The Adult Critical Care Specialty (ACCS) certification is a subspecialty credential offered by the American Board of Internal Medicine (ABIM) for physicians who provide comprehensive critical care to adult patients. The ACCS examination assesses competency across the full spectrum of intensive care medicine — from managing respiratory failure and mechanical ventilation to diagnosing and treating septic shock, acute kidney injury, and neurological emergencies. Earning ACCS board certification demonstrates a high standard of clinical expertise and is increasingly valued in academic medical centers and large health systems.
Our free ACCS practice test PDF contains high-yield questions drawn from the core content domains of the ACCS exam. Whether you are a fellow preparing for initial certification or a physician pursuing maintenance of certification, these practice questions will help you identify knowledge gaps and build confidence across the clinical areas tested. Download the PDF below and use it as part of a structured study plan leading up to your exam date.
Respiratory failure is one of the most common reasons for ICU admission and accounts for a significant portion of the ACCS exam content. Candidates must understand the distinction between hypoxemic respiratory failure (Type I) and hypercapnic respiratory failure (Type II), as well as the management principles for each. Mechanical ventilation questions focus on lung-protective ventilation strategies for acute respiratory distress syndrome (ARDS), including the ARDSnet protocol of low tidal volumes (6 mL/kg ideal body weight) and plateau pressure limits below 30 cmH2O. Candidates should also be comfortable with ventilator settings — FiO2, PEEP, respiratory rate, inspiratory flow — and the rationale for adjustments based on arterial blood gas results and lung mechanics. High-yield topics include the management of ventilator-associated pneumonia, weaning criteria and spontaneous breathing trials, non-invasive ventilation indications, and the recognition and management of patient-ventilator asynchrony. Prone positioning for severe ARDS and inhaled nitric oxide as a rescue therapy are also commonly tested.
The ACCS exam places considerable emphasis on hemodynamic assessment and the management of different shock states. Candidates must be able to differentiate distributive shock (septic, anaphylactic, neurogenic), cardiogenic shock, hypovolemic shock, and obstructive shock (tension pneumothorax, cardiac tamponade, massive PE) based on hemodynamic parameters, physical examination findings, and bedside echocardiography. Invasive hemodynamic monitoring with pulmonary artery catheters — including interpretation of wedge pressures, cardiac output, and mixed venous oxygen saturation — remains testable content alongside less invasive techniques such as arterial line waveform analysis and point-of-care ultrasound. Vasopressor selection and dosing is a core topic: understanding the relative alpha and beta adrenergic effects of norepinephrine, epinephrine, dopamine, and vasopressin, and knowing when to choose each, is essential. Fluid resuscitation strategies, including the shift away from liberal fluid administration toward dynamic fluid responsiveness assessment (passive leg raise, pulse pressure variation), also appear frequently in ACCS question stems.
Sepsis and its complications — including septic shock and sepsis-induced organ dysfunction — dominate the critical care literature and the ACCS exam blueprint. Candidates should know the Sepsis-3 definitions: sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, and septic shock as a subset requiring vasopressors to maintain MAP ≥65 mmHg with a serum lactate above 2 mmol/L despite adequate resuscitation. The Surviving Sepsis Campaign Hour-1 Bundle — including blood cultures before antibiotics, broad-spectrum antibiotic administration within one hour, 30 mL/kg crystalloid for hypotension or lactate ≥4, and vasopressor initiation for refractory hypotension — is extensively tested. Acute kidney injury (AKI) is another high-yield topic. Candidates must understand the KDIGO staging criteria for AKI, recognize the major causes in ICU patients (sepsis-induced, contrast nephropathy, nephrotoxic medications, abdominal compartment syndrome), and know the indications for continuous renal replacement therapy (CRRT) versus intermittent hemodialysis. Electrolyte management in the context of AKI — hyperkalemia, metabolic acidosis, volume overload — and the timing of renal replacement therapy initiation are frequently tested clinical decision-making scenarios.
Neurological emergencies constitute an important content domain within the ACCS examination. Intracranial pressure (ICP) management is a core topic — candidates should understand the Monroe-Kellie doctrine, the indications for ICP monitoring, and the stepwise approach to elevated ICP: head positioning, sedation and analgesia, osmotherapy with mannitol or hypertonic saline, controlled hyperventilation as a temporizing measure, and neurosurgical decompression when indicated. Status epilepticus is another high-yield area, including the definition of refractory status epilepticus, the benzodiazepine-first treatment algorithm, and second-line agents such as levetiracetam, valproate, and lacosamide. Candidates should also be familiar with the ICU management of intracerebral hemorrhage, subarachnoid hemorrhage (nimodipine, vasospasm monitoring), and hypoxic-ischemic encephalopathy after cardiac arrest, including targeted temperature management protocols. Regarding ACCS eligibility, candidates must hold a valid ABIM internal medicine certification, have completed a two-year ACGME-accredited critical care medicine fellowship, and submit an application within the ABIM's defined eligibility window. Physicians trained in other specialties may pursue critical care certification through their respective specialty boards.
This free PDF is a great starting point, but interactive practice is essential for ACCS success. PracticeTestGeeks offers full-length ACCS practice tests online with timed sessions, immediate feedback, and detailed answer explanations that reinforce the clinical reasoning required for the exam. Use online practice to simulate real testing conditions and build the stamina needed for the full ACCS examination.