ABPN Psychiatry Certification Exam — Questions and Answers

Question 1: What is the first-line pharmacological treatment for convulsive status epilepticus in an adult presenting to the emergency department with IV access?

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

Correct answer: Lorazepam IV

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

Question 2: What EEG pattern is most characteristic of childhood absence epilepsy?

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

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 3: 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
Alpha-2 adrenergic agonism
H1 histamine receptor antagonism and 5-HT2C blockade (Correct answer)

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 4: 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 5: A lesion causing loss of pain and temperature on one side of the body indicates damage to which tract?

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

Correct answer: Spinothalamic tract

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

Question 6: What is the most specific first-line treatment for status epilepticus in the acute setting?

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

Correct answer: IV benzodiazepine

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

Question 7: First-line pharmacologic treatment for generalized anxiety disorder is typically which class?

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

Correct answer: SSRIs or SNRIs

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

Question 8: Which subspecialty certification is offered jointly relevant to both neurology and psychiatry diplomates?

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

Correct answer: Sleep Medicine

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

Question 9: Which reflex tests the S1 nerve root?

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

Correct answer: Achilles (ankle) reflex

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

Question 10: Which of the following is a negative symptom of schizophrenia?

Delusions
Avolition (Correct answer)
Disorganized speech
Hallucinations

Correct answer: Avolition

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

Question 11: What components are included in a comprehensive psychiatric evaluation?

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

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

MAO inhibitors (Correct answer)
SNRIs
SSRIs
Tricyclics

Correct answer: MAO inhibitors

MAOIs plus tyramine can precipitate a hypertensive crisis.

Question 13: Which percentage of schizophreniform disorders patients progress to schizoaffective or schizophrenia?

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

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

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

Correct answer: Normal pressure hydrocephalus

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

Question 15: Which feature distinguishes delirium from dementia on assessment?

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

Correct answer: Acute onset with fluctuating attention

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

Question 16: A patient with anorexia nervosa is being assessed. Which feature is a required diagnostic criterion?

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

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

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

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

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

Correct answer: Corticospinal tract

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

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

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

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

ABMS
ACGME (Correct answer)
NBME
FSMB

Correct answer: ACGME

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

Question 21: Which medication prevents dopamine from being taken up from the synaptic cleft by blocking dopamine transporters?

All of the above
Amphetamine
Methlyphenidate (Correct answer)

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

Dravet syndrome
Lennox-Gastaut syndrome
West syndrome (Correct answer)
Ohtahara 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 23: Broca aphasia is best characterized by:

Complete mutism with no comprehension
Fluent speech with poor 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 24: Which drug interaction is MOST clinically significant in a patient taking valproate who starts carbamazepine?

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

Correct answer: Carbamazepine induces CYP enzymes, decreasing valproate levels

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

Question 25: Which cranial nerve is assessed by testing the corneal reflex's afferent limb?

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

Correct answer: CN V

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

Question 26: 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
Renal adjustment is required
Onset of action = 2-3 weeks, Trial requires = 3-8 weeks
Common ADE- Dizziness, somnolence
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 27: The Neurodevelopmental Disabilities subspecialty of the ABPN is jointly certificated with which other specialty board?

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

Correct answer: American Board of Pediatrics (ABP)

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

Question 28: A patient opens eyes to pain (2), gives confused speech (4), and localizes to pain (5). What is the total Glasgow Coma Scale score?

9
11 (Correct answer)
12
10

Correct answer: 11

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

Question 29: The Kernig sign, resistance and pain on extending the knee with the hip flexed, indicates:

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

Correct answer: Meningeal irritation

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

Question 30: What is the Glasgow Coma Scale and what does it measure?

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

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

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

Correct answer: PRNP (prion protein gene)

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

Question 32: Brain Injury Medicine, an ABPN subspecialty, is open to diplomates from which primary boards among others?

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

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

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

Question 33: What is the mechanism by which acetylcholinesterase inhibitors improve symptoms in Alzheimer's disease?

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

Correct answer: They increase acetylcholine availability at synapses

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

Question 34: Which EEG pattern is classically associated with absence seizures?

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

Correct answer: 3-Hz spike-and-wave

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

Question 35: Which grade on the Medical Research Council (MRC) scale indicates movement with gravity eliminated but not against gravity?

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

Correct answer: Grade 2

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

Question 36: The 'Brain and Behavior' content is central to which ABPN primary certification?

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

Correct answer: Psychiatry

Brain and behavior foundations are core to the Psychiatry certification.

