ABPN Psychiatry Certification Exam — Questions and Answers

Question 1: The ABPN Sleep Medicine subspecialty certification is unique in that it is jointly awarded with which other medical specialty board?

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

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

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

Question 2: 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 3: Epilepsy is recognized by the ABPN as a subspecialty primarily under which primary certification?

Sleep Medicine
Psychiatry
Addiction Psychiatry
Neurology (Correct answer)

Correct answer: Neurology

Epilepsy is a neurology subspecialty recognized by the ABPN.

Question 4: For a diagnosis of PTSD, the characteristic symptoms must persist for more than:

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

Correct answer: 1 month

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

Question 5: 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?

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

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

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

Question 6: Which accreditation body oversees residency and fellowship training programs in psychiatry in the United States?

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

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

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

Question 7: Which landmark US Supreme Court case established that prisoners have a constitutional right to psychiatric treatment?

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

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

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

Correct answer: Guarantee that treatment will be successful

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

Question 9: What is the minimum number of ABPN-approved CME credits required per 3-year block for continuing certification?

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

Correct answer: 90 credits

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

Question 10: First-line pharmacologic treatment for generalized anxiety disorder is typically which class?

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

Correct answer: SSRIs or SNRIs

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

Question 11: Which antiepileptic drug should be AVOIDED in juvenile myoclonic epilepsy because it may paradoxically worsen myoclonic seizures?

Lamotrigine
Carbamazepine (Correct answer)
Levetiracetam
Clonazepam

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

Flumazenil (Correct answer)
Atropine
Naloxone
Physostigmine

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used cautiously for reversal.

Question 13: 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?

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

Correct answer: Anorexia nervosa

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

Question 14: 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 15: Which cranial nerve is tested by asking the patient to shrug the shoulders and turn the head against resistance?

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

Correct answer: CN XI (accessory)

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

Question 16: 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)
Informed consent is not required in correctional settings
Lack of legal basis for treating prisoners with PTSD
Mandatory reporting requirements for PTSD

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

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

Question 17: What is the first-line pharmacological treatment for convulsive status epilepticus in an adult presenting to the emergency department with IV access?

Valproate IV
Lorazepam IV (Correct answer)
Phenobarbital IV
Phenytoin 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 18: 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 acted under the influence of a substance
They had a severe mental illness at time of the crime
They did not know the nature of the act or did not know it was wrong due to mental disease (Correct answer)
They could not control their behavior due to irresistible impulse

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

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

Correct answer: West syndrome

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

Question 20: Fatigable ptosis and diplopia that worsen with sustained upward gaze are hallmark signs of:

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

Correct answer: Myasthenia gravis

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

Question 21: During assessment, a patient invents new words that have meaning only to them. This is termed:

Neologism (Correct answer)
Circumstantiality
Perseveration
Echolalia

Correct answer: Neologism

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

Question 22: A child shows persistent deficits in social communication plus restricted, repetitive behaviors present from early development. This pattern is characteristic of:

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

Correct answer: Autism spectrum disorder

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

Question 23: Loss of pain and temperature sensation with preserved proprioception suggests a lesion of which tract?

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

Correct answer: Spinothalamic tract

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

Question 24: Which demyelinating disease shows oligoclonal bands in the CSF and periventricular white-matter lesions?

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

Correct answer: Multiple sclerosis

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

Question 25: Which drug interaction is MOST clinically significant in a patient taking valproate who starts carbamazepine?

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

Correct answer: Carbamazepine induces CYP enzymes, decreasing valproate levels

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

Question 26: What distinguishes a mood disorder from an anxiety disorder in DSM-5?

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

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

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

Question 27: Which of the following claims regarding alcohol's PK and PD is NOT TRUE?

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

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

Glutamate
Dopamine (Correct answer)
Acetylcholine
Serotonin

Correct answer: Dopamine

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

Question 29: Which reflex tests the S1 nerve root?

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

Correct answer: Achilles (ankle) reflex

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

Question 30: Which anticonvulsant is considered FIRST-LINE for trigeminal neuralgia?

Lamotrigine
Carbamazepine (Correct answer)
Valproate
Levetiracetam

Correct answer: Carbamazepine

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

Question 31: Which mood stabilizer is MOST teratogenic and requires mandatory REMS enrollment due to risk of major congenital malformations?

