How it is examined
The CICM First Part written section is two papers, each with 10 short answer questions and 50 multiple choice questions, over 2.5 hours. Candidates who reach the Angoff standard in both the SAQs and the MCQs progress to cross-table vivas: 2 minutes of reading, then 10 minutes with the examiners on basic sciences applied to intensive care, including monitoring equipment. Up to five attempts are allowed. Check the CICM website and syllabus for current details.
SAQs often ask you to compare and contrast two drugs, for example propofol and dexmedetomidine, or noradrenaline and vasopressin. A table is a good way to structure an answer.
A structure for every drug
- Class and presentation.
- Mechanism of action and receptors.
- Pharmacokinetics: absorption, distribution, metabolism, elimination.
- Pharmacodynamics by system.
- Adverse effects and toxicity.
- Doses and special situations.
Key drug groups
| Group | Compare | Key points |
|---|---|---|
| Sedatives | Propofol, midazolam, dexmedetomidine | Propofol infusion syndrome; dexmedetomidine alpha-2 agonism and bradycardia |
| Induction agents | Propofol, ketamine, thiopental | Haemodynamic profiles |
| Opioids | Morphine, fentanyl, remifentanil | Metabolites in renal failure; context-sensitive half-time |
| Neuromuscular blockers | Suxamethonium, rocuronium, cisatracurium | Hofmann elimination of cisatracurium; sugammadex |
| Vasopressors | Noradrenaline, adrenaline, vasopressin, metaraminol | Receptor profiles and effects |
| Inotropes | Dobutamine, milrinone, levosimendan | Mechanisms and vasodilatory effects |
| Anticoagulants | Heparin, LMWH, DOACs | Monitoring and reversal |
Practice questions
SAQ-style practice
Compare and contrast propofol and dexmedetomidine for sedation in ICU.
Show a model answer outline
- Mechanism: GABA-A potentiation versus alpha-2 agonism.
- Respiratory: propofol depresses ventilation; dexmedetomidine preserves drive.
- Cardiovascular: propofol hypotension; dexmedetomidine bradycardia and hypotension.
- Kinetics: both hepatically metabolised; propofol has rapid offset.
- Adverse effects: propofol infusion syndrome; dexmedetomidine rebound hypertension.
Worked MCQ · Neuromuscular blockers
Which neuromuscular blocker is eliminated largely by Hofmann degradation, independent of renal and hepatic function?
- A Rocuronium
- B Vecuronium
- C Cisatracurium
- D Pancuronium
- E Suxamethonium
Show the reasoning
Answer C. Cisatracurium undergoes Hofmann elimination, a temperature- and pH-dependent breakdown in plasma, making it useful in renal and hepatic failure.
Common mistakes
- Unstructured drug answers.
- Forgetting active metabolites.
- Mixing up receptor profiles.
- No comparison table in compare and contrast questions.
- Missing adverse effects.
Free sample anaesthetic and icu drugs questions
Questions from our Intensive care (CICM) bank. Choose your answer, then open the explanation.
Dobutamine mainly acts on:
- APhosphodiesterase III
- BBeta-1 receptors
- CAlpha-1 receptors only
- DDopamine receptors
- EV1 receptors
Show answer and explanation
Answer B. Dobutamine is a beta-1 agonist (some beta-2 and alpha-1), increasing contractility and HR; it may lower SVR. Milrinone inhibits PDE III.
Learning point: Dobutamine: beta-1 inotrope.
Which opioid has active metabolites that accumulate in renal failure?
- AFentanyl
- BAlfentanil
- CMorphine
- DSufentanil
- ERemifentanil
Show answer and explanation
Answer C. Morphine-6-glucuronide (active) and morphine-3-glucuronide (neuroexcitatory) accumulate in renal failure. Fentanyl is preferred.
Learning point: Morphine metabolites accumulate in renal failure.
Which is the main action of noradrenaline at usual doses?
- ABeta-2 bronchodilation
- BDopamine D1 renal vasodilation
- CAlpha-1 vasoconstriction
- DVasopressin V1 agonism
- EMuscarinic blockade
Show answer and explanation
Answer C. Noradrenaline is a potent alpha-1 agonist with some beta-1 action, raising SVR and MAP. It is first-line vasopressor in septic shock.
Learning point: Noradrenaline: alpha-1 with some beta-1; first-line in septic shock.
Practise more anaesthetic and icu drugs questions free
Every anaesthetic and icu drugs subtopic in our bank
The bank holds 26 anaesthetic and icu drugs questions across 24 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Albumin1
- Amiodarone1
- Dexmedetomidine2
- Dobutamine1
- Etomidate1
- Haloperidol1
- Heparin1
- Heparin reversal1
- Hydrocortisone in shock1
- Insulin infusion1
- Ketamine1
- Levosimendan1
- Magnesium1
- Milrinone1
- Noradrenaline1
- Opioid conversion1
- Phenytoin1
- Propofol1
- Propofol infusion syndrome1
- Rocuronium reversal1
- Suxamethonium1
- Tranexamic acid1
- Vancomycin1
- Vasopressin2
Common questions
How do I learn so many drugs?
Use a fixed template for every drug and compare drugs within each class.
Are doses tested?
Know usual doses of common ICU drugs and their pharmacological basis.
Is antimicrobial pharmacology included?
Antimicrobials and their kinetics in critical illness are part of ICU pharmacology.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.