Question 37: 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 38: What is the legal standard used in most US states for civil involuntary psychiatric commitment?

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

Correct answer: Clear and convincing evidence

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

Question 39: 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)
Benzodiazepine plus CBT
SSRI plus habit reversal training
Antipsychotic plus supportive therapy

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

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

Correct answer: Neuroleptic malignant syndrome

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

Question 41: 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 42: A patient describes recurrent, intrusive thoughts of contamination that they neutralize by repeated handwashing. Which diagnosis is most consistent?

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

Correct answer: Obsessive-compulsive disorder

Intrusive obsessions paired with compensatory compulsions define OCD.

Question 43: 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?

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

Correct answer: Anorexia nervosa

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

Question 44: A positive Romberg sign indicates a deficit primarily in which system?

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

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

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

Correct answer: Delusions

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

Question 46: Wernicke encephalopathy is caused by deficiency of which vitamin?

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

Correct answer: Vitamin B1 (thiamine)

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

Question 47: What are the key components of the Mental Status Examination (MSE)?

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

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

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

Correct answer: Video-EEG monitoring capturing a typical event

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

Question 49: What is required annually of diplomates besides holding a license, to stay on track for continuing certification?

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

Correct answer: Ongoing CME participation toward the block requirement

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

Question 50: Which vitamin deficiency causes Wernicke encephalopathy?

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

Correct answer: Thiamine (B1)

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

Question 51: Which antiepileptic drug requires monitoring of serum levels and is known to cause Steven-Johnson syndrome, particularly in patients with HLA-B*1502 allele?

Lacosamide
Gabapentin
Levetiracetam
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 52: Which mood stabilizer requires monitoring of serum levels, renal, and thyroid function?

Lithium (Correct answer)
Lamotrigine
Sertraline
Bupropion

Correct answer: Lithium

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

Question 53: 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 54: A patient on lithium develops tremor, polyuria, and polydipsia. What is the MOST appropriate next step?

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

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

Elevated TSH
Hyperkalemia
Hypernatremia
Hepatotoxicity and thrombocytopenia (Correct answer)

Correct answer: Hepatotoxicity and thrombocytopenia

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

Question 56: Which pathway allows diplomates to satisfy the cognitive exam requirement without sitting a proctored 10-year exam?

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

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

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

Correct answer: Strong social support and religious beliefs

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

Question 58: The EEG hallmark of absence seizures is:

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

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

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

Question 59: Obstructive sleep apnea is MOST strongly associated with which neuropsychiatric condition?

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

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 60: Huntington disease is inherited in which pattern?

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

Correct answer: Autosomal dominant

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

Question 61: The CIWA-Ar score is used to determine how to treat sedative and hypnotic withdrawal, which is different from alcohol withdrawal.

False (Correct answer)
True

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

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

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

Oxcarbazepine
Lamotrigine
Levetiracetam
Valproate (Correct answer)

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

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

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

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

Correct answer: 10 years

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

Question 66: Which test is most useful to confirm a diagnosis of myasthenia gravis serologically?

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

Correct answer: Anti-acetylcholine receptor antibodies

Acetylcholine receptor antibodies are highly specific for myasthenia gravis.

Question 67: A patient's polysomnography shows repetitive apneas despite preserved respiratory effort, with oxygen desaturation. What type of sleep apnea does this MOST likely represent?

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

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

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

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 69: Which drug is used to reverse acute benzodiazepine overdose?

Flumazenil (Correct answer)
Physostigmine
Atropine
Naloxone

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used cautiously for reversal.

Question 70: 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?

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
Complete 100 CME hours and submit a portfolio

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

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

Correct answer: CN XI (accessory)

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

Question 72: A child with intellectual disability is found to have an IQ of 45. What level of intellectual disability does this represent?

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

Correct answer: Moderate (IQ 40-55)

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

Question 73: What is the mortality rate of Neuroleptic Malignant Syndrome if left untreated?

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

Correct answer: 20%

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

Question 74: Which of the following statements regarding Lyrica, or pregabalin is NOT TRUE?

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

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 75: A cherry-red spot on the macula is associated with which condition?

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

Correct answer: Tay-Sachs disease

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

Question 76: What is the minimum number of ABPN-approved CME credits required per 3-year block for continuing certification?

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

Correct answer: 90 credits

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

Question 77: 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 78: Which neurotransmitter/hormone is MOST involved in regulating the sleep-wake circadian rhythm and is secreted by the pineal gland?

