Pre-hospital medical emergencies: DipIMC practice questions
PHEM curriculum unit 2.4 · Theme 2: Providing Pre-hospital Emergency Medical Care
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 2.4, Manage acute medical emergencies in the pre-hospital environment.
Below are 3 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 58 questions on this unit.
Question 1 · Environmental & Analgesia · Easy
A marathon runner collapses. He is confused and agitated, and his rectal temperature, taken with a flexible probe to 15 cm, is 41.5 C. According to the FPHC exertional heat illness consensus statement (2024), what is the priority?
AImmediate transport, with active cooling started on arrival at hospital
BCold-water immersion on scene, with transport only after cooling
CParacetamol 1 g intravenously on scene, then transport with fanning en route
DCold intravenous fluids on scene, then transport with fanning en route
EOral fluids and rest in the shade, then transport if not improving
Show answer
Answer: B
Cold-water immersion on scene, with transport only after cooling
Confusion and agitation with a core temperature above 40 C during exercise is severe exertional heat illness (exertional heat stroke). The FPHC 2024 consensus statement makes rapid cooling before transfer the priority and calls this one of the few conditions in which transport to hospital should be delayed to cool on scene. Cold-water immersion is its preferred and recommended method, stopped at a core temperature of 38.5–39 C to avoid overshoot. Transporting first delays the one treatment that limits organ damage. The statement does not recommend anti-pyretics such as paracetamol, and does not recommend cold intravenous fluids as an initial cooling method. Oral fluids and shade are not active cooling for a patient with central nervous system (CNS) dysfunction. The held books agree that cooling comes first but differ on method: the ABC (2013) calls evaporative cooling with fanning the most powerful method, and the Oxford Handbook (2021) describes spraying and fanning. RCUK 2025 also prioritises the most rapid methods, such as cold-water immersion, in heat stroke. For the exam, the FPHC statement is the governing UK pre-hospital guidance.
Oxford Handbook of Pre-Hospital Carepp. 550–551Ch. 9 The hostile environment · Major heat illness—heat stroke: management“The key to management is rapid effective cooling.”
ABC of Prehospital Emergency Medicine
Ch. 24 Environmental Injuries · Heat illness: management · p. 138“Management of heat illness must start with cooling.”
Ch. 24 Environmental Injuries · Heat illness: cooling methods · p. 138“fanning is the most powerful cooling method”
A 45-year-old develops stridor, widespread urticaria and hypotension minutes after a wasp sting. What is the correct initial adrenaline dose and route?
A500 micrograms intramuscular (0.5 ml of 1:1000)
B1 mg by intravenous bolus (10 ml of 1:10,000)
C150 micrograms intramuscular (0.15 ml of 1:1000)
D1,000 micrograms intramuscular (1 ml of 1:1000)
E500 micrograms subcutaneous (0.5 ml of 1:1000)
Show answer
Answer: A
500 micrograms intramuscular (0.5 ml of 1:1000)
RCUK Guidelines 2025 (special circumstances): immediately inject intramuscular (IM) adrenaline 500 mcg (1 mg/mL concentration) at first suspicion of anaphylaxis, and repeat if there is no improvement within 5 minutes. JRCALC gives 500 micrograms (0.5 ml of 1 in 1,000) IM for anyone aged 12 or over, and the Oxford Handbook the same. 150 micrograms is the dose for a young child, not an adult. 1,000 micrograms IM doubles the adult dose by borrowing the 1 mg cardiac arrest figure, and RCUK specifies the intramuscular route, not subcutaneous. A 1 mg intravenous (IV) bolus of 1:10,000 is the cardiac arrest dose, not treatment for a patient with a circulation; the Oxford Handbook allows intravenous adrenaline in anaphylaxis only in severe cases where cardiac arrest or airway obstruction is imminent, and then with great care in small aliquots of 1 in 10,000; RCUK's first step is the IM dose. The ABC of Prehospital Emergency Medicine (2013) gives a range of 0.3–0.5 ml of 1:1000 IM; current RCUK and JRCALC guidance fixes the adult dose at 500 micrograms.
JRCALC Clinical Guidelines — Adrenaline 1 mg in 1 ml (1 in 1,000)JRCALC / AACE·Dosage: IM, anaphylaxis and life-threatening asthma“Adrenaline 1 in 1,000 — IM dosage, ≥12 years and adult row”
Oxford Handbook of Pre-Hospital Care
Ch. 2 Acute medical and surgical problems · Anaphylaxis: immediate management“adrenaline: 500 mcg (0.5 ml of adrenaline 1/1000 solution) by IM injection”
Ch. 2 Acute medical and surgical problems · Anaphylaxis: immediate management, notes“adrenaline may be given intravenously with great care in small aliquots”
Ch. 4 Formulary · Adrenaline (epinephrine): Table 4.1 · p. 287“Doses of IM adrenaline in anaphylaxis”
ABC of Prehospital Emergency Medicinep. 129Ch. 23 Acute Medical Emergencies · Anaphylaxis: treatment“Repeat doses as needed (0.3–0.5 ml of 1:1000 adrenaline (epinephrine) intramuscularly)”
med-003 · Medical & Resuscitation · Medical · Easy · v5
Question 3 · Medical & Resuscitation · Moderate
Which single finding in an adult with acute asthma classifies the attack as life-threatening rather than acute severe?
APeak flow 40% of best or predicted
BRespiratory rate of 28 per minute
CHeart rate of 115 beats per minute
DUnable to speak in full sentences
EA silent chest on auscultation
Show answer
Answer: E
A silent chest on auscultation
Both held books classify a silent chest as a life-threatening feature, alongside a peak flow below 33% of best or predicted, oxygen saturation (SpO2) below 92%, cyanosis, poor respiratory effort, arrhythmia, exhaustion, altered consciousness and hypotension. The other options are features of acute severe asthma: peak flow 33–50% of best or predicted, respiratory rate of 25 or more a minute, heart rate of 110 or more, and inability to complete sentences in one breath. A patient with any of them needs urgent treatment, but they do not by themselves make the attack life-threatening.
Where this comes from
Oxford Handbook of Pre-Hospital Care
Ch. 2 Acute medical and surgical problems · Classification of asthma for pre-hospital use (Box 2.8) · p. 109“Silent chest”
Ch. 2 Acute medical and surgical problems · Classification of asthma: acute severe asthma (Box 2.8) · p. 109“Inability to complete sentence in one breath”
ABC of Prehospital Emergency Medicine
Ch. 23 Acute Medical Emergencies · Asthma: Table 23.1, life-threatening asthma · p. 126“Any one of the following in a patient with severe asthma”
Ch. 23 Acute Medical Emergencies · Asthma: Table 23.1, acute severe asthma · p. 126“inability to complete sentences in one breath”
med-004 · Medical & Resuscitation · Medical · Moderate · v6