ABPN Psychiatry Certification Exam — Questions and Answers

Question 1: Which percentage of schizophreniform disorders patients progress to schizoaffective or schizophrenia?

88%
25%
15%
50%
66% (Correct answer)

Correct answer: 66%

Schizophreniform disorder is diagnosed when symptoms of schizophrenia last for at least one month but less than six months. Approximately two-thirds (66%) of individuals diagnosed with schizophreniform disorder will eventually progress to a full diagnosis of schizophrenia or schizoaffective disorder if their symptoms persist beyond the six-month mark. The remaining one-third may recover completely.

Question 2: Serotonin syndrome is best distinguished from NMS by the presence of:

Lead-pipe rigidity
Hyperreflexia and clonus (Correct answer)
Normal deep tendon reflexes
Slow onset over days

Correct answer: Hyperreflexia and clonus

Serotonin syndrome features hyperreflexia, clonus, and rapid onset, unlike the rigidity of NMS.

Question 3: Which developmental milestone should RAISE concern if absent in a 12-month-old child?

No two-word phrases
Not yet walking independently
No pointing or waving gesture (Correct answer)
No scribbling with a crayon

Correct answer: No pointing or waving gesture

Absence of gesture use (pointing, waving) by 12 months is a red flag for developmental delay and ASD, as these are important prelinguistic social-communication milestones.

Question 4: Which mood stabilizer is MOST teratogenic and requires mandatory REMS enrollment due to risk of major congenital malformations?

Carbamazepine
Lamotrigine
Valproate (Correct answer)
Lithium

Correct answer: Valproate

Valproate carries the highest teratogenic risk among mood stabilizers, causing neural tube defects and cognitive impairment, and requires the FDA's Valproate REMS program.

Question 5: Which neurotransmitter is most implicated in the pathophysiology of Parkinson disease?

Acetylcholine
Dopamine (Correct answer)
Serotonin
Glutamate

Correct answer: Dopamine

Parkinson disease results from degeneration of dopaminergic neurons in the substantia nigra.

Question 6: The American Board of Psychiatry and Neurology (ABPN) requires initial certification candidates to complete how many years of accredited residency training in psychiatry?

2 years
3 years
4 years (Correct answer)
5 years

Correct answer: 4 years

ABPN requires completion of a 4-year ACGME-accredited psychiatry residency program before candidates are eligible to sit for the initial certification examination.

Question 7: Which neurotransmitter deficiency is associated with narcolepsy type 1?

Acetylcholine
Hypocretin (orexin) (Correct answer)
Dopamine
Serotonin

Correct answer: Hypocretin (orexin)

Narcolepsy type 1 is caused by selective loss of hypocretin (orexin)-producing neurons in the lateral hypothalamus, likely through autoimmune mechanisms.

Question 8: What are the key components of the Mental Status Examination (MSE)?

Appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment (Correct answer)
Only cognitive testing
Just appearance and speech
Only mood and affect

Correct answer: Appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment

The MSE systematically evaluates appearance, psychomotor behavior, speech, mood (patient's report), affect (observed emotion), thought process, thought content, perceptions, cognition, insight, and judgment.

Question 9: A patient repeats the interviewer's questions verbatim instead of answering. This speech abnormality is called:

Neologism
Echolalia (Correct answer)
Perseveration
Clang association

Correct answer: Echolalia

Echolalia is the pathological repetition of another person's words.

Question 10: Which medication is FDA-approved as FIRST-LINE pharmacotherapy for ADHD in children aged 6 and older?

Clonidine
Methylphenidate (Correct answer)
Atomoxetine
Guanfacine

Correct answer: Methylphenidate

Stimulant medications including methylphenidate are first-line FDA-approved pharmacotherapy for ADHD due to superior efficacy over non-stimulant options.

Question 11: In the ABPN certification process, what is the PRIMARY purpose of the Clinical Skills Verification (CSV) requirement for psychiatry residents?

To assess performance on simulation-based procedures
To assess knowledge of psychopharmacology through written examination
To verify completion of research requirements
To evaluate clinical competency in patient interviews and communication skills (Correct answer)

Correct answer: To evaluate clinical competency in patient interviews and communication skills

The ABPN Clinical Skills Verification assesses residents' clinical competency through direct observation of patient interviews, evaluating communication and clinical reasoning skills.

Question 12: For a diagnosis of PTSD, the characteristic symptoms must persist for more than:

6 months
1 week
1 month (Correct answer)
3 days

Correct answer: 1 month

PTSD requires symptom duration greater than 1 month; shorter durations suggest acute stress disorder.

Question 13: During assessment, a patient invents new words that have meaning only to them. This is termed:

Echolalia
Perseveration
Circumstantiality
Neologism (Correct answer)

Correct answer: Neologism

A neologism is a newly coined word or phrase with idiosyncratic meaning, often seen in psychosis.

Question 14: Which of the following is a current ABPN-recognized subspecialty requiring additional fellowship training and certification?

Integrative psychiatry
Child and adolescent psychiatry (Correct answer)
Addiction medicine
Neuropsychiatry

Correct answer: Child and adolescent psychiatry

Child and adolescent psychiatry is an ABPN-recognized subspecialty requiring a 2-year fellowship after residency and a separate ABPN subspecialty certification examination.

Question 15: What is a suicide risk assessment and what are its key elements?

A structured evaluation of risk and protective factors including ideation, plan, intent, means access, and history of attempts (Correct answer)
Only checking for depression symptoms
Asking a single question about suicidal thoughts
A one-time screening at intake only

Correct answer: A structured evaluation of risk and protective factors including ideation, plan, intent, means access, and history of attempts

Suicide risk assessment evaluates ideation (passive vs. active), plan specificity, intent, means access, previous attempts, risk factors (psychiatric illness, substance use, loss), and protective factors (social support, reasons for living).

Question 16: Under ABPN rules, a psychiatry resident who has NOT yet passed the ABPN examination may legally practice psychiatry under which condition?

Only in research settings without direct patient care
With a valid state medical license, as board certification is voluntary (not required for licensure) (Correct answer)
Only for 2 years after residency completion before mandatory re-examination
Only if supervised by an ABPN-certified psychiatrist at all times

Correct answer: With a valid state medical license, as board certification is voluntary (not required for licensure)

Board certification by ABPN is a voluntary professional credential; state medical licensure (not board certification) is the legal requirement to practice medicine.

Question 17: A psychiatrist believes a patient with schizophrenia who refuses medication lacks capacity to make treatment decisions. What legal mechanism is used in the US to authorize involuntary treatment?

Guardianship or substitute decision-maker appointment (Correct answer)
Tarasoff duty to protect
Habeas corpus petition
Direct physician override without legal process

Correct answer: Guardianship or substitute decision-maker appointment

When a patient lacks decision-making capacity, a legal guardian or healthcare proxy must be appointed to authorize treatment on the patient's behalf.

Question 18: In Weber's tuning fork test, sound lateralizing to the affected ear suggests:

Normal hearing
Conductive hearing loss in that ear (Correct answer)
Sensorineural hearing loss in that ear
Central deafness

Correct answer: Conductive hearing loss in that ear

Weber lateralizes to the ear with conductive loss (or away from the sensorineural-loss ear).

Question 19: On average, how long does the active phase of schizophrenia last?

5 Months
1 Year
8 Months
1 Month (Correct answer)
1 Week

Correct answer: 1 Month

The active phase of schizophrenia, characterized by prominent positive symptoms like delusions and hallucinations, must last for at least one month to meet diagnostic criteria according to the DSM-5. While the overall duration of the disorder is longer, the 'active phase' specifically refers to this period of acute symptom presentation. This duration helps differentiate schizophrenia from brief psychotic disorder, which is shorter.

Question 20: A 22-year-old has brief morning myoclonic jerks shortly after awakening and occasional generalized tonic-clonic seizures. Which epilepsy syndrome is the most likely diagnosis?

Dravet syndrome
Childhood absence epilepsy
Lennox-Gastaut syndrome
Juvenile myoclonic epilepsy (Correct answer)

Correct answer: Juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy (JME) classically presents in adolescence or young adulthood with myoclonic jerks on awakening, generalized tonic-clonic seizures, and absence seizures.

Question 21: A patient cannot recognize objects placed in the hand by touch alone despite intact sensation. This is called:

Aphasia
Agnosia for faces
Apraxia
Astereognosis (Correct answer)

Correct answer: Astereognosis

Astereognosis is the inability to identify objects by touch, indicating a parietal cortical lesion.

Question 22: Which laboratory abnormality is a known adverse effect requiring monitoring on valproate?

Hypernatremia
Elevated TSH
Hyperkalemia
Hepatotoxicity and thrombocytopenia (Correct answer)

Correct answer: Hepatotoxicity and thrombocytopenia

Valproate can cause hepatotoxicity and thrombocytopenia, so liver enzymes and platelets are monitored.

Question 23: Which of the following does NOT qualify as a typical, targeted side effect of stimulants?

Changes in mood
Headache
Ataxia (Correct answer)
Anorexia

Correct answer: Ataxia

Common side effects of stimulant medications include changes in mood (e.g., irritability, anxiety), headache, and anorexia (decreased appetite). Ataxia, which refers to impaired coordination or balance, is not a typical or expected side effect of stimulants. Its presence would suggest an unusual or concerning neurological issue.

Question 24: Which neurotransmitter system is the PRIMARY target of typical antipsychotic medications?

Norepinephrine (alpha-1)
Dopamine (D2) (Correct answer)
Serotonin (5-HT2A)
GABA-A

Correct answer: Dopamine (D2)

Typical antipsychotics primarily block dopamine D2 receptors, which accounts for both their antipsychotic efficacy and extrapyramidal side effects.

Question 25: Continuous positive airway pressure (CPAP) is the FIRST-LINE treatment for moderate-to-severe obstructive sleep apnea. What is the primary mechanism by which CPAP prevents apneas?

It provides pneumatic splinting to maintain upper airway patency (Correct answer)
It increases respiratory muscle strength during sleep
It suppresses REM sleep when most apneas occur
It stimulates the hypoglossal nerve to maintain tongue position

Correct answer: It provides pneumatic splinting to maintain upper airway patency

CPAP delivers continuous pressurized air that acts as a pneumatic splint, preventing collapse of the pharyngeal soft tissues that cause obstruction.

Question 26: Idiopathic REM sleep behavior disorder is MOST strongly associated with future development of which neurodegenerative disease?

ALS (amyotrophic lateral sclerosis)
Huntington's disease
Synucleinopathies (Parkinson's disease, Lewy body dementia) (Correct answer)
Alzheimer's disease

Correct answer: Synucleinopathies (Parkinson's disease, Lewy body dementia)

Idiopathic RBD is a strong prodromal marker for synucleinopathies; over 80% of patients eventually develop Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy.

Question 27: Which agent is used to reverse acute benzodiazepine overdose?

Physostigmine
Naloxone
Flumazenil (Correct answer)
Atropine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used to reverse overdose.

Question 28: A patient on lithium develops tremor, polyuria, and polydipsia. What is the MOST appropriate next step?

Check serum lithium level (Correct answer)
Add propranolol for tremor
Switch to valproate
Immediately discontinue lithium

Correct answer: Check serum lithium level

Checking the serum lithium level is essential to determine if symptoms reflect toxicity or are side effects at therapeutic levels.

Question 29: What does the ABPN Pilot Assessment Program (now part of Continuing Certification) require diplomates to do periodically?

Submit patient outcome data to a national registry
Attend mandatory annual symposia
Take an oral examination before a panel of examiners
Complete online self-assessment modules and cognitive tests (Correct answer)

Correct answer: Complete online self-assessment modules and cognitive tests

The ABPN's CC program includes periodic online self-assessment activities and cognitive assessments to ensure diplomates maintain current knowledge.

Question 30: REM sleep behavior disorder (RBD) is characterized by which polysomnographic finding?

Loss of normal REM sleep atonia allowing dream enactment (Correct answer)
Sleep spindles and K-complexes during REM
Periodic leg movements during NREM sleep
Sleep-onset REM periods (SOREMPs)

Correct answer: Loss of normal REM sleep atonia allowing dream enactment

RBD is characterized by loss of muscle atonia during REM sleep, causing patients to physically act out their dreams, which can result in injury.

Question 31: Which condition is characterized by bilateral leg discomfort that worsens at rest and in the evening, is relieved by movement, and interferes with sleep?

Periodic limb movement disorder
Nocturnal leg cramps
Restless legs syndrome (RLS) (Correct answer)
Painful neuropathy

Correct answer: Restless legs syndrome (RLS)

Restless legs syndrome has four diagnostic criteria: urge to move legs, worsening at rest/evening, temporary relief with movement, and not solely explained by another condition.

Question 32: Which finding is characteristic of neuroleptic malignant syndrome?

Resting tremor and bradykinesia
Flaccid paralysis and hypothermia
Lead-pipe rigidity and hyperthermia (Correct answer)
Ataxia and nystagmus

Correct answer: Lead-pipe rigidity and hyperthermia

NMS features muscular rigidity, hyperthermia, autonomic instability, and elevated CK.

Question 33: Which demyelinating disease shows oligoclonal bands in the CSF and periventricular white-matter lesions?