Adenosine
Cortisol
Serotonin
Melatonin (Correct answer)

Correct answer: Melatonin

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

Question 79: 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 80: Which anticonvulsant is considered FIRST-LINE for trigeminal neuralgia?

Carbamazepine (Correct answer)
Lamotrigine
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 81: A patient experiences neuroleptic malignant syndrome (NMS). Which combination of features is MOST characteristic?

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

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 82: 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?

Bulimia nervosa (Correct answer)
Avoidant/restrictive food intake disorder
Binge-eating disorder
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 83: Which of the following claims regarding childhood ADHD is NOT TRUE?

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

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

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

Question 84: A 25-year-old presents with 8 months of hallucinations, disorganized speech, and social withdrawal without a mood episode. Which diagnosis best fits?

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

Correct answer: Schizophrenia

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

Question 85: Which class of medication is first-line for acute mania?

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

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

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

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

Correct answer: Completion of an ACGME-accredited neurology residency

Eligibility requires completing an ACGME-accredited neurology residency.

Question 88: 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)
Unethical but legally permissible in some states
A boundary violation only when the patient is a minor
A boundary crossing that may sometimes be therapeutic

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

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

Question 89: Under HIPAA, which type of disclosure of protected health information does NOT require patient authorization?

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

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

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

Correct answer: Extends upward (dorsiflexes)

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

Question 91: Serotonin syndrome is most likely when an SSRI is combined with which agent?

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

Correct answer: An MAO inhibitor

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

Question 92: Which is the most common cause of new-onset epilepsy in adults over 60 years of age?

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

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

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

Correct answer: Initial response to medication

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

Question 94: Geriatric Psychiatry as an ABPN subspecialty focuses on the mental health of which population?

Pregnant patients
Children
Older adults (Correct answer)
Adolescents

Correct answer: Older adults

Geriatric Psychiatry addresses mental health in older adults.

Question 95: Which imaging finding is most characteristic of an acute ischemic stroke on early non-contrast CT?

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

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

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

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

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

Question 97: Which combination of antipsychotics causes the most weight gain?

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

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

Psychiatry (Correct answer)
Neurology
Sleep Medicine
Neuromuscular Medicine

Correct answer: Psychiatry

Addiction Psychiatry requires prior Psychiatry certification.

Question 99: 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 could not control their behavior due to irresistible impulse
They did not know the nature of the act or did not know it was wrong due to mental disease (Correct answer)
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 100: In Weber's tuning fork test, sound lateralizing to the affected ear suggests:

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

Correct answer: Conductive hearing loss in that ear

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

Question 101: Which medication is FDA-approved for the treatment of alcohol use disorder by blocking opioid reward pathways?

Acamprosate
Disulfiram
Topiramate
Naltrexone (Correct answer)

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

Valproate (Correct answer)
Lamotrigine
Lithium
Carbamazepine

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

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

Correct answer: REM sleep

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

Question 104: Which finding best distinguishes delirium from dementia?

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

Correct answer: Fluctuating level of consciousness

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

Question 105: 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)
Scheduling weekly psychotherapy
Starting an antidepressant immediately
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 106: Idiopathic REM sleep behavior disorder is MOST strongly associated with future development of which neurodegenerative disease?

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

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

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

Correct answer: Section III

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

Question 108: 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 109: Which of the following best describes the mechanism of action of vagus nerve stimulation (VNS) in epilepsy treatment?

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

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

Valproate
Lamotrigine (Correct answer)
Gabapentin
Levetiracetam

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

Circumstantiality
Echolalia
Perseveration
Neologism (Correct answer)

Correct answer: Neologism

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

Question 112: What cranial nerves are tested during a standard neurological examination?

Cranial nerves are not part of the neurological exam
All 12 cranial nerves (I-XII), testing smell, vision, eye movement, facial sensation/motor, hearing, taste, palate, voice, neck muscles, and tongue (Correct answer)
Only the optic nerve
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 113: Which of the tools listed below is used to evaluate how severe the symptoms of alcohol withdrawal are?

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

Correct answer: CIWA-Ar

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

Question 114: 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?

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

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

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

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

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

Correct answer: Dissociative identity disorder

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

Question 117: Constipation is the pharmacologic side effect of opioid receptors (mu, kappa, and delta) based on the action of the delta receptor.

