100+ Free ABS Surgical Critical Care Practice Questions

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~85-90% first-time among ACGME SCC fellowship graduates (ABS annual statistics) Pass Rate

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Question 1

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According to the Surviving Sepsis Campaign 2021 1-hour bundle, which combination of interventions should be initiated for a patient with septic shock?

Lactate, blood cultures before antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid if hypotensive or lactate >=4, vasopressors to MAP >=65

Lactate, blood cultures, narrow-spectrum antibiotics, 10 mL/kg crystalloid, vasopressin

Procalcitonin, antibiotics within 6 hours, 500 mL colloid bolus, dobutamine

Lactate, antibiotics within 3 hours, albumin resuscitation, early intubation

to track

2026 Statistics

Key Facts: ABS Surgical Critical Care Exam

~200

Total MCQ Items

ABS Surgical Critical Care Certifying Examination

~6-7 hr

Total Exam Time

1-day computer-based test including breaks

~14%

Pulmonary Weight

Largest domain on 2026 ABS SCC content outline

~$1,950

2026 Certifying Exam Fee

ABS (verify current schedule)

1 yr

SCC Fellowship

ACGME-accredited Surgical Critical Care fellowship

~85-90%

First-Time Pass Rate

ABS annual statistics (SCC fellowship graduates)

The ABS Surgical Critical Care Certifying Exam is a 1-day computer-based test from the American Board of Surgery comprising ~200 single-best-answer MCQs over ~6-7 hours at Pearson VUE. Content spans pulmonary (~14%), infection/sepsis (~12%), hematologic/transfusion (~12%), neurologic (~10%), trauma (~10%), GI/nutrition (~9%), renal/fluids (~7%), endocrine (~7%), cardiovascular (~6%), burns/toxicology (~6%), ethics/end-of-life (~5%), and perioperative (~2%). Certifying Examination fee is ~$1,950; requires ABS General Surgery certification plus a 1-year ACGME SCC fellowship.

Sample ABS Surgical Critical Care Practice Questions

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

1According to the Surviving Sepsis Campaign 2021 1-hour bundle, which combination of interventions should be initiated for a patient with septic shock?

A.Lactate, blood cultures before antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid if hypotensive or lactate >=4, vasopressors to MAP >=65

B.Lactate, blood cultures, narrow-spectrum antibiotics, 10 mL/kg crystalloid, vasopressin

C.Procalcitonin, antibiotics within 6 hours, 500 mL colloid bolus, dobutamine

D.Lactate, antibiotics within 3 hours, albumin resuscitation, early intubation

Explanation: The SSC 2021 1-hour bundle: measure lactate (remeasure if >2), obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, begin 30 mL/kg IV crystalloid for hypotension or lactate >=4 mmol/L, and start vasopressors during or after resuscitation to maintain MAP >=65 mmHg.

2A 62-year-old patient with septic shock remains hypotensive (MAP 58) after 30 mL/kg crystalloid. What is the recommended first-line vasopressor per SSC 2021?

A.Dopamine

B.Phenylephrine

C.Epinephrine

D.Norepinephrine

Explanation: Norepinephrine is the first-line vasopressor for septic shock (SSC 2021, strong recommendation). Vasopressin 0.03 U/min may be added if MAP remains inadequate on moderate-dose norepinephrine (typically ~0.25-0.5 mcg/kg/min), and epinephrine is the next add-on. Dopamine is associated with higher arrhythmia rates.

3Per the Berlin Definition of ARDS, a PaO2/FiO2 ratio of 110 on PEEP 10 cm H2O represents which severity?

A.Severe ARDS

B.Moderate ARDS

C.Mild ARDS

D.Does not meet ARDS criteria

Explanation: Berlin ARDS severity (with PEEP >=5): mild P/F 201-300, moderate P/F 101-200, severe P/F <=100. All require acute onset within 1 week, bilateral opacities, and not explained by cardiac failure/volume overload. P/F of 110 = moderate ARDS.

4What is the recommended initial tidal volume for lung-protective ventilation in ARDS?

A.4 mL/kg actual body weight

B.6 mL/kg predicted body weight

C.10 mL/kg actual body weight

D.8 mL/kg predicted body weight

Explanation: The ARDSNet ARMA trial established 6 mL/kg of predicted (ideal) body weight with plateau pressure <30 cm H2O as the standard of care in ARDS. Predicted body weight is sex- and height-based, not actual weight, which is why tall thin patients and obese patients need the same Vt for a given height.

5In moderate-to-severe ARDS (P/F <150), what is the strongest evidence-based adjunctive therapy shown to reduce mortality?

