kg. Capillary ketones 0.8 mmol/L. Venous pH 7.33.

What is the most appropriate initial management?

A. Fixed-rate intravenous insulin at 0.1 units/kg/hour
B. Intravenous 0.45% sodium chloride at 1 L over 1 hour
C. Intravenous 0.9% sodium chloride at 1 L over 1 hour
D. Subcutaneous rapid-acting insulin 10 units
E. Variable-rate intravenous insulin infusion

Answer: C. Intravenous 0.9% sodium chloride at 1 L over 1 hour. Marked hyperglycaemia, osmolality above 320 mOsm/kg, hypovolaemia and only mild ketonaemia without significant acidosis make this a hyperosmolar hyperglycaemic state rather than diabetic ketoacidosis. The first priority is volume replacement with 0.9% sodium chloride, aiming for a positive balance of 2 to 3 litres by six hours, because restoring circulating volume alone brings the glucose down steadily. Insulin is not started at the outset unless ketones are significant (3 mmol/L or above), because a fast fall in glucose before the volume is replaced drops the osmolality too quickly and risks cerebral oedema; a fixed-rate infusion at 0.05 units/kg/hour is added later only if glucose stops falling with fluids. Hypotonic 0.45% saline is reserved for when the osmolality is not falling despite adequate fluid and the sodium is climbing. Subcutaneous insulin and a variable-rate infusion are both inappropriate at this stage. Clinical Tip: in HHS, fluid first and insulin later; aim for the osmolality to fall by no more than 3 to 8 mOsm/kg per hour.

About the Acute Medicine SCE

What is it? The Specialty Certificate Examination in Acute Internal Medicine is the knowledge-based assessment for the specialty. It is run by the Federation of the Royal Colleges of Physicians of the UK with the Society for Acute Medicine, and passing it is required for a UK CCT in Acute Internal Medicine. It is also open to doctors outside UK training who want a recognised assessment of acute medicine knowledge.

What is the format? Two papers on one day, each lasting three hours and each containing 100 best-of-five questions. There is no negative marking, so answer every question.

When is it held? Once a year, with the sitting usually in the spring and applications opening a few months before. Dates, fees and the current blueprint are published by the Federation at mrcpuk.org.

When should UK trainees sit it? Most sit it in the later years of higher specialty training, once they have had enough time on the acute take to recognise the patterns the questions describe. There is no limit on how early you can attempt it.

How is it marked? The two papers are combined into one score and compared with a pass mark set by standard-setting for that sitting. Pass rates are usually comfortably above those of MRCP Part 1 but vary from year to year.

How should I revise? The exam rewards knowing the first step in each emergency and the guideline behind it. Work through the bank by blueprint topic, read every explanation in full, then spend the final month doing timed blocks of 100 questions to match the pace of the real paper.

Written by a UK consultant physician. Every explanation follows current NICE, Resuscitation Council UK and Royal College guidance and is reviewed when guidelines change. Sitting MRCP first? See the MRCP Part 2 Written question bank.