Myasthenia gravis
Multiple sclerosis (Correct answer)
Parkinson disease
Amyotrophic lateral sclerosis

Correct answer: Multiple sclerosis

MS produces CNS demyelination with CSF oligoclonal bands and MRI white-matter plaques.

Question 34: Which antiepileptic drug primarily blocks T-type calcium channels and is the first-line treatment for childhood absence epilepsy?

Ethosuximide (Correct answer)
Lamotrigine
Oxcarbazepine
Phenobarbital

Correct answer: Ethosuximide

Ethosuximide selectively blocks thalamic T-type calcium channels, disrupting the thalamocortical rhythms responsible for absence seizures, and is considered first-line for absence-only epilepsy.

Question 35: Which medication is FIRST-LINE for restless legs syndrome (RLS)?

Opioid analgesics
Dopamine agonists (e.g., pramipexole, ropinirole) (Correct answer)
SSRIs
Benzodiazepines

Correct answer: Dopamine agonists (e.g., pramipexole, ropinirole)

Dopamine agonists are first-line for moderate-to-severe RLS due to their efficacy in reducing the urge to move and sensory discomfort, though augmentation is a long-term concern.

Question 36: Which medication raises dopamine levels in the synaptic cleft?

Methlyphenidate
All of the above (Correct answer)
Amphetamine

Correct answer: All of the above

Both methylphenidate and amphetamine effectively increase dopamine levels in the synaptic cleft. Methylphenidate primarily achieves this by blocking dopamine reuptake, while amphetamine not only blocks reuptake but also promotes the release of dopamine from presynaptic terminals. Thus, both medications contribute to higher synaptic dopamine.

Question 37: Which is a prerequisite for taking the ABPN certification examination in psychiatry?

A PhD in clinical psychology
Ten years of independent practice
Board certification in family medicine
Completion of an ACGME-accredited psychiatry residency (Correct answer)

Correct answer: Completion of an ACGME-accredited psychiatry residency

Candidates must complete an ACGME-accredited psychiatry residency to be eligible.

Question 38: A patient with delayed sleep phase disorder characteristically shows what sleep pattern?

Randomly variable sleep-wake timing with no consistent pattern
Falls asleep and wakes up much later than desired but sleeps a normal duration (Correct answer)
Falls asleep and wakes up earlier than socially desired
Excessive total sleep time regardless of schedule

Correct answer: Falls asleep and wakes up much later than desired but sleeps a normal duration

Delayed sleep phase disorder involves a delayed circadian rhythm, causing inability to fall asleep until very late at night and difficulty waking in the morning.

Question 39: Which imaging finding is most characteristic of an acute ischemic stroke on early non-contrast CT?

Ring-enhancing lesion
Often normal in the first hours (Correct answer)
Diffuse cerebral edema within minutes
Immediate hyperdense parenchyma

Correct answer: Often normal in the first hours

Non-contrast CT is often normal early, which is why it is used mainly to exclude hemorrhage.

Question 40: Which sleep stage is characterized by high-amplitude, slow (< 2 Hz) delta waves on EEG and is considered essential for physical restoration?

Stage N1 (light NREM)
Stage N2 (intermediate NREM)
Stage N3 (slow-wave/deep NREM) (Correct answer)
REM sleep

Correct answer: Stage N3 (slow-wave/deep NREM)

Stage N3 slow-wave sleep is characterized by delta waves and is associated with physical restoration, growth hormone release, and memory consolidation.

Question 41: Which of the following best describes the mechanism of action of vagus nerve stimulation (VNS) in epilepsy treatment?

Parasympathetic activation reducing overall cerebral blood flow and neuronal excitability
Antidromic activation of the vagus nerve blocking peripheral seizure spread
Direct suppression of hippocampal ictal discharge via electrode contact
Afferent stimulation of the vagus nerve modulating thalamocortical networks and locus coeruleus noradrenergic pathways (Correct answer)

Correct answer: Afferent stimulation of the vagus nerve modulating thalamocortical networks and locus coeruleus noradrenergic pathways

VNS works via afferent vagal fibers projecting to the nucleus tractus solitarius, which in turn modulates thalamocortical circuits and activates noradrenergic projections from the locus coeruleus, reducing seizure susceptibility.

Question 42: A patient with bipolar disorder, currently stable, reveals a plan to kill a specific coworker. The psychiatrist warns the intended victim. Under which legal principle is this disclosure justified?

Mandatory reporting statutes
Involuntary commitment statute
HIPAA treatment exception
Duty to warn (Tarasoff doctrine) (Correct answer)

Correct answer: Duty to warn (Tarasoff doctrine)

The Tarasoff duty to warn/protect mandates disclosure to identifiable, threatened third parties when a patient makes credible threats of serious violence.

Question 43: Which of the following claims regarding childhood ADHD is NOT TRUE?

Higher doses for inattentive or mixed forms of ADHD, lower doses for hyperactive type (Correct answer)
60% respond to stimulants
This age group benefits most from medication studies.
Formulations with a long half-life are more preferred.

Correct answer: Higher doses for inattentive or mixed forms of ADHD, lower doses for hyperactive type

There is no established clinical guideline that dictates higher stimulant doses for inattentive or mixed forms of ADHD and lower doses for the hyperactive type. Dosing of stimulant medication is highly individualized, based on the patient's response, symptom severity, and tolerability, regardless of the specific ADHD presentation type. The goal is always to find the lowest effective dose.

Question 44: A patient stabilized on olanzapine gains 25 pounds over 6 months and develops hyperglycemia. This best exemplifies which pharmacological mechanism?

D2 receptor blockade
H1 histamine receptor antagonism and 5-HT2C blockade (Correct answer)
Muscarinic M1 receptor blockade
Alpha-2 adrenergic agonism

Correct answer: H1 histamine receptor antagonism and 5-HT2C blockade

Olanzapine's metabolic side effects are primarily attributed to H1 and 5-HT2C receptor blockade, which increase appetite and impair glucose regulation.

Question 45: How common is schizophrenia in the general population?

3 to 10%
5 to 15%
20 to 25%
0.5 to 1.5% (Correct answer)
1 to 3%

Correct answer: 0.5 to 1.5%

Schizophrenia is a relatively uncommon but severe mental illness, with its prevalence in the general population consistently estimated to be around 0.5% to 1.5% worldwide. This figure represents the proportion of people who will experience schizophrenia at some point in their lives. This highlights its impact despite its lower prevalence compared to other mental health conditions.

Question 46: What is the primary mechanism of action of phenytoin?

Blocks voltage-gated sodium channels (Correct answer)
Inhibits carbonic anhydrase
Enhances GABA-A receptor activity
Blocks T-type calcium channels

Correct answer: Blocks voltage-gated sodium channels

Phenytoin stabilizes neuronal membranes by blocking voltage-gated sodium channels in their inactive state, reducing repetitive high-frequency firing.

Question 47: For medically refractory temporal lobe epilepsy with MRI evidence of hippocampal sclerosis, which surgical procedure is most commonly performed and has the highest rate of seizure freedom?

Corpus callosotomy
Functional hemispherectomy
Anterior temporal lobectomy (Correct answer)
Vagus nerve stimulator implantation

Correct answer: Anterior temporal lobectomy

Anterior temporal lobectomy (ATL) is the most commonly performed epilepsy surgery and yields 60-90% seizure freedom rates in well-selected patients with unilateral hippocampal sclerosis.

Question 48: Which of the following claims regarding alcohol's PK and PD is NOT TRUE?

Prolonged open chloride ion channel times are the eventual result.
Long-term alcohol use causes glutamate hypersensitivity.
Alcohol dehydrogenase's downregulation causes acute toxicity. (Correct answer)
Alcohol attaches itself to the GABA receptor's benzodiazepine site.
All of the above.

Correct answer: Alcohol dehydrogenase's downregulation causes acute toxicity.

Alcohol dehydrogenase (ADH) is an enzyme that metabolizes alcohol. If ADH is downregulated, alcohol is metabolized slower, leading to higher and more prolonged levels of alcohol in the body. This would exacerbate the severity and duration of acute toxicity caused by alcohol, rather than directly causing the toxicity itself. Therefore, the claim that downregulation of ADH *causes* acute toxicity is not true.

Question 49: By the use of the descending pain pathway, the dorsal horn facilitates the transmission of signals from peripheral nerves to the thalamus in response to noxious stimuli.

True
False (Correct answer)

Correct answer: False

The statement is false. The descending pain pathway primarily functions to *modulate* or *inhibit* pain signals, rather than facilitating their transmission. It originates in the brainstem and projects to the dorsal horn of the spinal cord, where it can release neurotransmitters to reduce the intensity of incoming pain signals from peripheral nerves. The *ascending* pain pathway is responsible for transmitting pain signals to the thalamus and higher brain centers.

Question 50: Under the M'Naghten standard used in many US states, a defendant is found not guilty by reason of insanity (NGRI) when they demonstrate which of the following?

They had a severe mental illness at time of the crime
They could not control their behavior due to irresistible impulse
They acted under the influence of a substance
They did not know the nature of the act or did not know it was wrong due to mental disease (Correct answer)

Correct answer: They did not know the nature of the act or did not know it was wrong due to mental disease

The M'Naghten standard focuses on cognitive incapacity: the defendant either did not understand what they were doing or did not know it was wrong due to a mental disease.

Question 51: Which organization does the ABPN partner with to provide continuing certification for physicians?

American Medical Association (AMA)
American Board of Medical Specialties (ABMS) (Correct answer)
Accreditation Council for Graduate Medical Education (ACGME)
Federation of State Medical Boards (FSMB)

Correct answer: American Board of Medical Specialties (ABMS)

The ABPN is one of 24 member boards of the ABMS.

Question 52: The most common cause of dementia in older adults is:

Alzheimer disease (Correct answer)
Frontotemporal dementia
Lewy body dementia
Vascular dementia

Correct answer: Alzheimer disease

Alzheimer disease is the leading cause of dementia, marked by amyloid plaques and tau tangles.

Question 53: Which antiepileptic drug is most strongly associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Levetiracetam
Gabapentin
Lamotrigine (Correct answer)
Valproate

Correct answer: Lamotrigine

Lamotrigine carries a significant risk of serious skin reactions including SJS/TEN, especially when titrated rapidly or combined with valproate; slow titration substantially reduces this risk.

Question 54: Fatal familial insomnia is caused by a mutation in which gene?

APP (amyloid precursor protein)
MAPT (microtubule-associated protein tau)
PRNP (prion protein gene) (Correct answer)
LRRK2 (leucine-rich repeat kinase 2)

Correct answer: PRNP (prion protein gene)

Fatal familial insomnia is caused by a D178N mutation in the PRNP gene, leading to prion accumulation in the thalamus and destruction of sleep-regulatory circuits.

Question 55: In schizophrenia, which of the following is the best prognostic sign?

Highly negative symptoms
Female gender
Initial response to medication (Correct answer)
Residing in a developed country
High emotive family dynamic

Correct answer: Initial response to medication

A strong initial response to antipsychotic medication is considered one of the best prognostic indicators for individuals with schizophrenia. Early and significant improvement in symptoms with treatment suggests a better likelihood of long-term symptom control, reduced relapse rates, and improved functional outcomes. This direct measure of treatment effectiveness is a powerful predictor of future success.

Question 56: Which of the following qualities of bupropion (Wellbutrin) is NOT TRUE?

Has a risk of having seizures
Selective Norepinephrine reuptake inhibitor (Correct answer)
Primarily used in adults
Not susceptible to abuse

Correct answer: Selective Norepinephrine reuptake inhibitor

Bupropion (Wellbutrin) is primarily classified as a norepinephrine-dopamine reuptake inhibitor (NDRI). While it does inhibit norepinephrine reuptake, its significant action on dopamine reuptake distinguishes it from a selective norepinephrine reuptake inhibitor (SNRI). Therefore, describing it solely as a selective norepinephrine reuptake inhibitor is not entirely accurate.

Question 57: Which ABPN subspecialty is MOST relevant for a neurologist treating patients with epilepsy-associated psychiatric comorbidities and behavioral changes?

Geriatric psychiatry
Behavioral neurology and neuropsychiatry (Correct answer)
Neurodevelopmental disabilities
Consultation-liaison psychiatry

Correct answer: Behavioral neurology and neuropsychiatry

Behavioral neurology and neuropsychiatry is the ABPN subspecialty focused on the interface of neurological conditions and behavioral/psychiatric manifestations.

Question 58: What is the mechanism by which acetylcholinesterase inhibitors improve symptoms in Alzheimer's disease?

They prevent amyloid beta aggregation
They increase dopamine in the prefrontal cortex
They block glutamate NMDA receptor excitotoxicity
They increase acetylcholine availability at synapses (Correct answer)

Correct answer: They increase acetylcholine availability at synapses

Acetylcholinesterase inhibitors (e.g., donepezil, rivastigmine) prevent the breakdown of acetylcholine, compensating for the cholinergic deficit in Alzheimer's disease.

Question 59: Which condition is characterized by sudden onset of severe OCD symptoms and motor or vocal tics in a child following group A streptococcal infection?

Sydenham chorea
Pediatric acute-onset neuropsychiatric syndrome (PANS)
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) (Correct answer)
Tourette disorder

Correct answer: PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections)

PANDAS describes abrupt onset of OCD and/or tic disorders temporally associated with group A streptococcal (GAS) infections in prepubertal children.

