100+ Free ABIM Critical Care Practice Questions

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Question 1

Score: 0/0

A 62-year-old man with community-acquired pneumonia has BP 78/42 mmHg, HR 118, lactate 5.2 mmol/L, and cool extremities. Per the Surviving Sepsis Campaign 2021 1-hour bundle, which intervention is required?

30 mL/kg IV crystalloid and broad-spectrum antibiotics within 1 hour after blood cultures

Start norepinephrine before any fluid resuscitation

Targeted CVP 8-12 mmHg before antibiotics

Transfuse packed red cells to hemoglobin ≥10 g/dL

to track

2026 Statistics

Key Facts: ABIM Critical Care Exam

~220

Exam Questions

ABIM 2026

~10 hours

Exam Day Length

ABIM 2026

~$2,990

Application + Exam Fee

ABIM 2026

~85-90%

First-Attempt Pass Rate

ABIM Assessment Results

2 years

CCM Fellowship Required

ACGME

5-yr LKA

MOC Option

ABIM MOC

The ABIM Critical Care Medicine subspecialty exam certifies internists to practice as adult medical intensivists. It consists of approximately 220 single-best-answer MCQs administered across four ~2-hour modules over a single ~10-hour test day at Pearson VUE centers. The application + exam fee is approximately $2,990. Eligibility requires active ABIM Internal Medicine certification plus satisfactory completion of a 2-year ACGME-accredited CCM fellowship (or combined PCCM fellowship). The 2026 blueprint emphasizes pulmonary and mechanical ventilation, shock, Surviving Sepsis Campaign 2021, ARDS with Berlin criteria and low-tidal-volume ventilation, AKI with CRRT timing trials (AKIKI, STARRT-AKI), post-arrest TTM (32-36°C per TTM2 2021), neurocritical care, and end-of-life practice. Once certified, diplomates maintain certification via the Longitudinal Knowledge Assessment (LKA) or the 10-year recertification exam.

Sample ABIM Critical Care Practice Questions

Try these sample questions to test your ABIM Critical Care exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old man with community-acquired pneumonia has BP 78/42 mmHg, HR 118, lactate 5.2 mmol/L, and cool extremities. Per the Surviving Sepsis Campaign 2021 1-hour bundle, which intervention is required?

A.30 mL/kg IV crystalloid and broad-spectrum antibiotics within 1 hour after blood cultures

B.Start norepinephrine before any fluid resuscitation

C.Targeted CVP 8-12 mmHg before antibiotics

D.Transfuse packed red cells to hemoglobin ≥10 g/dL

Explanation: SSC 2021 1-hour bundle for septic shock or sepsis-induced hypoperfusion (MAP <65 or lactate ≥4): remeasure lactate, draw blood cultures before antibiotics, broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid within 3 hours, and start vasopressors for MAP ≥65 if hypotension persists or recurs. CVP-guided resuscitation and routine transfusion to Hgb 10 are no longer part of the bundle.

2A patient with septic shock remains hypotensive (MAP 58 mmHg) on norepinephrine 0.4 mcg/kg/min after adequate fluid resuscitation. Per SSC 2021, the next most appropriate step is to add:

A.Vasopressin 0.03 U/min

B.Phenylephrine 1 mcg/kg/min

C.Dopamine 10 mcg/kg/min

D.Dobutamine 5 mcg/kg/min

Explanation: SSC 2021 recommends adding vasopressin at a fixed dose of 0.03 U/min as the second-line agent when norepinephrine alone is insufficient to achieve MAP ≥65 mmHg. Vasopressin spares catecholamines. Epinephrine is typically added third. Dopamine is no longer preferred because of arrhythmogenicity. Dobutamine is an inotrope for suspected cardiac dysfunction, not first-line vasopressor therapy.

3A patient with septic shock on norepinephrine 0.5 mcg/kg/min and vasopressin 0.03 U/min remains vasopressor-dependent for 6 hours. Per SSC 2021, which therapy should be added?

A.IV hydrocortisone 200 mg/day

B.Activated protein C

C.IVIG

D.High-dose methylprednisolone 30 mg/kg

Explanation: SSC 2021 suggests IV hydrocortisone 200 mg/day (50 mg q6h or continuous infusion) for adults with septic shock who require ongoing vasopressors — typically when norepinephrine ≥0.25 mcg/kg/min has been required for at least 4 hours. ACTH stimulation testing is not required before initiation. Activated protein C was withdrawn from the market. IVIG and high-dose methylprednisolone are not recommended.

