FLORIDA BOARD OF MEDICINE CRITICAL
CARE MEDICINE CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1.
A 67-year-old man with severe community-acquired pneumonia is
intubated for acute hypoxemic respiratory failure. He is receiving
volume-controlled ventilation with a tidal volume of 8 mL/kg predicted
body weight. His plateau pressure is 34 cm H₂O. Chest radiography
demonstrates bilateral diffuse infiltrates without evidence of cardiogenic
pulmonary edema. Which ventilator strategy is most appropriate?
A. Increase tidal volume to 10 mL/kg predicted body weight
B. Decrease tidal volume to approximately 6 mL/kg predicted body
weight
C. Increase respiratory rate while maintaining the current tidal volume
D. Increase PEEP to 20 cm H₂O immediately without changing tidal
volume
E. Switch to pressure-support ventilation
Answer: B. Decrease tidal volume to approximately 6 mL/kg
predicted body weight
Rationale: In acute respiratory distress syndrome (ARDS), lung-
protective ventilation with low tidal volumes based on predicted body
weight is fundamental. A plateau pressure above 30 cm H₂O increases
the risk of ventilator-induced lung injury. The appropriate response is
to reduce tidal volume, generally toward 6 mL/kg predicted body
1
,weight, while accepting a degree of permissive hypercapnia when
clinically appropriate. Increasing tidal volume would worsen
volutrauma.
2.
A 54-year-old woman with septic shock remains hypotensive after
administration of 30 mL/kg of crystalloid. Her blood pressure is 78/42
mm Hg, lactate is 5.2 mmol/L, and extremities are cool. Which
vasopressor is generally preferred as the initial agent?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Epinephrine
E. Vasopressin
Answer: C. Norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for
septic shock because it produces potent α-adrenergic vasoconstriction
with relatively limited β₁ stimulation. Dopamine is associated with
greater arrhythmogenic potential. Vasopressin is generally used as an
adjunct rather than the initial vasopressor. Phenylephrine may
decrease stroke volume because of pure α-mediated vasoconstriction.
3.
A 72-year-old man with COPD is intubated for severe hypercapnic
respiratory failure. Shortly afterward, his blood pressure falls from
128/74 to 72/38 mm Hg. Peak airway pressure is markedly elevated, and
expiration appears incomplete before the next breath begins. Which
mechanism most likely explains the hypotension?
2
,A. Acute left ventricular infarction
B. Dynamic hyperinflation causing decreased venous return
C. Massive pulmonary embolism
D. Acute adrenal insufficiency
E. Septic cardiomyopathy
Answer: B. Dynamic hyperinflation causing decreased venous
return
Rationale: Severe airflow obstruction combined with inadequate
expiratory time can cause intrinsic PEEP (auto-PEEP). Progressive
air trapping raises intrathoracic pressure, reduces venous return,
decreases right and left ventricular preload, and may produce
profound hypotension. Management includes reducing respiratory
rate, decreasing tidal volume when appropriate, increasing expiratory
time, and addressing bronchospasm.
4.
A patient with septic shock receives norepinephrine but remains
hypotensive despite escalating doses. Cardiac function is adequate, but
vasoplegia persists. Which additional medication is most appropriate?
A. Dobutamine
B. Vasopressin
C. Milrinone
D. Digoxin
E. Phenobarbital
Answer: B. Vasopressin
Rationale: Vasopressin can be added to norepinephrine in vasodilatory
septic shock requiring escalating vasopressor doses. It produces
vasoconstriction through V1 receptors and may reduce the required
catecholamine dose. Dobutamine is an inotrope and is more
3
, appropriate when cardiac output is inadequate despite adequate
preload and blood pressure support.
5.
A 61-year-old woman with septic shock has received fluids and
norepinephrine. Echocardiography demonstrates a hyperdynamic left
ventricle, and passive leg raising produces a substantial increase in
stroke volume. Which finding most strongly indicates that additional
intravenous fluid is likely to increase cardiac output?
A. Elevated central venous pressure
B. Positive passive leg-raise response
C. Pulmonary crackles
D. Peripheral edema
E. Low serum albumin
Answer: B. Positive passive leg-raise response
Rationale: Dynamic assessments of fluid responsiveness are generally
more useful than static measurements such as central venous
pressure. Passive leg raising transiently transfers venous blood toward
the central circulation and functions as a reversible fluid challenge.
An increase in stroke volume indicates preload responsiveness.
6.
A 43-year-old man with severe ARDS has a PaO₂ of 52 mm Hg despite
optimized lung-protective ventilation and appropriate PEEP. He is
deeply sedated and has no contraindication to neuromuscular blockade.
Which intervention has evidence for improving outcomes in severe
ARDS?
