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Exam Review

Key Facts: Saudi Board Critical Care Medicine Exam

2 papers

Written exam structure (100-125 single-best-answer MCQs each)

SCFHS Adult Critical Care Blueprint 2024-2027

Up to 10%

Unscored pilot items per paper

SCFHS Adult Critical Care Blueprint 2024-2027

70%

Standard passing mark

SCFHS Examination Regulations (floor 65%)

34%

Combined Cardio & Pulmonary weight

SCFHS Adult Critical Care Blueprint 2024-2027

Not published

Examination fee

SCFHS Mumaris+ System

SCFHS

Certifying body

Saudi Commission for Health Specialties

Saudi Board Final Written Examination - Adult Critical Care Medicine (SCFHS). Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint. The standard pass mark is 70%; when the initial pass rate is below 70%, SCFHS lowers the score one mark at a time toward a 70% pass rate or a 65% score, whichever comes first. A separate final clinical examination follows the written examination.

Sample Saudi Board Critical Care Medicine Practice Questions

Try these sample questions to review concepts for the Saudi Board Critical Care Medicine exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old critically ill man with septic shock on continuous venovenous hemodiafiltration (CVVHDF) with regional citrate anticoagulation develops a total serum calcium of 3.1 mmol/L and an ionized calcium of 0.85 mmol/L (systemic). Arterial blood gas reveals a worsening metabolic acidosis with an elevated anion gap. What is the most appropriate management for this complication?
A.Decrease the citrate infusion rate and increase the dialysate/replacement effluent rate
B.Increase the post-filter calcium chloride infusion rate immediately
C.Switch immediately to systemic unfractionated heparin without changing blood flow
D.Administer intravenous sodium bicarbonate to correct the metabolic acidosis
Explanation: A total-to-ionized calcium ratio greater than 2.5 (here 3.1 / 0.85 = 3.65) accompanied by worsening high anion gap metabolic acidosis indicates citrate accumulation ('citrate toxicity'), commonly seen with hepatic hypoperfusion. Management requires reducing citrate delivery by decreasing the blood flow rate or citrate infusion rate, increasing citrate clearance across the hemofilter via higher effluent flow, and maintaining systemic ionized calcium within normal target range (1.1-1.3 mmol/L).
2A 58-year-old woman with diabetic ketoacidosis (DKA) is admitted to the ICU with a plasma glucose of 34 mmol/L, serum sodium of 130 mmol/L, potassium of 4.2 mmol/L, and bicarbonate of 8 mmol/L. Intravenous insulin infusion and isotonic crystalloids are initiated. At what plasma glucose threshold should intravenous dextrose (5% or 10%) be added to the infusion fluids?
A.Below 13.9 mmol/L (250 mg/dL)
B.16.7 to 19.4 mmol/L (300 to 350 mg/dL)
C.7.0 to 8.5 mmol/L (126 to 153 mg/dL)
D.4.0 to 6.0 mmol/L (72 to 108 mg/dL)
Explanation: The 2024 international consensus report recommends adding 5–10% dextrose when glucose falls below 250 mg/dL (13.9 mmol/L). Glucose often normalizes before ketoacidosis resolves, so dextrose permits continued insulin treatment while reducing the risk of hypoglycemia.
3After pituitary surgery, an adult develops a serum sodium rise from 138 to 156 mmol/L, urine output of 350 mL/h, and urine osmolality of 120 mOsm/kg H2O. Blood glucose is normal and there is no hypertonic sodium infusion. Which diagnosis best explains the findings?
A.Central diabetes insipidus due to impaired vasopressin release after surgery
