FCCN LEVEL 1 EXAM WITH COMPLETE
SOLUTIONS.
Introduction
This 75-item examination replicates the length and cognitive complexity of the Society
of Critical Care Medicine (SCCM) Fundamental Critical Care Support (FCCS) Level 1
certification test. Domains span recognition & management of the critically ill patient,
airway & ventilator support, shock & hemodynamic monitoring, trauma & neuro-
emergencies, infection control & sepsis, metabolic-electrolyte disorders, and ICU
protocols / patient safety. All items are original, board-style, and referenced to the 2024-
2025 SCCM FCCS curriculum and current evidence-based critical-care guidelines for
mastery-level performance.
Question 1
A 62-year-old man is admitted with community-acquired pneumonia. At 18:00 his SpO₂
is 89 % on 6 L·min⁻¹ nasal cannula, respiratory rate 32·min⁻¹, and he is using accessory
muscles. The MOST appropriate next action is:
A. Increase nasal cannula to 10 L·min⁻¹
B. Start high-flow nasal oxygen (HFNO) at 50 L·min⁻¹
C. Intubate immediately with rapid-sequence technique
D. Initiate non-invasive positive-pressure ventilation (NIV)
Answer: B. Start high-flow nasal oxygen (HFNO) at 50 L·min⁻¹
Solution: HFNO delivers up to 60 L·min⁻¹ with FiO₂ 1.0, reduces work of breathing, and
buys time while avoiding intubation risks. NIV (D) is second-line if HFNO fails;
immediate intubation (C) is premature without HFNO trial.
Question 2
During rapid-sequence intubation the patient desaturates to 75 % despite 3 min pre-
oxygenation. The MOST effective immediate maneuver is:
A. Apply cricoid pressure
B. Perform a 30-second apnoeic oxygenation with 15 L·min⁻¹ nasal oxygen
C. Proceed with intubation while ventilating with bag-mask
D. Insert an oropharyngeal airway and suction
Answer: B. Perform a 30-second apnoeic oxygenation with 15 L·min⁻¹ nasal
oxygen
Solution: Apnoeic oxygenation extends safe apnoea time by maintaining alveolar
pg. 1
,oxygenation. Cricoid (A) does not raise SpO₂; bag-mask (C) risks aspiration in rapid-
sequence.
Question 3
A patient on volume-control ventilation (VC-AC) has PIP 40 cmH₂O and Pplat 28 cmH₂O.
The calculated driving pressure is:
A. 12 cmH₂O
B. 28 cmH₂O
C. 40 cmH₂O
D. 68 cmH₂O
Answer: A. 12 cmH₂O
Solution: Driving pressure = Pplat − PEEP (normal < 15). 28 − 16 (assumed PEEP) = 12.
PIP includes airway resistance, not alveolar stress.
Question 4
A 55-year-old woman with septic shock has MAP 58 mmHg despite 4 L balanced
crystalloid. CVP 14 mmHg, ScvO₂ 65 %. The NEXT recommended intervention is:
A. Start norepinephrine 0.1 µg·kg⁻¹·min⁻¹
B. Give 2 L more crystalloid
C. Start dobutamine 5 µg·kg⁻¹·min⁻¹
D. Transfuse 2 units PRBC
Answer: A. Start norepinephrine 0.1 µg·kg⁻¹·min⁻¹
Solution: Surviving Sepsis 2023: initiate vasopressors if hypotensive after 30 mL·kg⁻¹
fluid and MAP < 65. CVP 14 suggests adequate preload; more fluid (B) risks overload.
Question 5
ECG shows irregular narrow-complex tachycardia 150 bpm, absent P waves, RR
intervals irregularly irregular. The rhythm is:
A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. AVNRT
Answer: B. Atrial fibrillation
Solution: Irregular RR without discernible P waves = AF. Flutter (A) has saw-tooth
baseline; sinus (C) has upright P; AVNRT (D) is regular.
pg. 2
, Question 6
A trauma patient arrives with GCS 6, BP 80/40, HR 130. FAST exam shows free fluid in
Morrison’s pouch. The priority intervention is:
A. CT abdomen-pelvis
B. Emergent OR for exploratory laparotomy
C. Transfuse 1:1:1 ratio PRBC:plasma:platelets
D. Diagnostic peritoneal lavage
Answer: B. Emergent OR for exploratory laparotomy
Solution: Positive FAST + hypotension = operative management per ATLS. CT (A) delays
care; massive transfusion (C) begins in parallel, not instead of surgery.
Question 7
A patient with TBI has ICP 28 mmHg and MAP 90 mmHg. Calculated cerebral perfusion
pressure (CPP) is:
A. 62 mmHg
B. 118 mmHg
C. 28 mmHg
D. 90 mmHg
Answer: A. 62 mmHg
Solution: CPP = MAP − ICP = 90 − 28 = 62 mmHg. Target CPP 60–70 mmHg for TBI.
Question 8
Which electrolyte abnormality MOST commonly precipitates torsades de pointes in ICU
patients?
A. Hyperkalemia
B. Hypomagnesemia
C. Hypercalcemia
D. Hyponatremia
Answer: B. Hypomagnesemia
Solution: Mg²⁺ stabilizes cardiac membrane; level < 1.2 mg·dL⁻¹ predisposes to QT
prolongation and torsades. Other choices do not prolong QT.
Question 9
A patient on piperacillin-tazobactam develops fever, rash, and eosinophilia 48 h after
initiation. The MOST likely diagnosis is:
pg. 3
SOLUTIONS.