Lithium
Carbamazepine
Valproate (Correct answer)
Lamotrigine

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

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

Correct answer: Violence risk assessment

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

Question 33: 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
Bipolar II disorder
Major depressive disorder with atypical features
Kleine-Levin syndrome (Correct answer)

Correct answer: Kleine-Levin syndrome

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

Question 34: Which finding is most consistent with an upper motor neuron lesion?

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

Correct answer: Hyperreflexia and spasticity

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

Question 35: Which of the following qualities of bupropion (Wellbutrin) is NOT TRUE?

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

Correct answer: Selective Norepinephrine reuptake inhibitor

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

Question 36: Huntington disease is inherited in which pattern?

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

Correct answer: Autosomal dominant

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

Question 37: A patient with anorexia nervosa is being assessed. Which feature is a required diagnostic criterion?

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

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

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

Correct answer: Atonic seizure

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

Question 39: Which of the following DOES NOT indicate that a person has positive symptoms of schizophrenia?

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

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 40: 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 41: A structured tool used specifically to assess obsessive-compulsive symptom severity is the:

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

Correct answer: Y-BOCS

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

Question 42: A patient taking clozapine develops fever, sore throat, and an absolute neutrophil count of 400/μL. What is the MOST appropriate action?

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

Correct answer: Immediately discontinue clozapine

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

Question 43: Which of the following is NOT TRUE about tramadol?

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

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

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

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

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

Question 45: Which pathway allows diplomates to satisfy the cognitive exam requirement without sitting a proctored 10-year exam?

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

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

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

Correct answer: Completion of an ACGME-accredited psychiatry residency

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

Question 47: What approximate percentage of patients who experience a single unprovoked seizure will have a recurrence within 2 years?

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

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

Sertraline
Valproate
Risperidone and aripiprazole (Correct answer)
Methylphenidate

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

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

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 50: 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 51: Tardive dyskinesia is MOST commonly caused by long-term use of which class of drugs?

Dopamine receptor antagonists (Correct answer)
Anticholinergics
Benzodiazepines
Mood stabilizers

Correct answer: Dopamine receptor antagonists

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

Question 52: A patient describes recurrent, intrusive thoughts of contamination that they neutralize by repeated handwashing. Which diagnosis is most consistent?

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

Correct answer: Obsessive-compulsive disorder

Intrusive obsessions paired with compensatory compulsions define OCD.

Question 53: Psychogenic non-epileptic seizures (PNES) are most definitively diagnosed by which investigation?

Neuropsychological testing battery
Video-EEG monitoring capturing a typical event (Correct answer)
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 54: A patient with refractory epilepsy is started on the ketogenic diet. Which metabolic change is primarily responsible for the diet's antiseizure mechanism?

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

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

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

Question 55: A sudden severe headache described as the 'worst of my life' most warrants evaluation for what?

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

Correct answer: Subarachnoid hemorrhage

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

Question 56: Serotonin syndrome is best distinguished from NMS by the presence of:

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

Correct answer: Hyperreflexia and clonus

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

Question 57: What components are included in a comprehensive psychiatric evaluation?

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

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

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

Question 58: A psychiatrist evaluating a defendant for competency to stand trial concludes the defendant is incompetent. What is the MOST typical next legal step?

The case is dismissed and the defendant is released
The defendant is sent for competency restoration treatment (Correct answer)
The defendant is immediately tried and sentenced
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 59: How common is schizophrenia in the general population?

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

Correct answer: 0.5 to 1.5%

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

Question 60: A patient states they have no problem despite obvious functional impairment from their illness. The clinician documents this as:

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

Correct answer: Poor insight

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

Question 61: When a patient can state the correct date, place, and who they are, the clinician documents that the patient is:

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

Correct answer: Oriented to person, place, and time

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

Question 62: A 35-year-old patient with bipolar I disorder is started on lithium. Which baseline laboratory test is MOST important before initiating therapy?

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

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

A one-time screening at intake only
Asking a single question about suicidal thoughts
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

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

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

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 65: 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
12
11 (Correct answer)
10

Correct answer: 11

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

Question 66: 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
Obstructive sleep apnea (Correct answer)
Cheyne-Stokes respirations
Mixed sleep apnea

Correct answer: Obstructive sleep apnea

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

Question 67: Which defense mechanism involves attributing one's own unacceptable feelings to another person?