True
False (Correct answer)

Correct answer: False

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

Question 118: Guillain-Barré syndrome typically presents with:

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

Correct answer: Ascending symmetric weakness with areflexia

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

Question 119: 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
Obstructive sleep apnea
Narcolepsy type 1 (Correct answer)
Idiopathic hypersomnia

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

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

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

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

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

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

Question 122: Which personality disorder is characterized by unstable relationships, impulsivity, identity disturbance, and fear of abandonment?

Schizoid
Borderline (Correct answer)
Obsessive-compulsive
Narcissistic

Correct answer: Borderline

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

Question 123: Which landmark US Supreme Court case established that prisoners have a constitutional right to psychiatric treatment?

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

Correct answer: Estelle v. Gamble

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

Question 124: Which finding is characteristic of neuroleptic malignant syndrome?

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

Correct answer: Lead-pipe rigidity and hyperthermia

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

Question 125: Nuchal rigidity, fever, and photophobia in an acutely ill patient most strongly suggest:

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

Correct answer: Meningitis

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

Question 126: According to the 2017 ILAE classification, which of the following is correctly categorized as a focal seizure type?

Myoclonic seizure
Focal aware seizure (Correct answer)
Absence seizure
Tonic-clonic 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 127: A positive Babinski sign in an adult indicates a lesion of which pathway?

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

Correct answer: Corticospinal tract

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

Question 128: Addiction psychiatry as an ABPN subspecialty addresses which clinical area?

Emergency psychiatric evaluation and crisis stabilization
Consultation-liaison services for general hospital patients
Psychopharmacology of treatment-resistant disorders
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 129: Forensic Psychiatry certification qualifies a diplomate to work primarily at the intersection of psychiatry and what field?

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

Correct answer: The law/legal system

Forensic Psychiatry addresses psychiatric issues within legal contexts.

Question 130: Which of the following is NOT TRUE about tramadol?

Lower chance of respiratory depression
All of the above.
Titrate up as tolerated (Correct answer)
Non-controlled substance
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 131: Which psychiatric subspecialty is PRIMARILY concerned with providing psychiatric evaluation and treatment to individuals involved in the legal system?

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

Correct answer: Forensic psychiatry

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

Question 132: Testing the corneal reflex primarily assesses which two cranial nerves?

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

Correct answer: CN V and VII

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

Question 133: What is the recommended FIRST-LINE psychotherapy for separation anxiety disorder in children?

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

Correct answer: Cognitive-behavioral therapy (CBT)

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

Question 134: Which sleep stage is characterized by high-amplitude, slow (< 2 Hz) delta waves on EEG and is considered essential for physical restoration?

Stage N3 (slow-wave/deep NREM) (Correct answer)
REM sleep
Stage N2 (intermediate NREM)
Stage N1 (light 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 135: Which condition is characterized by sudden brief loss of muscle tone triggered by emotion?

Myoclonus
Absence seizure
Syncope
Cataplexy (Correct answer)

Correct answer: Cataplexy

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

Question 136: Clonidine, sometimes known as catapres, is an option for treating ADHD when stimulant medication causes tics to increase.

True (Correct answer)
False

Correct answer: True

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

Question 137: A patient with delayed sleep phase disorder characteristically shows what sleep pattern?

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

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

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

Question 138: Which receptors are inhibited by antipsychotics of the second generation?

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

Correct answer: D2 and 5HT2

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

Question 139: Which medication is FDA-approved as FIRST-LINE pharmacotherapy for ADHD in children aged 6 and older?

Methylphenidate (Correct answer)
Atomoxetine
Clonidine
Guanfacine

Correct answer: Methylphenidate

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

Question 140: Which is a first-line treatment for obsessive-compulsive disorder?

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

Correct answer: SSRIs with exposure and response prevention

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

Question 141: A patient cannot recognize objects placed in the hand by touch alone despite intact sensation. This is called:

Apraxia
Astereognosis (Correct answer)
Aphasia
Agnosia for faces

Correct answer: Astereognosis

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

Question 142: What approximate percentage of patients who experience a single unprovoked seizure will have a recurrence within 2 years?

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

Correct answer: 40-50%

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

Question 143: Which ABPN subspecialty addresses disorders of nerves and muscles such as ALS and peripheral neuropathies?

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

Correct answer: Neuromuscular Medicine

Neuromuscular Medicine covers disorders of nerve and muscle.

Question 144: For medically refractory temporal lobe epilepsy with MRI evidence of hippocampal sclerosis, which surgical procedure is most commonly performed and has the highest rate of seizure freedom?