B.Osmotic diuresis induced by high-protein enteral nutrition
C.Postoperative syndrome of inappropriate antidiuretic hormone secretion
D.Exogenous hypertonic sodium load from intravenous maintenance fluids
Explanation: Pituitary surgery can impair vasopressin release and produce central diabetes insipidus. Excessive loss of dilute urine despite rising sodium supports this diagnosis. Normal glucose and very dilute urine favor water diuresis over glucose-driven osmotic diuresis.
4According to the KDIGO guidelines, which criterion defines Stage 3 Acute Kidney Injury based on serum creatinine criteria?
A.Increase in serum creatinine to 3.0 times baseline or to >= 353.6 micromol/L (>= 4.0 mg/dL), in a patient meeting AKI diagnostic criteria
B.Increase in serum creatinine to 2.0 to 2.9 times baseline
C.Increase in serum creatinine of >= 26.5 micromol/L (>= 0.3 mg/dL) within 48 hours
D.Increase in serum creatinine to 1.5 to 1.9 times baseline within 7 days
Explanation: KDIGO stage 3 includes a serum creatinine increase to three times baseline or to at least 4.0 mg/dL in a patient who meets the diagnostic definition of AKI. KDIGO removed the older requirement for an additional acute rise of 0.5 mg/dL at the 4.0 mg/dL threshold. Initiation of kidney replacement therapy also establishes stage 3, independently of the creatinine value.
5A 45-year-old woman with severe myxedema coma is admitted to the intensive care unit. In addition to mechanical ventilation, gentle rewarming, and intravenous levothyroxine (T4) / liothyronine (T3), which medication must be administered before or concurrently with thyroid hormone replacement?
A.Intravenous hydrocortisone
B.Intravenous propranolol
C.Intravenous broad-spectrum cephalosporin
D.Intravenous potassium chloride infusion
Explanation: In myxedema coma, patients often have concomitant central or primary adrenal insufficiency. Administering thyroid hormone accelerates hepatic clearance of cortisol, which can precipitate lethal acute adrenal crisis if glucocorticoid coverage is not provided. Stress-dose intravenous hydrocortisone (100 mg every 8 hours) should always be administered concurrently with or prior to thyroid replacement.
6A 68-year-old man in the ICU with severe acute pancreatitis develops oliguria and refractory hyperkalemia of 6.9 mmol/L with peaked T waves. Continuous venovenous hemofiltration (CVVH) is planned. Which modality parameter primarily determines solute clearance in pure hemofiltration?
A.Ultrafiltration rate (convective clearance)
B.Dialysate flow rate (diffusive clearance)
C.Blood flow rate across the semipermeable membrane
D.Effluent bicarbonate concentration
Explanation: Continuous venovenous hemofiltration (CVVH) relies entirely on convection (solvent drag), in which solutes are swept across a semipermeable membrane alongside ultrafiltered plasma water. Therefore, the ultrafiltration rate (plus replacement fluid rate) directly governs the convective clearance rate in pure hemofiltration.
7A 52-year-old woman with a history of Graves disease undergoes emergency surgery for perforated appendicitis. Postoperatively in the ICU, she exhibits a temperature of 40.2 C, heart rate of 165 beats/min (atrial fibrillation), agitation, and jaundice. Her Burch-Wartofsky score is 65. What is the correct sequence of pharmacological management for this condition?
A.Propylthiouracil first, followed at least 1 hour later by potassium iodide (Lugol solution), alongside beta-blockers and hydrocortisone