Introduction
This 75-item examination replicates the length and cognitive complexity of the Society
of Critical Care Medicine (SCCM) Fundamental Critical Care Support (FCCS) Level 1
certification test. Domains span recognition & management of the critically ill patient,
airway & ventilator support, shock & hemodynamic monitoring, trauma & neuro-
emergencies, infection control & sepsis, metabolic-electrolyte disorders, and ICU
protocols / patient safety. All items are original, board-style, and referenced to the 2024-
2025 SCCM FCCS curriculum and current evidence-based critical-care guidelines for
mastery-level performance.
Question 1
A 62-year-old man is admitted with community-acquired pneumonia. At 18:00 his SpO₂
is 89 % on 6 L·min⁻¹ nasal cannula, respiratory rate 32·min⁻¹, and he is using accessory
muscles. The MOST appropriate next action is:
A. Increase nasal cannula to 10 L·min⁻¹
B. Start high-flow nasal oxygen (HFNO) at 50 L·min⁻¹
C. Intubate immediately with rapid-sequence technique
D. Initiate non-invasive positive-pressure ventilation (NIV)
Answer: B. Start high-flow nasal oxygen (HFNO) at 50 L·min⁻¹
Solution: HFNO delivers up to 60 L·min⁻¹ with FiO₂ 1.0, reduces work of breathing, and
buys time while avoiding intubation risks. NIV (D) is second-line if HFNO fails;
immediate intubation (C) is premature without HFNO trial.
Question 2
During rapid-sequence intubation the patient desaturates to 75 % despite 3 min pre-
oxygenation. The MOST effective immediate maneuver is:
A. Apply cricoid pressure
B. Perform a 30-second apnoeic oxygenation with 15 L·min⁻¹ nasal oxygen
C. Proceed with intubation while ventilating with bag-mask
D. Insert an oropharyngeal airway and suction
Answer: B. Perform a 30-second apnoeic oxygenation with 15 L·min⁻¹ nasal
oxygen
Solution: Apnoeic oxygenation extends safe apnoea time by maintaining alveolar
pg. 1
,oxygenation. Cricoid (A) does not raise SpO₂; bag-mask (C) risks aspiration in rapid-
sequence.
Question 3
A patient on volume-control ventilation (VC-AC) has PIP 40 cmH₂O and Pplat 28 cmH₂O.
The calculated driving pressure is:
A. 12 cmH₂O
B. 28 cmH₂O
C. 40 cmH₂O
D. 68 cmH₂O
Answer: A. 12 cmH₂O
Solution: Driving pressure = Pplat − PEEP (normal < 15). 28 − 16 (assumed PEEP) = 12.
PIP includes airway resistance, not alveolar stress.
Question 4
A 55-year-old woman with septic shock has MAP 58 mmHg despite 4 L balanced
crystalloid. CVP 14 mmHg, ScvO₂ 65 %. The NEXT recommended intervention is:
A. Start norepinephrine 0.1 µg·kg⁻¹·min⁻¹
B. Give 2 L more crystalloid
C. Start dobutamine 5 µg·kg⁻¹·min⁻¹
D. Transfuse 2 units PRBC
Answer: A. Start norepinephrine 0.1 µg·kg⁻¹·min⁻¹
Solution: Surviving Sepsis 2023: initiate vasopressors if hypotensive after 30 mL·kg⁻¹
fluid and MAP < 65. CVP 14 suggests adequate preload; more fluid (B) risks overload.
Question 5
ECG shows irregular narrow-complex tachycardia 150 bpm, absent P waves, RR
intervals irregularly irregular. The rhythm is:
A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. AVNRT
Answer: B. Atrial fibrillation
Solution: Irregular RR without discernible P waves = AF. Flutter (A) has saw-tooth
baseline; sinus (C) has upright P; AVNRT (D) is regular.
pg. 2
, Question 6
A trauma patient arrives with GCS 6, BP 80/40, HR 130. FAST exam shows free fluid in
Morrison’s pouch. The priority intervention is:
A. CT abdomen-pelvis
B. Emergent OR for exploratory laparotomy
C. Transfuse 1:1:1 ratio PRBC:plasma:platelets
D. Diagnostic peritoneal lavage
Answer: B. Emergent OR for exploratory laparotomy
Solution: Positive FAST + hypotension = operative management per ATLS. CT (A) delays
care; massive transfusion (C) begins in parallel, not instead of surgery.
Question 7
A patient with TBI has ICP 28 mmHg and MAP 90 mmHg. Calculated cerebral perfusion
pressure (CPP) is:
A. 62 mmHg
B. 118 mmHg
C. 28 mmHg
D. 90 mmHg
Answer: A. 62 mmHg
Solution: CPP = MAP − ICP = 90 − 28 = 62 mmHg. Target CPP 60–70 mmHg for TBI.
Question 8
Which electrolyte abnormality MOST commonly precipitates torsades de pointes in ICU
patients?
A. Hyperkalemia
B. Hypomagnesemia
C. Hypercalcemia
D. Hyponatremia
Answer: B. Hypomagnesemia
Solution: Mg²⁺ stabilizes cardiac membrane; level < 1.2 mg·dL⁻¹ predisposes to QT
prolongation and torsades. Other choices do not prolong QT.
Question 9
A patient on piperacillin-tazobactam develops fever, rash, and eosinophilia 48 h after
initiation. The MOST likely diagnosis is:
pg. 3