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

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

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

Correct answer: Abducens (CN VI)

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

Question 146: The dermatome that covers the nipple line is:

L1
C5
T10
T4 (Correct answer)

Correct answer: T4

The T4 dermatome corresponds to the level of the nipples.

Question 147: Which is the ONLY FDA-approved medication for irritability associated with autism spectrum disorder in children?

Risperidone and aripiprazole (Correct answer)
Methylphenidate
Sertraline
Valproate

Correct answer: Risperidone and aripiprazole

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

Question 148: Which ethical principle MOST directly supports a patient's right to refuse medical treatment?

Nonmaleficence
Autonomy (Correct answer)
Beneficence
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 149: 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 150: 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)
All headaches are the same type
Headache type cannot be differentiated clinically
Only migraines are clinically significant

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

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

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

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

Correct answer: Complete blood count

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

Question 153: Which medication is first-line for acute mania in bipolar disorder along with mood stabilizers?

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

Correct answer: An atypical antipsychotic

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

Question 154: Which medication requires monitoring for agranulocytosis with regular blood counts?

Lithium
Sertraline
Fluoxetine
Clozapine (Correct answer)

Correct answer: Clozapine

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

Question 155: Consultation-liaison (C-L) psychiatry focuses on which clinical practice setting?

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

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

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

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

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

Correct answer: Middle cerebral artery

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

Question 158: Which antidepressant is MOST associated with serotonin syndrome when combined with an MAOI?

Mirtazapine
Fluoxetine (Correct answer)
Bupropion
Trazodone

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 159: The triad of confusion, ophthalmoplegia, and ataxia defines:

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

Correct answer: Wernicke encephalopathy

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

Question 160: Which organization does the ABPN partner with to provide continuing certification for physicians?

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

Correct answer: American Board of Medical Specialties (ABMS)

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

Question 161: Which antiepileptic drug primarily blocks T-type calcium channels and is the first-line treatment for childhood absence epilepsy?

Ethosuximide (Correct answer)
Phenobarbital
Lamotrigine
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 162: Which ABPN subspecialty is MOST relevant for a neurologist treating patients with epilepsy-associated psychiatric comorbidities and behavioral changes?

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

Correct answer: Behavioral neurology and neuropsychiatry

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

Question 163: 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 obtain informed consent before treatment
Duty to warn/protect identifiable third parties from patient violence (Correct answer)
Duty to hospitalize imminently suicidal patients

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

Ataxia (Correct answer)
Anorexia
Headache
Changes in mood

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 165: 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)
Concrete thinking
Intact reality testing

Correct answer: Poor insight

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

Question 166: Which of the following is a current ABPN-recognized subspecialty requiring additional fellowship training and certification?

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

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 167: 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 psychoanalytic theory
A purely social explanation of mental illness
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 168: What is the difference between upper motor neuron (UMN) and lower motor neuron (LMN) lesions?

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

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

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

Question 169: Which seizure type is characterized by a sudden loss of postural muscle tone, often causing the patient to fall?

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

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 170: 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)
Selective mutism
Reactive attachment disorder
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 171: Where can the public verify a physician's ABPN certification status?

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

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

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

Question 172: Which antipsychotic medication is linked to retinal pigmentation?

Fluphenazine
Trifluoperazine
Haloperidol
Thioridazine (Correct answer)
Chlorpromazine

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

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

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

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

Correct answer: Guillain-Barré syndrome

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

Question 175: Which neurology subspecialty is jointly recognized by the ABPN and involves expertise in muscle and nerve diseases (peripheral nervous system)?

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

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

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

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

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

Correct answer: Guillain-Barré syndrome

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

Question 178: Which neurotransmitter is most implicated in the pathophysiology of Parkinson disease?

Glutamate
Serotonin
Dopamine (Correct answer)
Acetylcholine

Correct answer: Dopamine

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

Question 179: On average, how long does the active phase of schizophrenia last?

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

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

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

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

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

Question 181: Which is a prerequisite for taking the ABPN certification examination in psychiatry?

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

Correct answer: Completion of an ACGME-accredited psychiatry residency

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

Question 182: What is the primary mechanism of action of phenytoin?

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

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

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

Correct answer: Spinothalamic tract

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

Question 184: What is the most common metabolic cause of neonatal seizures?

Hypoglycemia (Correct answer)
Hypercalcemia
Hypernatremia
Hyperthyroidism

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

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

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

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

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

Mirtazapine
Escitalopram
Sertraline
Bupropion (Correct answer)

Correct answer: Bupropion

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

Question 188: Which antidepressant class carries the greatest risk in overdose due to cardiac and seizure effects?

