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Shock, anaphylaxis and emergencies: RCSI aptitude test practice questions

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Shock, anaphylaxis and emergencies on the RCSI theory paper

Four types and three stages of shock, lactate and MAP, anaphylaxis and IM adrenaline, adult basic life support, AED, choking, hypoglycaemia, bleeding, stroke, heat stroke.

28 multiple-choice questions, each with an explanation and the document it was checked against. Three questions are free; the pass opens the other 25 and every other topic. Wrong answers come back first the next time you practise, and a question counts as mastered after two correct answers in a row.

Sample questions from this topic

  1. Question 1

    Which finding points towards cardiogenic rather than hypovolaemic shock?

    1. ARaised jugular venous pressure with lung crackles
    2. BWarm flushed skin with a bounding pulse
    3. CPostural drop in blood pressure after a week of high-dose diuretics
    4. DFlat neck veins and a history of melaena for two days
    Show answer

    Answer: A. StatPearls, History and physical: cardiogenic shock is suggested by cardiac chest pain, a narrow pulse pressure, elevated jugular venous pulsations, lung crackles and arrhythmias on the monitor; the failing pump backs blood up behind it. Hypovolaemia shows flattened neck veins, pallor and orthostatic hypotension. Warm skin with vasodilation is early distributive shock.

    Source: StatPearls: Shock (NCBI Bookshelf), History and physical

  2. Question 2

    Which blood test does the Irish sepsis guideline use as a marker of tissue hypoperfusion?

    1. ASerum lactate
    2. BThyroid stimulating hormone
    3. CSerum amylase
    4. DHbA1c
    Show answer

    Answer: A. NCG 26 (2025) recommends guiding resuscitation to normalise lactate in patients with an elevated level, as a marker of tissue hypoperfusion; lactate is drawn with the blood cultures at the start of the hour-1 bundle. The HSE Sepsis Screening Tool adds point-of-care lactate to the FBC, renal and liver profile and CRP, and a lactate above 2 mmol/L is repeated after the Sepsis 6 bundle. Lactate rises when cells switch to anaerobic metabolism, so it tracks perfusion in any cause of shock.

    Source: NCG No. 26 Sepsis Management for Adults v2 (2025), recommendations 1 to 5 (hour-1 bundle, lactate); HSE Sepsis Screening Tool for Adults (2025), Sepsis 6

  3. Question 3

    Below which mean arterial pressure, despite fluid resuscitation, does the HSE sepsis form say to consider septic shock?

    1. A50 mmHg
    2. B65 mmHg
    3. C90 mmHg
    4. D120 mmHg
    Show answer

    Answer: B. HSE Sepsis Screening Tool 2025: consider septic shock if the MAP is less than 65 mmHg despite fluid resuscitation, and escalate to critical care. The fluid step gives a 250 to 500 ml bolus of balanced crystalloid to patients with hypotension or hypoperfusion, up to 30 ml/kg within the first 3 hours unless fluid intolerant, reassessing frequently. NCG 26 defines septic shock as needing vasopressors to hold a MAP of 65 mmHg or more with a lactate above 2 mmol/L after adequate fluids. MAP is roughly diastolic plus a third of the pulse pressure.

    Source: HSE Sepsis Screening Tool for Adults (2025), Sepsis 6 and septic shock box; NCG No. 26 Sepsis Management for Adults v2 (2025), s. 2.1.1.3

The practice above shuffles the options each time and keeps your score. 30 more free questions across the paper, with a PDF.

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