4
CARE MEDICINE CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1.
A 67-year-old man with severe community-acquired pneumonia is
intubated for acute hypoxemic respiratory failure. He is receiving
volume-controlled ventilation with a tidal volume of 8 mL/kg predicted
body weight. His plateau pressure is 34 cm H₂O. Chest radiography
demonstrates bilateral diffuse infiltrates without evidence of cardiogenic
pulmonary edema. Which ventilator strategy is most appropriate?
A. Increase tidal volume to 10 mL/kg predicted body weight
B. Decrease tidal volume to approximately 6 mL/kg predicted body
weight
C. Increase respiratory rate while maintaining the current tidal volume
D. Increase PEEP to 20 cm H₂O immediately without changing tidal
volume
E. Switch to pressure-support ventilation
Answer: B. Decrease tidal volume to approximately 6 mL/kg
predicted body weight
Rationale: In acute respiratory distress syndrome (ARDS), lung-
protective ventilation with low tidal volumes based on predicted body
weight is fundamental. A plateau pressure above 30 cm H₂O increases
the risk of ventilator-induced lung injury. The appropriate response is
to reduce tidal volume, generally toward 6 mL/kg predicted body
1
,weight, while accepting a degree of permissive hypercapnia when
clinically appropriate. Increasing tidal volume would worsen
volutrauma.
2.
A 54-year-old woman with septic shock remains hypotensive after
administration of 30 mL/kg of crystalloid. Her blood pressure is 78/42
mm Hg, lactate is 5.2 mmol/L, and extremities are cool. Which
vasopressor is generally preferred as the initial agent?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Epinephrine
E. Vasopressin
Answer: C. Norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for
septic shock because it produces potent α-adrenergic vasoconstriction
with relatively limited β₁ stimulation. Dopamine is associated with
greater arrhythmogenic potential. Vasopressin is generally used as an
adjunct rather than the initial vasopressor. Phenylephrine may
decrease stroke volume because of pure α-mediated vasoconstriction.
3.
A 72-year-old man with COPD is intubated for severe hypercapnic
respiratory failure. Shortly afterward, his blood pressure falls from
128/74 to 72/38 mm Hg. Peak airway pressure is markedly elevated, and
expiration appears incomplete before the next breath begins. Which
mechanism most likely explains the hypotension?
2
,A. Acute left ventricular infarction
B. Dynamic hyperinflation causing decreased venous return
C. Massive pulmonary embolism
D. Acute adrenal insufficiency
E. Septic cardiomyopathy
Answer: B. Dynamic hyperinflation causing decreased venous
return
Rationale: Severe airflow obstruction combined with inadequate
expiratory time can cause intrinsic PEEP (auto-PEEP). Progressive
air trapping raises intrathoracic pressure, reduces venous return,
decreases right and left ventricular preload, and may produce
profound hypotension. Management includes reducing respiratory
rate, decreasing tidal volume when appropriate, increasing expiratory
time, and addressing bronchospasm.
4.
A patient with septic shock receives norepinephrine but remains
hypotensive despite escalating doses. Cardiac function is adequate, but
vasoplegia persists. Which additional medication is most appropriate?
A. Dobutamine
B. Vasopressin
C. Milrinone
D. Digoxin
E. Phenobarbital
Answer: B. Vasopressin
Rationale: Vasopressin can be added to norepinephrine in vasodilatory
septic shock requiring escalating vasopressor doses. It produces
vasoconstriction through V1 receptors and may reduce the required
catecholamine dose. Dobutamine is an inotrope and is more
3
, appropriate when cardiac output is inadequate despite adequate
preload and blood pressure support.
5.
A 61-year-old woman with septic shock has received fluids and
norepinephrine. Echocardiography demonstrates a hyperdynamic left
ventricle, and passive leg raising produces a substantial increase in
stroke volume. Which finding most strongly indicates that additional
intravenous fluid is likely to increase cardiac output?
A. Elevated central venous pressure
B. Positive passive leg-raise response
C. Pulmonary crackles
D. Peripheral edema
E. Low serum albumin
Answer: B. Positive passive leg-raise response
Rationale: Dynamic assessments of fluid responsiveness are generally
more useful than static measurements such as central venous
pressure. Passive leg raising transiently transfers venous blood toward
the central circulation and functions as a reversible fluid challenge.
An increase in stroke volume indicates preload responsiveness.
6.
A 43-year-old man with severe ARDS has a PaO₂ of 52 mm Hg despite
optimized lung-protective ventilation and appropriate PEEP. He is
deeply sedated and has no contraindication to neuromuscular blockade.
Which intervention has evidence for improving outcomes in severe
ARDS?
4