Question 60: Which is the most common cause of new-onset epilepsy in adults over 60 years of age?

CNS tumors
Genetic epilepsy syndromes
Traumatic brain injury
Cerebrovascular disease (Correct answer)

Correct answer: Cerebrovascular disease

Cerebrovascular disease (stroke) is the leading identifiable cause of epilepsy in older adults, accounting for approximately 30-40% of cases.

Question 61: Which of the following statements of the many forms of chronic pain is NOT TRUE?

Neuralgia postherpetic might persist for years.
All of the above.
Microvasculature vasoconstriction leads to diabetic neuropathy.
The "tingling" sensation is caused by neurons that have become hypersensitive as a result of demyelinated axons and changes in sodium receptor concentrations.
Only morphologic changes are observed in cases of chronic back pain. (Correct answer)

Correct answer: Only morphologic changes are observed in cases of chronic back pain.

The statement that 'Only morphologic changes are observed in cases of chronic back pain' is NOT TRUE. Chronic back pain, like other chronic pain conditions, involves complex neuroplastic changes in the central nervous system, including sensitization of neurons, altered pain processing, and functional changes in brain regions involved in pain perception and modulation. These changes extend far beyond mere morphological alterations and contribute significantly to the persistent pain experience.

Question 62: Which of the following DOES NOT indicate that a person has positive symptoms of schizophrenia?

Erratic behaviors
Movement disorders
Disorganized speech
Delusions
Avolition (Correct answer)

Correct answer: Avolition

Positive symptoms of schizophrenia are those that add to or distort normal functions, such as delusions, hallucinations, and disorganized speech. Avolition, on the other hand, is a negative symptom, characterized by a decrease in motivated self-initiated purposeful activities. Negative symptoms represent a deficit or absence of normal functions, distinguishing them from the 'added' features of positive symptoms.

Question 63: Obstructive sleep apnea is MOST strongly associated with which neuropsychiatric condition?

Depression and cognitive impairment (Correct answer)
Bipolar disorder
Panic disorder
Schizophrenia

Correct answer: Depression and cognitive impairment

OSA is strongly associated with depression, cognitive impairment, and executive dysfunction due to intermittent hypoxemia and sleep fragmentation.

Question 64: Which childhood-onset psychiatric condition is characterized by recurrent episodes of excessive food intake with loss of control, followed by compensatory behaviors such as purging or excessive exercise?

Avoidant/restrictive food intake disorder
Bulimia nervosa (Correct answer)
Anorexia nervosa binge-eating/purging type
Binge-eating disorder

Correct answer: Bulimia nervosa

Bulimia nervosa involves recurrent binge eating followed by compensatory behaviors (purging, fasting, excessive exercise) with body image disturbance, typically at normal or above-normal weight.

Question 65: Which class of medication is first-line for acute mania?

Mood stabilizers or second-generation antipsychotics (Correct answer)
Benzodiazepines alone
SSRIs
Stimulants

Correct answer: Mood stabilizers or second-generation antipsychotics

Acute mania is treated with mood stabilizers (e.g., lithium, valproate) or atypical antipsychotics.

Question 66: A positive Babinski sign in an adult indicates a lesion of which pathway?

Cerebellar peduncles
Corticospinal tract (Correct answer)
Dorsal columns
Spinothalamic tract

Correct answer: Corticospinal tract

An extensor plantar response reflects upper motor neuron (corticospinal) dysfunction.

Question 67: Which concept refers to the likelihood that a released psychiatric patient will commit violence, assessed using validated instruments in forensic evaluations?

Criminal responsibility
Violence risk assessment (Correct answer)
Diminished capacity
Competency restoration

Correct answer: Violence risk assessment

Violence risk assessment uses structured professional judgment and actuarial tools to estimate the probability of future violence in forensic psychiatric evaluations.

Question 68: What are the common types of headache and their distinguishing features?

Tension (bilateral, pressing), migraine (unilateral, pulsating, with aura), cluster (severe unilateral orbital pain with autonomic symptoms) (Correct answer)
Only migraines are clinically significant
All headaches are the same type
Headache type cannot be differentiated clinically

Correct answer: Tension (bilateral, pressing), migraine (unilateral, pulsating, with aura), cluster (severe unilateral orbital pain with autonomic symptoms)

Tension headaches present as bilateral, pressing pain. Migraines are typically unilateral, pulsating, with nausea and photophobia, sometimes preceded by aura. Cluster headaches cause severe unilateral orbital pain with lacrimation and nasal congestion.

Question 69: Which of the following best defines a hallucination?

A misinterpretation of a real stimulus
A fixed false belief
A perception without an external stimulus (Correct answer)
An unwanted intrusive thought

Correct answer: A perception without an external stimulus

A hallucination is a sensory perception occurring in the absence of an external stimulus.

Question 70: Which antidepressant is CONTRAINDICATED in patients with a seizure disorder or eating disorders due to lowered seizure threshold?

Escitalopram
Mirtazapine
Bupropion (Correct answer)
Sertraline

Correct answer: Bupropion

Bupropion dose-dependently lowers the seizure threshold and is contraindicated in patients with seizure disorders or active eating disorders.

Question 71: A patient with refractory epilepsy is started on the ketogenic diet. Which metabolic change is primarily responsible for the diet's antiseizure mechanism?

Reduction of dietary sodium decreasing neuronal excitability
Elevation of serum glucose stabilizing neuronal membranes
Alkalosis from dietary changes suppressing seizure threshold
Production of ketone bodies that alter neuronal energy metabolism and neurotransmitter levels (Correct answer)

Correct answer: Production of ketone bodies that alter neuronal energy metabolism and neurotransmitter levels

The ketogenic diet shifts brain metabolism to ketone bodies (beta-hydroxybutyrate, acetoacetate), which alter GABA/glutamate balance, mitochondrial function, and ion channel activity to produce antiseizure effects.

Question 72: A patient reports excessive daytime sleepiness, sudden loss of muscle tone triggered by strong emotion, sleep paralysis, and hypnagogic hallucinations. What is the MOST likely diagnosis?

Obstructive sleep apnea
Idiopathic hypersomnia
Narcolepsy type 1 (Correct answer)
REM sleep behavior disorder

Correct answer: Narcolepsy type 1

Narcolepsy type 1 is characterized by the tetrad of excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations, caused by hypocretin/orexin deficiency.

Question 73: Which is the most appropriate initial screening tool for cognitive impairment in a clinic setting?

Lumbar puncture
PET scan
EEG
Mini-Mental State Examination or MoCA (Correct answer)

Correct answer: Mini-Mental State Examination or MoCA

Brief bedside tools like the MMSE or MoCA are first-line cognitive screens.

Question 74: The Kernig sign, resistance and pain on extending the knee with the hip flexed, indicates:

Sciatic disc herniation only
Peripheral neuropathy
Cerebellar disease
Meningeal irritation (Correct answer)

Correct answer: Meningeal irritation

A positive Kernig sign reflects meningeal irritation, as seen in meningitis or subarachnoid hemorrhage.

Question 75: Geriatric psychiatry as an ABPN subspecialty focuses primarily on which patient population?

Patients over age 65 with psychiatric and cognitive disorders (Correct answer)
Patients over 50 with treatment-resistant depression
Nursing home residents regardless of age
Patients of any age with age-related cognitive decline

Correct answer: Patients over age 65 with psychiatric and cognitive disorders

Geriatric psychiatry subspecialists are trained to manage the psychiatric, cognitive, and behavioral disorders particularly affecting adults 65 and older.

Question 76: Which medication requires monitoring for agranulocytosis with regular blood counts?

Clozapine (Correct answer)
Sertraline
Lithium
Fluoxetine

Correct answer: Clozapine

Clozapine can cause agranulocytosis, requiring scheduled absolute neutrophil count monitoring.

Question 77: A 7-year-old boy has difficulty paying attention, frequently interrupts others, and cannot stay seated in class. His symptoms are present at home and school. What is the MOST likely diagnosis?

Oppositional defiant disorder
Anxiety disorder
Autism spectrum disorder
Attention-deficit/hyperactivity disorder (ADHD) (Correct answer)

Correct answer: Attention-deficit/hyperactivity disorder (ADHD)

ADHD requires symptoms of inattention and/or hyperactivity-impulsivity present in two or more settings before age 12, fitting this presentation.

Question 78: The EEG hallmark of absence seizures is:

Burst suppression
Focal temporal spikes
3-Hz generalized spike-and-wave (Correct answer)
Triphasic waves

Correct answer: 3-Hz generalized spike-and-wave

Absence seizures classically produce 3-Hz generalized spike-and-wave discharges.

Question 79: A lesion causing loss of pain and temperature on one side of the body indicates damage to which tract?

Spinothalamic tract (Correct answer)
Dorsal columns
Corticospinal tract
Spinocerebellar tract

Correct answer: Spinothalamic tract

Pain and temperature sensation travel via the spinothalamic tract, which crosses near its level of entry.

Question 80: A patient with anorexia nervosa is being assessed. Which feature is a required diagnostic criterion?

Binge eating at least weekly
Body weight above normal range
Significantly low body weight relative to expectations (Correct answer)
Purging after every meal

Correct answer: Significantly low body weight relative to expectations

Anorexia nervosa requires restriction leading to a significantly low body weight along with fear of weight gain and body image disturbance.

Question 81: Which neurotransmitter/hormone is MOST involved in regulating the sleep-wake circadian rhythm and is secreted by the pineal gland?

Cortisol
Adenosine
Serotonin
Melatonin (Correct answer)

Correct answer: Melatonin

Melatonin, secreted by the pineal gland in response to darkness, entrains the circadian clock and promotes sleep onset; its secretion is suppressed by light.

Question 82: Which cognitive symptom is a core feature of major depressive disorder rather than normal grief?

Missing the deceased
Crying spells
Persistent worthlessness and guilt (Correct answer)
Sadness after a loss

Correct answer: Persistent worthlessness and guilt

Pervasive worthlessness and excessive guilt point to major depression rather than uncomplicated grief.

Question 83: The ABPN Sleep Medicine subspecialty certification is unique in that it is jointly awarded with which other medical specialty board?

American Board of Internal Medicine (ABIM) only
American Board of Neurology only
Multiple boards including ABIM, American Board of Pediatrics, and American Board of Otolaryngology (Correct answer)
American Board of Family Medicine only

Correct answer: Multiple boards including ABIM, American Board of Pediatrics, and American Board of Otolaryngology

Sleep medicine is a multi-specialty certification jointly overseen by multiple ABMS member boards including ABPN, ABIM, ABP, ABOTO, and others, reflecting its interdisciplinary nature.

Question 84: Which of these DOES NOT describe an individual with Autism Spectrum Disorders?

Impairment in verbal and nonverbal communication
Delusions (Correct answer)
Weakened social relationships
Repetitive behaviors

Correct answer: Delusions

Autism Spectrum Disorders (ASD) are characterized by persistent deficits in social communication and interaction, and restricted, repetitive patterns of behavior, interests, or activities. Delusions, which are fixed, false beliefs not amenable to change in light of conflicting evidence, are not a core diagnostic criterion or typical feature of ASD; they are more characteristic of psychotic disorders.

Question 85: Which of the following descriptions of Neurontin, or gabapentin is NOT TRUE?

Renal adjustment is required
Onset of action = 2-3 weeks, Trial requires = 3-8 weeks
All of the above. (Correct answer)
Titration- Day 1- 300mg at bedtime; Day 2- 300mg BiD; Day 3- 300mg TiD
Common ADE- Dizziness, somnolence

Correct answer: All of the above.

The question asks which statement about gabapentin is NOT TRUE, and the correct answer is 'All of the above.' This implies that statements A, B, C, and D are all considered FALSE. However, renal adjustment is required for gabapentin (A is TRUE), the titration schedule provided is common (B is TRUE), dizziness and somnolence are common adverse effects (C is TRUE), and the onset of action and trial duration are generally accurate (D is TRUE). Given that A, B, C, and D are generally true, the premise that 'All of the above' are NOT TRUE (i.e., all are false) is incorrect, indicating a potential flaw in the question's design or answer choices.

Question 86: A 55-year-old with a history of alcohol use disorder presents with ophthalmoplegia, ataxia, and confusion. What is the MOST likely diagnosis and its cause?

Cerebellar degeneration due to direct ethanol toxicity
Korsakoff syndrome due to folic acid deficiency
Wernicke encephalopathy due to thiamine (B1) deficiency (Correct answer)
Hepatic encephalopathy due to liver failure

Correct answer: Wernicke encephalopathy due to thiamine (B1) deficiency

Wernicke encephalopathy is caused by thiamine deficiency, classically presenting with the triad of ophthalmoplegia, ataxia, and confusion in the setting of alcohol use disorder.

Question 87: Which epilepsy syndrome is characterized by the triad of infantile spasms, hypsarrhythmia on EEG, and developmental regression or arrest?

Lennox-Gastaut syndrome
Dravet syndrome
Ohtahara syndrome
West syndrome (Correct answer)

Correct answer: West syndrome

West syndrome presents in infancy with the classic triad of epileptic (infantile) spasms, hypsarrhythmic EEG pattern, and psychomotor developmental regression.