Displacement
Sublimation
Projection (Correct answer)
Reaction formation

Correct answer: Projection

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

Question 68: A patient on lithium develops tremor, polyuria, and polydipsia. What is the MOST appropriate next step?

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

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

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

Correct answer: Neuromuscular Medicine

Neuromuscular Medicine covers disorders of nerve and muscle.

Question 70: Which of the following statements of the many forms of chronic pain is NOT TRUE?

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)
Microvasculature vasoconstriction leads to diabetic neuropathy.
All of the above.
Neuralgia postherpetic might persist for years.

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

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

Question 71: The ABPN Continuing Certification (CC) program replaced which older requirement?

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

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

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

Question 72: What is the MINIMUM age at which conduct disorder can be diagnosed, and what key feature distinguishes it from oppositional defiant disorder?

Age 5; conduct disorder requires peer rejection
Age 12; conduct disorder includes substance use
Age 10; conduct disorder requires truancy
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 73: Which laboratory abnormality is a known adverse effect requiring monitoring on valproate?

Hepatotoxicity and thrombocytopenia (Correct answer)
Elevated TSH
Hypernatremia
Hyperkalemia

Correct answer: Hepatotoxicity and thrombocytopenia

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

Question 74: Which medication requires regular white blood cell monitoring due to agranulocytosis risk?

Quetiapine
Olanzapine
Clozapine (Correct answer)
Risperidone

Correct answer: Clozapine

Clozapine can cause agranulocytosis, mandating routine ANC monitoring.

Question 75: A patient develops facial droop involving the forehead on one side with inability to close the eye. This localizes the lesion to:

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

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

Bupropion
Fluoxetine (Correct answer)
Mirtazapine
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 77: Combining cognitive behavior therapy with selective serotonin reuptake inhibitors (SSRIs) is superior to either treatment alone for treating severe depressive disorder in pediatric patients.

True (Correct answer)
False

Correct answer: True

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

Question 78: What is required annually of diplomates besides holding a license, to stay on track for continuing certification?

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

Correct answer: Ongoing CME participation toward the block requirement

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

Question 79: 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?

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

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

Paroxetine (Correct answer)
Sertraline
Citalopram
Fluoxetine

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

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

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 82: Which medication raises dopamine levels in the synaptic cleft?

All of the above (Correct answer)
Methlyphenidate
Amphetamine

Correct answer: All of the above

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

Question 83: Which antiepileptic drug primarily blocks T-type calcium channels and is the first-line treatment for childhood absence epilepsy?

Ethosuximide (Correct answer)
Lamotrigine
Phenobarbital
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 84: Which neurology subspecialty is jointly recognized by the ABPN and involves expertise in muscle and nerve diseases (peripheral nervous system)?

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

Correct answer: Neuromuscular medicine

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

Question 85: Which element is NOT typically a component of the standard Mental Status Examination?

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

Correct answer: Complete blood count

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

Question 86: The Babinski sign (extensor plantar response) in an adult indicates dysfunction of which pathway?

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

Correct answer: Corticospinal tract

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

Question 87: A woman with epilepsy is planning a pregnancy. Which antiepileptic drug carries the highest risk of major congenital malformations and cognitive teratogenicity?

Valproate (Correct answer)
Lamotrigine
Oxcarbazepine
Levetiracetam

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 88: 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 89: 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 lasts indefinitely; forensic hold lasts 72 hours
Civil commitment is voluntary; forensic hold is involuntary
Civil commitment is for mental illness with danger to self/others; forensic hold is legally tied to the criminal justice system (Correct answer)

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 90: Which antipsychotic medication is linked to retinal pigmentation?

Trifluoperazine
Chlorpromazine
Haloperidol
Thioridazine (Correct answer)
Fluphenazine

Correct answer: Thioridazine

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

Question 91: Which condition is characterized by bilateral leg discomfort that worsens at rest and in the evening, is relieved by movement, and interferes with sleep?

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

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

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

Correct answer: Meningeal irritation

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

Question 93: Which personality disorder is characterized by unstable relationships, impulsivity, identity disturbance, and fear of abandonment?

