ABPN Psychiatry Certification Exam — Questions and Answers

Question 1: A woman with epilepsy is planning a pregnancy. Which antiepileptic drug carries the highest risk of major congenital malformations and cognitive teratogenicity?

Levetiracetam
Valproate (Correct answer)
Oxcarbazepine
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 2: Which finding is characteristic of neuroleptic malignant syndrome?

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

Correct answer: Lead-pipe rigidity and hyperthermia

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

Question 3: Loss of pain and temperature sensation with preserved proprioception suggests a lesion of which tract?

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

Correct answer: Spinothalamic tract

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

Question 4: A patient believes that news anchors are sending them personal coded messages. This symptom is classified as a:

Idea of reference / delusion of reference (Correct answer)
Auditory hallucination
Delusion of grandeur
Thought insertion

Correct answer: Idea of reference / delusion of reference

Interpreting neutral external events as having special personal meaning is a delusion (or idea) of reference.

Question 5: Sexual contact between a psychiatrist and a patient is MOST accurately categorized as which type of boundary violation?

An egregious boundary violation that is always unethical and often illegal (Correct answer)
A boundary violation only when the patient is a minor
Unethical but legally permissible in some states
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 6: Which medication is FDA-approved for the treatment of alcohol use disorder by blocking opioid reward pathways?

Naltrexone (Correct answer)
Topiramate
Acamprosate
Disulfiram

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

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

Correct answer: Normal pressure hydrocephalus

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

Question 8: In schizophrenia, which of the following is the best prognostic sign?

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

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 9: What components are included in a comprehensive psychiatric evaluation?

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

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

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

Correct answer: Corticospinal tract

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

Question 11: Which medication is first-line for acute mania in bipolar disorder along with mood stabilizers?

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

Correct answer: An atypical antipsychotic

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

Question 12: Which is the ONLY FDA-approved medication for irritability associated with autism spectrum disorder in children?

Sertraline
Valproate
Methylphenidate
Risperidone and aripiprazole (Correct answer)

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

American Board of Family Medicine only
Multiple boards including ABIM, American Board of Pediatrics, and American Board of Otolaryngology (Correct answer)
American Board of Internal Medicine (ABIM) only
American Board of Neurology 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 14: A patient's tongue deviates to the left when protruded. This suggests a lesion of which cranial nerve on which side?

Right vagus (CN X)
Left hypoglossal (CN XII) (Correct answer)
Left facial (CN VII)
Right hypoglossal (CN XII)

Correct answer: Left hypoglossal (CN XII)

The tongue deviates toward the side of a hypoglossal lesion, so leftward deviation indicates a left CN XII lesion.

Question 15: The DSM-5 uses a categorical approach, but which section introduced dimensional assessment tools for further study?

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

Correct answer: Section III

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

Question 16: The triad of confusion, ophthalmoplegia, and ataxia defines:

Delirium tremens
Korsakoff syndrome
Hepatic encephalopathy
Wernicke encephalopathy (Correct answer)

Correct answer: Wernicke encephalopathy

Wernicke encephalopathy classically presents with confusion, ophthalmoplegia, and ataxia.

Question 17: What is the difference between upper motor neuron (UMN) and lower motor neuron (LMN) lesions?

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

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

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

Correct answer: The law/legal system

Forensic Psychiatry addresses psychiatric issues within legal contexts.

Question 19: Which finding best distinguishes an upper motor neuron lesion from a lower motor neuron lesion?

Flaccid paralysis
Hyperreflexia and spasticity (Correct answer)
Fasciculations and atrophy
Absent reflexes

Correct answer: Hyperreflexia and spasticity

Upper motor neuron lesions typically cause spasticity and hyperreflexia, whereas lower motor neuron lesions cause flaccidity and hyporeflexia.

Question 20: In Weber's tuning fork test, sound lateralizing to the affected ear suggests:

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

Correct answer: Conductive hearing loss in that ear

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

Question 21: Which body accredits the residency and fellowship training programs whose completion the ABPN requires for eligibility?

NBME
FSMB
ACGME (Correct answer)
ABMS

Correct answer: ACGME

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

Question 22: The ABPN Continuing Certification (CC) program replaced which older requirement?

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

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 23: A patient reports at least two distinct identity states that recurrently take control of behavior, with gaps in memory. This suggests:

Schizophrenia
Dissociative identity disorder (Correct answer)
Borderline personality disorder
Bipolar I disorder

Correct answer: Dissociative identity disorder

Dissociative identity disorder involves two or more distinct personality states plus recurrent amnesia.

Question 24: Which concept refers to the likelihood that a released psychiatric patient will commit violence, assessed using validated instruments in forensic evaluations?

Diminished capacity
Criminal responsibility
Violence risk assessment (Correct answer)
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 25: Which imaging finding is most characteristic of an acute ischemic stroke on early non-contrast CT?

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

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

Just appearance and speech
Appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment (Correct answer)
Only cognitive testing
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 27: Which antiepileptic drug requires monitoring of serum levels and is known to cause Steven-Johnson syndrome, particularly in patients with HLA-B*1502 allele?

Levetiracetam
Lacosamide
Gabapentin
Carbamazepine (Correct answer)

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

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

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

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

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 30: Which reflex tests the S1 nerve root?

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

Correct answer: Achilles (ankle) reflex

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

Question 31: Under HIPAA, which type of disclosure of protected health information does NOT require patient authorization?

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

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 32: A patient presents with sudden weakness of the entire right face, arm, and leg, plus aphasia. Which vascular territory is most likely involved?

Basilar artery tip
Right posterior cerebral artery
Left middle cerebral artery (Correct answer)
Right anterior cerebral artery

Correct answer: Left middle cerebral artery

The left MCA supplies motor/sensory cortex for the right body and dominant-hemisphere language areas, explaining right-sided weakness with aphasia.

Question 33: A patient on lithium develops tremor, polyuria, and polydipsia. What is the MOST appropriate next step?