Question 88: What is the minimum number of ABPN-approved CME credits required per 3-year block for continuing certification?

90 credits (Correct answer)
150 credits
30 credits
50 credits

Correct answer: 90 credits

Diplomates must earn at least 90 CME credits over each 3-year block, averaging 30 per year.

Question 89: Psychogenic non-epileptic seizures (PNES) are most definitively diagnosed by which investigation?

Neuropsychological testing battery
Brain MRI with epilepsy protocol
Video-EEG monitoring capturing a typical event (Correct answer)
Serum prolactin level measured 10-20 minutes post-event

Correct answer: Video-EEG monitoring capturing a typical event

Video-EEG monitoring that captures a typical event with no ictal EEG correlate is the gold standard for diagnosing PNES, demonstrating semiology without epileptiform activity.

Question 90: What components are included in a comprehensive psychiatric evaluation?

Only the mental status examination
Just a symptom checklist
Only medication history
Chief complaint, psychiatric history, medical history, substance use, family history, mental status exam, and risk assessment (Correct answer)

Correct answer: Chief complaint, psychiatric history, medical history, substance use, family history, mental status exam, and risk assessment

A thorough psychiatric evaluation includes the presenting complaint, complete psychiatric and medical history, substance use assessment, family psychiatric history, social/developmental history, mental status examination, and risk assessment.

Question 91: A psychiatry resident in the US completes 4 years of ACGME-accredited residency and then applies to the ABPN. What is the NEXT required step for initial board certification?

Complete a 6-month fellowship in general hospital psychiatry
Complete 100 CME hours and submit a portfolio
Obtain state licensure in two US states
Pass the ABPN written (Part I) examination (Correct answer)

Correct answer: Pass the ABPN written (Part I) examination

After completing residency and meeting eligibility requirements, candidates must pass the ABPN written examination to achieve initial board certification in psychiatry.

Question 92: Geriatric Psychiatry as an ABPN subspecialty focuses on the mental health of which population?

Adolescents
Pregnant patients
Older adults (Correct answer)
Children

Correct answer: Older adults

Geriatric Psychiatry addresses mental health in older adults.

Question 93: What is the Glasgow Coma Scale and what does it measure?

A scale measuring pain levels
A depression screening tool
A 3-15 point scale measuring consciousness through eye opening, verbal response, and motor response (Correct answer)
A measure of cognitive ability

Correct answer: A 3-15 point scale measuring consciousness through eye opening, verbal response, and motor response

The GCS rates consciousness on a 3-15 scale: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Score 15 = fully conscious, 3 = deep coma. Used for traumatic brain injury and altered consciousness assessment.

Question 94: Which drug is used to reverse acute benzodiazepine overdose?

Flumazenil (Correct answer)
Physostigmine
Naloxone
Atropine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used cautiously for reversal.

Question 95: What is the biopsychosocial model in psychiatry?

A model focusing only on brain chemistry
A psychoanalytic theory
A purely social explanation of mental illness
An integrative approach considering biological, psychological, and social factors in understanding and treating mental illness (Correct answer)

Correct answer: An integrative approach considering biological, psychological, and social factors in understanding and treating mental illness

The biopsychosocial model, developed by George Engel, considers the interaction of biological factors (genetics, neurochemistry), psychological factors (coping, personality), and social factors (relationships, culture) in mental health.

Question 96: In the Tarasoff case, what CRITICAL duty was established for mental health clinicians in the United States?

Duty to obtain informed consent before treatment
Duty to warn/protect identifiable third parties from patient violence (Correct answer)
Duty to hospitalize imminently suicidal patients
Duty to report child abuse to authorities

Correct answer: Duty to warn/protect identifiable third parties from patient violence

Tarasoff v. Regents of University of California established that therapists have a legal duty to protect identifiable third parties when a patient makes credible threats of violence.

Question 97: Applying a 5% patch, which can be cut to fit the administration site, once a day is part of the proper lidocaine patch administration protocol.

True
False (Correct answer)

Correct answer: False

The statement that a 5% lidocaine patch can be cut to fit the administration site is false. Lidocaine patches, particularly those with a drug matrix design (like Lidoderm), are generally not recommended to be cut. Cutting the patch can compromise the integrity of the drug delivery system, potentially altering the release rate, exposing the drug to air, or leading to inconsistent dosing. Patients are typically instructed to apply the patch whole to the affected area.

Question 98: Which condition classically presents with the triad of dementia, gait apraxia, and urinary incontinence?

Creutzfeldt-Jakob disease
Parkinson disease
Normal pressure hydrocephalus (Correct answer)
Alzheimer disease

Correct answer: Normal pressure hydrocephalus

NPH presents with the triad often summarized as wet, wobbly, and wacky.

Question 99: Which of the following is NOT TRUE about tramadol?

All of the above.
Lower chance of respiratory depression
Epileptogenic risk
Titrate up as tolerated (Correct answer)
Non-controlled substance

Correct answer: Titrate up as tolerated

The statement 'Titrate up as tolerated' for tramadol is considered NOT TRUE in a strict sense. While dose titration is common for tramadol to manage efficacy and side effects, its unique pharmacological profile, including its serotonergic effects and potential to lower the seizure threshold, necessitates careful and often more structured titration protocols. Simply titrating 'as tolerated' might not adequately account for these specific risks, requiring more cautious and guided dose adjustments to prevent adverse events like seizures or serotonin syndrome.

Question 100: When a patient can state the correct date, place, and who they are, the clinician documents that the patient is:

Displaying confabulation
Exhibiting poor insight
Oriented to person, place, and time (Correct answer)
Showing impaired abstraction

Correct answer: Oriented to person, place, and time

Correctly identifying person, place, and time indicates full orientation on the MSE.

Question 101: A patient experiences neuroleptic malignant syndrome (NMS). Which combination of features is MOST characteristic?

Sedation, respiratory depression, miosis, bradycardia
Hyperthermia, diarrhea, agitation, myoclonus
Tremor, bradykinesia, cogwheel rigidity, shuffling gait
Fever, muscle rigidity, altered consciousness, autonomic instability (Correct answer)

Correct answer: Fever, muscle rigidity, altered consciousness, autonomic instability

NMS is characterized by the tetrad of hyperthermia, severe muscle rigidity, altered consciousness, and autonomic instability following dopamine antagonist exposure.

Question 102: What approximate percentage of patients who experience a single unprovoked seizure will have a recurrence within 2 years?

40-50% (Correct answer)
20-30%
Greater than 80%
Less than 10%

Correct answer: 40-50%

Approximately 40-50% of patients have a recurrence after a single unprovoked seizure within 2 years, which informs the decision about whether to initiate antiepileptic therapy.

Question 103: A prisoner asks a psychiatrist to evaluate him for possible PTSD related to prison conditions. What unique ethical challenge does this situation present?

Lack of legal basis for treating prisoners with PTSD
Dual-agency conflict between clinical role and institutional obligations (Correct answer)
Informed consent is not required in correctional settings
Mandatory reporting requirements for PTSD

Correct answer: Dual-agency conflict between clinical role and institutional obligations

In correctional settings, the psychiatrist serves both the prisoner-patient and the institution, creating a dual-agency conflict that must be transparently managed.

Question 104: A sudden severe headache described as the 'worst of my life' most warrants evaluation for what?

Subarachnoid hemorrhage (Correct answer)
Migraine with aura
Tension headache
Cluster headache

Correct answer: Subarachnoid hemorrhage

A thunderclap 'worst headache of life' raises concern for subarachnoid hemorrhage.

Question 105: Which ABPN subspecialty addresses disorders of nerves and muscles such as ALS and peripheral neuropathies?

Forensic Psychiatry
Sleep Medicine
Addiction Psychiatry
Neuromuscular Medicine (Correct answer)

Correct answer: Neuromuscular Medicine

Neuromuscular Medicine covers disorders of nerve and muscle.

Question 106: What condition is not usually associated with Neuroleptic Malignant Syndrome (NMS)?

Lead pipe rigidity
Leukopenia (Correct answer)
Elevated fever
Dysphagia
Autonomic instability

Correct answer: Leukopenia

Neuroleptic Malignant Syndrome (NMS) is characterized by elevated fever, severe muscle rigidity, autonomic instability, and altered mental status. While NMS can cause leukocytosis (elevated white blood cell count) due to stress, leukopenia (low white blood cell count) is not typically associated with NMS itself. Leukopenia, specifically agranulocytosis, is a known serious side effect of clozapine, but not a feature of NMS.

Question 107: Which condition is characterized by a child's failure to speak in specific social situations (e.g., school) despite speaking normally in other settings (e.g., home)?

Expressive language disorder
Selective mutism (Correct answer)
Autism spectrum disorder
Social anxiety disorder

Correct answer: Selective mutism

Selective mutism involves consistent failure to speak in specific social situations where speech is expected, despite speaking in other settings.

Question 108: Which antipsychotic medication is linked to retinal pigmentation?

Fluphenazine
Chlorpromazine
Haloperidol
Thioridazine (Correct answer)
Trifluoperazine

Correct answer: Thioridazine

Thioridazine, a first-generation antipsychotic, is specifically linked to the rare but serious side effect of retinal pigmentation (retinitis pigmentosa). This adverse effect can lead to impaired vision and, in severe cases, blindness, especially at higher doses. Due to this and other side effects, its use has become very limited, and it is crucial to monitor for visual changes if prescribed.

Question 109: A 3-year-old child, following placement in multiple foster homes with severe neglect, shows indiscriminate affection toward strangers and lack of reticence with unfamiliar adults. What diagnosis is MOST likely?

Disinhibited social engagement disorder (Correct answer)
Separation anxiety disorder
Reactive attachment disorder
Autism spectrum disorder

Correct answer: Disinhibited social engagement disorder

Disinhibited social engagement disorder is characterized by culturally inappropriate behavior with unfamiliar adults following early social neglect or deprivation.

Question 110: Which body accredits the residency and fellowship training programs whose completion the ABPN requires for eligibility?

NBME
FSMB
ABMS
ACGME (Correct answer)

Correct answer: ACGME

The ACGME accredits the graduate medical education programs required for ABPN eligibility.

Question 111: Which antiepileptic drug should be AVOIDED in juvenile myoclonic epilepsy because it may paradoxically worsen myoclonic seizures?

Levetiracetam
Clonazepam
Carbamazepine (Correct answer)
Lamotrigine

Correct answer: Carbamazepine

Carbamazepine is a sodium channel blocker that may worsen myoclonic and absence seizures and is contraindicated in generalized epilepsy syndromes including JME.

Question 112: Which element is NOT required to establish informed consent for psychiatric treatment in the United States?

Voluntariness (absence of coercion)
Capacity to make the decision
Guarantee that treatment will be successful (Correct answer)
Information about diagnosis and proposed treatment

Correct answer: Guarantee that treatment will be successful

Informed consent requires information, capacity, and voluntariness, but does not require guaranteeing treatment outcomes, as medicine cannot promise specific results.

Question 113: Which medication is FDA-approved for the treatment of alcohol use disorder by blocking opioid reward pathways?

Naltrexone (Correct answer)
Disulfiram
Topiramate
Acamprosate

Correct answer: Naltrexone

Naltrexone is an opioid receptor antagonist that reduces alcohol craving and pleasure by blocking the endogenous opioid reward pathway activated by alcohol.

Question 114: What is required annually of diplomates besides holding a license, to stay on track for continuing certification?

Ongoing CME participation toward the block requirement (Correct answer)
Retaking the residency exam
Publishing a research paper
Renewing a passport

Correct answer: Ongoing CME participation toward the block requirement

Diplomates must continuously accrue CME toward the 90-credit, 3-year block requirement.

Question 115: Which ethical principle MOST directly supports a patient's right to refuse medical treatment?

Autonomy (Correct answer)
Nonmaleficence
Justice
Beneficence

Correct answer: Autonomy

Autonomy is the ethical principle that upholds individuals' rights to make their own informed decisions about their healthcare, including refusal of treatment.

Question 116: Clonidine, sometimes known as catapres, is an option for treating ADHD when stimulant medication causes tics to increase.

True (Correct answer)
False

Correct answer: True

Clonidine, an alpha-2 adrenergic agonist, is a recognized treatment option for ADHD, particularly when stimulant medications are not tolerated or when co-occurring conditions like tics are present. It can help manage tics and reduce hyperactivity and impulsivity, making it a suitable alternative or adjunct when stimulants exacerbate tics. Therefore, the statement is true.

Question 117: What is the legal standard used in most US states for civil involuntary psychiatric commitment?

Probable cause
Clear and convincing evidence (Correct answer)
Preponderance of the evidence (more likely than not)
Beyond a reasonable doubt

Correct answer: Clear and convincing evidence

The Supreme Court in Addington v. Texas (1979) held that civil commitment requires clear and convincing evidence of mental illness and dangerousness.

Question 118: Consultation-liaison (C-L) psychiatry focuses on which clinical practice setting?

Outpatient community mental health centers
School-based mental health programs
Correctional facilities and court-ordered evaluations
Medical and surgical hospital units, assessing psychiatric issues in medically ill patients (Correct answer)

Correct answer: Medical and surgical hospital units, assessing psychiatric issues in medically ill patients

Consultation-liaison psychiatry involves psychiatric assessment and treatment of patients in general medical and surgical settings, addressing the interface of physical and mental illness.

