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Physician Board Certification

ABIM Critical Care Medicine Initial Certification Examination Practice Test

Critical care medicine applies physiology and evidence-based treatment to adults with life-threatening illness or injury. The practice bank includes scenarios involving ventilatory failure, shock, neurologic emergencies, acute respiratory distress, kidney injury, and medication complications, asking you to identify urgent problems and choose appropriate ICU interventions.

Exam overview

Exam providerAmerican Board of Internal Medicine
Exam codeNot listed
CategoryPhysician Board Certification

About the ABIM Critical Care Medicine Initial Certification Examination Exam

The cases call for rapid interpretation of bedside findings and laboratory data, prioritization of stabilization, and selection of treatment under time pressure. Examples include recognizing impending respiratory failure in neuromuscular disease, assessing tamponade physiology, and managing suspected pulmonary embolism during cardiac arrest. Other scenarios test decisions about antimicrobial timing when lumbar puncture is delayed, blood pressure before stroke thrombolysis, and prevention of delayed cerebral ischemia after secured aneurysmal subarachnoid hemorrhage. Ventilator choices for acute lung injury, continuous kidney replacement therapy in hemodynamic instability, fever management after stroke, and evaluation of possible propofol toxicity draw on respiratory, renal, neurologic, cardiovascular, and pharmacologic reasoning. For each case, connect the clinical pattern to the immediate threat, relevant contraindications, and next practical action.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

A patient with myasthenia gravis develops progressive bulbar weakness and respiratory distress. Which bedside finding most strongly supports impending ventilatory failure and the need for close airway planning?

  1. AA declining forced vital capacity
  2. BAn isolated mild increase in serum creatinine
  3. CA normal oxygen saturation while receiving supplemental oxygen
  4. DA reduced serum bicarbonate concentration
Show answerCorrect answer: A

Declining forced vital capacity is a useful measure of worsening respiratory muscle weakness in myasthenic crisis. Oxygen saturation may remain deceptively normal until late, so serial respiratory mechanics and clinical assessment are important when planning airway support.

Question 2

A patient with acute ischemic stroke is being considered for intravenous thrombolysis. Which blood pressure target is generally required before treatment can be given?

  1. ABelow 220/120 mm Hg
  2. BBelow 200/110 mm Hg
  3. CBelow 185/110 mm Hg
  4. DBelow 160/90 mm Hg
Show answerCorrect answer: C

For eligible patients receiving intravenous thrombolysis, blood pressure is generally lowered to below 185/110 mm Hg before treatment and maintained below 180/105 mm Hg afterward. Specific eligibility and treatment decisions should follow current stroke protocols.

Question 3

A patient with a large circumferential pericardial effusion develops worsening hypotension and elevated jugular venous pressure. Bedside echocardiography shows right atrial and right ventricular diastolic collapse. What is the most appropriate urgent intervention?

  1. AUrgent pericardial drainage
  2. BAggressive diuresis
  3. CA high-dose beta blocker
  4. DPositive-pressure ventilation as the sole intervention
Show answerCorrect answer: A

Hypotension with echocardiographic chamber collapse in the setting of a pericardial effusion indicates cardiac tamponade. Urgent pericardial drainage is needed; diuresis and positive-pressure ventilation can further impair cardiac filling and should not substitute for drainage.

Question 4

A patient with suspected bacterial meningitis is unstable and lumbar puncture will be delayed for imaging and stabilization. What is the best approach to antimicrobial treatment?

  1. AWait for lumbar puncture results before starting antibiotics
  2. BObtain blood cultures if this does not cause meaningful delay, then start empiric antibiotics promptly
  3. CGive corticosteroids alone until imaging is complete
  4. DDefer all treatment until cerebrospinal fluid culture is positive
Show answerCorrect answer: B

When lumbar puncture is delayed, empiric antibiotics should not be postponed because treatment delay can worsen outcomes. Blood cultures should be obtained first when feasible without materially delaying therapy; adjunctive dexamethasone may be indicated in selected cases.

Question 5

A patient with aneurysmal subarachnoid hemorrhage is admitted to the ICU after the aneurysm has been secured. Which medication is routinely used to reduce the risk of delayed cerebral ischemia?

  1. ANimodipine
  2. BMannitol
  3. CPhenytoin
  4. DDexamethasone
Show answerCorrect answer: A

Enteral nimodipine is routinely given after aneurysmal subarachnoid hemorrhage because it improves neurologic outcomes by reducing the risk of delayed cerebral ischemia. It does not replace monitoring and management of complications such as vasospasm.

Question 6

A patient with severe acute pancreatitis develops hypoxemia and bilateral pulmonary opacities. Which ventilator strategy is most appropriate if invasive ventilation is required?

  1. AUse low tidal volumes based on predicted body weight and limit plateau pressure
  2. BUse high tidal volumes to normalize carbon dioxide rapidly
  3. CMaintain plateau pressure above 35 cm H₂O to recruit alveoli
  4. DAvoid positive end-expiratory pressure in all cases
Show answerCorrect answer: A

In acute respiratory distress syndrome, including that associated with pancreatitis, lung-protective ventilation uses low tidal volumes based on predicted body weight and limits plateau pressure to reduce ventilator-induced lung injury. Ventilator settings are individualized, but routinely using high tidal volumes or avoiding PEEP is not appropriate.

Question 7

A patient with acute kidney injury has severe metabolic acidosis and refractory volume overload despite medical therapy. Continuous kidney replacement therapy is initiated. Which feature most favors a continuous rather than intermittent modality in a hemodynamically unstable patient?

  1. ASlower fluid and solute removal with better hemodynamic tolerance
  2. BMore rapid fluid removal over a short session
  3. CAvoidance of any need for vascular access
  4. DNo requirement for monitoring anticoagulation or circuit function
Show answerCorrect answer: A

Continuous kidney replacement therapy removes fluid and solutes gradually, which is often better tolerated in patients with hemodynamic instability or limited ability to tolerate rapid shifts. It still requires vascular access and close monitoring, and anticoagulation may be considered depending on the patient and circuit.

How to use this practice test

Access is free. A practice session presents up to 20 randomly selected questions from the 50-question bank, with results shown after the session. Use each case to explain why the selected intervention fits the patient’s physiology and urgency, then review missed or uncertain decisions.

Preparation tips

  • Practice identifying impending ventilatory failure from bedside respiratory mechanics and bulbar weakness, and connect the findings to airway planning.
  • Compare immediate stabilization and definitive treatment priorities in obstructive shock, including tamponade and suspected massive pulmonary embolism.
  • Review time-sensitive neurologic care, including blood pressure considerations before thrombolysis and delayed cerebral ischemia prevention after aneurysmal subarachnoid hemorrhage.
  • Contrast lung-protective ventilation for acute lung injury with continuous kidney replacement therapy for patients who cannot tolerate intermittent fluid shifts.
  • For ICU medication scenarios, track adverse-effect clues such as rising creatine kinase and triglycerides during propofol infusion.
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