A.High-frequency oscillatory ventilation

B.Inhaled nitric oxide

C.Prone positioning for at least 16 hours/day

D.Routine systemic corticosteroids

Explanation: The PROSEVA trial demonstrated a mortality reduction with early prone positioning (>=16 hours/day) in severe ARDS (P/F <150). HFOV failed in OSCILLATE/OSCAR, and iNO improves oxygenation without mortality benefit. Prone positioning is a strong recommendation in SSC and ATS/ESICM/SCCM ARDS guidelines.

6Which KDIGO AKI stage is defined by a serum creatinine increase of 2.0-2.9 times baseline or urine output <0.5 mL/kg/h for >=12 hours?

A.Stage 1

B.Stage 2

C.Stage 3

D.AKI risk (pre-stage)

Explanation: KDIGO AKI staging: Stage 1 = Cr 1.5-1.9x baseline or >=0.3 mg/dL increase, or UOP <0.5 mL/kg/h for 6-12 h. Stage 2 = Cr 2.0-2.9x, or UOP <0.5 mL/kg/h for >=12 h. Stage 3 = Cr 3.0x or >=4.0 mg/dL or RRT initiation, or anuria >=12 h or UOP <0.3 mL/kg/h for >=24 h.

7The STARRT-AKI trial addressed what clinical question in critically ill patients with AKI?

A.CRRT versus intermittent hemodialysis for stable AKI

B.Accelerated versus standard initiation of renal replacement therapy

C.Bicarbonate versus saline for contrast nephropathy prevention

D.Furosemide stress test to predict AKI progression

Explanation: STARRT-AKI (2020) randomized critically ill patients with severe AKI to accelerated versus standard-timing RRT. There was no 90-day mortality difference, and accelerated initiation increased long-term dialysis dependence. Combined with AKIKI and IDEAL-ICU, the evidence supports standard (symptom/metabolic-driven) initiation.

8Per the 2016 Brain Trauma Foundation guidelines (reaffirmed), what ICP threshold should trigger treatment in severe TBI?

A.ICP >15 mmHg

B.ICP >22 mmHg

C.ICP >30 mmHg

D.ICP >40 mmHg

Explanation: Brain Trauma Foundation 4th edition guidelines recommend treating ICP >22 mmHg (Level IIB). CPP goal is 60-70 mmHg (Level IIB). Prior guidelines used 20 mmHg; the updated threshold is supported by outcome data. CPP = MAP - ICP.

9According to the PROPPR trial, what ratio of plasma:platelets:pRBC should be used in massive transfusion for trauma?

A.1:1:1

B.1:1:2

C.4:1:1

D.2:1:1

Explanation: PROPPR (2015) compared 1:1:1 to 1:1:2 (plasma:platelets:pRBC) in major trauma. While 24-hour and 30-day mortality were similar, 1:1:1 achieved better hemostasis and lower exsanguination deaths at 24 hours, and is the preferred empiric ratio in trauma massive transfusion protocols.

10A trauma patient on dabigatran presents with intracranial hemorrhage. What is the preferred reversal agent?

A.4-factor PCC

B.Andexanet alfa

C.Idarucizumab

D.Fresh frozen plasma

Explanation: Idarucizumab (Praxbind) is the monoclonal antibody fragment that specifically reverses dabigatran (a direct thrombin inhibitor), FDA-approved based on REVERSE-AD. Andexanet alfa reverses factor Xa inhibitors (apixaban/rivaroxaban). 4F-PCC reverses warfarin. FFP is not indicated for DOAC reversal.

About the ABS Surgical Critical Care Exam

The ABS Surgical Critical Care Certifying Examination validates subspecialty knowledge for independent practice as a surgical intensivist. Content spans pulmonary and respiratory failure (Berlin ARDS, PROSEVA prone, EOLIA/CESAR ECMO, lung-protective ventilation), infection and sepsis (Surviving Sepsis 2021 1-hour bundle, ATHOS-3 angiotensin II, source control, VAP/CLABSI/CAUTI), hematologic and transfusion medicine (PROPPR 1:1:1, CRASH-2/3 TXA, ANNEXA-4 andexanet, HIT, MINT/TRICS III), neurologic critical care (AAN 2023 brain death/DNC, BTF TBI ICP/CPP, ESETT status epilepticus, ABCDEF/PADIS delirium), trauma and resuscitation (ATLS, damage control, REBOA, abdominal compartment syndrome), GI and hepatic (PANTER/MISER step-up pancreatitis, acute liver failure King's College, variceal bleed, nutrition), renal and fluids (KDIGO AKI, STARRT-AKI/AKIKI, CLASSIC/CLOVERS, PLUS/SMART balanced crystalloids), endocrine (DKA/HHS, NICE-SUGAR, adrenal insufficiency), cardiovascular and shock, burns and toxicology (Parkland, CO/cyanide, APAP, TCA, β-blocker), and ICU ethics/end-of-life. Requires ABS General Surgery certification plus a 1-year ACGME-accredited Surgical Critical Care fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~6-7 hours including breaks)