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

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

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

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 35: 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 assess criminal responsibility (sanity) for legal proceedings (Correct answer)
To provide treatment recommendations for the defendant
To determine whether the defendant is dangerous
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 36: 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?

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

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

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

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

Circadian rhythm disorders
NREM parasomnias (disorders of arousal) (Correct answer)
Hypnic 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 39: Which of these DOES NOT correspond to a schizophrenia subtype?

Cataleptic Type (Correct answer)
Residual Type
Undifferentiated Type
Paranoid 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 40: The EEG hallmark of absence seizures is:

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

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

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

Question 41: 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
Hepatic encephalopathy due to liver failure
Wernicke encephalopathy due to thiamine (B1) deficiency (Correct answer)
Korsakoff syndrome due to folic acid deficiency

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 42: Per DSM-5, a manic episode must last at least how long (if not requiring hospitalization)?

4 days
1 week (Correct answer)
1 month
2 weeks

Correct answer: 1 week

A manic episode requires elevated or irritable mood and increased energy lasting at least 1 week (or any duration if hospitalization is needed).

Question 43: 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 44: 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 did not know the nature of the act or did not know it was wrong due to mental disease (Correct answer)
They could not control their behavior due to irresistible impulse
They had a severe mental illness at time of the crime
They acted under the influence of a substance

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

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

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 46: Which antidepressant is contraindicated with tyramine-rich foods?

MAO inhibitors (Correct answer)
Tricyclics
SSRIs
SNRIs

Correct answer: MAO inhibitors

MAOIs plus tyramine can precipitate a hypertensive crisis.

Question 47: 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?

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

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

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

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

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

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

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

Correct answer: Subarachnoid hemorrhage

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

Question 51: When assessing suicide risk, which of the following is considered a protective factor?

Strong social support and religious beliefs (Correct answer)
History of prior attempts
Recent discharge from a psychiatric hospital
Access to firearms

Correct answer: Strong social support and religious beliefs

Robust social connectedness and moral or religious objections to suicide reduce risk.

Question 52: The Combined Neurology and Psychiatry training pathway leads to eligibility for certification in which combination?

Neurosurgery only
Both Neurology and Psychiatry (Correct answer)
Pathology and Neurology
Radiology and Psychiatry

Correct answer: Both Neurology and Psychiatry

Combined training programs allow eligibility for both Neurology and Psychiatry certification.

Question 53: Which developmental milestone should RAISE concern if absent in a 12-month-old child?

Not yet walking independently
No pointing or waving gesture (Correct answer)
No two-word phrases
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 54: Epilepsy is recognized by the ABPN as a subspecialty primarily under which primary certification?

Addiction Psychiatry
Sleep Medicine
Neurology (Correct answer)
Psychiatry

Correct answer: Neurology

Epilepsy is a neurology subspecialty recognized by the ABPN.

Question 55: In the Tarasoff case, what CRITICAL duty was established for mental health clinicians in the United States?

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

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 56: Which combination of antipsychotics causes the most weight gain?

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

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

Restless legs syndrome
Hypnic jerks (sleep starts)
Periodic limb movement disorder (PLMD) (Correct answer)
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 58: What is the primary distinction between a civil commitment and a criminal forensic hold?

Civil commitment lasts indefinitely; forensic hold lasts 72 hours
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 is voluntary; forensic hold is involuntary
Civil commitment requires a crime; forensic hold does not

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

CN VII (facial)
CN XI (accessory) (Correct answer)
CN XII (hypoglossal)
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 60: Under ABPN rules, a psychiatry resident who has NOT yet passed the ABPN examination may legally practice psychiatry under which condition?

Only if supervised by an ABPN-certified psychiatrist at all times
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

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 61: 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.

False (Correct answer)
True

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

They prevent amyloid beta aggregation
They block glutamate NMDA receptor excitotoxicity
They increase dopamine in the prefrontal cortex
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 63: Pronator drift, where one arm slowly pronates and drifts downward with eyes closed, indicates a lesion of which tract?

Spinocerebellar tract
Dorsal column
Contralateral corticospinal tract (Correct answer)
Spinothalamic tract

Correct answer: Contralateral corticospinal tract

Pronator drift is a subtle sign of upper motor neuron weakness from a contralateral corticospinal tract lesion.

Question 64: Which ABPN subspecialty addresses disorders of nerves and muscles such as ALS and peripheral neuropathies?

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

Correct answer: Neuromuscular Medicine

Neuromuscular Medicine covers disorders of nerve and muscle.

Question 65: Which grade on the Medical Research Council (MRC) scale indicates movement with gravity eliminated but not against gravity?

Grade 4
Grade 3
Grade 1
Grade 2 (Correct answer)

Correct answer: Grade 2

MRC grade 2 is active movement possible only when gravity is removed.

Question 66: The ABPN certifies subspecialists in which of the following fields?

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

Correct answer: Child and Adolescent Psychiatry

Child and Adolescent Psychiatry is an ABPN-recognized subspecialty.

Question 67: Which personality disorder is characterized by unstable relationships, impulsivity, identity disturbance, and fear of abandonment?

Obsessive-compulsive
Schizoid
Narcissistic
Borderline (Correct answer)

Correct answer: Borderline

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

Question 68: Constipation is the pharmacologic side effect of opioid receptors (mu, kappa, and delta) based on the action of the delta receptor.

False (Correct answer)
True

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

Glutamate
Serotonin
Acetylcholine
Dopamine (Correct answer)

Correct answer: Dopamine

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

Question 70: Which of the following is a current ABPN-recognized subspecialty requiring additional fellowship training and certification?

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

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

Neologism
Clang association
Perseveration
Echolalia (Correct answer)

Correct answer: Echolalia

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

Question 72: In the ABPN certification process, what is the PRIMARY purpose of the Clinical Skills Verification (CSV) requirement for psychiatry residents?

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

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

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

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

Beneficence
Nonmaleficence
Autonomy (Correct answer)
Justice

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

Psychiatry (Correct answer)
Sleep Medicine
Neurology
Neuromuscular Medicine

Correct answer: Psychiatry

Addiction Psychiatry requires prior Psychiatry certification.

