American Board of Internal Medicine
Questions and Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
Download Pdf
1. A 65-year-old man is admitted to the ICU with septic shock
secondary to pneumonia. Despite adequate fluid resuscitation, his
mean arterial pressure remains 55 mmHg. Which of the following
is the first-line vasopressor recommended in this scenario?
A) Dopamine
B) Phenylephrine
C) Norepinephrine
D) Epinephrine
C) Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock
because it primarily acts on alpha-adrenergic receptors to increase
vascular tone with minimal tachycardia.
2. Which of the following ventilator strategies has been shown to
reduce mortality in patients with acute respiratory distress
syndrome (ARDS)?
A) High tidal volume (12 mL/kg)
B) Low tidal volume (6 mL/kg)
C) High-frequency oscillatory ventilation
D) Pressure-controlled ventilation only
,B) Low tidal volume (6 mL/kg)
Rationale: Low tidal volume ventilation reduces ventilator-induced lung
injury and has been shown to improve survival in ARDS.
3. A patient with septic shock is on norepinephrine infusion. Blood
pressure remains inadequate. Which of the following is the
recommended second-line vasopressor?
A) Dopamine
B) Vasopressin
C) Dobutamine
D) Phenylephrine
B) Vasopressin
Rationale: Vasopressin can be added to norepinephrine in refractory
septic shock to achieve target blood pressure and reduce
norepinephrine requirements.
4. In mechanically ventilated patients, plateau pressure should be
kept below which of the following to minimize barotrauma?
A) 20 cm H2O
B) 25 cm H2O
C) 30 cm H2O
D) 35 cm H2O
C) 30 cm H2O
Rationale: Limiting plateau pressure to ≤30 cm H2O helps prevent
ventilator-induced lung injury.
, 5. Which of the following is the most sensitive marker of tissue
hypoperfusion in septic shock?
A) Serum lactate
B) Blood pressure
C) Urine output
D) Heart rate
A) Serum lactate
Rationale: Elevated lactate reflects anaerobic metabolism due to tissue
hypoperfusion and is a sensitive marker of shock.
6. A patient develops ARDS after severe pancreatitis. Which of the
following is the most appropriate initial fluid management
strategy?
A) Liberal fluid resuscitation
B) Conservative fluid management
C) Immediate diuretics
D) High-volume albumin infusion
B) Conservative fluid management
Rationale: After initial resuscitation, conservative fluid management
improves oxygenation and reduces ventilator days in ARDS.
7. Which of the following sedation regimens is associated with
shorter ICU stay in mechanically ventilated patients?
A) Continuous benzodiazepine infusion
B) Intermittent benzodiazepines
C) Daily sedation interruption with propofol or dexmedetomidine
D) High-dose opioids alone
, C) Daily sedation interruption with propofol or dexmedetomidine
Rationale: Daily sedation interruption and use of non-benzodiazepine
agents reduce duration of mechanical ventilation and ICU length of
stay.
8. Which of the following scoring systems is most widely used to
predict ICU mortality?
A) APACHE II
B) SOFA
C) GCS
D) MELD
A) APACHE II
Rationale: APACHE II uses physiologic variables, age, and comorbidities
to estimate ICU mortality risk.
9. A patient with ARDS is receiving mechanical ventilation.
Oxygenation remains poor despite optimal settings. Which
adjunctive therapy may improve survival?
A) Inhaled nitric oxide
B) Prone positioning
C) High-dose corticosteroids
D) Hyperbaric oxygen
B) Prone positioning
Rationale: Prone positioning improves ventilation-perfusion matching
and has been shown to reduce mortality in severe ARDS.
Questions and Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A | Instant
Download Pdf
1. A 65-year-old man is admitted to the ICU with septic shock
secondary to pneumonia. Despite adequate fluid resuscitation, his
mean arterial pressure remains 55 mmHg. Which of the following
is the first-line vasopressor recommended in this scenario?
A) Dopamine
B) Phenylephrine
C) Norepinephrine
D) Epinephrine
C) Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock
because it primarily acts on alpha-adrenergic receptors to increase
vascular tone with minimal tachycardia.
2. Which of the following ventilator strategies has been shown to
reduce mortality in patients with acute respiratory distress
syndrome (ARDS)?
A) High tidal volume (12 mL/kg)
B) Low tidal volume (6 mL/kg)
C) High-frequency oscillatory ventilation
D) Pressure-controlled ventilation only
,B) Low tidal volume (6 mL/kg)
Rationale: Low tidal volume ventilation reduces ventilator-induced lung
injury and has been shown to improve survival in ARDS.
3. A patient with septic shock is on norepinephrine infusion. Blood
pressure remains inadequate. Which of the following is the
recommended second-line vasopressor?
A) Dopamine
B) Vasopressin
C) Dobutamine
D) Phenylephrine
B) Vasopressin
Rationale: Vasopressin can be added to norepinephrine in refractory
septic shock to achieve target blood pressure and reduce
norepinephrine requirements.
4. In mechanically ventilated patients, plateau pressure should be
kept below which of the following to minimize barotrauma?
A) 20 cm H2O
B) 25 cm H2O
C) 30 cm H2O
D) 35 cm H2O
C) 30 cm H2O
Rationale: Limiting plateau pressure to ≤30 cm H2O helps prevent
ventilator-induced lung injury.
, 5. Which of the following is the most sensitive marker of tissue
hypoperfusion in septic shock?
A) Serum lactate
B) Blood pressure
C) Urine output
D) Heart rate
A) Serum lactate
Rationale: Elevated lactate reflects anaerobic metabolism due to tissue
hypoperfusion and is a sensitive marker of shock.
6. A patient develops ARDS after severe pancreatitis. Which of the
following is the most appropriate initial fluid management
strategy?
A) Liberal fluid resuscitation
B) Conservative fluid management
C) Immediate diuretics
D) High-volume albumin infusion
B) Conservative fluid management
Rationale: After initial resuscitation, conservative fluid management
improves oxygenation and reduces ventilator days in ARDS.
7. Which of the following sedation regimens is associated with
shorter ICU stay in mechanically ventilated patients?
A) Continuous benzodiazepine infusion
B) Intermittent benzodiazepines
C) Daily sedation interruption with propofol or dexmedetomidine
D) High-dose opioids alone
, C) Daily sedation interruption with propofol or dexmedetomidine
Rationale: Daily sedation interruption and use of non-benzodiazepine
agents reduce duration of mechanical ventilation and ICU length of
stay.
8. Which of the following scoring systems is most widely used to
predict ICU mortality?
A) APACHE II
B) SOFA
C) GCS
D) MELD
A) APACHE II
Rationale: APACHE II uses physiologic variables, age, and comorbidities
to estimate ICU mortality risk.
9. A patient with ARDS is receiving mechanical ventilation.
Oxygenation remains poor despite optimal settings. Which
adjunctive therapy may improve survival?
A) Inhaled nitric oxide
B) Prone positioning
C) High-dose corticosteroids
D) Hyperbaric oxygen
B) Prone positioning
Rationale: Prone positioning improves ventilation-perfusion matching
and has been shown to reduce mortality in severe ARDS.
