Fellowship of the Australasian College for Emergency Medicine (FACEM) — Questions and Answers

Question 1: A new policy mandates that ED patients wait no longer than four hours before being admitted or discharged. As clinical leader, you believe this target may compromise quality for complex presentations. What is the MOST constructive leadership response?

Comply with the policy without comment to maintain good relationships with management
Collect and present data demonstrating specific clinical harms, then engage leadership in policy review (Correct answer)
Instruct staff to discharge patients before four hours regardless of clinical status
Ignore the policy and continue current practice

Correct answer: Collect and present data demonstrating specific clinical harms, then engage leadership in policy review

Evidence-based advocacy through proper channels is the appropriate response when clinical leaders identify policy risks, rather than non-compliance or silent compliance.

Question 2: What is the recommended compression-to-ventilation ratio in adult CPR for a single rescuer?

30:2 (Correct answer)
15:2
15:1
20:2

Correct answer: 30:2

The 2020 AHA guidelines recommend a 30:2 compression-to-ventilation ratio for adult CPR with a single rescuer, prioritizing chest compressions.

Question 3: What is the most appropriate response when a patient says 'No one has told me anything about what's happening'?

Explain that the ED is busy and information sharing takes time
Tell the patient to ask the attending physician when they arrive
Apologise on behalf of other staff and blame them for the communication failure
Acknowledge the patient's frustration, apologise for the gap, and provide a clear update (Correct answer)

Correct answer: Acknowledge the patient's frustration, apologise for the gap, and provide a clear update

Acknowledging the breakdown, apologising sincerely, and providing immediate information addresses the patient's core concern effectively.

Question 4: In a clinical trial, allocation concealment refers to:

Blinding participants to their treatment assignment
Randomizing in blocks to balance covariates
Keeping the statistician unaware of group labels
Preventing foreknowledge of the next assignment before enrolment (Correct answer)

Correct answer: Preventing foreknowledge of the next assignment before enrolment

Allocation concealment prevents selection bias by ensuring the next assignment is unknown until after a patient is enrolled.

Question 5: Which acid-base disturbance is most commonly seen in early septic shock?

High anion gap metabolic acidosis (Correct answer)
Hyperchloremic metabolic acidosis
Respiratory alkalosis
Metabolic alkalosis

Correct answer: High anion gap metabolic acidosis

High anion gap metabolic acidosis from lactic acidosis is the most common acid-base abnormality in early septic shock due to tissue hypoperfusion and anaerobic metabolism.

Question 6: A competent adult patient with a serious but treatable injury clearly refuses all treatment. The emergency physician should:

Override refusal if the condition is life-threatening
Contact police to enforce treatment under duty-of-care laws
Sedate the patient to allow treatment
Document the refusal thoroughly and respect the patient's autonomous decision (Correct answer)

Correct answer: Document the refusal thoroughly and respect the patient's autonomous decision

A competent adult's informed refusal of treatment must be respected regardless of the severity of condition; thorough documentation is essential.

Question 7: When assessing a patient with suspected acute coronary syndrome, which ECG finding indicates the highest immediate risk requiring emergent intervention?

New left bundle branch block (Correct answer)
T-wave inversions in precordial leads
Prolonged QTc interval
ST depression in V4-V6

Correct answer: New left bundle branch block

New LBBB in the context of acute chest pain is treated as a STEMI equivalent per current guidelines, requiring emergent reperfusion therapy.

Question 8: A patient arrives from a chemical spill with severe bronchospasm, lacrimation, salivation, and muscle fasciculations. Which class of agents is MOST likely responsible?

Vesicants (blister agents)
Cyanide compounds
Pulmonary agents (phosgene)
Cholinergic agents (organophosphates/nerve agents) (Correct answer)

Correct answer: Cholinergic agents (organophosphates/nerve agents)

The SLUDGE/DUMBELS constellation of cholinergic symptoms (salivation, lacrimation, fasciculations, bronchospasm) indicates nerve agent or organophosphate exposure.

Question 9: An emergency physician suspects a colleague is impaired by alcohol while on shift. What is the most appropriate immediate action?

Notify hospital administration and remove the colleague from clinical duties (Correct answer)
Document concerns and report after the shift ends
Contact the medical board without informing hospital administration
Confront the colleague privately and allow them to self-assess fitness

Correct answer: Notify hospital administration and remove the colleague from clinical duties

Patient safety requires immediate removal of an impaired clinician from clinical duties, with prompt notification to hospital administration.

Question 10: In designing a simulation scenario for FACEM trainees, which element is most critical for maximizing transfer of learning to real clinical practice?

Ensuring scenarios are always novel and unpredictable
High physical fidelity (realistic manikin and equipment)
Use of actual patients rather than simulated ones
Psychological fidelity (realistic clinical context, pressure, and decision-making demands) (Correct answer)

Correct answer: Psychological fidelity (realistic clinical context, pressure, and decision-making demands)

Psychological fidelity — creating realistic cognitive and emotional demands — is more predictive of learning transfer than physical realism alone.