Bupropion alone
SSRIs
Tricyclic antidepressants (Correct answer)
SNRIs

Correct answer: Tricyclic antidepressants

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

Question 189: What is the primary distinction between a civil commitment and a criminal forensic hold?

Civil commitment requires a crime; forensic hold does not
Civil commitment is voluntary; forensic hold is involuntary
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)

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

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

Correct answer: Immediately discontinue clozapine

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

Question 191: 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
Duty to warn (Tarasoff doctrine) (Correct answer)
Mandatory reporting statutes
Involuntary commitment statute

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 192: 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
4 years (Correct answer)
2 years
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 193: What is the difference between psychosis and delirium?

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

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

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

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

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

Correct answer: Passing the traditional proctored 10-year exam

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

Question 196: A patient has ptosis, miosis, and anhidrosis on one side of the face. This triad is called:

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

Correct answer: Horner syndrome

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

Question 197: Which mechanism best describes how benzodiazepines produce their sedative-anxiolytic effects?

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

Correct answer: Potentiate GABA-A chloride channel opening

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

Question 198: A patient with a lesion of Broca's area would most likely have:

Normal speech and comprehension
Complete inability to hear
Non-fluent, effortful speech with intact comprehension (Correct answer)
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 199: Which psychotherapy is MOST effective for adolescent depression according to evidence-based guidelines?

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

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

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

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

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

Correct answer: Multiple sclerosis

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

Question 202: 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 203: Which medication raises dopamine levels in the synaptic cleft?

Methlyphenidate
All of the above (Correct answer)
Amphetamine

Correct answer: All of the above

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

Question 204: 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
Obstructive sleep apnea
Idiopathic hypersomnia

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

CT scan with contrast
MRI brain with epilepsy protocol (Correct answer)
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 206: 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?

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

Correct answer: Guardianship or substitute decision-maker appointment

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

Question 207: Fatigable ptosis and diplopia that worsen with sustained upward gaze are hallmark signs of:

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

Correct answer: Myasthenia gravis

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

Question 208: Which ABPN subspecialty focuses on the neurological care of patients with cancer-related nervous system conditions?

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

Correct answer: Neuro-oncology (Neurology)

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

Question 209: 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)?

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

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

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

Correct answer: Hospice and Palliative Medicine

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

Question 211: Which legal standard is used to determine whether a defendant is competent to stand trial in the United States?

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

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

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

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

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

Correct answer: Vascular Neurology

Vascular Neurology is an ABPN-recognized neurology subspecialty.

Question 214: Which medication requires regular white blood cell monitoring due to agranulocytosis risk?

Clozapine (Correct answer)
Olanzapine
Risperidone
Quetiapine

Correct answer: Clozapine

Clozapine can cause agranulocytosis, mandating routine ANC monitoring.

Question 215: Which medication is FIRST-LINE for restless legs syndrome (RLS)?

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

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

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

Question 216: In the ABPN certification process, what is the PRIMARY purpose of the Clinical Skills Verification (CSV) requirement for psychiatry residents?

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

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

Fluoxetine
Citalopram
Paroxetine (Correct answer)
Sertraline

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 218: 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?

Separation anxiety disorder
Disinhibited social engagement disorder (Correct answer)
Autism spectrum disorder
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 219: First-line pharmacotherapy for generalized anxiety disorder is typically which class?

SSRIs (Correct answer)
Benzodiazepines
Beta-blockers
Antipsychotics

Correct answer: SSRIs

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

Question 220: Which of the following DOES NOT indicate that a person has positive symptoms of schizophrenia?

Movement disorders
Avolition (Correct answer)
Disorganized speech
Erratic behaviors
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 221: The most common cause of dementia in older adults is:

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

Correct answer: Alzheimer disease

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

Question 222: Which defense mechanism involves attributing one's own unacceptable feelings to another person?

Reaction formation
Projection (Correct answer)
Displacement
Sublimation

Correct answer: Projection

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

Question 223: 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?

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

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 224: Which neurotransmitter deficiency is associated with narcolepsy type 1?

Serotonin
Dopamine
Acetylcholine
Hypocretin (orexin) (Correct answer)

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 225: 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 226: 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 227: In the United States, what is the FDA's black box warning for antidepressants in children and adolescents?