Question 119: A 10-year-old is brought in for evaluation after 8 months of irritability, severe outbursts, and persistently dysphoric mood that is not episodic. What DSM-5 diagnosis BEST fits?

Oppositional defiant disorder
Major depressive disorder
Disruptive mood dysregulation disorder (DMDD) (Correct answer)
Bipolar I disorder

Correct answer: Disruptive mood dysregulation disorder (DMDD)

DMDD is characterized by severe, recurrent temper outbursts and persistently irritable/angry mood that is non-episodic, distinguishing it from bipolar disorder.

Question 120: A diplomate who fails to meet continuing certification requirements is reported as which status?

Board eligible
Not meeting Continuing Certification requirements (Correct answer)
Time-unlimited certified
Provisionally certified

Correct answer: Not meeting Continuing Certification requirements

Diplomates who lapse are publicly reported as not meeting continuing certification requirements.

Question 121: Under HIPAA, which type of disclosure of protected health information does NOT require patient authorization?

Disclosure to law enforcement to prevent serious and imminent threat (Correct answer)
Sharing records with an employer for hiring decisions
Disclosure to family members for non-emergency purposes
Marketing communications

Correct answer: Disclosure to law enforcement to prevent serious and imminent threat

HIPAA permits covered entities to disclose PHI to law enforcement when necessary to prevent or lessen a serious and imminent threat to health or safety.

Question 122: Which is the ONLY FDA-approved medication for irritability associated with autism spectrum disorder in children?

Methylphenidate
Risperidone and aripiprazole (Correct answer)
Sertraline
Valproate

Correct answer: Risperidone and aripiprazole

Both risperidone and aripiprazole have FDA approval for treating irritability associated with autism spectrum disorder in children aged 5 and older.

Question 123: Which term describes a sleep disorder characterized by confusional arousals, sleepwalking, and sleep terrors arising from NREM slow-wave sleep?

NREM parasomnias (disorders of arousal) (Correct answer)
Hypnic disorders
Circadian rhythm disorders
REM parasomnias

Correct answer: NREM parasomnias (disorders of arousal)

NREM parasomnias (disorders of arousal) include sleepwalking, sleep terrors, and confusional arousals, all arising from incomplete awakening from deep NREM sleep.

Question 124: Which of the following claims about Wernicke's Encephalopathy (WE) is NOT TRUE?

Although there are no set rules, it is preferable to use IV therapy with a continuous infusion of 2000 mg for more than 60 minutes. (Correct answer)
Korsakoff's Syndrome deteriorating is one of the complications of WE.
Characterized by neurological issues such as ataxia of the gait, disorientation, and ophthalmoplegia (impaired eye movement).
When WE is suspected, treatment should start immediately even before probable test findings.
WE is caused by a thiamine deficit brought on by alcohol misuse.

Correct answer: Although there are no set rules, it is preferable to use IV therapy with a continuous infusion of 2000 mg for more than 60 minutes.

The standard treatment for Wernicke's Encephalopathy involves high-dose intravenous thiamine, typically 500 mg three times daily for several days, or 100 mg daily. A continuous infusion of 2000 mg for more than 60 minutes is not a recognized or preferred regimen. Such a high single dose administered continuously is not supported by current clinical guidelines for WE treatment.

Question 125: What is the first-line pharmacological treatment for convulsive status epilepticus in an adult presenting to the emergency department with IV access?

Phenytoin IV
Valproate IV
Lorazepam IV (Correct answer)
Phenobarbital IV

Correct answer: Lorazepam IV

Benzodiazepines—specifically lorazepam IV (0.1 mg/kg)—are the first-line treatment for status epilepticus due to their rapid onset and proven efficacy.

Question 126: Which legal standard is used to determine whether a defendant is competent to stand trial in the United States?

ALI/MPC standard
Durham rule
M'Naghten rule
Dusky standard (Correct answer)

Correct answer: Dusky standard

Dusky v. United States (1960) established that competency requires the defendant to have a rational and factual understanding of the proceedings and the ability to consult with counsel.

Question 127: What is the most common metabolic cause of neonatal seizures?

Hyperthyroidism
Hypernatremia
Hypoglycemia (Correct answer)
Hypercalcemia

Correct answer: Hypoglycemia

Hypoglycemia is the most common metabolic cause of neonatal seizures and requires prompt glucose correction; other causes include hypocalcemia and hypomagnesemia.

Question 128: Which mechanism best describes how benzodiazepines produce their sedative-anxiolytic effects?

Inhibit dopamine reuptake
Block serotonin 5-HT3 receptors
Block NMDA glutamate receptors
Potentiate GABA-A chloride channel opening (Correct answer)

Correct answer: Potentiate GABA-A chloride channel opening

Benzodiazepines bind to GABA-A receptors and increase the frequency of chloride channel opening in response to GABA, enhancing inhibitory neurotransmission.

Question 129: What is the difference between psychosis and delirium?

Psychosis involves impaired reality testing (hallucinations, delusions) with clear consciousness; delirium involves fluctuating consciousness and attention (Correct answer)
Psychosis always includes violence
They are identical conditions
Delirium only affects elderly patients

Correct answer: Psychosis involves impaired reality testing (hallucinations, delusions) with clear consciousness; delirium involves fluctuating consciousness and attention

Psychosis involves impaired reality testing with preserved consciousness, while delirium features fluctuating awareness, inattention, and often has an identifiable medical cause requiring urgent evaluation.

Question 130: Which seizure type is characterized by a sudden loss of postural muscle tone, often causing the patient to fall?

Clonic seizure
Myoclonic seizure
Atonic seizure (Correct answer)
Tonic seizure

Correct answer: Atonic seizure

Atonic seizures (drop attacks) involve sudden loss of muscle tone, causing abrupt falls; they are associated with Lennox-Gastaut syndrome.

Question 131: Brain Injury Medicine, an ABPN subspecialty, is open to diplomates from which primary boards among others?

Pathology only
Radiology only
Surgery only
Neurology and Psychiatry (and PM&R) (Correct answer)

Correct answer: Neurology and Psychiatry (and PM&R)

Brain Injury Medicine is offered to neurology, psychiatry, and physical medicine diplomates.

Question 132: A patient develops facial droop involving the forehead on one side with inability to close the eye. This localizes the lesion to:

Cerebellum
Trigeminal nerve
Upper motor neuron (cortical stroke)
Lower motor neuron facial nerve (Bell's palsy) (Correct answer)

Correct answer: Lower motor neuron facial nerve (Bell's palsy)

Forehead involvement indicates a peripheral (lower motor neuron) CN VII lesion, since the upper face has bilateral cortical innervation.

Question 133: Which receptor does memantine target for the treatment of moderate-to-severe Alzheimer's disease?

Acetylcholine muscarinic M1
GABA-A chloride channel
NMDA glutamate receptor (Correct answer)
Sigma-1 receptor

Correct answer: NMDA glutamate receptor

Memantine is a non-competitive NMDA receptor antagonist that reduces glutamate excitotoxicity implicated in Alzheimer's disease neurodegeneration.

Question 134: The ABPN certifies subspecialists in which of the following fields?

Orthopedic Sports Medicine
Child and Adolescent Psychiatry (Correct answer)
Interventional Cardiology
Pediatric Surgery

Correct answer: Child and Adolescent Psychiatry

Child and Adolescent Psychiatry is an ABPN-recognized subspecialty.

Question 135: Which antiepileptic drug requires monitoring of serum levels and is known to cause Steven-Johnson syndrome, particularly in patients with HLA-B*1502 allele?

Lacosamide
Gabapentin
Carbamazepine (Correct answer)
Levetiracetam

Correct answer: Carbamazepine

Carbamazepine is associated with Stevens-Johnson syndrome, and the risk is significantly higher in patients of Asian descent carrying the HLA-B*1502 allele.

Question 136: Fluctuating muscle weakness that worsens with activity and improves with rest suggests:

Bell palsy
Multiple sclerosis
Guillain-Barré syndrome
Myasthenia gravis (Correct answer)

Correct answer: Myasthenia gravis

Myasthenia gravis causes fatigable weakness from acetylcholine receptor antibodies.

Question 137: Which side effect is most specifically associated with valproate use in pregnancy?

Cleft palate only
Cardiac septal defects only
Neural tube defects (Correct answer)
Limb shortening

Correct answer: Neural tube defects

Valproate carries a high risk of neural tube defects and should be avoided in pregnancy.

Question 138: The ABPN's Part I written examination for psychiatry residents PRIMARILY tests which type of knowledge?

Communication skills and interprofessional collaboration
Medical knowledge through multiple-choice questions (Correct answer)
Research methodology and biostatistics
Procedural skills and clinical simulation

Correct answer: Medical knowledge through multiple-choice questions

The ABPN Part I examination assesses medical knowledge and clinical reasoning through computer-based multiple-choice questions covering psychiatry and neurology.

Question 139: What Methylphenidate mediation has an osmotic release and lasts for 12 hours?

Strattera
Vyvanse
Concerta (Correct answer)
Daytrana

Correct answer: Concerta

Concerta is an extended-release formulation of methylphenidate that utilizes an osmotic controlled-release oral delivery system (OROS). This technology allows for a gradual and sustained release of the medication over approximately 12 hours, providing effective symptom control with once-daily dosing. This matches the description of osmotic release and 12-hour duration.

Question 140: Which accreditation body oversees residency and fellowship training programs in psychiatry in the United States?

Accreditation Council for Graduate Medical Education (ACGME) (Correct answer)
American Psychiatric Association (APA)
American Board of Medical Specialties (ABMS)
National Board of Medical Examiners (NBME)

Correct answer: Accreditation Council for Graduate Medical Education (ACGME)

The ACGME sets program requirements, accredits residency and fellowship training programs, and oversees graduate medical education quality in all US specialties including psychiatry.

Question 141: The Babinski sign (extensor plantar response) in an adult indicates dysfunction of which pathway?

Dorsal column
Corticospinal tract (Correct answer)
Peripheral nerve
Spinothalamic tract

Correct answer: Corticospinal tract

An extensor plantar response reflects corticospinal (upper motor neuron) tract dysfunction.

Question 142: A woman with epilepsy is planning a pregnancy. Which antiepileptic drug carries the highest risk of major congenital malformations and cognitive teratogenicity?

Levetiracetam
Oxcarbazepine
Valproate (Correct answer)
Lamotrigine

Correct answer: Valproate

Valproate has the highest teratogenic risk among AEDs, associated with neural tube defects, craniofacial abnormalities, and significant neurocognitive impairment in exposed offspring.

Question 143: A patient states they have no problem despite obvious functional impairment from their illness. The clinician documents this as:

Poor insight (Correct answer)
Concrete thinking
Intact reality testing
Good judgment

Correct answer: Poor insight

Lack of awareness of one's own illness or its consequences reflects poor insight.

Question 144: What is the mortality rate of Neuroleptic Malignant Syndrome if left untreated?

20% (Correct answer)
85%
25%
50%
10%

Correct answer: 20%

Neuroleptic Malignant Syndrome (NMS) is a medical emergency with a significant mortality rate if not promptly recognized and treated. Historically, the mortality rate for untreated NMS was reported to be as high as 20-30%, though with modern supportive care and early intervention, it has decreased. This high mortality underscores the importance of immediate discontinuation of the offending antipsychotic and aggressive medical management.

Question 145: Tardive dyskinesia is MOST commonly caused by long-term use of which class of drugs?

Benzodiazepines
Dopamine receptor antagonists (Correct answer)
Mood stabilizers
Anticholinergics

Correct answer: Dopamine receptor antagonists

Tardive dyskinesia results from chronic blockade of dopamine receptors, causing receptor supersensitivity and abnormal involuntary movements.

Question 146: The CIWA-Ar score is used to determine how to treat sedative and hypnotic withdrawal, which is different from alcohol withdrawal.

True
False (Correct answer)

Correct answer: False

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) scale is specifically designed and validated to assess the severity of alcohol withdrawal symptoms. While some symptoms may overlap, it is not intended or validated for managing withdrawal from other substances like sedative-hypnotics (e.g., benzodiazepines or barbiturates). Therefore, the statement is false.

Question 147: Which receptors are inhibited by antipsychotics of the second generation?

Alpha 1 and Beta 2
D2 and 5HT2 (Correct answer)
D2 and Beta 2
D1 and Alpha 1
5HT2 and Alpha 1

Correct answer: D2 and 5HT2

Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, primarily exert their therapeutic effects by blocking dopamine D2 receptors and serotonin 5-HT2A receptors. The D2 receptor antagonism helps reduce positive symptoms, while the 5-HT2A receptor antagonism is thought to contribute to their efficacy against negative and cognitive symptoms and a lower risk of extrapyramidal side effects compared to first-generation antipsychotics.

Question 148: Which antiepileptic drug is considered the preferred first-line agent for juvenile myoclonic epilepsy?

Phenytoin
Carbamazepine
Valproate (Correct answer)
Gabapentin

Correct answer: Valproate

Valproate is the most effective broad-spectrum agent for JME, controlling myoclonic jerks, absence, and generalized tonic-clonic seizures.

Question 149: How often must a diplomate complete a self-assessment activity under the ABPN Continuing Certification program (3-year block)?