Passing Score

Criterion-referenced scaled score set by ABS (modified Angoff standard)

Exam Fee

~$1,950 Certifying Examination fee (ABS 2026 — verify current schedule) (American Board of Surgery (ABS) / Pearson VUE)

ABS Surgical Critical Care Exam Content Outline

~14%

Pulmonary / Respiratory Failure

Berlin ARDS (P/F ratio mild/moderate/severe), lung-protective ventilation (6 mL/kg PBW, plateau ≤30, driving pressure <15), PEEP titration (ARDSnet high/low tables, esophageal balloon), PROSEVA prone ≥16 hr/day for P/F <150, ROSE/ACURASYS cisatracurium, EOLIA/CESAR VV-ECMO for refractory ARDS, extubation readiness (SBT, RSBI <105, cuff leak), tracheostomy timing, massive PE (PERC/Wells, PEITHO systemic vs catheter-directed lysis), status asthmaticus, COPD exacerbation.

~12%

Infection & Sepsis

Surviving Sepsis 2021 1-hour bundle (lactate, cultures, broad-spectrum antibiotics within 1 hr, 30 mL/kg crystalloid for hypotension/lactate ≥4, MAP ≥65), norepinephrine first-line + vasopressin + epinephrine, ATHOS-3 angiotensin II for refractory vasodilatory shock, ADRENAL/APROCCHSS hydrocortisone, source control timing, VAP/CAUTI/CLABSI/SSI bundles, C. difficile (fidaxomicin), necrotizing soft tissue (LRINEC, early debridement), invasive candidiasis, MDRO stewardship.

~12%

Hematologic / Coagulation / Transfusion

PROPPR 1:1:1 massive transfusion protocol, TEG/ROTEM-guided resuscitation, CRASH-2/CRASH-3 TXA within 3 hr of injury, ANNEXA-4 andexanet alfa for factor Xa reversal, idarucizumab for dabigatran, 4-factor PCC for warfarin, DIC (ISTH score), HIT (4T score, argatroban/bivalirudin), TTP (ADAMTS13, PLEX), MINT/TRICS III restrictive transfusion (Hb <7 g/dL generally), VTE prophylaxis and treatment, platelet thresholds.

~10%

Neurologic Critical Care

AAN 2023 brain death/DNC (prerequisites, clinical exam, apnea test, ancillary testing), TBI management (BTF — ICP >22, CPP 60-70, hyperosmolar 3% saline/mannitol, decompressive craniectomy RESCUEicp/DECRA), ESETT status epilepticus (levetiracetam/fosphenytoin/valproate equivalence), SAH (Hunt-Hess, nimodipine, vasospasm), stroke (tPA, thrombectomy windows), ICU delirium (CAM-ICU, ICDSC — ABCDEF/PADIS), spinal cord injury (ASIA, MAP >85).

~10%

Trauma & Resuscitation

ATLS primary/secondary survey, damage control resuscitation and surgery, permissive hypotension in penetrating trauma, FAST/E-FAST, pelvic fracture (binder, preperitoneal packing, angioembolization, REBOA zone 3), blunt cerebrovascular injury (Denver criteria), cardiac tamponade, tension PTX, blunt aortic injury, compartment syndrome, abdominal compartment syndrome (bladder pressure >20 + organ failure), rhabdomyolysis, fat embolism, crush.

~9%

GI / Hepatic / Nutrition

Acute pancreatitis (BISAP/APACHE, PANTER/MISER step-up — delayed minimally invasive >4 weeks for infected necrosis), ALF (King's College, NAC, transplant listing), hepatic encephalopathy (lactulose, rifaximin), variceal bleed (octreotide, ceftriaxone, TIPS), ACLF, SBP, GI bleeding, mesenteric ischemia, Ogilvie (neostigmine), early enteral <48 hr preferred, refeeding syndrome, indirect calorimetry targets.

~7%

Renal / Fluids / Electrolytes

KDIGO AKI staging, STARRT-AKI/AKIKI RRT initiation timing (no benefit to early), CRRT vs iHD, CLASSIC/CLOVERS restrictive vs liberal fluid resuscitation in septic shock, PLUS/SMART balanced crystalloids vs saline (chloride-restrictive benefit), hyponatremia (acute/chronic, ODS risk, DDAVP clamp), hypernatremia, hyper/hypokalemia, hyper/hypocalcemia (ionized), hypomagnesemia, hyperphosphatemia, contrast nephropathy, rhabdo-AKI.