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

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 228: Which diagnosis requires symptoms lasting at least 6 months in DSM-5 criteria?

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

Correct answer: Schizophrenia

Schizophrenia requires continuous signs for at least 6 months.

Question 229: Which neurotransmitter is most implicated in the positive symptoms of schizophrenia?

Acetylcholine
GABA
Dopamine (Correct answer)
Histamine

Correct answer: Dopamine

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

Question 230: 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
Tourette disorder
Pediatric acute-onset neuropsychiatric syndrome (PANS)

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

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

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

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

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

Sleep Medicine
Addiction Psychiatry
Psychiatry
Neurology (Correct answer)

Correct answer: Neurology

Epilepsy is a neurology subspecialty recognized by the ABPN.

Question 234: What effects on the neuroanatomy of norepinephrine neurons do amphetamine and methlyphenidate have in addition to changing dopamine levels?

Activate locus coeruleus NE neurons
Suppress locus coeruleus NE neurons (Correct answer)
Activate decimus meridius 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 235: 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?

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

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

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

Question 236: 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 237: Fluctuating muscle weakness that worsens with activity and improves with rest suggests:

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

Correct answer: Myasthenia gravis

Myasthenia gravis causes fatigable weakness from acetylcholine receptor antibodies.

Question 238: A patient repeats the interviewer's questions verbatim instead of answering. This speech abnormality is called:

Clang association
Neologism
Perseveration
Echolalia (Correct answer)

Correct answer: Echolalia

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

Question 239: Which of the following statements of the many forms of chronic pain is NOT TRUE?

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

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

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

Question 240: The ABPN's Part I written examination for psychiatry residents PRIMARILY tests which type of knowledge?

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

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

Nocturnal leg cramps
Painful neuropathy
Restless legs syndrome (RLS) (Correct answer)
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 242: A patient's tongue deviates to the left when protruded. This suggests a lesion of which cranial nerve on which side?

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

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

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

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

Valproate (Correct answer)
Carbamazepine
Phenytoin
Gabapentin

Correct answer: Valproate

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

Question 245: A sudden severe headache described as the 'worst of my life' most warrants evaluation for what?

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

Correct answer: Subarachnoid hemorrhage

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

Question 246: Which side effect is most specifically associated with valproate use in pregnancy?

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

Correct answer: Neural tube defects

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

Question 247: Which finding is characteristic of a cerebellar rather than a sensory ataxia?

Ataxia markedly worse with eyes closed
Ataxia unchanged by eye closure (Correct answer)
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 248: 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?

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

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

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

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

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

Correct answer: Not meeting Continuing Certification requirements

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

Question 251: Which of the following claims regarding alcohol's PK and PD is NOT TRUE?

Prolonged open chloride ion channel times are the eventual result.
Alcohol dehydrogenase's downregulation causes acute toxicity. (Correct answer)
All of the above.
Long-term alcohol use causes glutamate hypersensitivity.
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 252: For a diagnosis of PTSD, the characteristic symptoms must persist for more than:

6 months
3 days
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 253: According to current operational guidelines, status epilepticus is defined as a seizure lasting at least how long, or two seizures without return to baseline?

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

Correct answer: 5 minutes

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

Question 254: A patient with resting tremor, bradykinesia, and cogwheel rigidity most likely has dysfunction of which structure?

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

Correct answer: Substantia nigra

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

Question 255: A patient on lithium presents with tremor, ataxia, and confusion. What is the priority action?

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

Correct answer: Check a serum lithium level

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

Question 256: Tardive dyskinesia is MOST commonly caused by long-term use of which class of drugs?

Dopamine receptor antagonists (Correct answer)
Anticholinergics
Mood stabilizers
Benzodiazepines

Correct answer: Dopamine receptor antagonists

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

Question 257: The ABPN certifies subspecialists in which of the following fields?

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

Correct answer: Child and Adolescent Psychiatry

Child and Adolescent Psychiatry is an ABPN-recognized subspecialty.

Question 258: ABPN Maintenance of Certification (MOC) requires diplomates to demonstrate which of the following on an ongoing basis?

Continuous medical education, quality improvement, and assessment activities (Correct answer)
Annual board re-examination
Annual state licensing examination
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 259: Which agent is used to reverse acute benzodiazepine overdose?

Flumazenil (Correct answer)
Naloxone
Atropine
Physostigmine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used to reverse overdose.