Question 76: Brain Injury Medicine, an ABPN subspecialty, is open to diplomates from which primary boards among others?

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

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

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

Question 77: Which medication is FDA-approved as FIRST-LINE pharmacotherapy for ADHD in children aged 6 and older?

Clonidine
Guanfacine
Atomoxetine
Methylphenidate (Correct answer)

Correct answer: Methylphenidate

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

Question 78: During assessment, a patient invents new words that have meaning only to them. This is termed:

Perseveration
Circumstantiality
Echolalia
Neologism (Correct answer)

Correct answer: Neologism

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

Question 79: How common is schizophrenia in the general population?

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

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

Activate decimus meridius NE neurons
Suppress locus coeruleus NE neurons (Correct answer)
Activate locus coeruleus NE neurons
Suppress 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 81: 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 82: What is the most common metabolic cause of neonatal seizures?

Hypoglycemia (Correct answer)
Hypernatremia
Hyperthyroidism
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 83: Which of the following claims regarding childhood ADHD is NOT TRUE?

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

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

Apraxia
Aphasia
Agnosia for faces
Astereognosis (Correct answer)

Correct answer: Astereognosis

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

Question 85: Which neurotransmitter system is the PRIMARY target of typical antipsychotic medications?

Serotonin (5-HT2A)
Dopamine (D2) (Correct answer)
Norepinephrine (alpha-1)
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 86: The most common cause of dementia in older adults is:

Frontotemporal dementia
Alzheimer disease (Correct answer)
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 87: 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?

Autism spectrum disorder
Separation anxiety disorder
Disinhibited social engagement disorder (Correct answer)
Reactive attachment 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 88: A patient displays a lack of emotional reactivity with a face that shows minimal expression. This is documented as:

Euthymic mood
Labile affect
Blunted or flat affect (Correct answer)
Expansive affect

Correct answer: Blunted or flat affect

Markedly reduced intensity of emotional expression is described as blunted or flat affect.

Question 89: The dermatome that covers the nipple line is:

L1
C5
T4 (Correct answer)
T10

Correct answer: T4

The T4 dermatome corresponds to the level of the nipples.

Question 90: Which ABPN subspecialty focuses on the neurological care of patients with cancer-related nervous system conditions?

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

Correct answer: Neuro-oncology (Neurology)

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

Question 91: 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 92: Combining cognitive behavior therapy with selective serotonin reuptake inhibitors (SSRIs) is superior to either treatment alone for treating severe depressive disorder in pediatric patients.

True (Correct answer)
False

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

Displacement
Reaction formation
Sublimation
Projection (Correct answer)

Correct answer: Projection

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

Question 94: Which finding is most consistent with an upper motor neuron lesion?

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

Correct answer: Hyperreflexia and spasticity

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

Question 95: 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?

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

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

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

Correct answer: SSRIs or SNRIs

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

Question 97: What credential must a candidate hold to sit for the ABPN Neurology certification exam?

Board certification in radiology
Completion of an ACGME-accredited neurology residency (Correct answer)
A master's degree in neuroscience
A surgical fellowship

Correct answer: Completion of an ACGME-accredited neurology residency

Eligibility requires completing an ACGME-accredited neurology residency.

Question 98: 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)
9
12
10

Correct answer: 11

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

Question 99: Which accreditation body oversees residency and fellowship training programs in psychiatry in the United States?

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

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 100: 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?

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

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

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

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

Complete inability to hear
Non-fluent, effortful speech with intact comprehension (Correct answer)
Normal speech and comprehension
Fluent speech with poor 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 103: According to current operational guidelines, status epilepticus is defined as a seizure lasting at least how long, or two seizures without return to baseline?

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

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 104: A patient reports depressed mood, anhedonia, insomnia, and fatigue for the past 3 weeks following the death of a spouse. Which factor most strongly favors a diagnosis of Major Depressive Disorder over normal grief?

Presence of tearfulness when reminded of the deceased
Persistent thoughts of worthlessness and suicidal ideation not focused on the deceased (Correct answer)
Waves of sadness that come and go
Ability to experience positive emotions with support

Correct answer: Persistent thoughts of worthlessness and suicidal ideation not focused on the deceased

Pervasive worthlessness and self-focused suicidal ideation are characteristic of MDD rather than uncomplicated bereavement.

Question 105: 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 100 CME hours and submit a portfolio
Obtain state licensure in two US states
Pass the ABPN written (Part I) examination (Correct answer)
Complete a 6-month fellowship in general hospital psychiatry

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

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

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

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

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

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

Correct answer: Hyperreflexia and clonus

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

Question 109: Which is a first-line treatment for obsessive-compulsive disorder?

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

Correct answer: SSRIs with exposure and response prevention

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

Question 110: Which percentage of schizophreniform disorders patients progress to schizoaffective or schizophrenia?

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

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

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

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

Elevated TSH
Hyperkalemia
Hepatotoxicity and thrombocytopenia (Correct answer)
Hypernatremia

Correct answer: Hepatotoxicity and thrombocytopenia

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

Question 113: Which vitamin deficiency causes Wernicke encephalopathy?

Cobalamin (B12)
Thiamine (B1) (Correct answer)
Niacin (B3)
Folate (B9)

Correct answer: Thiamine (B1)

Wernicke encephalopathy results from thiamine deficiency, often in chronic alcohol use.

Question 114: Which element is NOT typically a component of the standard Mental Status Examination?

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

Correct answer: Complete blood count

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

Question 115: For a diagnosis of PTSD, the characteristic symptoms must persist for more than:

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

Correct answer: 1 month

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

Question 116: Which neurotransmitter deficiency is associated with narcolepsy type 1?

Hypocretin (orexin) (Correct answer)
Dopamine
Serotonin
Acetylcholine

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 117: A 25-year-old presents with 8 months of hallucinations, disorganized speech, and social withdrawal without a mood episode. Which diagnosis best fits?