Every 3 years (Correct answer)
Every 5 years
Every year
Every 10 years

Correct answer: Every 3 years

Diplomates must complete a self-assessment CME activity within each 3-year block.

Question 150: The dermatome that covers the nipple line is:

T4 (Correct answer)
C5
T10
L1

Correct answer: T4

The T4 dermatome corresponds to the level of the nipples.

Question 151: Which medication requires regular white blood cell monitoring due to agranulocytosis risk?

Risperidone
Olanzapine
Clozapine (Correct answer)
Quetiapine

Correct answer: Clozapine

Clozapine can cause agranulocytosis, mandating routine ANC monitoring.

Question 152: What are the cardinal features of Parkinson's disease?

Rapid involuntary movements
Resting tremor, rigidity, bradykinesia, and postural instability (TRAP) (Correct answer)
Only tremor
Sudden onset paralysis

Correct answer: Resting tremor, rigidity, bradykinesia, and postural instability (TRAP)

Parkinson's disease is characterized by the TRAP mnemonic: Tremor (at rest, pill-rolling), Rigidity (cogwheel type), Akinesia/Bradykinesia (slowness of movement), and Postural instability, resulting from dopaminergic neuron loss in the substantia nigra.

Question 153: Which ABPN subspecialty focuses on the neurological care of patients with cancer-related nervous system conditions?

Geriatric Psychiatry
Addiction Psychiatry
Neuro-oncology (Neurology) (Correct answer)
Forensic Psychiatry

Correct answer: Neuro-oncology (Neurology)

The ABPN offers subspecialty recognition addressing nervous-system tumors within neurology.

Question 154: Huntington disease is inherited in which pattern?

Autosomal dominant (Correct answer)
X-linked recessive
Autosomal recessive
Mitochondrial

Correct answer: Autosomal dominant

Huntington disease is autosomal dominant, caused by CAG trinucleotide repeat expansion.

Question 155: The Neurodevelopmental Disabilities subspecialty of the ABPN is jointly certificated with which other specialty board?

American Board of Family Medicine (ABFM)
American Board of Pediatrics (ABP) (Correct answer)
American Board of Internal Medicine (ABIM)
American Board of Preventive Medicine (ABPM)

Correct answer: American Board of Pediatrics (ABP)

Neurodevelopmental disabilities is a subspecialty jointly certified by ABPN and the American Board of Pediatrics, reflecting the primarily pediatric patient population.

Question 156: A psychiatrist is asked to perform an independent medical examination for a personal injury lawsuit. What must the psychiatrist clearly explain to the examinee at the outset?

That the results will only be shared with the examinee's attorney
That everything discussed is protected by doctor-patient confidentiality
That the examinee has the right to refuse psychiatric treatment
That the evaluation is for legal purposes and not for treatment, and that confidentiality is limited (Correct answer)

Correct answer: That the evaluation is for legal purposes and not for treatment, and that confidentiality is limited

In forensic evaluations, the psychiatrist must clarify the non-treatment nature of the evaluation, the limited confidentiality, and that the report will be shared with the retaining party.

Question 157: Which neurological condition is characterized by brief, involuntary jerks of the legs during sleep and is associated with periodic leg movements on polysomnography?

Periodic limb movement disorder (PLMD) (Correct answer)
Restless legs syndrome
Hypnic jerks (sleep starts)
Nocturnal myoclonus from seizure disorder

Correct answer: Periodic limb movement disorder (PLMD)

PLMD is characterized by repetitive, stereotyped limb movements (typically legs) during sleep on polysomnography, causing sleep disruption and daytime fatigue.

Question 158: A patient taking clozapine develops fever, sore throat, and an absolute neutrophil count of 400/μL. What is the MOST appropriate action?

Immediately discontinue clozapine (Correct answer)
Add G-CSF and continue clozapine
Reduce clozapine dose by 50%
Continue clozapine and recheck CBC in 1 week

Correct answer: Immediately discontinue clozapine

Severe agranulocytosis (ANC < 500/μL) requires immediate discontinuation of clozapine to prevent life-threatening infection.

Question 159: Which condition presents with episodic hypersomnia (sleeping 16-18 hours per day), hyperphagia, hypersexuality, and behavioral changes lasting days to weeks followed by complete return to normal?

Bipolar II disorder
Narcolepsy with cataplexy
Kleine-Levin syndrome (Correct answer)
Major depressive disorder with atypical features

Correct answer: Kleine-Levin syndrome

Kleine-Levin syndrome is a rare condition predominantly affecting adolescent males, characterized by recurrent hypersomnia episodes with cognitive, behavioral, and sometimes hypersexual features.

Question 160: Loss of pain and temperature sensation with preserved proprioception suggests a lesion of which tract?

Dorsal columns
Spinothalamic tract (Correct answer)
Spinocerebellar tract
Corticospinal tract

Correct answer: Spinothalamic tract

The spinothalamic tract carries pain and temperature, so its lesion spares proprioception.

Question 161: Which antidepressant is MOST associated with serotonin syndrome when combined with an MAOI?

Trazodone
Bupropion
Mirtazapine
Fluoxetine (Correct answer)

Correct answer: Fluoxetine

Fluoxetine, a potent SSRI with a long half-life, carries the highest risk of serotonin syndrome when combined with or shortly after an MAOI.

Question 162: Combining cognitive behavior therapy with selective serotonin reuptake inhibitors (SSRIs) is superior to either treatment alone for treating severe depressive disorder in pediatric patients.

False
True (Correct answer)

Correct answer: True

Research, notably the Treatment for Adolescents with Depression Study (TADS), has demonstrated that combining cognitive behavioral therapy (CBT) with selective serotonin reuptake inhibitors (SSRIs) is more effective than either treatment alone for moderate to severe major depressive disorder in pediatric patients. This combined approach often yields superior outcomes. Therefore, the statement is true.

Question 163: A 9-year-old boy has recurrent, intrusive thoughts about contamination and spends 2 hours per day performing hand-washing rituals. What is the FIRST-LINE treatment?

Benzodiazepine plus CBT
SSRI plus habit reversal training
Antipsychotic plus supportive therapy
SSRI plus exposure and response prevention (ERP) (Correct answer)

Correct answer: SSRI plus exposure and response prevention (ERP)

Pediatric OCD is best treated with ERP (a specialized form of CBT) and/or an SSRI; the combination is superior to either alone for moderate-to-severe cases.

Question 164: Which of these DOES NOT correspond to a schizophrenia subtype?

Cataleptic Type (Correct answer)
Residual Type
Paranoid Type
Undifferentiated Type
Disorganized Type

Correct answer: Cataleptic Type

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), previously recognized several subtypes of schizophrenia, including Paranoid, Disorganized, Catatonic, Undifferentiated, and Residual types. However, the DSM-5 eliminated these subtypes due to their limited diagnostic stability and predictive validity. While 'catatonic' was a subtype, 'cataleptic type' is not a recognized subtype of schizophrenia.

Question 165: Which of the tools listed below is used to evaluate how severe the symptoms of alcohol withdrawal are?

McGill
All of the above.
NIH Consensus Scale
CIWA-Ar (Correct answer)
COWS

Correct answer: CIWA-Ar

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) is a widely recognized and validated tool specifically used to assess the severity of alcohol withdrawal symptoms. It consists of 10 items that quantify symptoms such as nausea, tremor, anxiety, agitation, and hallucinations, providing a score that guides treatment decisions and monitors the patient's progress during alcohol detoxification. Other scales like COWS are for opioid withdrawal.

Question 166: Which psychiatric subspecialty is PRIMARILY concerned with providing psychiatric evaluation and treatment to individuals involved in the legal system?

Forensic psychiatry (Correct answer)
Emergency psychiatry
Addiction psychiatry
Geriatric psychiatry

Correct answer: Forensic psychiatry

Forensic psychiatry involves the application of clinical psychiatry to legal contexts, including competency evaluations, criminal responsibility assessments, and expert testimony.

Question 167: A patient's polysomnography shows repetitive apneas despite preserved respiratory effort, with oxygen desaturation. What type of sleep apnea does this MOST likely represent?

Cheyne-Stokes respirations
Mixed sleep apnea
Obstructive sleep apnea (Correct answer)
Central sleep apnea

Correct answer: Obstructive sleep apnea

Obstructive sleep apnea is characterized by airway obstruction with continued respiratory effort, in contrast to central sleep apnea where respiratory effort ceases.

Question 168: Which personality disorder is characterized by unstable relationships, impulsivity, identity disturbance, and fear of abandonment?

Schizoid
Obsessive-compulsive
Borderline (Correct answer)
Narcissistic

Correct answer: Borderline

Borderline personality disorder features affective instability, impulsivity, and frantic efforts to avoid abandonment.

Question 169: What is the role of neuroimaging in neurological assessment?

Imaging is never needed in neurological assessment
Only CT scanning is used in neurology
CT for acute stroke and trauma; MRI for detailed brain structure; functional imaging for specific clinical questions (Correct answer)
Neuroimaging replaces the clinical examination entirely

Correct answer: CT for acute stroke and trauma; MRI for detailed brain structure; functional imaging for specific clinical questions

CT is preferred for acute emergencies (hemorrhage, trauma). MRI provides superior soft tissue detail for tumors, MS, and structural abnormalities. Functional imaging (PET, fMRI) evaluates metabolism and brain activity for specific indications.

Question 170: A forensic psychiatrist is asked to evaluate a criminal defendant's mental state at the time of the offense. What is the PRIMARY purpose of this evaluation?

To provide treatment recommendations for the defendant
To determine whether the defendant is dangerous
To assess criminal responsibility (sanity) for legal proceedings (Correct answer)
To evaluate competency to stand trial

Correct answer: To assess criminal responsibility (sanity) for legal proceedings

Forensic evaluations of mental state at the time of the offense (MSO) assess criminal responsibility or sanity, which is a legal determination informed by psychiatric opinion.

Question 171: Which finding is characteristic of a cerebellar rather than a sensory ataxia?

Loss of vibration sense
Positive Romberg sign
Ataxia markedly worse with eyes closed
Ataxia unchanged by eye closure (Correct answer)

Correct answer: Ataxia unchanged by eye closure

Cerebellar ataxia does not significantly worsen with eyes closed, unlike sensory ataxia which relies on visual compensation.

Question 172: Which psychotherapy is MOST effective for adolescent depression according to evidence-based guidelines?

Supportive counseling only
Interpersonal therapy for adolescents (IPT-A) or CBT (Correct answer)
Psychoanalysis
Art therapy alone

Correct answer: Interpersonal therapy for adolescents (IPT-A) or CBT

Both IPT-A and CBT have strong evidence for adolescent depression and are recommended as first-line psychotherapies by clinical guidelines.

Question 173: Which of the following SSRIs is NOT highly advised by experts when treating pediatric patients with major depressive disorder?

Citalopram
Fluoxetine
Sertraline
Paroxetine (Correct answer)

Correct answer: Paroxetine

While several SSRIs are used in pediatric depression, paroxetine (Paxil) is generally not highly advised by experts. This is due to concerns about its side effect profile, including a higher risk of discontinuation syndrome and potential for increased suicidality in some studies, compared to other SSRIs like fluoxetine and sertraline, which are often preferred.

Question 174: What is the difference between upper motor neuron (UMN) and lower motor neuron (LMN) lesions?

UMN causes spasticity, hyperreflexia, and Babinski sign; LMN causes flaccidity, areflexia, fasciculations, and muscle atrophy (Correct answer)
They produce identical symptoms
UMN only affects the legs
LMN only affects the arms

Correct answer: UMN causes spasticity, hyperreflexia, and Babinski sign; LMN causes flaccidity, areflexia, fasciculations, and muscle atrophy

UMN lesions (brain, spinal cord) cause spastic paralysis, increased reflexes, positive Babinski sign, and clonus. LMN lesions (anterior horn cells, peripheral nerves) cause flaccid paralysis, decreased reflexes, fasciculations, and muscle wasting.

Question 175: Which is a first-line treatment for obsessive-compulsive disorder?

Lithium monotherapy
Electroconvulsive therapy
Benzodiazepines alone
SSRIs with exposure and response prevention (Correct answer)

Correct answer: SSRIs with exposure and response prevention

OCD is treated with SSRIs (often high-dose) combined with ERP therapy.

Question 176: Which condition is characterized by sudden brief loss of muscle tone triggered by emotion?

Absence seizure
Syncope
Myoclonus
Cataplexy (Correct answer)

Correct answer: Cataplexy

Cataplexy is sudden emotion-triggered loss of muscle tone, associated with narcolepsy.

Question 177: What effects on the neuroanatomy of norepinephrine neurons do amphetamine and methlyphenidate have in addition to changing dopamine levels?

Suppress locus coeruleus NE neurons (Correct answer)
Activate locus coeruleus NE neurons
Suppress decimus meridius NE neurons
Activate decimus meridius NE neurons

Correct answer: Suppress locus coeruleus NE neurons

Stimulants like amphetamine and methylphenidate increase norepinephrine levels in the prefrontal cortex, which is beneficial for ADHD symptoms. However, they also lead to a suppression of the firing rate of norepinephrine neurons in the locus coeruleus (LC), a major source of NE in the brain. This suppression is likely due to increased alpha-2 adrenergic receptor activation and feedback inhibition.