Question 260: 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)
REM parasomnias
Hypnic disorders

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 261: 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 12; conduct disorder includes substance use
Age 5; conduct disorder requires peer rejection
Age 5; conduct disorder includes violations of others' basic rights (Correct answer)

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

Clonazepam
Lamotrigine
Carbamazepine (Correct answer)
Levetiracetam

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

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

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

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

Correct answer: Hyperreflexia and clonus

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

Question 265: Which bedside test best assesses cerebellar function of the upper limbs?

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

Correct answer: Finger-to-nose testing

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

Question 266: A tuning fork placed on the mastoid then near the ear canal (Rinne test) normally shows:

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

Correct answer: Air conduction louder than bone

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

Question 267: 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 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)
It increases respiratory muscle strength during sleep

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

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

Correct answer: NMDA glutamate receptor

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

Question 269: 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?

Narcolepsy with cataplexy
Major depressive disorder with atypical features
Bipolar II disorder
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 270: Which of the following claims about Wernicke's Encephalopathy (WE) is NOT TRUE?

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.
Korsakoff's Syndrome deteriorating is one of the complications of WE.
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)
When WE is suspected, treatment should start immediately even before probable test findings.

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

Nigrostriatal dopaminergic (Correct answer)
Cerebellar
Corticospinal
Dorsal column

Correct answer: Nigrostriatal dopaminergic

Loss of nigrostriatal dopamine produces the classic parkinsonian triad.

Question 272: A patient with a resting tremor, cogwheel rigidity, and bradykinesia most likely has:

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

Correct answer: Parkinson disease

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

Question 273: Which brain structure is primarily responsible for consolidating new declarative memories?

Amygdala
Basal ganglia
Cerebellum
Hippocampus (Correct answer)

Correct answer: Hippocampus

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

Question 274: A prisoner asks a psychiatrist to evaluate him for possible PTSD related to prison conditions. What unique ethical challenge does this situation present?

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

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

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

Question 275: How common is schizophrenia in the general population?

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

Correct answer: 0.5 to 1.5%

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

Question 276: 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
CAGE
MMSE (Correct answer)

Correct answer: MMSE

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

Question 277: Which finding on assessment most strongly suggests malingering rather than a genuine psychiatric disorder?

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

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

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

Correct answer: Time-unlimited (lifetime) certificate

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

Question 279: Which of the following best defines a hallucination?

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

Correct answer: A perception without an external stimulus

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

Question 280: The Combined Neurology and Psychiatry training pathway leads to eligibility for certification in which combination?

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

Correct answer: Both Neurology and Psychiatry

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

Question 281: Combining cognitive behavior therapy with selective serotonin reuptake inhibitors (SSRIs) is superior to either treatment alone for treating severe depressive disorder in pediatric patients.

False
True (Correct answer)

Correct answer: True

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

Question 282: 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?

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

Correct answer: Disruptive mood dysregulation disorder (DMDD)

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

Question 283: A structured tool used specifically to assess obsessive-compulsive symptom severity is the:

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

Correct answer: Y-BOCS

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

Question 284: Pronator drift, where one arm slowly pronates and drifts downward with eyes closed, indicates a lesion of which tract?

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

Correct answer: Contralateral corticospinal tract

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

Question 285: 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)
Stereotypic movement disorder
Tourette disorder
Provisional tic 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 286: 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 287: Which cognitive symptom is a core feature of major depressive disorder rather than normal grief?

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

Correct answer: Persistent worthlessness and guilt

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

Question 288: Which is the most appropriate initial screening tool for cognitive impairment in a clinic setting?

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

Correct answer: Mini-Mental State Examination or MoCA

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

Question 289: How many required activities make up the ABPN Continuing Certification program?

Only CME credits
Professionalism, Lifelong Learning/Self-Assessment, and Cognitive Expertise (Correct answer)
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 290: 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
Thought blocking
Flight of ideas (Correct answer)
Circumstantiality

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

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

Correct answer: Hyperreflexia and spasticity

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

Question 292: A patient presents with sudden weakness of the entire right face, arm, and leg, plus aphasia. Which vascular territory is most likely involved?

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

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

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

Correct answer: Left middle cerebral artery

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

Question 294: Which of these DOES NOT correspond to a schizophrenia subtype?

Cataleptic Type (Correct answer)
Disorganized Type
Undifferentiated Type
Paranoid Type
Residual 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 295: The ABPN Continuing Certification (CC) program replaced which older requirement?

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

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

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

ABPN Psychiatry Certification Exam

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

300

Questions

450 min

Time Limit

70%

To Pass

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