Schizophreniform disorder
Brief psychotic disorder
Schizoaffective disorder
Schizophrenia (Correct answer)

Correct answer: Schizophrenia

Symptoms persisting 6 months or longer with functional decline and no dominant mood episode meet criteria for schizophrenia.

Question 118: Which medication is FIRST-LINE for restless legs syndrome (RLS)?

SSRIs
Dopamine agonists (e.g., pramipexole, ropinirole) (Correct answer)
Opioid analgesics
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 119: Which drug is used to reverse acute benzodiazepine overdose?

Flumazenil (Correct answer)
Atropine
Naloxone
Physostigmine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used cautiously for reversal.

Question 120: 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?

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

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 121: A patient develops muscle rigidity, hyperthermia, and elevated CK after starting an antipsychotic. What is the diagnosis?

Malignant hyperthermia
Serotonin syndrome
Tardive dyskinesia
Neuroleptic malignant syndrome (Correct answer)

Correct answer: Neuroleptic malignant syndrome

Rigidity, fever, autonomic instability, and elevated CK after antipsychotic use indicate NMS.

Question 122: 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 123: Which ABPN subspecialty is MOST relevant for a neurologist treating patients with epilepsy-associated psychiatric comorbidities and behavioral changes?

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

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

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

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

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

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 126: What is the primary mechanism of action of phenytoin?

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

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

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

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

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

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

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

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

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

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

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

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

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

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 133: 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
Binge-eating disorder
Bulimia nervosa (Correct answer)
Anorexia nervosa binge-eating/purging type

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

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

Correct answer: 10 years

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

Question 135: What is the difference between psychosis and delirium?

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

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 136: Serotonin syndrome is most likely when an SSRI is combined with which agent?

A proton pump inhibitor
Acetaminophen
A calcium channel blocker
An MAO inhibitor (Correct answer)

Correct answer: An MAO inhibitor

Combining an SSRI with an MAOI markedly raises serotonin and can cause serotonin syndrome.

Question 137: Nuchal rigidity, fever, and photophobia in an acutely ill patient most strongly suggest:

Bell's palsy
Migraine
Tension headache
Meningitis (Correct answer)

Correct answer: Meningitis

Meningeal irritation from meningitis classically causes neck stiffness, fever, and photophobia.

Question 138: Which antipsychotic medication is linked to retinal pigmentation?

Trifluoperazine
Haloperidol
Chlorpromazine
Thioridazine (Correct answer)
Fluphenazine

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

Lithium
Fluoxetine
Clozapine (Correct answer)
Sertraline

Correct answer: Clozapine

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

Question 140: Guillain-Barré syndrome typically presents with:

Resting tremor
Unilateral facial droop
Descending weakness with hyperreflexia
Ascending symmetric weakness with areflexia (Correct answer)

Correct answer: Ascending symmetric weakness with areflexia

GBS causes ascending flaccid paralysis with loss of deep tendon reflexes.

Question 141: 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?

Narcolepsy (Correct answer)
Insufficient sleep syndrome
Idiopathic hypersomnia
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 142: 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
Anorexia nervosa (Correct answer)
Bulimia nervosa
Body dysmorphic disorder

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 143: What is the most specific first-line treatment for status epilepticus in the acute setting?

Oral phenytoin
IV benzodiazepine (Correct answer)
Oral levetiracetam
IV mannitol

Correct answer: IV benzodiazepine

IV benzodiazepines such as lorazepam are first-line to abort ongoing seizures.

Question 144: What is the recommended FIRST-LINE psychotherapy for separation anxiety disorder in children?

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

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

Benzodiazepines
Antipsychotics
Beta-blockers
SSRIs (Correct answer)

Correct answer: SSRIs

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

Question 146: Which drug interaction is MOST clinically significant in a patient taking valproate who starts carbamazepine?

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

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 147: Which mood stabilizer requires monitoring of serum levels, renal, and thyroid function?

Lamotrigine
Sertraline
Bupropion
Lithium (Correct answer)

Correct answer: Lithium

Lithium has a narrow therapeutic index and affects thyroid and renal function.

Question 148: The 'Brain and Behavior' content is central to which ABPN primary certification?

Pain Medicine
Sleep Medicine
Hospice and Palliative Medicine
Psychiatry (Correct answer)

Correct answer: Psychiatry

Brain and behavior foundations are core to the Psychiatry certification.

Question 149: Which antiepileptic drug should be AVOIDED in juvenile myoclonic epilepsy because it may paradoxically worsen myoclonic seizures?

Lamotrigine
Clonazepam
Levetiracetam
Carbamazepine (Correct answer)

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

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

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

Concerta (Correct answer)
Daytrana
Vyvanse
Strattera

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

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

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 153: Which screening instrument is most commonly used in primary care to assess depression severity?

AUDIT
PHQ-9 (Correct answer)
MMSE
Y-BOCS

Correct answer: PHQ-9

The PHQ-9 is a validated 9-item self-report tool that maps onto DSM depression criteria and quantifies severity.

Question 154: A patient develops facial droop involving the forehead on one side with inability to close the eye. This localizes the lesion to:

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

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

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

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

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

Correct answer: Mini-Mental State Examination or MoCA

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

Question 157: Which of the following best describes the mechanism of action of vagus nerve stimulation (VNS) in epilepsy treatment?

Direct suppression of hippocampal ictal discharge via electrode contact
Parasympathetic activation reducing overall cerebral blood flow and neuronal excitability
Antidromic activation of the vagus nerve blocking peripheral seizure spread
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 158: Which condition is characterized by sudden onset of severe OCD symptoms and motor or vocal tics in a child following group A streptococcal infection?

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) (Correct answer)
Sydenham chorea
Pediatric acute-onset neuropsychiatric syndrome (PANS)
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 159: A 35-year-old patient with bipolar I disorder is started on lithium. Which baseline laboratory test is MOST important before initiating therapy?

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

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

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

Correct answer: Multiple sclerosis

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

Question 161: Which artery occlusion most commonly causes contralateral face and arm weakness with aphasia?