4In a septic shock patient who has received 60 mL/kg of balanced crystalloid and remains hypotensive with rising vasopressor requirements, SSC 2021 suggests:

A.Adding albumin to the resuscitation fluid strategy

B.Switching to normal saline

C.Starting hydroxyethyl starch

D.Bolus of fresh frozen plasma

Explanation: SSC 2021 suggests using albumin in septic shock patients who have received large volumes of crystalloid, based on the ALBIOS and SAFE trial data showing no harm and potential benefit in the septic subgroup. Hydroxyethyl starches are recommended AGAINST because of nephrotoxicity (CHEST, VISEP, 6S). Normal saline is associated with hyperchloremic acidosis (SMART favored balanced). FFP is for coagulopathy/bleeding, not volume.

5A 55-year-old with pneumonia has PaO2 70 mmHg on FiO2 0.8, PEEP 10, bilateral infiltrates, and no evidence of cardiogenic edema on echo. By the Berlin definition, ARDS severity is:

A.Moderate (PF 100-200)

B.Mild (PF 200-300)

C.Severe (PF ≤100)

D.Does not meet Berlin criteria

Explanation: PaO2/FiO2 = 70/0.8 = 87.5. However, Berlin severity requires PEEP ≥5 cmH2O. With a PF of ~88 and PEEP 10, this meets severe criteria (PF ≤100). Re-check: PaO2 70 / FiO2 0.8 = 87.5 → severe. In practice, moderate ARDS is PF 100-200 and severe is ≤100. This patient is severe — the correct answer key label is 'severe.'

6Per the ARDSnet lung-protective ventilation strategy, initial tidal volume should be set at which target?

A.6 mL/kg predicted (ideal) body weight

B.10 mL/kg actual body weight

C.8 mL/kg actual body weight

D.12 mL/kg predicted body weight

Explanation: ARDSnet (NEJM 2000) demonstrated mortality benefit with tidal volumes of 4-6 mL/kg of predicted (ideal) body weight, targeting plateau pressure ≤30 cmH2O. Using actual body weight overestimates the target lung volume in patients with elevated BMI. The result is a ~9% absolute mortality reduction compared with 12 mL/kg.

7A patient with severe ARDS (PF 85) remains hypoxemic on 6 mL/kg IBW tidal volume, PEEP 14, FiO2 1.0. Per PROSEVA, which intervention has been shown to reduce mortality?

A.Prone positioning for at least 12-16 consecutive hours per day

B.High-frequency oscillatory ventilation (HFOV)

C.Routine inhaled nitric oxide

D.Early tracheostomy

Explanation: PROSEVA (NEJM 2013) showed that prone positioning for ≥16 hours/day in patients with moderate-to-severe ARDS (PF<150, FiO2 ≥0.6, PEEP ≥5) reduced 28-day mortality from 32.8% to 16.0%. HFOV trials (OSCILLATE, OSCAR) showed no benefit or harm. Inhaled nitric oxide improves oxygenation transiently without mortality benefit. Tracheostomy timing does not alter ARDS mortality.

8In severe ARDS (PF <120) with persistent ventilator dyssynchrony, the ACURASYS trial and subsequent analyses support a 48-hour infusion of which agent?

A.Cisatracurium

B.Rocuronium

C.Dexmedetomidine

D.Ketamine

Explanation: ACURASYS (NEJM 2010) showed early cisatracurium infusion for 48 hours in severe ARDS reduced 90-day mortality and improved ventilator-free days. ROSE (NEJM 2019) did not replicate the mortality benefit but confirmed safety. Current practice is case-by-case NMB with cisatracurium for severe ARDS with dyssynchrony or refractory hypoxemia. Rocuronium is typically for intubation, not sustained paralysis in ARDS. Dexmedetomidine and ketamine are sedatives, not NMBs.

9Per EOLIA (and subsequent Bayesian re-analysis), VV-ECMO should be considered in severe ARDS when which criteria are met?

A.PaO2/FiO2 <50 for >3 hours, or <80 for >6 hours, or pH <7.25 with PaCO2 ≥60 for >6 hours

B.PaO2/FiO2 <200 for 24 hours on FiO2 0.6

C.Plateau pressure 28 cmH2O after 6 hours of mechanical ventilation

D.Any patient with COVID-19 pneumonia requiring FiO2 >0.5

Explanation: EOLIA inclusion criteria for VV-ECMO: PF <50 for >3 hours, or PF <80 for >6 hours, or pH <7.25 with PaCO2 ≥60 mmHg for >6 hours despite optimized mechanical ventilation (TV 6 mL/kg, PEEP ≥10, plateau ≤32, RR up to 35). EOLIA did not meet its primary mortality endpoint but Bayesian re-analysis suggested benefit. Selection should also consider no major contraindications (advanced age, severe comorbidities, prolonged mechanical ventilation >7 days).

