Critical Care Medicine Prometric exam questions with answers

1. Question 1Cardiovascular critical caremedium

   During cardiac arrest in ventricular fibrillation, when should the first dose of amiodarone be given?

   1. A150 mg after the first shock
   2. B300 mg before the first shock
   3. C150 mg after the fifth shock
   4. D300 mg after the third shock
   Show answer and explanation▾

   Answer: D. 300 mg after the third shock

   In adult ALS, amiodarone 300 mg IV is given after three shocks, with a further 150 mg after five shocks. Adrenaline 1 mg is also given after the third shock.

2. Question 2Haematology, gastrointestinal and nutritionhard

   On day 7 of unfractionated heparin, a patient's platelets fall from 250 to 90 x 10^9/L and a new deep vein thrombosis is found. What is the best management?

   1. ASwitch to enoxaparin at treatment dose
   2. BStop heparin and start warfarin immediately
   3. CContinue heparin and transfuse platelets
   4. DStop heparin and start argatroban
   Show answer and explanation▾

   Answer: D. Stop heparin and start argatroban

   Suspected HIT with thrombosis requires stopping all heparin and starting a non-heparin anticoagulant such as argatroban. Low molecular weight heparin cross-reacts, and starting warfarin during acute HIT can cause venous limb gangrene.

3. Question 3Neurocritical caremedium

   A man is still seizing 10 minutes after two adequate doses of intravenous lorazepam. Which is an appropriate next drug?

   1. AIntravenous levetiracetam 60 mg/kg (maximum 4500 mg)
   2. BA third dose of intravenous lorazepam
   3. COral carbamazepine via nasogastric tube
   4. DIntravenous magnesium sulfate 4 g
   Show answer and explanation▾

   Answer: A. Intravenous levetiracetam 60 mg/kg (maximum 4500 mg)

   Benzodiazepine-refractory status epilepticus is treated with a second-line agent: levetiracetam, fosphenytoin or valproate had similar efficacy in the ESETT trial. Repeated benzodiazepine doses beyond two add respiratory depression without much benefit.

4. Question 4Renal, metabolic, fluids and electrolytesmedium

   A patient's creatinine rises from a baseline of 80 to 200 micromol/L over 3 days, with urine output 0.6 mL/kg/h. What KDIGO AKI stage is this?

   1. AStage 1
   2. BStage 3
   3. CStage 2
   4. DDoes not meet AKI criteria
   Show answer and explanation▾

   Answer: C. Stage 2

   Creatinine 200/80 = 2.5 times baseline, which falls in the 2.0 to 2.9 times range for stage 2. Stage 3 requires 3 times baseline, creatinine of at least 353.6 micromol/L, or renal replacement therapy.

5. Question 5Shock, resuscitation and haemodynamicseasy

   A 64-year-old man is hypotensive two days after an anterior myocardial infarction. He has cool peripheries, cardiac index 1.6 L/min/m2, pulmonary artery wedge pressure 24 mmHg and raised systemic vascular resistance. Which type of shock is most likely?

   1. ADistributive shock
   2. BCardiogenic shock
   3. CHypovolaemic shock
   4. DObstructive shock
   Show answer and explanation▾

   Answer: B. Cardiogenic shock

   Low cardiac index with high filling pressure and compensatory vasoconstriction is the cardiogenic pattern. Hypovolaemic shock also shows low output and high resistance, but the wedge pressure would be low, not raised.

6. Question 6Respiratory failure and mechanical ventilationmedium

   A ventilated patient with bilateral infiltrates not explained by heart failure has PaO2 75 mmHg on FiO2 0.6 with PEEP 10 cmH2O. How is this ARDS classified by the Berlin definition?

   1. AMild ARDS
   2. BModerate ARDS
   3. CSevere ARDS
   4. DDoes not meet ARDS criteria
   Show answer and explanation▾

   Answer: B. Moderate ARDS

   PaO2/FiO2 is 75/0.6 = 125 mmHg, which lies in the moderate band (over 100 up to 200 mmHg) with PEEP of at least 5 cmH2O. Severe ARDS requires a ratio of 100 mmHg or less.

7. Question 7Sepsis and infection in the ICUhard

   A patient with septic shock has needed noradrenaline 0.3 microgram/kg/min for over 4 hours. Which corticosteroid regimen is suggested?

   1. ADexamethasone 6 mg orally once daily
   2. BMethylprednisolone 1 g daily for 3 days
   3. CHydrocortisone 50 mg intravenously every 6 hours
   4. DFludrocortisone alone 50 micrograms daily
   Show answer and explanation▾

   Answer: C. Hydrocortisone 50 mg intravenously every 6 hours

   For septic shock with an ongoing requirement for noradrenaline of 0.25 microgram/kg/min or more for at least 4 hours, intravenous hydrocortisone 200 mg/day (commonly 50 mg every 6 hours) is suggested. Pulse methylprednisolone is not recommended for septic shock.

8. Question 8Trauma, toxicology and environmental emergencieseasy

   A trauma patient with suspected major haemorrhage arrives 1 hour after injury. What tranexamic acid regimen is recommended?

   1. A2 g over 1 hour, then 2 g over 24 hours
   2. B1 g over 10 minutes only if beyond 3 hours
   3. C1 g over 10 minutes, then 1 g over 8 hours
   4. D500 mg orally every 8 hours for 3 days
   Show answer and explanation▾

   Answer: C. 1 g over 10 minutes, then 1 g over 8 hours

   Tranexamic acid 1 g over 10 minutes then 1 g infused over 8 hours, started within 3 hours of injury, reduced death from bleeding. Starting after 3 hours was associated with harm.

