Royal College of Emergency Medicine

MRCEM Primary Anatomy MCQ
The posterior one-third of the tongue is attached to the:

A Maxilla and hyoid

B Mandible and hyoid

C Palatine bones only

D Styloid process

E Thyroid cartilage

4-day-old baby was brought to the emergency
department by worried parents. The baby was
delivered in the same hospital 4 days back by a c
section. Vaccinations are up to date. The parents
complain that the baby is in distress after every
feed. They deny any colour change during the
episode. A chest X-ray is taken and it is shown
below.
What is the likely diagnosis?

A-Diaphragmatic hernia
B-Congenital heart disease.
C-Perforation hollow viscous organ
D-Pneumonia
E-Pneumothorax

A 5-year-old boy is brought to the emergency
department by his mum. He slipped and fell down
on his elbow while he was playingsat his school. A
swelling is noted around the elbow joint. His vital
parameters are within normal limits. An X-ray of
the elbow joint is shown below.
What is the likely diagnosis?

A-Supracondylar fracture
B-Fracture head of radius
C-Radioulnar dislocation
D-Olecranon fracture
E-Radial head fracture

Stay Safe from Pneumonia ( Vaccines You Shouldn’t Miss )

Pneumococcal Vaccines
There are two main types:

A. Pneumococcal Conjugate Vaccines (PCV)
B. Pneumococcal Polysaccharide Vaccine (PPSV)

A. Pneumococcal Conjugate Vaccines (PCV)
• PCV13 (Prevnar 13)
• PCV15 (Vaxneuvance)
• PCV20 (Prevnar 20)

B. Pneumococcal Polysaccharide Vaccine (PPSV)
• PPSV23 (Pneumovax 23)

Pneumococcal Vaccine Indications

1. All infants and children: Routine PCV series (PCV13/15/20).

2. Adults ≥65 years: Prefer PCV20; alternatively PCV15 + PPSV23.

3. Adults 19–64 with risk factors (chronic heart, lung, liver, kidney disease, diabetes, immunocompromised, asplenia, cochlear implants, CSF leaks): PCV20 or PCV15 + PPSV23.

4. High-risk/immunocompromised adults: Shorter intervals between PCV and PPSV23 may be needed.

5. PPSV23 alone: Only if conjugate vaccine not given; may require repeat after 5 years in high-risk adults.

Dosage

Adults
• PCV20: single dose (no further PCV needed)
• PCV15: single dose, followed by PPSV23 after ≥8 weeks (immunocompromised) or ≥1 year (immunocompetent)

Pneumococcal Polysaccharide Vaccine (PPSV23)

Adults ≥65 years or high-risk adults 19–64 years
• Single dose
• Repeat dose: Only in high-risk adults (immunocompromised, asplenia, chronic renal failure) after 5 years

MRCEM – Membership of the Royal College of Emergency Medicine

Emergency Medicine is a rapidly evolving and highly dynamic specialty. Despite its growing importance, there remains a global shortage of formally trained professionals within Accident & Emergency (A&E) departments. The Membership of the Royal College of Emergency Medicine (MRCEM) is a widely recognised postgraduate qualification, valued both in the UK and internationally. Achieving MRCEM opens doors to work as a specialist in several regions, including the Middle East and, for many, in their home countries.

However, before committing to the MRCEM pathway, it is essential to carefully consider the demands, expectations, and long-term implications of pursuing a career in Emergency Medicine.

KEY CONSIDERATIONS BEFORE PURSUING MRCEM:

• Genuine Passion is Essential
If you are not genuinely interested in emergency medicine, the fast-paced, high-pressure environment, or the nature of acute care, MRCEM may not be the right choice. The specialty demands a deep commitment and enthusiasm for urgent and emergent care. Without this passion, sustaining a career in A&E can be difficult.

• Beware of Misleading Guidance
In recent years, some influencers and organisations have promoted MRCEM as a route to enter the UK NHS system. This is a misguided and potentially harmful narrative. Choosing a specialty should always be based on personal interest and long-term career goals, not perceived shortcuts or external pressure. MRCEM is not a substitute for genuine interest in A&E, and undertaking it without commitment can lead to professional dissatisfaction and financial loss.

• Work–Life Balance and Demands
Emergency Medicine is physically and emotionally demanding. Hectic rotas, irregular shift patterns, and limited work-life balance are common. Those entering this field must be prepared for these challenges.

• If It Is Your Passion, Pursue It Wholeheartedly
For those truly passionate about emergency medicine, MRCEM can be a rewarding and fulfilling career pathway. With dedication and the right preparation, it is an achievable goal that opens meaningful opportunities to practise at a high level in this vital field.

OVERVIEW OF MRCEM EXAMINATION STRUCTURE:

1. MRCEM Primary
Computer-based written examination (best-of-five MCQs) focusing on basic sciences: anatomy, physiology, and other foundational topics.
Conducted online at Pearson VUE centres globally.

2. MRCEM Intermediate (SBA)
Written exam assessing clinical knowledge relevant to emergency medicine.
Also held at Pearson VUE centres.

3. MRCEM OSCE (Objective Structured Clinical Examination)
A clinical skills exam involving simulated patient scenarios.
Conducted in person in the UK, India, and Malaysia.

PREPARATION AND TIMELINE:

• With sincere and consistent effort, MRCEM can be completed within two years.

• Both written exams (Primary and Intermediate) are manageable through self-study without the need for expensive preparatory courses.

• For the OSCE, it is highly recommended to attend a preparatory course and to practise clinical scenarios, especially those related to life support and emergency presentations.

• Familiarity with NHS protocols and the functioning of A&E departments in the UK is particularly helpful for success in the OSCE.

I am always happy to respond to any questions related to the MRCEM pathway and exam preparation. Wishing all aspiring Emergency Medicine professionals the very best in their journey ahead. If you have a true passion for this field, MRCEM is an excellent step towards a rewarding and impactful career.