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

Correct answer: Middle cerebral artery

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

Question 162: Which antiepileptic drug is most strongly associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Levetiracetam
Lamotrigine (Correct answer)
Gabapentin
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 163: Which is a prerequisite for taking the ABPN certification examination in psychiatry?

Board certification in family medicine
A PhD in clinical psychology
Ten years of independent practice
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 164: A cherry-red spot on the macula is associated with which condition?

Multiple sclerosis
Tay-Sachs disease (Correct answer)
Huntington disease
Myasthenia gravis

Correct answer: Tay-Sachs disease

Tay-Sachs disease features a macular cherry-red spot from GM2 ganglioside accumulation.

Question 165: Which antidepressant is CONTRAINDICATED in patients with a seizure disorder or eating disorders due to lowered seizure threshold?

Bupropion (Correct answer)
Mirtazapine
Sertraline
Escitalopram

Correct answer: Bupropion

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

Question 166: Clonidine, sometimes known as catapres, is an option for treating ADHD when stimulant medication causes tics to increase.

False
True (Correct answer)

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 167: A patient cannot abduct the eye on the affected side and reports horizontal diplopia worse at distance. Which cranial nerve is most likely affected?

Trochlear (CN IV)
Optic (CN II)
Oculomotor (CN III)
Abducens (CN VI) (Correct answer)

Correct answer: Abducens (CN VI)

CN VI innervates the lateral rectus, so its palsy impairs eye abduction and causes horizontal diplopia.

Question 168: Which organization does the ABPN partner with to provide continuing certification for physicians?

American Board of Medical Specialties (ABMS) (Correct answer)
Accreditation Council for Graduate Medical Education (ACGME)
American Medical Association (AMA)
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 169: Which mechanism best describes how benzodiazepines produce their sedative-anxiolytic effects?

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

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 170: Which laboratory or clinical step is most important before attributing new psychiatric symptoms to a primary mental disorder?

Ruling out medical and substance-induced causes (Correct answer)
Starting an antidepressant immediately
Scheduling weekly psychotherapy
Ordering a personality inventory

Correct answer: Ruling out medical and substance-induced causes

Medical conditions and substances must be excluded before diagnosing a primary psychiatric disorder.

Question 171: A patient has ptosis, miosis, and anhidrosis on one side of the face. This triad is called:

Cushing's triad
Horner syndrome (Correct answer)
Bell's palsy
Weber syndrome

Correct answer: Horner syndrome

Horner syndrome results from disruption of the sympathetic pathway, producing drooping lid, small pupil, and reduced sweating.

Question 172: Which finding on assessment most strongly suggests malingering rather than a genuine psychiatric disorder?

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

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

D2 receptor blockade
Muscarinic M1 receptor blockade
H1 histamine receptor antagonism and 5-HT2C blockade (Correct answer)
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 174: 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?

Bipolar I disorder
Disruptive mood dysregulation disorder (DMDD) (Correct answer)
Major depressive disorder
Oppositional defiant 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 175: Which neurotransmitter is most implicated in the positive symptoms of schizophrenia?

Histamine
Dopamine (Correct answer)
Acetylcholine
GABA

Correct answer: Dopamine

Excess dopamine activity in the mesolimbic pathway drives positive symptoms like hallucinations and delusions.

Question 176: A patient with refractory epilepsy is started on the ketogenic diet. Which metabolic change is primarily responsible for the diet's antiseizure mechanism?

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

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

Trazodone
Fluoxetine (Correct answer)
Mirtazapine
Bupropion

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 178: Which of the following is a negative symptom of schizophrenia?

Delusions
Avolition (Correct answer)
Hallucinations
Disorganized speech

Correct answer: Avolition

Avolition (lack of motivation) is a negative symptom reflecting a reduction in normal function.

Question 179: REM sleep behavior disorder (RBD) is characterized by which polysomnographic finding?

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

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 180: How many required activities make up the ABPN Continuing Certification program?

Professionalism, Lifelong Learning/Self-Assessment, and Cognitive Expertise (Correct answer)
Only CME credits
Peer review and malpractice history
Only a proctored exam

Correct answer: Professionalism, Lifelong Learning/Self-Assessment, and Cognitive Expertise

The program requires professionalism (licensure), lifelong learning/self-assessment (CME), and cognitive expertise (exam or ABCC).

Question 181: Which side effect is most specifically associated with valproate use in pregnancy?

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

Correct answer: Neural tube defects

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

Question 182: The ABPN's Part I written examination for psychiatry residents PRIMARILY tests which type of knowledge?

Research methodology and biostatistics
Medical knowledge through multiple-choice questions (Correct answer)
Communication skills and interprofessional collaboration
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 183: A patient describes recurrent, intrusive thoughts of contamination that they neutralize by repeated handwashing. Which diagnosis is most consistent?

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

Correct answer: Obsessive-compulsive disorder

Intrusive obsessions paired with compensatory compulsions define OCD.

Question 184: Which neurology subspecialty is jointly recognized by the ABPN and involves expertise in muscle and nerve diseases (peripheral nervous system)?

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

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

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

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 186: A tuning fork placed on the mastoid then near the ear canal (Rinne test) normally shows:

Bone conduction louder than air
Equal loudness in both
Air conduction louder than bone (Correct answer)
No sound in either position

Correct answer: Air conduction louder than bone

In normal hearing, air conduction is louder and heard longer than bone conduction (positive Rinne).

Question 187: Which antidepressant class carries the greatest risk in overdose due to cardiac and seizure effects?

Bupropion alone
SNRIs
Tricyclic antidepressants (Correct answer)
SSRIs

Correct answer: Tricyclic antidepressants

TCAs cause QRS widening, arrhythmias, and seizures, making overdose especially dangerous.

Question 188: Huntington disease is inherited in which pattern?