Question 178: Which combination of antipsychotics causes the most weight gain?

Aripiprazole and Clozapine
Olanzapine and Clozapine (Correct answer)
Olanzapine and Ziprasidone
Olanzapine and Risperidone
Risperidone and Clozapine

Correct answer: Olanzapine and Clozapine

Among the antipsychotic medications, olanzapine and clozapine are consistently associated with the highest risk of significant weight gain and metabolic side effects. This is due to their potent antagonism of various receptors, including histamine H1 and serotonin 5-HT2C receptors, which play roles in appetite regulation and metabolism. Clinicians must carefully monitor patients on these medications for metabolic changes.

Question 179: Which defense mechanism involves attributing one's own unacceptable feelings to another person?

Displacement
Projection (Correct answer)
Reaction formation
Sublimation

Correct answer: Projection

Projection attributes one's own unacceptable impulses or feelings to someone else.

Question 180: Which neuroimaging modality is considered the gold standard for structural evaluation in patients with epilepsy?

PET scan
CT scan with contrast
MRI brain with epilepsy protocol (Correct answer)
SPECT scan

Correct answer: MRI brain with epilepsy protocol

MRI with an epilepsy-specific protocol (thin cuts, FLAIR, T1 volumetric) is the gold standard for detecting structural abnormalities such as hippocampal sclerosis, cortical dysplasia, and tumors.

Question 181: Which reflex tests the S1 nerve root?

Biceps reflex
Triceps reflex
Patellar reflex
Achilles (ankle) reflex (Correct answer)

Correct answer: Achilles (ankle) reflex

The Achilles reflex is mediated primarily by the S1 nerve root.

Question 182: A psychiatrist evaluating a defendant for competency to stand trial concludes the defendant is incompetent. What is the MOST typical next legal step?

The defendant is permanently committed to a psychiatric facility
The defendant is immediately tried and sentenced
The defendant is sent for competency restoration treatment (Correct answer)
The case is dismissed and the defendant is released

Correct answer: The defendant is sent for competency restoration treatment

When found incompetent to stand trial, defendants are typically committed to a treatment facility for competency restoration, after which the proceedings resume.

Question 183: A patient presents with sudden right-sided weakness and expressive aphasia. Which arterial territory is most likely involved?

Basilar artery
Right posterior cerebral artery
Anterior spinal artery
Left middle cerebral artery (Correct answer)

Correct answer: Left middle cerebral artery

Broca (expressive) aphasia with right hemiparesis localizes to the left MCA territory.

Question 184: Fatigable ptosis and diplopia that worsen with sustained upward gaze are hallmark signs of:

Myasthenia gravis (Correct answer)
Bell's palsy
Stroke
Parkinson's disease

Correct answer: Myasthenia gravis

Myasthenia gravis causes fluctuating, fatigable weakness of ocular and other muscles due to antibodies against acetylcholine receptors.

Question 185: Which element is NOT typically a component of the standard Mental Status Examination?

Mood and affect
Appearance and behavior
Thought process and content
Complete blood count (Correct answer)

Correct answer: Complete blood count

A complete blood count is a laboratory test, not part of the observational MSE.

Question 186: Ascending symmetric weakness with areflexia developing over days after a viral illness is most consistent with:

Guillain-Barré syndrome (Correct answer)
Amyotrophic lateral sclerosis
Multiple sclerosis
Myasthenia gravis

Correct answer: Guillain-Barré syndrome

Guillain-Barré syndrome typically presents as an acute ascending flaccid paralysis with loss of reflexes following an infection.

Question 187: What EEG pattern is most characteristic of childhood absence epilepsy?

Burst-suppression pattern
3 Hz generalized spike-and-wave discharges (Correct answer)
Hypsarrhythmia
Periodic lateralized epileptiform discharges (PLEDs)

Correct answer: 3 Hz generalized spike-and-wave discharges

Childhood absence epilepsy classically produces 3 Hz generalized spike-and-wave discharges on EEG, often triggered by hyperventilation.

Question 188: Addiction psychiatry as an ABPN subspecialty addresses which clinical area?

Psychopharmacology of treatment-resistant disorders
Consultation-liaison services for general hospital patients
Emergency psychiatric evaluation and crisis stabilization
Prevention, evaluation, and treatment of substance use disorders and behavioral addictions (Correct answer)

Correct answer: Prevention, evaluation, and treatment of substance use disorders and behavioral addictions

Addiction psychiatry subspecialists have expertise in diagnosing and treating substance use disorders, co-occurring psychiatric disorders, and behavioral addictions.

Question 189: Forensic Psychiatry certification qualifies a diplomate to work primarily at the intersection of psychiatry and what field?

Anesthesiology
Radiology
Surgery
The law/legal system (Correct answer)

Correct answer: The law/legal system

Forensic Psychiatry addresses psychiatric issues within legal contexts.

Question 190: The DSM-5 uses a categorical approach, but which section introduced dimensional assessment tools for further study?

The appendix of codes only
Section II
Section I
Section III (Correct answer)

Correct answer: Section III

DSM-5 Section III contains emerging measures, dimensional models, and conditions for further study.

Question 191: What is the standard duration of an ABPN certification cycle before continuing certification requirements reset?

3 years
1 year
20 years
10 years (Correct answer)

Correct answer: 10 years

Time-limited certificates operate on a 10-year certification cycle.

Question 192: A child shows persistent deficits in social communication plus restricted, repetitive behaviors present from early development. This pattern is characteristic of:

Autism spectrum disorder (Correct answer)
Specific learning disorder
ADHD
Oppositional defiant disorder

Correct answer: Autism spectrum disorder

Autism spectrum disorder combines social-communication deficits with restricted, repetitive behaviors from an early age.

Question 193: In the context of a psychiatric malpractice case involving suicide, which element is typically the MOST difficult to prove?

That there was a doctor-patient relationship
That the psychiatrist had a duty of care
That the patient died by suicide
That the standard of care was breached (negligence) (Correct answer)

Correct answer: That the standard of care was breached (negligence)

In suicide malpractice cases, proving that the psychiatrist's specific action or inaction fell below the standard of care is the most contested and difficult element to establish.

Question 194: Ascending symmetric weakness with areflexia following an infection suggests which diagnosis?

Multiple sclerosis
Myasthenia gravis
Guillain-Barré syndrome (Correct answer)
Amyotrophic lateral sclerosis

Correct answer: Guillain-Barré syndrome

Guillain-Barré syndrome presents with ascending weakness and areflexia, often after infection.

Question 195: Broca aphasia is best characterized by:

Intact repetition with word-finding pauses
Nonfluent speech with preserved comprehension (Correct answer)
Complete mutism with no comprehension
Fluent speech with poor comprehension

Correct answer: Nonfluent speech with preserved comprehension

Broca (expressive) aphasia features effortful, nonfluent speech with intact comprehension.

Question 196: First-line pharmacotherapy for generalized anxiety disorder is typically which class?

Antipsychotics
Beta-blockers
SSRIs (Correct answer)
Benzodiazepines

Correct answer: SSRIs

SSRIs are first-line for GAD due to efficacy and lower dependence risk than benzodiazepines.

Question 197: A 35-year-old patient with bipolar I disorder is started on lithium. Which baseline laboratory test is MOST important before initiating therapy?

Renal function (BMP/creatinine) and thyroid function (Correct answer)
Urine drug screen and prolactin level
Fasting lipids and HbA1c
Liver function tests and CBC

Correct answer: Renal function (BMP/creatinine) and thyroid function

Lithium is renally cleared and can cause nephrotoxicity and hypothyroidism, so baseline renal function and thyroid tests are mandatory before initiation.

Question 198: A multiple sleep latency test (MSLT) showing a mean sleep onset latency of 4 minutes and two or more sleep-onset REM periods (SOREMPs) is MOST consistent with which diagnosis?

Insufficient sleep syndrome
Idiopathic hypersomnia
Narcolepsy (Correct answer)
Obstructive sleep apnea

Correct answer: Narcolepsy

Narcolepsy is diagnosed by MSLT showing mean sleep latency ≤ 8 minutes and ≥ 2 SOREMPs, reflecting intrusion of REM sleep into wakefulness.

Question 199: A patient with a resting tremor, cogwheel rigidity, and bradykinesia most likely has:

Essential tremor
Cerebellar degeneration
Parkinson disease (Correct answer)
Huntington disease

Correct answer: Parkinson disease

Resting tremor, rigidity, and bradykinesia form the core parkinsonian triad.

Question 200: The 'Cognitive Expertise' component of continuing certification can be met by the ABCC pathway or by what alternative?

Passing the traditional proctored 10-year exam (Correct answer)
Paying an additional fee only
Attending one conference
Submitting malpractice records

Correct answer: Passing the traditional proctored 10-year exam

Diplomates may satisfy cognitive expertise via ABCC articles or the proctored 10-year exam.

Question 201: What is the MINIMUM age at which conduct disorder can be diagnosed, and what key feature distinguishes it from oppositional defiant disorder?

Age 5; conduct disorder requires peer rejection
Age 5; conduct disorder includes violations of others' basic rights (Correct answer)
Age 10; conduct disorder requires truancy
Age 12; conduct disorder includes substance use

Correct answer: Age 5; conduct disorder includes violations of others' basic rights

Conduct disorder can be diagnosed at any age but requires a persistent pattern that violates the basic rights of others or major age-appropriate societal norms, beyond the defiant behavior of ODD.

Question 202: What cranial nerves are tested during a standard neurological examination?

Only motor nerves
Cranial nerves are not part of the neurological exam
All 12 cranial nerves (I-XII), testing smell, vision, eye movement, facial sensation/motor, hearing, taste, palate, voice, neck muscles, and tongue (Correct answer)
Only the optic nerve

Correct answer: All 12 cranial nerves (I-XII), testing smell, vision, eye movement, facial sensation/motor, hearing, taste, palate, voice, neck muscles, and tongue

The neurological exam systematically tests all 12 cranial nerves: I (olfactory), II (optic), III/IV/VI (oculomotor), V (trigeminal), VII (facial), VIII (vestibulocochlear), IX/X (glossopharyngeal/vagus), XI (accessory), XII (hypoglossal).

Question 203: A 4-year-old child does not make eye contact, does not respond to his name, lacks joint attention, and engages in repetitive hand-flapping. What is the MOST likely diagnosis?

Reactive attachment disorder
Selective mutism
Intellectual disability
Autism spectrum disorder (ASD) (Correct answer)

Correct answer: Autism spectrum disorder (ASD)

Autism spectrum disorder is characterized by persistent deficits in social communication and restricted, repetitive behaviors presenting in early development.

Question 204: Which subspecialty certification addresses care for patients with serious, life-limiting illness and is open to ABPN diplomates?

Vascular Neurology
Nuclear Medicine
Hospice and Palliative Medicine (Correct answer)
Interventional Cardiology

Correct answer: Hospice and Palliative Medicine

Hospice and Palliative Medicine is an ABPN subspecialty open to eligible diplomates.

Question 205: A patient with a lesion of Broca's area would most likely have:

Non-fluent, effortful speech with intact comprehension (Correct answer)
Fluent speech with poor comprehension
Complete inability to hear
Normal speech and comprehension

Correct answer: Non-fluent, effortful speech with intact comprehension

Broca's (expressive) aphasia causes halting, non-fluent speech while comprehension remains relatively preserved.

Question 206: According to current operational guidelines, status epilepticus is defined as a seizure lasting at least how long, or two seizures without return to baseline?

2 minutes
5 minutes (Correct answer)
10 minutes
30 minutes

Correct answer: 5 minutes

Current guidelines (Trinka et al., 2015) define status epilepticus operationally as a seizure lasting ≥5 minutes or two or more seizures without recovery of consciousness between them.

Question 207: Which artery occlusion most commonly causes contralateral face and arm weakness with aphasia?

Basilar artery
Anterior cerebral artery
Middle cerebral artery (Correct answer)
Posterior cerebral artery

Correct answer: Middle cerebral artery

MCA strokes classically cause contralateral face/arm weakness and, in the dominant hemisphere, aphasia.

Question 208: Where can the public verify a physician's ABPN certification status?

A private Facebook group
The physician's business card only
The ABPN 'Verify a Physician' online tool (Correct answer)
The local pharmacy

Correct answer: The ABPN 'Verify a Physician' online tool

The ABPN provides an official online tool to verify certification status.

Question 209: A child with intellectual disability is found to have an IQ of 45. What level of intellectual disability does this represent?

Profound (IQ below 25)
Moderate (IQ 40-55) (Correct answer)
Mild (IQ 55-70)
Severe (IQ 25-40)

Correct answer: Moderate (IQ 40-55)

Moderate intellectual disability corresponds to IQ scores of approximately 40–55, with significant limitations in adaptive functioning and usually requiring substantial support.

Question 210: A 14-year-old boy has a persistent eye-blinking tic and throat-clearing for more than 1 year, with onset before age 18. What diagnosis does this MOST likely represent?

Stereotypic movement disorder
Provisional tic disorder
Tourette disorder
Persistent (chronic) motor or vocal tic disorder (Correct answer)

Correct answer: Persistent (chronic) motor or vocal tic disorder

Persistent tic disorder requires at least one motor OR vocal (not both) tic for more than 1 year; Tourette requires both motor and vocal tics.