B.Potassium iodide first, followed immediately by methimazole and intravenous esmolol
C.Intravenous hydrocortisone alone followed by radioiodine ablation in the ICU
D.Immediate emergent total thyroidectomy before pharmacological stabilization
Explanation: In thyroid storm, thionamides (propylthiouracil or methimazole) must be administered at least 60 minutes before potassium iodide (Lugol solution or SSKI). If iodine is administered first, it serves as a substrate for new thyroid hormone synthesis (Jod-Basedow phenomenon), worsening thyrotoxicosis. Glucocorticoids reduce T4-to-T3 peripheral conversion and treat potential relative adrenal insufficiency, while beta-blockers control sympathetic overdrive.
8A 34-year-old woman with severe traumatic brain injury develops refractory hyponatremia with a serum sodium of 122 mmol/L. Volume status examination reveals dry mucous membranes, flat neck veins, blood pressure of 90/60 mmHg, urine sodium of 85 mmol/L, and urine osmolality of 520 mOsm/kg. What is the most likely diagnosis?
A.Cerebral salt wasting syndrome (CSW)
B.Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C.Central diabetes insipidus
D.Psychogenic polydipsia
Explanation: Cerebral salt wasting (CSW) is characterized by hyponatremia with high urine sodium (> 40 mmol/L) and concentrated urine, accompanied by true hypovolemia (hypotension, flat neck veins, hemoconcentration). In contrast, SIADH presents with euvolemic hyponatremia. Differentiating the two is critical because CSW is treated with volume and sodium repletion (hypertonic or isotonic saline and fludrocortisone), whereas SIADH is treated with fluid restriction.
9A patient with severe acute respiratory distress syndrome (ARDS) and septic shock has an arterial blood gas showing: pH 7.15, PaCO2 55 mmHg, PaO2 78 mmHg, and HCO3- 18 mmol/L. Serum sodium is 140 mmol/L, chloride is 108 mmol/L, and albumin is normal. The laboratory's reference interval for the anion gap calculated without potassium is 8–12 mmol/L. What is the correct acid-base interpretation?
A.Combined high anion gap metabolic acidosis and respiratory acidosis
B.Pure acute respiratory acidosis with normal metabolic compensation
C.Non-anion gap metabolic acidosis with appropriate respiratory compensation
D.High anion gap metabolic acidosis with metabolic alkalosis
Explanation: The anion gap is 140 - (108 + 18) = 14 mmol/L, above this laboratory's stated upper limit of 12. The low bicarbonate indicates metabolic acidosis, while the elevated PaCO2 indicates a concurrent respiratory acidosis rather than compensatory hyperventilation. This is a mixed metabolic and respiratory acidosis with a mildly elevated anion gap.
10What is the recommended maximum rate of serum sodium correction in a patient with chronic symptomatic hyponatremia to minimize the risk of osmotic demyelination syndrome (ODS)?
A.8 mmol/L in any 24-hour period (or 4-6 mmol/L for high-risk patients)
B.15 to 18 mmol/L in 24 hours
C.1 to 2 mmol/L per hour until sodium reaches 135 mmol/L
D.No limit, as rapid normalization prevents cerebral herniation
Explanation: In chronic hyponatremia (> 48 hours duration), brain cells have extruded organic osmoprotectants. Rapid correction leads to cellular dehydration and osmotic demyelination syndrome (central pontine myelinolysis). Guidelines recommend limiting correction to no more than 8 mmol/L in 24 hours, and 4 to 6 mmol/L per 24 hours in patients at high risk (cirrhosis, alcoholism, malnutrition).