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

Correct answer: Autosomal dominant

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

Question 189: Fatigable ptosis and diplopia that worsen with sustained upward gaze are hallmark signs of:

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

Correct answer: Myasthenia gravis

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

Question 190: Which of the following SSRIs is NOT highly advised by experts when treating pediatric patients with major depressive disorder?

Sertraline
Paroxetine (Correct answer)
Fluoxetine
Citalopram

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 191: What is the minimum symptom duration required to diagnose Generalized Anxiety Disorder per DSM-5?

6 months (Correct answer)
1 month
3 months
12 months

Correct answer: 6 months

GAD requires excessive anxiety and worry occurring more days than not for at least 6 months.

Question 192: A psychiatrist evaluating a defendant for competency to stand trial concludes the defendant is incompetent. What is the MOST typical next legal step?

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

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

Traumatic brain injury
Genetic epilepsy syndromes
CNS tumors
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 194: Which psychiatric subspecialty is PRIMARILY concerned with providing psychiatric evaluation and treatment to individuals involved in the legal system?

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

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

MRI brain with epilepsy protocol (Correct answer)
CT scan with contrast
SPECT scan
PET 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 196: A patient with resting tremor, bradykinesia, and cogwheel rigidity most likely has dysfunction of which structure?

Broca's area
Cerebellum
Substantia nigra (Correct answer)
Hippocampus

Correct answer: Substantia nigra

Loss of dopaminergic neurons in the substantia nigra causes the classic parkinsonian triad.

Question 197: What is the minimum number of ABPN-approved CME credits required per 3-year block for continuing certification?

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

Correct answer: 90 credits

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

Question 198: 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
Major depressive disorder with atypical features
Kleine-Levin syndrome (Correct answer)

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

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

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 200: A patient with suspected dementia scores 22/30 on cognitive testing with deficits in delayed recall and orientation. Which bedside instrument produced this score range?

PHQ-9
GAD-7
MMSE (Correct answer)
CAGE

Correct answer: MMSE

The Mini-Mental State Examination is scored out of 30 and tests orientation, recall, attention, and language.

Question 201: 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?

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

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 202: Wernicke encephalopathy is caused by deficiency of which vitamin?

Vitamin B1 (thiamine) (Correct answer)
Vitamin D
Vitamin B12
Vitamin C

Correct answer: Vitamin B1 (thiamine)

Thiamine (B1) deficiency causes Wernicke encephalopathy, often in chronic alcohol use.

Question 203: Which subspecialty certification addresses care for patients with serious, life-limiting illness and is open to ABPN diplomates?

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

Correct answer: Hospice and Palliative Medicine

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

Question 204: A patient with delayed sleep phase disorder characteristically shows what sleep pattern?

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

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

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

Correct answer: Y-BOCS

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

Question 206: Which agent is used to reverse acute benzodiazepine overdose?

Flumazenil (Correct answer)
Naloxone
Physostigmine
Atropine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used to reverse overdose.

Question 207: Which receptor does memantine target for the treatment of moderate-to-severe Alzheimer's disease?

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

Correct answer: NMDA glutamate receptor

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

Question 208: Which class of medication is first-line for acute mania?

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

Correct answer: Mood stabilizers or second-generation antipsychotics

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

Question 209: ABPN Maintenance of Certification (MOC) requires diplomates to demonstrate which of the following on an ongoing basis?

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

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 210: Which finding best distinguishes delirium from dementia?

Fluctuating level of consciousness (Correct answer)
Preserved attention
Gradual onset over years
Stable course

Correct answer: Fluctuating level of consciousness

Delirium features acute onset with a fluctuating, impaired level of consciousness and attention.

Question 211: 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 212: Which antiepileptic drug primarily blocks T-type calcium channels and is the first-line treatment for childhood absence epilepsy?

Lamotrigine
Phenobarbital
Ethosuximide (Correct answer)
Oxcarbazepine

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 213: Which feature distinguishes delirium from dementia on assessment?

Preserved level of consciousness
Stable course throughout the day
Gradual onset over months
Acute onset with fluctuating attention (Correct answer)

Correct answer: Acute onset with fluctuating attention

Delirium is characterized by acute onset, waxing-and-waning course, and impaired attention/consciousness.

Question 214: Which sleep stage is associated with vivid dreaming and skeletal muscle atonia?

REM sleep (Correct answer)
N1
N3 (slow-wave)
N2

Correct answer: REM sleep

REM sleep features vivid dreaming, rapid eye movements, and skeletal muscle atonia.

Question 215: Broca aphasia is best characterized by:

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

Correct answer: Nonfluent speech with preserved comprehension

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

Question 216: Which EEG pattern is classically associated with absence seizures?

Alpha coma
Triphasic waves
Burst suppression
3-Hz spike-and-wave (Correct answer)

Correct answer: 3-Hz spike-and-wave

Generalized 3-Hz spike-and-wave discharges are characteristic of absence seizures.

Question 217: 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)
REM sleep
Stage N3 (slow-wave/deep NREM) (Correct answer)
Stage N2 (intermediate NREM)

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

Phenytoin
Carbamazepine
Gabapentin
Valproate (Correct answer)

Correct answer: Valproate

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

Question 219: 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)
Headache type cannot be differentiated clinically
Only migraines are clinically significant
All headaches are the same type

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

3 years
2 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 221: A positive Romberg sign indicates a deficit primarily in which system?

Vestibular canal function only
Corticospinal motor tract
Proprioceptive/dorsal column pathways (Correct answer)
Cerebellar coordination

Correct answer: Proprioceptive/dorsal column pathways

Romberg is positive when standing balance worsens with eyes closed, indicating loss of proprioceptive input via the dorsal columns.

Question 222: Addiction psychiatry as an ABPN subspecialty addresses which clinical area?

Emergency psychiatric evaluation and crisis stabilization
Psychopharmacology of treatment-resistant disorders
Consultation-liaison services for general hospital patients
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 223: 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
Direct physician override without legal process
Habeas corpus petition

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

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

Correct answer: Persistent worthlessness and guilt

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

Question 225: Which of the following qualities of bupropion (Wellbutrin) is NOT TRUE?