Question 211: In the United States, what is the FDA's black box warning for antidepressants in children and adolescents?

Increased risk of agranulocytosis
Increased risk of suicidal ideation and behavior in those under 25 (Correct answer)
Increased risk of mania induction
Increased risk of Stevens-Johnson syndrome

Correct answer: Increased risk of suicidal ideation and behavior in those under 25

The FDA mandates a black box warning on all antidepressants about increased risk of suicidal thinking and behavior in children, adolescents, and young adults up to age 25.

Question 212: A 16-year-old girl refuses to eat, has lost 20% of her body weight, believes she is overweight despite being underweight, and has stopped menstruating. What is the MOST likely diagnosis?

Avoidant/restrictive food intake disorder
Body dysmorphic disorder
Bulimia nervosa
Anorexia nervosa (Correct answer)

Correct answer: Anorexia nervosa

Anorexia nervosa is characterized by restriction of energy intake, intense fear of gaining weight, and distorted body image, with serious medical complications.

Question 213: Which drug interaction is MOST clinically significant in a patient taking valproate who starts carbamazepine?

Carbamazepine induces CYP enzymes, decreasing valproate levels (Correct answer)
Carbamazepine increases valproate levels causing toxicity
No significant interaction occurs between these agents
Valproate inhibits carbamazepine metabolism causing toxicity

Correct answer: Carbamazepine induces CYP enzymes, decreasing valproate levels

Carbamazepine is a potent CYP3A4 inducer that significantly reduces valproate serum levels, potentially causing loss of seizure control.

Question 214: Which pathway allows diplomates to satisfy the cognitive exam requirement without sitting a proctored 10-year exam?

Maintenance of Licensure (MOL)
ABPN Article-Based Continuing Certification (ABCC) (Correct answer)
Time-Unlimited Certification
Focused Practice Designation

Correct answer: ABPN Article-Based Continuing Certification (ABCC)

The ABCC pathway lets diplomates read journal articles and answer questions instead of a 10-year exam.

Question 215: What is the recommended FIRST-LINE psychotherapy for separation anxiety disorder in children?

Cognitive-behavioral therapy (CBT) (Correct answer)
Family systems therapy
Psychodynamic therapy
Play therapy

Correct answer: Cognitive-behavioral therapy (CBT)

CBT with graduated exposure is the evidence-based first-line treatment for separation anxiety disorder and other childhood anxiety disorders.

Question 216: What distinguishes a mood disorder from an anxiety disorder in DSM-5?

Anxiety disorders never involve sadness
Mood disorders only affect children
They are the same diagnosis
Mood disorders primarily involve disturbances in emotional state (depression, mania); anxiety disorders involve excessive fear and worry about future threats (Correct answer)

Correct answer: Mood disorders primarily involve disturbances in emotional state (depression, mania); anxiety disorders involve excessive fear and worry about future threats

Mood disorders (MDD, bipolar) involve pathological mood states, while anxiety disorders (GAD, panic, social anxiety) primarily involve excessive fear, worry, and avoidance behaviors, though significant overlap exists.

Question 217: The ABPN Continuing Certification (CC) program replaced which older requirement?

Annual in-training examination (ITE)
Time-limited certification with 10-year written re-examination (Correct answer)
Mandatory peer supervision hours
Oral board examination for clinical competency

Correct answer: Time-limited certification with 10-year written re-examination

ABPN's Continuing Certification program replaced the high-stakes 10-year written recertification examination with a continuous, ongoing assessment model.

Question 218: Homonymous hemianopia (loss of the same visual field in both eyes) results from a lesion where?

Optic nerve
Optic chiasm
Optic tract or occipital cortex behind the chiasm (Correct answer)
Retina of one eye

Correct answer: Optic tract or occipital cortex behind the chiasm

Lesions posterior to the optic chiasm affect the same visual field in both eyes, producing homonymous hemianopia.

Question 219: What is the primary distinction between a civil commitment and a criminal forensic hold?

Civil commitment is voluntary; forensic hold is involuntary
Civil commitment is for mental illness with danger to self/others; forensic hold is legally tied to the criminal justice system (Correct answer)
Civil commitment requires a crime; forensic hold does not
Civil commitment lasts indefinitely; forensic hold lasts 72 hours

Correct answer: Civil commitment is for mental illness with danger to self/others; forensic hold is legally tied to the criminal justice system

Civil commitment is triggered by mental illness and dangerousness through a civil court process, while forensic holds relate to defendants involved in criminal proceedings (e.g., competency restoration).

Question 220: Sexual contact between a psychiatrist and a patient is MOST accurately categorized as which type of boundary violation?

Unethical but legally permissible in some states
An egregious boundary violation that is always unethical and often illegal (Correct answer)
A boundary violation only when the patient is a minor
A boundary crossing that may sometimes be therapeutic

Correct answer: An egregious boundary violation that is always unethical and often illegal

Sexual contact between a psychiatrist and a patient is a serious boundary violation that is categorically unethical and constitutes grounds for license revocation and criminal charges in most jurisdictions.

Question 221: Which finding on assessment most strongly suggests malingering rather than a genuine psychiatric disorder?

Cooperative engagement with evaluation
Marked discrepancy between reported distress and objective findings, with external incentive (Correct answer)
Symptoms consistent across interviews
Symptoms that improve with treatment

Correct answer: Marked discrepancy between reported distress and objective findings, with external incentive

Malingering is suggested by inconsistency between claimed and observed impairment in the context of clear external gain.

Question 222: Which medication is first-line for acute mania in bipolar disorder along with mood stabilizers?

A stimulant
An atypical antipsychotic (Correct answer)
An SSRI monotherapy
A benzodiazepine taper

Correct answer: An atypical antipsychotic

Atypical antipsychotics, often with lithium or valproate, are first-line for acute mania.

Question 223: ABPN Maintenance of Certification (MOC) requires diplomates to demonstrate which of the following on an ongoing basis?

Continuous medical education, quality improvement, and assessment activities (Correct answer)
Annual state licensing examination
Monthly peer review of patient cases
Annual board re-examination

Correct answer: Continuous medical education, quality improvement, and assessment activities

ABPN MOC requires diplomates to engage in lifelong learning through CME, practice performance improvement, and periodic assessment to maintain certification.

Question 224: A structured tool used specifically to assess obsessive-compulsive symptom severity is the:

MoCA
PANSS
HAM-D
Y-BOCS (Correct answer)

Correct answer: Y-BOCS

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) rates OCD symptom severity.

Question 225: Which finding is most consistent with an upper motor neuron lesion?

Absent reflexes
Fasciculations
Hyperreflexia and spasticity (Correct answer)
Muscle atrophy

Correct answer: Hyperreflexia and spasticity

Upper motor neuron lesions cause hyperreflexia, spasticity, and a positive Babinski sign.

Question 226: Which anticonvulsant is considered FIRST-LINE for trigeminal neuralgia?

Levetiracetam
Lamotrigine
Valproate
Carbamazepine (Correct answer)

Correct answer: Carbamazepine

Carbamazepine is first-line for trigeminal neuralgia due to its efficacy in blocking sodium channels and reducing ectopic neuronal firing.

Question 227: Which neurology subspecialty is jointly recognized by the ABPN and involves expertise in muscle and nerve diseases (peripheral nervous system)?

Neuro-oncology
Neuromuscular medicine (Correct answer)
Clinical neurophysiology
Vascular neurology

Correct answer: Neuromuscular medicine

Neuromuscular medicine is an ABPN-recognized subspecialty focusing on diseases of peripheral nerves, neuromuscular junctions, and muscles, including ALS, myasthenia gravis, and muscular dystrophies.

Question 228: A patient opens eyes to pain (2), gives confused speech (4), and localizes to pain (5). What is the total Glasgow Coma Scale score?

11 (Correct answer)
12
9
10

Correct answer: 11

GCS is the sum of the eye (2), verbal (4), and motor (5) components, totaling 11.

Question 229: Epilepsy is recognized by the ABPN as a subspecialty primarily under which primary certification?

Psychiatry
Neurology (Correct answer)
Sleep Medicine
Addiction Psychiatry

Correct answer: Neurology

Epilepsy is a neurology subspecialty recognized by the ABPN.

Question 230: According to the 2017 ILAE classification, which of the following is correctly categorized as a focal seizure type?

Tonic-clonic seizure
Absence seizure
Myoclonic seizure
Focal aware seizure (Correct answer)

Correct answer: Focal aware seizure

Focal aware seizure is the updated ILAE 2017 term for what was previously called a simple partial seizure, indicating preserved awareness during the event.

Question 231: Which landmark US Supreme Court case established that prisoners have a constitutional right to psychiatric treatment?

Estelle v. Gamble (Correct answer)
Ford v. Wainwright
Addington v. Texas
Jackson v. Indiana

Correct answer: Estelle v. Gamble

Estelle v. Gamble (1976) established that deliberate indifference to the serious medical (and psychiatric) needs of prisoners violates the Eighth Amendment prohibition on cruel and unusual punishment.

Question 232: Constipation is the pharmacologic side effect of opioid receptors (mu, kappa, and delta) based on the action of the delta receptor.

True
False (Correct answer)

Correct answer: False

The statement is false. While constipation is a very common pharmacologic side effect of opioids, it is primarily mediated by the activation of *mu* opioid receptors in the gastrointestinal tract, not the delta receptors. Mu receptor activation reduces gut motility, increases fluid absorption, and decreases intestinal secretions, all contributing to opioid-induced constipation.

Question 233: Which of the following statements regarding Lyrica, or pregabalin is NOT TRUE?

Maximum dosages based on the indication
All of the above.
Requires renal adjustment
Patients at risk of cardiovascular disease should use this medication with caution since there is a possibility of peripheral edema.
Starting dose - 500mg/day; Titration-Within 1 week (Correct answer)

Correct answer: Starting dose - 500mg/day; Titration-Within 1 week

The statement 'Starting dose - 500mg/day; Titration-Within 1 week' for Lyrica (pregabalin) is NOT TRUE. The typical starting dose for pregabalin is significantly lower, often 75mg twice daily or 50mg three times daily (totaling 100-150mg/day), not 500mg/day. While titration can be relatively quick, starting at such a high dose and titrating within one week is not standard practice and would likely lead to severe side effects.

Question 234: Which cranial nerve is tested by asking the patient to shrug the shoulders and turn the head against resistance?

CN VII (facial)
CN XII (hypoglossal)
CN XI (accessory) (Correct answer)
CN X (vagus)

Correct answer: CN XI (accessory)

The spinal accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid, tested by shoulder shrug and head turn.

Question 235: Which medication prevents dopamine from being taken up from the synaptic cleft by blocking dopamine transporters?

Methlyphenidate (Correct answer)
All of the above
Amphetamine

Correct answer: Methlyphenidate

Methylphenidate primarily acts as a dopamine and norepinephrine reuptake inhibitor. It blocks the dopamine transporter (DAT), preventing dopamine from being reabsorbed into the presynaptic neuron. This action increases dopamine levels in the synaptic cleft, making it the correct answer among the choices.

Question 236: A patient describes recurrent, intrusive thoughts of contamination that they neutralize by repeated handwashing. Which diagnosis is most consistent?

Specific phobia
Obsessive-compulsive disorder (Correct answer)
Illness anxiety disorder
Generalized anxiety disorder

Correct answer: Obsessive-compulsive disorder

Intrusive obsessions paired with compensatory compulsions define OCD.

Question 237: Addiction Psychiatry is an ABPN subspecialty primarily building upon which primary certification?

Neuromuscular Medicine
Psychiatry (Correct answer)
Neurology
Sleep Medicine

Correct answer: Psychiatry

Addiction Psychiatry requires prior Psychiatry certification.

Question 238: First-line pharmacologic treatment for generalized anxiety disorder is typically which class?

Antipsychotics
SSRIs or SNRIs (Correct answer)
Barbiturates
Long-term benzodiazepines

Correct answer: SSRIs or SNRIs

SSRIs and SNRIs are first-line for long-term management of generalized anxiety disorder.

Question 239: A physician certified in psychiatry before October 1994 holds what type of certificate?

Conditional certificate
10-year time-limited certificate
Time-unlimited (lifetime) certificate (Correct answer)
Provisional certificate

Correct answer: Time-unlimited (lifetime) certificate

Certificates issued before October 1994 are time-unlimited and do not expire.

Question 240: A patient on phenelzine (MAOI) eats aged cheese and develops a hypertensive crisis. Which mechanism explains this reaction?

Tyramine displaces norepinephrine causing massive sympathetic discharge (Correct answer)
Serotonin syndrome from tyramine's serotonergic activity
Tyramine directly activates CNS dopamine receptors
Cheese triggers an IgE-mediated allergic response

Correct answer: Tyramine displaces norepinephrine causing massive sympathetic discharge

MAOIs prevent gut and hepatic MAO from metabolizing tyramine in aged foods, allowing tyramine to enter systemic circulation and displace norepinephrine from vesicles.

ABPN Psychiatry Certification Exam

The ABPN Psychiatry Certification Examination assesses a physician's knowledge, judgment, and skills in the practice of psychiatry.

300

Questions

450 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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