9. Question 9Respiratory failure and mechanical ventilationmedium

   During a spontaneous breathing trial a patient breathes at 30 breaths/min with a tidal volume of 250 mL. What is the rapid shallow breathing index and its interpretation?

   1. A120; above the threshold, suggesting weaning failure
   2. B75; below the threshold, suggesting weaning success
   3. C120; below the threshold, suggesting weaning success
   4. D75; above the threshold, suggesting weaning failure
   Show answer and explanation▾

   Answer: A. 120; above the threshold, suggesting weaning failure

   RSBI is respiratory rate divided by tidal volume in litres: 30/0.25 = 120 breaths/min/L. Values above about 105 predict failure of weaning.

10. Question 10Sepsis and infection in the ICUmedium

    A patient with septic shock remains at MAP 58 mmHg on noradrenaline 0.3 microgram/kg/min after adequate fluid. What is the recommended next agent?

    1. AAdd vasopressin
    2. BReplace noradrenaline with dopamine
    3. CAdd phenylephrine as first addition
    4. DAdd dobutamine
    Show answer and explanation▾

    Answer: A. Add vasopressin

    Guidelines suggest adding vasopressin rather than escalating noradrenaline further, typically when the dose is in the 0.25 to 0.5 microgram/kg/min range. Dopamine causes more arrhythmias, and dobutamine is for persistent hypoperfusion with cardiac dysfunction.

11. Question 11Shock, resuscitation and haemodynamicsmedium

    A spontaneously breathing ICU patient in atrial fibrillation is hypotensive. You want to know whether a fluid bolus will raise cardiac output. Which test is most reliable in this situation?

    1. APulse pressure variation from the arterial line
    2. BA single central venous pressure reading
    3. CPassive leg raise with real-time cardiac output measurement
    4. DInferior vena cava diameter in a spontaneous breather
    Show answer and explanation▾

    Answer: C. Passive leg raise with real-time cardiac output measurement

    A passive leg raise with a cardiac output or stroke volume increase of about 10% or more predicts fluid responsiveness and remains valid with arrhythmia and spontaneous breathing. Pulse pressure variation requires sinus rhythm and controlled ventilation with adequate tidal volumes.

12. Question 12Shock, resuscitation and haemodynamicsmedium

    A 52-year-old woman with confirmed pulmonary embolism has blood pressure 78/50 mmHg despite fluids, a dilated right ventricle on echo and no contraindication to lysis. What is the most appropriate next step?

    1. AUnfractionated heparin infusion alone
    2. BSystemic thrombolysis with alteplase
    3. CInsertion of an inferior vena cava filter
    4. DOral apixaban and repeat echo in 24 hours
    Show answer and explanation▾

    Answer: B. Systemic thrombolysis with alteplase

    High-risk (massive) pulmonary embolism with sustained hypotension is an indication for systemic reperfusion therapy unless contraindicated. Anticoagulation alone is appropriate for normotensive patients but does not rapidly relieve right ventricular obstruction.

13. Question 13Shock, resuscitation and haemodynamicsmedium

    A patient develops anaphylaxis after intravenous antibiotic. After two appropriate doses of intramuscular adrenaline and a fluid bolus she remains hypotensive with wheeze. What is the next best step?

    1. AGive intravenous hydrocortisone and observe
    2. BStart a low-dose intravenous adrenaline infusion
    3. CGive a third dose of intramuscular adrenaline in one hour
    4. DStart intravenous chlorphenamine as sole therapy
    Show answer and explanation▾

    Answer: B. Start a low-dose intravenous adrenaline infusion

    Anaphylaxis persisting after two doses of intramuscular adrenaline is refractory and should be treated with an intravenous adrenaline infusion with expert support. Corticosteroids and antihistamines are not first-line treatment and do not treat shock or bronchospasm acutely.

14. Question 14Trauma, toxicology and environmental emergenciesmedium

    A patient took repeated supratherapeutic doses of paracetamol over 36 hours and now has raised ALT. What is the correct management?

    1. AStart acetylcysteine without using the treatment nomogram
    2. BPlot the paracetamol level on the nomogram first
    3. CGive activated charcoal and discharge if level is low
    4. DStart acetylcysteine only if INR exceeds 2.0
    Show answer and explanation▾

    Answer: A. Start acetylcysteine without using the treatment nomogram

    The nomogram is valid only for a single acute ingestion with a known time. Staggered overdoses with evidence of liver injury should be treated with acetylcysteine regardless of the level.

15. Question 15Trauma, toxicology and environmental emergenciesmedium

    A patient after amitriptyline overdose has a QRS duration of 140 ms and blood pressure 85/50 mmHg. What is the most appropriate specific treatment?

    1. AIntravenous flumazenil
    2. BIntravenous sodium bicarbonate
    3. CIntravenous physostigmine
    4. DIntravenous procainamide
    Show answer and explanation▾

    Answer: B. Intravenous sodium bicarbonate

    Sodium bicarbonate counteracts sodium channel blockade from tricyclics and narrows the QRS. Flumazenil and physostigmine can precipitate seizures and arrhythmias, and class Ia drugs worsen sodium channel blockade.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.