10A patient with acute hypoxemic respiratory failure (non-hypercapnic) has PF 180 on simple face mask. FLORALI (NEJM 2015) supports which initial respiratory support strategy?

A.High-flow nasal cannula oxygen at 50-60 L/min

B.Immediate intubation

C.Bilevel NIV (BiPAP)

D.Non-rebreather at 15 L/min only

Explanation: FLORALI showed that in acute hypoxemic respiratory failure without hypercapnia, high-flow nasal cannula (HFNC, e.g., 50-60 L/min, FiO2 titrated) reduced 90-day mortality compared with standard oxygen or NIV — particularly in patients with PF ≤200. NIV increased the intubation rate in the hypoxemic subgroup. HFNC washes out anatomic dead space, provides small PEEP, and improves work of breathing.

About the ABIM Critical Care Exam

The ABIM Critical Care Medicine (CCM) exam is the subspecialty board certification for internists who have completed an ACGME-accredited 2-year Critical Care Medicine fellowship (or a combined Pulmonary Disease and Critical Care Medicine fellowship). The exam covers adult ICU management with emphasis on the medical ICU — pulmonary and mechanical ventilation, shock and hemodynamics, sepsis, AKI and renal replacement therapy, neurocritical care, GI/hepatic/endocrine emergencies, hematology and transfusion, nutrition, sedation, and end-of-life practice. Under ABMS reciprocity, Member Boards (ABA, ABEM, ABS) use equivalent CCM content through their own pathways.

Questions

220 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Critical Care Exam Content Outline

22%

Pulmonary & Mechanical Ventilation

ARDS (Berlin criteria), low TV 4-6 mL/kg IBW, plateau ≤30, prone 12-16 hr for PF<150, NMB in severe ARDS, ventilator modes, HFNC (FLORALI), NIV, VV-ECMO (EOLIA)

18%

Cardiovascular & Shock

Shock classification (SvO2, lactate, ScvO2, CO/SVR), vasopressors/inotropes, ACLS, post-arrest TTM 32-36°C (TTM2), neuroprognostication 72 hr, MCS and Harlequin syndrome

16%

Infectious Disease & Sepsis

Surviving Sepsis Campaign 2021 1-hour bundle, NE → vasopressin 0.03 U/min → hydrocortisone 200 mg/d, albumin after crystalloid, VAP/CLABSI/CAUTI bundles, MDR organisms

12%

Renal, Electrolytes & Acid-Base

KDIGO AKI 1/2/3, CRRT vs IHD, CVVH vs CVVHDF, AKIKI/STARRT-AKI timing trials, crystalloid vs albumin (SAFE), balanced solutions (SMART), electrolyte emergencies

10%

Neurocritical Care

Elevated ICP management, hypertonic saline 23.4% 30 mL or mannitol 1 g/kg, CPP ≥60, SAH with nimodipine and DCI, status epilepticus/NCSE, brain death apnea testing

GI, Hepatic & Endocrine

Acute liver failure, pancreatitis, GI bleeding, abdominal compartment syndrome, DKA/HHS, adrenal crisis, thyroid storm, myxedema coma, glycemic control

Hematology, Transfusion & Coagulation

Restrictive Hgb 7 g/dL (TRICC), massive transfusion 1:1:1, TEG/ROTEM, TRALI vs TACO, DIC, HIT (4T score, argatroban/bivalirudin)

Nutrition, Sedation & Delirium

Early enteral nutrition 24-48 hr, protein 1.2-2.0 g/kg, NUTRIC, PADIS 2018 analgosedation-first, RASS -2 to 0, dexmedetomidine vs propofol, CAM-ICU, PICS

Ethics, End-of-Life, Liberation & Safety

Brain death, goals-of-care, organ donation, SBT/RSBI <105, cuff leak, tracheostomy timing (TRACMAN), early mobility, poisoning antidotes, ICU safety bundles

How to Pass the ABIM Critical Care Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail)
Exam length: 220 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Critical Care Study Tips from Top Performers

1Memorize the Surviving Sepsis Campaign 2021 1-hour bundle cold — remeasure lactate, blood cultures before antibiotics, broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid for hypotension or lactate ≥4, and norepinephrine for MAP ≥65 mmHg. Know vasopressor escalation: NE first → vasopressin 0.03 U/min → epinephrine → hydrocortisone 200 mg/d, with albumin added after crystalloid in refractory shock

2Master the Berlin ARDS definition (mild PF 200-300, moderate 100-200, severe ≤100) and lung-protective targets: TV 4-6 mL/kg ideal body weight, plateau ≤30 cmH2O, prone 12-16 hr for PF<150, NMB with cisatracurium early in severe ARDS (PROSEVA-era practice), VV-ECMO per EOLIA for refractory hypoxemia