Question 11: What is a key aspect of professional development during the Fellowship program?

Self-study modules.
Learning new clinical procedures only.
Observing senior consultants.
Participation in workshops, conferences, and peer review. (Correct answer)

Correct answer: Participation in workshops, conferences, and peer review.

Professional development during the FACEM Fellowship program extends beyond direct clinical work to include active participation in educational events. Engaging in workshops, attending conferences, and participating in peer review processes are crucial for staying updated with the latest evidence-based practices, refining skills, and fostering a culture of continuous learning and quality improvement in emergency medicine.

Question 12: What should be done if an error is discovered in a patient record?

Use white-out to cover the mistake
Draw a single line through the error, correct it, and initial with date (Correct answer)
Remove the page and rewrite it
Ignore it if no one has noticed

Correct answer: Draw a single line through the error, correct it, and initial with date

The standard correction method preserves the original entry while making the correction transparent and traceable.

Question 13: When should documentation of a service or intervention be completed?

As soon as possible after the service is provided (Correct answer)
Only when requested by a supervisor
Within 30 days of service
At the end of the week in a batch

Correct answer: As soon as possible after the service is provided

Timely documentation ensures accuracy and completeness, as details are freshest immediately after service delivery.

Question 14: What is the most common reversible cause of pulseless electrical activity (PEA) in the emergency setting?

Hypermagnesemia
Tension pneumothorax (Correct answer)
Hypokalemia
Hypothermia

Correct answer: Tension pneumothorax

Tension pneumothorax is one of the most common and immediately reversible causes of PEA arrest, addressed by the '4 H's and 4 T's' framework.

Question 15: What is the target mean arterial pressure (MAP) recommended in the Surviving Sepsis Campaign for septic shock?

85 mmHg
55 mmHg
65 mmHg (Correct answer)
75 mmHg

Correct answer: 65 mmHg

The Surviving Sepsis Campaign recommends a target MAP of ≥65 mmHg as the initial resuscitation goal in adults with septic shock.

Question 16: What is a drug contraindication?

A drug interaction that enhances effectiveness
A type of allergic reaction
A condition that makes a particular treatment inadvisable (Correct answer)
A reason to increase the dosage

Correct answer: A condition that makes a particular treatment inadvisable

A contraindication is a specific situation where a drug should not be used because it may cause harm.

Question 17: How often should high-touch surfaces in clinical areas be cleaned?

At least daily and after known contamination (Correct answer)
Once per week
Once per month during deep cleaning
Only when visibly soiled

Correct answer: At least daily and after known contamination

High-touch surfaces harbor pathogens and should be cleaned at least daily, with additional cleaning after contamination events.

Question 18: In post-cardiac arrest care, what is the target temperature range for targeted temperature management (TTM)?

33–36°C (Correct answer)
32–34°C
36–38°C
30–32°C

Correct answer: 33–36°C

Current evidence supports TTM targeting 33–36°C for comatose survivors of cardiac arrest to reduce neurological injury, with active prevention of fever to at least 72 hours.

Question 19: An ED implements a ventilator bundle to reduce VAP. Which element of the bundle is specifically targeted at reducing gastric aspiration risk?

Oral decontamination with chlorhexidine
Avoiding neuromuscular blockade
Maintaining head-of-bed elevation at 30-45 degrees (Correct answer)
Daily sedation vacations

Correct answer: Maintaining head-of-bed elevation at 30-45 degrees

Elevating the head of the bed to 30-45 degrees reduces gastroesophageal reflux and microaspiration of gastric contents into the lower respiratory tract, thereby reducing VAP risk.

Question 20: During a resuscitation attempt, how should the emergency team communicate with a family member present in the room?

Assign a dedicated team member to provide ongoing explanation and emotional support to the family (Correct answer)
Ask the family member to leave immediately
Continue resuscitation without acknowledging the family member
Allow the family to direct resuscitation efforts

Correct answer: Assign a dedicated team member to provide ongoing explanation and emotional support to the family

Family presence during resuscitation is supported by evidence, and assigning a dedicated support person improves family outcomes and communication.

Question 21: An ACEM fellow is asked to complete a medical report for insurance purposes on a patient they have seen once. They should:

Forward the request to the patient's GP without informing the patient
Complete the full report based on the single encounter
Complete the report but note it is based on limited information
Decline if they lack sufficient knowledge of the patient's health to provide an accurate report (Correct answer)

Correct answer: Decline if they lack sufficient knowledge of the patient's health to provide an accurate report

Physicians should only provide reports for which they have adequate clinical knowledge; preparing reports beyond their knowledge base is ethically problematic.

Question 22: In hyperkalemia with ECG changes, what is the first drug that should be given?