~7%

Endocrine / Metabolic

DKA/HHS (insulin infusion, fluids, K+), glycemic control (140-180 target, NICE-SUGAR), adrenal insufficiency (cosyntropin, hydrocortisone — APROCCHSS), thyroid storm (PTU, β-blocker, hydrocortisone, iodine), myxedema coma, pheochromocytoma (α before β), SIADH vs CSW, central/nephrogenic DI, pituitary apoplexy, acid-base (anion gap, delta-delta, Winter's), lactic acidosis.

~6%

Cardiovascular / Shock

Shock classification (hypovolemic/cardiogenic/distributive/obstructive), hemodynamic monitoring (PA catheter, PiCCO, passive leg raise, dynamic indices), STEMI/NSTEMI, cardiogenic shock (DanGer Shock/Impella, IABP, VA-ECMO, SHOCK trial), arrhythmias (AF rate vs rhythm, amiodarone), post-arrest care (TTM2 targeted temperature 33-36°C), endocarditis, aortic dissection (Stanford A surgical, B medical/TEVAR), tamponade.

~6%

Burns & Toxicology

Parkland formula (4 mL/kg/%TBSA LR, half in first 8 hr from burn), burn depth, escharotomy, inhalation injury (CO — carboxyhemoglobin, hyperbaric; cyanide — hydroxocobalamin), acetaminophen (NAC, Rumack-Matthew), salicylates (alkalinization, HD), TCA (NaHCO3), β-blocker/CCB (glucagon, high-dose insulin-euglycemia, lipid emulsion, methylene blue), methanol/ethylene glycol (fomepizole), serotonin vs NMS, hypothermia/hyperthermia.

~5%

Ethics, End-of-Life & Quality

Informed consent and surrogate decision-making, advance directives/POLST, withdrawal vs withholding life-sustaining therapy, brain death and DCD organ donation, palliative care in ICU, family meetings (VALUE, Ask-Tell-Ask), conflict/futility, ABCDEF bundle and PADIS guidelines (pain, agitation/sedation, delirium, immobility, sleep), post-intensive care syndrome (PICS), disaster triage, biostatistics.

~2%

Perioperative / Special Populations

Cardiac risk assessment (RCRI, MINS, NSQIP), perioperative β-blocker/statin, pregnancy in ICU (perimortem C-section <4 min), geriatric ICU (frailty, CFS), obesity (ABW dosing, ventilation strategy), immunocompromised host, solid organ transplant recipients, ERAS pearls, handoffs and checklists.

How to Pass the ABS Surgical Critical Care Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABS (modified Angoff standard)
Exam length: 200 questions
Time limit: 1-day CBT (~6-7 hours including breaks)
Exam fee: ~$1,950 Certifying Examination fee (ABS 2026 — verify current schedule)

Keys to Passing

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

ABS Surgical Critical Care Study Tips from Top Performers

1Surviving Sepsis Campaign 2021 1-hour bundle high-yield: measure lactate (remeasure if >2), blood cultures BEFORE antibiotics, administer broad-spectrum antibiotics within 1 hour of recognition, 30 mL/kg crystalloid for hypotension or lactate ≥4, vasopressors to maintain MAP ≥65 mmHg. Norepinephrine is first-line; add vasopressin up to 0.03 U/min and epinephrine if needed. ATHOS-3 angiotensin II is reserved for refractory vasodilatory shock on multiple vasopressors.

2Berlin ARDS and lung-protective ventilation: P/F 201-300 mild, 101-200 moderate, ≤100 severe. Set tidal volume 6 mL/kg predicted body weight, plateau pressure ≤30 cm H2O, driving pressure <15. PROSEVA demonstrated mortality benefit from prone positioning ≥16 hr/day for P/F <150. ROSE updated ACURASYS — routine early NMB does NOT improve mortality; reserve cisatracurium for severe dyssynchrony. EOLIA/CESAR support VV-ECMO for refractory severe ARDS.

3AAN 2023 adult brain death / death by neurologic criteria (DNC): confirm catastrophic irreversible brain injury; prerequisites include absence of confounders (drugs, electrolytes, hypothermia <36°C, SBP ≥100 with vasopressors if needed). Clinical exam shows coma, absent brainstem reflexes (pupillary, corneal, oculocephalic/oculovestibular, gag, cough), no motor response. Apnea test demonstrates no respiratory effort with PaCO2 rise ≥20 mmHg from baseline to ≥60 mmHg. Ancillary tests (EEG, nuclear flow, TCD) when clinical exam cannot be completed.