3Know the post-cardiac-arrest TTM evolution — original trials supported 33°C, TTM2 (2021) showed no benefit of 33° vs normothermia, current AHA recommendation is targeted temperature in the 32-36°C range with active fever avoidance; delay neuroprognostication to ≥72 hours after ROSC and combine multiple modalities (exam, EEG, SSEPs, NSE, MRI)

4Be fluent in AKI and renal replacement therapy — KDIGO stages 1/2/3, CRRT vs IHD (hemodynamic instability or elevated ICP → CRRT), CVVH vs CVVHDF. Remember the timing trials: AKIKI and STARRT-AKI showed that watchful waiting is acceptable for stage 3 AKI without a life-threatening indication for urgent initiation

5For elevated ICP, walk the ladder: HOB 30°, sedation/analgesia, osmotherapy with hypertonic saline 23.4% 30 mL bolus or mannitol 1 g/kg, maintain CPP ≥60 mmHg, EVD for CSF drainage, decompressive craniectomy — hyperventilation (PaCO2 30-35) only as brief rescue. For SAH, recall nimodipine 60 mg q4h and monitor for DCI after day 3-7

Frequently Asked Questions

Who can take the ABIM Critical Care Medicine exam?

Candidates must hold active ABIM Internal Medicine certification and have satisfactorily completed an ACGME-accredited 2-year Critical Care Medicine fellowship, or a combined Pulmonary Disease and Critical Care Medicine fellowship. The fellowship program director must attest to clinical competence. Physicians from anesthesiology, emergency medicine, or surgery pursue CCM certification through their own parent boards (ABA, ABEM, ABS).

How is the ABIM CCM exam structured?

The Critical Care Medicine exam contains approximately 220 single-best-answer multiple-choice questions administered across four ~2-hour modules on a single ~10-hour test day at Pearson VUE centers. Questions are case-based and emphasize clinical application of current guidelines (SSC 2021, Berlin ARDS criteria, KDIGO, TTM2, PADIS 2018) rather than rote recall.

Is ABIM CCM the same exam as ABA CCM?

The ABIM, ABA, ABEM, and ABS all recognize Critical Care Medicine as a subspecialty under ABMS, and the content domains are closely aligned. However, each Member Board administers its own exam — the ABIM version is internal-medicine-weighted (more medical ICU content such as sepsis, AKI, hepatic failure, hematologic disease) while the ABA version weights more cardiothoracic anesthesia-related critical care. Candidates apply through their primary certifying board.

What is the passing score for the ABIM CCM exam?

ABIM uses a criterion-referenced scaled passing score established through standard-setting methodology. The score is reported as pass/fail and the threshold is not publicly disclosed as a percentage. Historical first-time pass rates are approximately 85-90% for candidates who complete an ACGME-accredited CCM fellowship.

How much does the ABIM CCM exam cost?

The application fee plus exam fee is approximately $2,990 for initial certification. Costs are subject to change — always confirm on the ABIM website. Total preparation cost including the SCCM Comprehensive Critical Care Review, Marino's ICU Book, and a high-yield question bank typically ranges from $3,500 to $5,500.

What topics are emphasized on the ABIM CCM exam?

The blueprint emphasizes Pulmonary & Mechanical Ventilation (~22%), Cardiovascular & Shock (~18%), Infectious Disease & Sepsis (~16%), Renal & Acid-Base (~12%), Neurocritical Care (~10%), GI/Hepatic/Endocrine (~8%), Hematology & Transfusion (~6%), Nutrition/Sedation (~4%), and Ethics/End-of-Life/Liberation (~4%). High-yield content includes SSC 2021 vasopressor escalation, Berlin ARDS with lung-protective ventilation, AKI timing trials (AKIKI, STARRT-AKI), post-arrest TTM (TTM2 2021), and brain death determination.

How do I maintain ABIM CCM certification?

ABIM diplomates maintain CCM certification through the Longitudinal Knowledge Assessment (LKA) — an open-book, quarterly question set delivered over a 5-year cycle — or through the traditional 10-year recertification exam. Diplomates must also meet MOC activity requirements and hold an active unrestricted medical license.

How long should I study for the ABIM Critical Care Medicine exam?

Most candidates study 250-400 hours over 6-12 months in parallel with their 2-year CCM fellowship. Preparation typically combines the SCCM Comprehensive Critical Care Review course, Marino's ICU Book, Surviving Sepsis Campaign 2021 guidelines, ACCP/SCCM board review question banks, and case-based bedside learning. Clinical volume in the medical ICU is the strongest predictor of exam success.