Salbutamol nebuliser
Insulin with dextrose
Sodium bicarbonate
Calcium gluconate or calcium chloride (Correct answer)

Correct answer: Calcium gluconate or calcium chloride

Calcium (gluconate or chloride) is given first in hyperkalemia with ECG changes to membrane-stabilise the myocardium and prevent fatal arrhythmias, acting within minutes.

Question 23: Which drug is used for rapid sequence intubation (RSI) as the preferred induction agent in hemodynamically unstable patients?

Midazolam
Ketamine (Correct answer)
Propofol
Thiopentone

Correct answer: Ketamine

Ketamine is the preferred induction agent in hemodynamically unstable patients due to its sympathomimetic properties, which help maintain blood pressure during RSI.

Question 24: When managing diabetic ketoacidosis (DKA), when should insulin infusion be initiated?

After fluid resuscitation and potassium ≥3.5 mmol/L (Correct answer)
When blood glucose is below 14 mmol/L
Only after bicarbonate has normalised
Immediately upon diagnosis

Correct answer: After fluid resuscitation and potassium ≥3.5 mmol/L

Insulin should only be started after initial fluid resuscitation and once potassium is ≥3.5 mmol/L to prevent life-threatening hypokalemia from insulin-driven cellular uptake.

Question 25: A pregnant ED nurse is assigned to care for a patient with varicella (chickenpox). She is uncertain of her immune status. What is the most appropriate action?

Reassign her from the varicella patient pending immune status confirmation (Correct answer)
Administer varicella vaccine immediately and proceed with care
Allow her to care for the patient using N95 and contact precautions
Test for VZV IgG urgently and allow care if positive

Correct answer: Reassign her from the varicella patient pending immune status confirmation

Pregnant healthcare workers with unknown varicella immune status should be reassigned from varicella cases because varicella in pregnancy carries significant maternal and fetal risks, and vaccine is contraindicated in pregnancy.

Question 26: How do members of the Fellowship contribute to advancing emergency medicine research?

By developing new pharmaceutical products.
By avoiding research participation.
By engaging in research, publishing findings, and sharing knowledge. (Correct answer)
By focusing solely on clinical practice.

Correct answer: By engaging in research, publishing findings, and sharing knowledge.

Members of the FACEM Fellowship contribute to advancing emergency medicine research through active engagement in the research cycle. This involves conducting studies, meticulously documenting and publishing their findings in peer-reviewed journals, and actively sharing their knowledge with the broader medical community. This collective effort builds the evidence base and informs best practices in emergency care.

Question 27: A p-value of 0.03 means:

The probability of observing this result by chance alone, assuming no true effect, is 3% (Correct answer)
The study has 97% power
There is a 3% chance the treatment works
The effect size is clinically significant

Correct answer: The probability of observing this result by chance alone, assuming no true effect, is 3%

A p-value is the probability of obtaining results at least as extreme as observed, assuming the null hypothesis is true.

Question 28: A registrar asks how to best prepare for the FACEM clinical examination. Which strategy is most strongly supported by evidence?

Deliberate practice with structured clinical cases, peer feedback, and mock OSCE stations (Correct answer)
Reviewing past examination papers without simulated practice
Extensive reading of textbooks to maximize factual recall
Focusing exclusively on areas of personal weakness identified from self-assessment

Correct answer: Deliberate practice with structured clinical cases, peer feedback, and mock OSCE stations

Deliberate practice using simulated OSCE stations and structured peer feedback directly rehearses the skills and integrates knowledge in the format assessed in the FACEM clinical examination.

Question 29: What is the most sensitive bedside test for ruling out pulmonary embolism in low-to-moderate pre-test probability patients?

D-dimer (Correct answer)
Sinus tachycardia on ECG
Troponin
ABG showing hypoxia

Correct answer: D-dimer

D-dimer has high sensitivity (>95%) for excluding PE when pre-test probability is low to moderate, making a negative result sufficient to rule out the diagnosis without imaging.

Question 30: A study reports a relative risk reduction (RRR) of 50% but an absolute risk reduction (ARR) of only 1%. Which statement best contextualizes this finding?

The NNT would be 2, indicating high efficacy
The ARR indicates the absolute benefit is small despite the large RRR (Correct answer)
The treatment has a clinically large effect because RRR is 50%
RRR is always more meaningful than ARR for clinical decisions

Correct answer: The ARR indicates the absolute benefit is small despite the large RRR

A large RRR can be misleading when baseline risk is low; ARR of 1% means NNT = 100, indicating modest absolute benefit.

Fellowship of the Australasian College for Emergency Medicine (FACEM)

The FACEM is the specialist qualification in Emergency Medicine awarded by the Australasian College for Emergency Medicine (ACEM), assessing advanced clinical expertise, critical care, and professional competency required for consultant-level emergency medicine practice in Australia and New Zealand.

120

Questions

180 min

Time Limit

70%

To Pass

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