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

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 226: Which cranial nerve is assessed by testing the corneal reflex's afferent limb?

CN IX
CN V (Correct answer)
CN II
CN VII

Correct answer: CN V

The trigeminal nerve (CN V) carries the sensory afferent limb of the corneal reflex.

Question 227: 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 228: A patient states they have no problem despite obvious functional impairment from their illness. The clinician documents this as:

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

Correct answer: Poor insight

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

Question 229: Which seizure type is characterized by a sudden loss of postural muscle tone, often causing the patient to fall?

Clonic seizure
Tonic seizure
Atonic seizure (Correct answer)
Myoclonic 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 230: Which pathway allows diplomates to satisfy the cognitive exam requirement without sitting a proctored 10-year exam?

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

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 231: What is the role of neuroimaging in neurological assessment?

Imaging is never needed in neurological assessment
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
Only CT scanning is used in neurology

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

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

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

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

Correct answer: Parkinson disease

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

Question 234: 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 235: What is the MINIMUM age at which conduct disorder can be diagnosed, and what key feature distinguishes it from oppositional defiant disorder?

Age 10; conduct disorder requires truancy
Age 5; conduct disorder includes violations of others' basic rights (Correct answer)
Age 5; conduct disorder requires peer rejection
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 236: What cranial nerves are tested during a standard neurological examination?

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

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

Quetiapine
Olanzapine
Clozapine (Correct answer)
Risperidone

Correct answer: Clozapine

Clozapine can cause agranulocytosis, mandating routine ANC monitoring.

Question 238: Which of the following claims about Wernicke's Encephalopathy (WE) is NOT TRUE?

Korsakoff's Syndrome deteriorating is one of the complications of WE.
When WE is suspected, treatment should start immediately even before probable test findings.
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)
Characterized by neurological issues such as ataxia of the gait, disorientation, and ophthalmoplegia (impaired eye movement).
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 239: Which subspecialty certification is offered jointly relevant to both neurology and psychiatry diplomates?

Vascular Surgery
Nuclear Medicine
Sleep Medicine (Correct answer)
Emergency Medicine

Correct answer: Sleep Medicine

Sleep Medicine is an ABPN subspecialty open to eligible neurology and psychiatry diplomates.

Question 240: What distinguishes a mood disorder from an anxiety disorder in DSM-5?

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

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

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

Correct answer: Spinothalamic tract

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

Question 242: Which of the following is NOT TRUE about tramadol?

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

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 243: During a Mental Status Examination, a clinician notes that a patient shifts rapidly between loosely related topics without reaching a point. This is best documented as:

Tangentiality
Flight of ideas (Correct answer)
Circumstantiality
Thought blocking

Correct answer: Flight of ideas

Flight of ideas is a rapid, continuous flow of accelerated speech with abrupt shifts between related topics, often seen in mania.

Question 244: Which legal standard is used to determine whether a defendant is competent to stand trial in the United States?

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

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

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

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 246: Which of the following best defines a hallucination?

A perception without an external stimulus (Correct answer)
A fixed false belief
A misinterpretation of a real stimulus
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 247: Geriatric Psychiatry as an ABPN subspecialty focuses on the mental health of which population?

Older adults (Correct answer)
Adolescents
Children
Pregnant patients

Correct answer: Older adults

Geriatric Psychiatry addresses mental health in older adults.

Question 248: In the United States, what is the FDA's black box warning for antidepressants in children and adolescents?

Increased risk of suicidal ideation and behavior in those under 25 (Correct answer)
Increased risk of mania induction
Increased risk of agranulocytosis
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 249: Tardive dyskinesia is MOST commonly caused by long-term use of which class of drugs?

Dopamine receptor antagonists (Correct answer)
Mood stabilizers
Benzodiazepines
Anticholinergics

Correct answer: Dopamine receptor antagonists

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

Question 250: What is the legal standard used in most US states for civil involuntary psychiatric commitment?

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

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 251: A patient on lithium presents with tremor, ataxia, and confusion. What is the priority action?

Add an SSRI
Increase the lithium dose
Order a chest X-ray
Check a serum lithium level (Correct answer)

Correct answer: Check a serum lithium level

These signs suggest lithium toxicity, so an immediate serum level guides management.

Question 252: 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 everything discussed is protected by doctor-patient confidentiality
That the results will only be shared with the examinee's attorney
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 253: Which medication prevents dopamine from being taken up from the synaptic cleft by blocking dopamine transporters?

Methlyphenidate (Correct answer)
Amphetamine
All of the above

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 254: Which state medical license status is required to maintain ABPN certification?

A restricted probationary license
An active, unrestricted medical license (Correct answer)
An international license only
No license once certified

Correct answer: An active, unrestricted medical license

Diplomates must hold at least one active, unrestricted U.S. or Canadian medical license.

Question 255: Which of the following does NOT qualify as a typical, targeted side effect of stimulants?

Changes in mood
Anorexia
Ataxia (Correct answer)
Headache

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 256: Which test is most useful to confirm a diagnosis of myasthenia gravis serologically?

Anti-dsDNA
Anti-acetylcholine receptor antibodies (Correct answer)
Rheumatoid factor
ANA titer

Correct answer: Anti-acetylcholine receptor antibodies

Acetylcholine receptor antibodies are highly specific for myasthenia gravis.

Question 257: Which of the following statements of the many forms of chronic pain is NOT TRUE?

Only morphologic changes are observed in cases of chronic back pain. (Correct answer)
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.
All of the above.
Neuralgia postherpetic might persist for years.

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

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

Correct answer: Meningeal irritation

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

Question 259: 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)?

Selective mutism (Correct answer)
Expressive language disorder
Social anxiety disorder
Autism spectrum 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 260: Fatal familial insomnia is caused by a mutation in which gene?

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

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

Cortisol
Serotonin
Adenosine
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 262: A physician certified in psychiatry before October 1994 holds what type of certificate?