4Massive transfusion and TXA: PROPPR showed 1:1:1 (plasma:platelets:RBC) did not improve 24-hr/30-day mortality but reduced hemostatic death and achieved hemostasis faster. CRASH-2 — TXA within 3 hours of injury reduces all-cause and bleeding mortality; NO benefit and possible harm if given >3 hours after injury. CRASH-3 — TXA within 3 hours reduces head-injury-related death in mild-to-moderate TBI. Use TEG/ROTEM to guide component therapy when available.

5Fluids and AKI: CLASSIC/CLOVERS showed restrictive fluid strategy after initial resuscitation was neither beneficial nor harmful in septic shock — both strategies acceptable. PLUS (no benefit) and SMART (benefit of balanced crystalloids over saline) support preferring balanced crystalloids (LR, Plasma-Lyte) over 0.9% saline for large-volume resuscitation. STARRT-AKI/AKIKI — accelerated RRT initiation in critically ill AKI does NOT improve 90-day mortality; wait for conventional indications (refractory hyperkalemia, acidosis, volume overload, uremia).

Frequently Asked Questions

What is the ABS Surgical Critical Care Certifying Examination?

The ABS Surgical Critical Care Certifying Examination is administered by the American Board of Surgery and is the subspecialty certification exam for surgeons completing a 1-year ACGME-accredited Surgical Critical Care fellowship. It validates breadth of knowledge across surgical ICU practice — pulmonary/ARDS, sepsis, trauma, hematologic/transfusion, neurologic critical care, renal and fluids, GI/hepatic, endocrine, cardiovascular shock, burns, toxicology, and ICU ethics.

Who is eligible to take the ABS SCC exam?

Candidates must hold ABS General Surgery certification (or complete an approved alternate/combined pathway such as ABTS, ABU, ABOG, or Neurosurgery) and successfully complete a 1-year ACGME-accredited Surgical Critical Care fellowship attested by the program director. A valid unrestricted medical license is required.

What is the format of the ABS SCC exam?

The ABS Surgical Critical Care Certifying Exam is a 1-day computer-based examination administered at Pearson VUE test centers, comprising approximately 200 single-best-answer multiple-choice questions over roughly 6-7 hours including breaks. Items commonly include clinical vignettes, hemodynamic tracings, ventilator waveforms, chest radiographs, CT imaging, ECG strips, and lab data. The exam is blueprinted to the ABS SCC content outline.

How much does the 2026 ABS SCC exam cost?

The 2026 ABS Surgical Critical Care Certifying Examination fee is approximately $1,950 — always verify the current schedule on the ABS website. Cancellation and refund policies follow the ABS schedule with decreasing refunds as the exam date approaches. Retakes require re-registration and full fee payment within the allowed qualification window following fellowship completion.

When is the 2026 exam administered?

The ABS Surgical Critical Care Certifying Examination is typically offered annually, most commonly in the autumn testing window. Applications open earlier in the year with a submission deadline several months before the test. Candidates schedule specific appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABS SCC page.

How is the exam scored?

ABS uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports include domain-level feedback so candidates can identify areas for continued learning.

What are the highest-yield topics?

Highest-yield topics include Surviving Sepsis Campaign 2021 1-hour bundle, Berlin ARDS with PROSEVA prone positioning, EOLIA/CESAR VV-ECMO criteria, PROPPR 1:1:1 massive transfusion, CRASH-2/3 TXA, ANNEXA-4 andexanet alfa, AAN 2023 brain death/DNC, BTF TBI ICP/CPP targets, ESETT status epilepticus, KDIGO AKI with STARRT-AKI RRT timing, CLASSIC/CLOVERS fluid strategy, PLUS/SMART balanced crystalloids, PANTER/MISER pancreatitis step-up, Parkland formula, and the ABCDEF/PADIS ICU liberation bundle.

How should I study for this exam?

Use a structured 9-12 month plan during and immediately after the SCC fellowship year. Map to the ABS SCC content outline: begin with respiratory failure and shock/sepsis, then trauma and transfusion, neuro/renal/GI/endocrine, and finish with burns/toxicology and ethics. Integrate the SCCM Fundamentals texts, Civetta/Marino ICU Book, Rogers' Textbook of Pediatric ICU (for peds content), SCCM Self-Assessment, high-volume MCQ practice, and 2-3 full-length timed mock exams. Attend the SCCM MCCKAP/ACS SCC review course if available.