About the Saudi Board Critical Care Medicine Exam

Independent English-language MCQ study adaptation by OpenExamPrep for Saudi Board Final Written Examination - Adult Critical Care Medicine (SCFHS). These questions practice selected clinical knowledge and decisions; additional study using the official scope is required. The bank does not simulate or replace the separate mandatory clinical/practical examination. Official assessment delivery languages are not confirmed by the written blueprint.

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

Time Limit

Not published by SCFHS

Passing Score

70% (lowered to minimum 65% if pass rate under 70%)

Exam / Certification Fees

Not published by SCFHS

Exam sponsor website

Reported exam pass rate: Not published by SCFHS. SCFHS publishes no candidate pass rate. The blueprint instead sets the passing score at 70% and, if fewer than 70% of candidates pass before final approval, lowers that score one mark at a time until a 70% pass rate is reached or the score reaches 65%, whichever comes first; it is never lowered below 65%. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

13%

Renal, Endocrine and Metabolic Disorders

Renal, Endocrine and Metabolic Disorders in the official SCFHS written-examination scope.

17%

Cardiovascular Disorders and Hemodynamics

Cardiovascular Disorders and Hemodynamics in the official SCFHS written-examination scope.

17%

Pulmonary Disease and Mechanical Ventilation

Pulmonary Disease and Mechanical Ventilation in the official SCFHS written-examination scope.

11%

Infectious Disease

Infectious Disease in the official SCFHS written-examination scope.

8%

Gastrointestinal Disorders

Gastrointestinal Disorders in the official SCFHS written-examination scope.

12%

Neurologic Disorders

Neurologic Disorders in the official SCFHS written-examination scope.

6%

Hematologic and Oncologic Disorders

Hematologic and Oncologic Disorders in the official SCFHS written-examination scope.

10%

Surgery, Trauma, Burns, Obstetrics and Transplantation

Surgery, Trauma, Burns, Obstetrics and Transplantation in the official SCFHS written-examination scope.

6%

Pharmacology, Toxicology and Critical Care Radiology

Pharmacology, Toxicology and Critical Care Radiology in the official SCFHS written-examination scope.

Preparing for the Saudi Board Critical Care Medicine Exam

What You Need to Know

  • Passing score: 70% (lowered to minimum 65% if pass rate under 70%)
  • Assessment: Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.
  • Time limit: Not published by SCFHS
  • Exam / certification fees: Not published by SCFHS Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Saudi Board Critical Care Medicine: Suggested Study Strategy

1Prioritize high-yield domains: Cardiovascular & Hemodynamics (17%) and Pulmonary Disease & Mechanical Ventilation (17%) together constitute over one-third of the total examination content.
2Master invasive hemodynamic assessment including pulmonary artery catheter profiles, waveform analysis, and bedside critical care echocardiography (POCUS) views for acute right ventricular failure and tamponade.
3Review evidence-based ventilator management protocols for ARDS, including low tidal volume ventilation (4-8 mL/kg PBW), plateau pressure limits (<30 cmH2O), driving pressure optimization, and prone positioning indications.
4Familiarize yourself with continuous renal replacement therapy (CRRT) operational mechanics, including filter clotting troubleshooting, regional citrate anticoagulation protocols, and clearance calculations.
5Study modern septic shock management protocols, source control principles, and empirical antibiotic selection for multidrug-resistant Gram-negative bacteria prevalent in regional ICUs.
6Understand brain death testing criteria, apnea test execution and contraindications, and organ donor hemodynamic management protocols.

Frequently Asked Questions

What is the structure of the Saudi Board Adult Critical Care Medicine final written examination?

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

What is the passing score and how is it determined?

The passing standard set by SCFHS is 70%. If fewer than 70% of candidates achieve this benchmark, the passing score is adjusted downward by one mark at a time until a 70% pass rate is reached, subject to a strict minimum passing floor of 65%.

How is the direct-entry Saudi Board distinguished from fellowship training and clinical exams?

This bank is an independent English-language MCQ study adaptation for the written examination. It does not simulate or replace the separate mandatory final clinical/practical assessment. Consult the specialty clinical blueprint for its station formats and any structured oral or OSCE components.

What clinical domains carry the greatest weight on the examination?

This bank is an independent English-language MCQ study adaptation for the written examination. It does not simulate or replace the separate mandatory final clinical/practical assessment. Consult the specialty clinical blueprint for its station formats and any structured oral or OSCE components.

What is the examination fee?

The examination fee is not published on the public blueprint documents. Candidates should check the SCFHS Mumaris+ portal or contact the examination department directly for current administrative fee schedules.

Is OpenExamPrep affiliated with or endorsed by SCFHS?

No. OpenExamPrep is an independent educational initiative providing free practice questions. It is not affiliated with, approved by, or endorsed by the Saudi Commission for Health Specialties (SCFHS).