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

Correct answer: Time-unlimited (lifetime) certificate

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

Question 263: Which landmark US Supreme Court case established that prisoners have a constitutional right to psychiatric treatment?

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

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

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

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 265: 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
Oppositional defiant disorder
ADHD

Correct answer: Autism spectrum disorder

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

Question 266: Which of the tools listed below is used to evaluate how severe the symptoms of alcohol withdrawal are?

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

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 267: 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?

HIPAA treatment exception
Involuntary commitment statute
Mandatory reporting statutes
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 268: Ascending symmetric weakness with areflexia following an infection suggests which diagnosis?

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

Correct answer: Guillain-Barré syndrome

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

Question 269: 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)
Attending one conference
Submitting malpractice records
Paying an additional fee only

Correct answer: Passing the traditional proctored 10-year exam

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

Question 270: Which condition is characterized by sudden brief loss of muscle tone triggered by emotion?

Syncope
Absence seizure
Myoclonus
Cataplexy (Correct answer)

Correct answer: Cataplexy

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

Question 271: What is required annually of diplomates besides holding a license, to stay on track for continuing certification?

Publishing a research paper
Retaking the residency exam
Ongoing CME participation toward the block requirement (Correct answer)
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 272: A patient on phenelzine (MAOI) eats aged cheese and develops a hypertensive crisis. Which mechanism explains this reaction?

Serotonin syndrome from tyramine's serotonergic activity
Tyramine directly activates CNS dopamine receptors
Tyramine displaces norepinephrine causing massive sympathetic discharge (Correct answer)
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.

Question 273: What is the biopsychosocial model in psychiatry?

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

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 274: The plantar (Babinski) reflex is considered pathological in an adult when the great toe does what?

Flexes downward
Extends upward (dorsiflexes) (Correct answer)
Curls medially
Does not move

Correct answer: Extends upward (dorsiflexes)

An upgoing great toe on plantar stimulation indicates an upper motor neuron lesion.

Question 275: Which of these is an ABPN subspecialty certification in the neurology domain?

Interventional Radiology
Neurosurgery
Vascular Neurology (Correct answer)
Physical Medicine and Rehabilitation

Correct answer: Vascular Neurology

Vascular Neurology is an ABPN-recognized neurology subspecialty.

Question 276: Which bedside test best assesses cerebellar function of the upper limbs?

Finger-to-nose testing (Correct answer)
Deep tendon reflexes
Grip strength
Two-point discrimination

Correct answer: Finger-to-nose testing

Finger-to-nose testing reveals dysmetria and intention tremor characteristic of cerebellar dysfunction.

Question 277: On average, how long does the active phase of schizophrenia last?

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

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

Multiple sclerosis
Amyotrophic lateral sclerosis
Guillain-Barré syndrome (Correct answer)
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 279: A patient presents with sudden right-sided weakness and expressive aphasia. Which arterial territory is most likely involved?

Basilar artery
Anterior spinal artery
Right posterior cerebral 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 280: Fluctuating muscle weakness that worsens with activity and improves with rest suggests:

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

Correct answer: Myasthenia gravis

Myasthenia gravis causes fatigable weakness from acetylcholine receptor antibodies.

Question 281: Which medication raises dopamine levels in the synaptic cleft?

All of the above (Correct answer)
Methlyphenidate
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 282: A patient's polysomnography shows repetitive apneas despite preserved respiratory effort, with oxygen desaturation. What type of sleep apnea does this MOST likely represent?

Mixed sleep apnea
Cheyne-Stokes respirations
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 283: Which diagnosis requires symptoms lasting at least 6 months in DSM-5 criteria?

Schizophreniform disorder
Brief psychotic disorder
Schizophrenia (Correct answer)
Major depressive episode

Correct answer: Schizophrenia

Schizophrenia requires continuous signs for at least 6 months.

Question 284: Testing the corneal reflex primarily assesses which two cranial nerves?

CN VII and VIII
CN IX and X
CN II and III
CN V and VII (Correct answer)

Correct answer: CN V and VII

The afferent limb is the trigeminal nerve (V1) and the efferent limb is the facial nerve (blink).

Question 285: Which brain structure is primarily responsible for consolidating new declarative memories?

Hippocampus (Correct answer)
Basal ganglia
Cerebellum
Amygdala

Correct answer: Hippocampus

The hippocampus is essential for forming and consolidating new declarative memories.

Question 286: A diplomate who fails to meet continuing certification requirements is reported as which status?

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

Correct answer: Not meeting Continuing Certification requirements

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

Question 287: Which anticonvulsant is considered FIRST-LINE for trigeminal neuralgia?

Lamotrigine
Carbamazepine (Correct answer)
Valproate
Levetiracetam

Correct answer: Carbamazepine

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

Question 288: 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 289: A resting tremor, bradykinesia, and cogwheel rigidity most suggest dysfunction of which system?

Corticospinal
Nigrostriatal dopaminergic (Correct answer)
Cerebellar
Dorsal column

Correct answer: Nigrostriatal dopaminergic

Loss of nigrostriatal dopamine produces the classic parkinsonian triad.

Question 290: How often must a diplomate complete a self-assessment activity under the ABPN Continuing Certification program (3-year block)?

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

Correct answer: Every 3 years

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

Question 291: Which of the following statements regarding Lyrica, or pregabalin is NOT TRUE?

Maximum dosages based on the indication
Requires renal adjustment
Patients at risk of cardiovascular disease should use this medication with caution since there is a possibility of peripheral edema.
All of the above.
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 292: The Babinski sign (extensor plantar response) in an adult indicates dysfunction of which pathway?

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

Correct answer: Corticospinal tract

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

Question 293: A patient experiences neuroleptic malignant syndrome (NMS). Which combination of features is MOST characteristic?

Hyperthermia, diarrhea, agitation, myoclonus
Sedation, respiratory depression, miosis, bradycardia
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 294: What is the first-line pharmacological treatment for convulsive status epilepticus in an adult presenting to the emergency department with IV access?

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

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

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

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

Correct answer: Immediately discontinue clozapine

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

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

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds