Multiple Choice Questions in Intensive Care Medicine.  By Steve Benington, M.B. Ch.B., M.R.C.P., F.R.C.A., Peter Nightingale, F.R.C.A., F.R.C.P., and Maire Shelly, M.B. Ch.B., F.R.C.A. Shrewsbury, United Kingdom, TFM Publishing Limited, 2009. Pages: 276. Price: $49.95.

Of all my years in training, my critical care fellowship year was the most challenging in terms of learning a vast amount of material, recovering from sleepless nights on call, and managing multiple strong personalities. When that grueling and rewarding year was completed, I was similarly challenged trying to find a multiple-choice question book to prepare me for the certification examination. Critical care has been practiced for decades, and board certification examinations in this specialty have been announced in the United States since the late 1980s. It is surprising that in the ensuing 2 decades, there have been fewer than five books dedicated for the preparation of critical care examination. Multiple Choice Questions in Intensive Care Medicine  stands alone as one of the very few critical care review books dedicated to multiple-choice questions.

I am not sure whether the lead author, Steve Benington, M.D., had the same challenges I faced during my training, but his preface suggests that he could not find an adequate source that focused on multiple-choice questions in critical care. This inspired him to create a book of 300 questions, divided into three examinations. His questions cover a variety of topics, including trauma, fluid management, toxicology, obstetrical emergencies, ethics, and applied pharmacology. A few questions have images, such as electrocardiograms, ventilator waveforms, and intracranial pressure tracings. At the end of each examination, detailed explanations follow each answer. Each explanation is accompanied by one or more recent references to guide further reading.

Each examination contains 50 “type A” questions (for which the examinee chooses the single best answer) and 50 “type K” questions (which consist of a statement followed by four stems, each requiring a true or false answer). The questions are designed to mirror the format of the European Diploma of Intensive Care Medicine. I went online to the official website of European Diploma of Intensive Care Medicine and found a recommendation for this book under the section “How to Prepare Yourself for Your Examination.”*A significant number of questions use negative words, such as NOT and EXCEPT, requiring the potential examinee to take an extra cognitive step when formulating an answer.

In an attempt to present questions in the format of the European Diploma of Intensive Care Medicine, they are not arranged by topic. Unfortunately, there is no subject index for this book to guide the student who wants to focus on one particular area. Although the variety of questions in this book provides a framework for the breadth of topics covered in United States board examinations, the American trainee may be frustrated by the format of questions because we do not answer K type questions for our certification examinations. This collection of questions is more likely to appeal to the critical care fellow in training than it is to the resident preparing for the anesthesiology, internal medicine, and surgery board examinations. The level of difficulty may be too high for a junior resident, but seems appropriate for fellows and practicing intensivists. For the European trainee searching for a format that follows the European Diploma of Intensive Care Medicine, I would recommend purchasing this edition. For the United States trainee looking to assess his/her knowledge base and identify deficiencies in it, Multiple Choice Questions in Intensive Care Medicine  is a welcome study guide.

Columbia College of Physicians and Surgeons, New York, New York.