Obsessive-compulsive
Schizoid
Borderline (Correct answer)
Narcissistic

Correct answer: Borderline

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

Question 94: 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
Anterior temporal lobectomy (Correct answer)
Functional hemispherectomy

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

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

Correct answer: Potentiate GABA-A chloride channel opening

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

Question 96: What condition is not usually associated with Neuroleptic Malignant Syndrome (NMS)?

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

Correct answer: Leukopenia

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

Question 97: Geriatric psychiatry as an ABPN subspecialty focuses primarily on which patient population?

Nursing home residents regardless of age
Patients over age 65 with psychiatric and cognitive disorders (Correct answer)
Patients of any age with age-related cognitive decline
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 98: Which antiepileptic drug requires monitoring of serum levels and is known to cause Steven-Johnson syndrome, particularly in patients with HLA-B*1502 allele?

Gabapentin
Levetiracetam
Lacosamide
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 99: Which percentage of schizophreniform disorders patients progress to schizoaffective or schizophrenia?

25%
88%
66% (Correct answer)
50%
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 100: The CIWA-Ar score is used to determine how to treat sedative and hypnotic withdrawal, which is different from alcohol withdrawal.

True
False (Correct answer)

Correct answer: False

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

Question 101: What is the mortality rate of Neuroleptic Malignant Syndrome if left untreated?

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

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

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

Correct answer: Spinothalamic tract

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

Question 103: 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?

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
Obtain state licensure in two US states

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

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

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 105: 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 106: A patient with delayed sleep phase disorder characteristically shows what sleep pattern?

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

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 107: 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)
COWS
McGill
All of the above.

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

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

Correct answer: Forensic psychiatry

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

Question 109: Which imaging finding is most characteristic of an acute ischemic stroke on early non-contrast CT?

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

Correct answer: Often normal in the first hours

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

Question 110: Which ABPN subspecialty focuses on the neurological care of patients with cancer-related nervous system conditions?

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

Correct answer: Neuro-oncology (Neurology)

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

Question 111: Which of the following does NOT qualify as a typical, targeted side effect of stimulants?

Anorexia
Ataxia (Correct answer)
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 112: What effects on the neuroanatomy of norepinephrine neurons do amphetamine and methlyphenidate have in addition to changing dopamine levels?

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

Correct answer: Suppress locus coeruleus NE neurons

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

Question 113: 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 114: In the Tarasoff case, what CRITICAL duty was established for mental health clinicians in the United States?

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

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

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

Question 115: 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?

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

Correct answer: Disinhibited social engagement disorder

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

Question 116: Broca aphasia is best characterized by:

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

Correct answer: Nonfluent speech with preserved comprehension

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

Question 117: 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
Surgery only
Pathology only

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

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

Question 118: Which of the following claims about Wernicke's Encephalopathy (WE) is NOT TRUE?

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

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

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

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

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

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

Question 121: Which combination of antipsychotics causes the most weight gain?

Olanzapine and Clozapine (Correct answer)
Olanzapine and Ziprasidone
Aripiprazole and Clozapine
Risperidone 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 122: A child with intellectual disability is found to have an IQ of 45. What level of intellectual disability does this represent?

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

Correct answer: Moderate (IQ 40-55)

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

Question 123: Which artery occlusion most commonly causes contralateral face and arm weakness with aphasia?

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

Correct answer: Middle cerebral artery

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

Question 124: 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 125: Which of the following best defines a hallucination?

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

Correct answer: A perception without an external stimulus

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

Question 126: What are the cardinal features of Parkinson's disease?

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

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

Naltrexone (Correct answer)
Disulfiram
Topiramate
Acamprosate

Correct answer: Naltrexone

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

Question 128: Addiction Psychiatry is an ABPN subspecialty primarily building upon which primary certification?

Psychiatry (Correct answer)
Neuromuscular Medicine
Neurology
Sleep Medicine

Correct answer: Psychiatry

Addiction Psychiatry requires prior Psychiatry certification.

Question 129: Fluctuating muscle weakness that worsens with activity and improves with rest suggests:

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

Correct answer: Myasthenia gravis

Myasthenia gravis causes fatigable weakness from acetylcholine receptor antibodies.

Question 130: 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 131: What cranial nerves are tested during a standard neurological examination?

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

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

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

Question 132: A patient cannot recognize objects placed in the hand by touch alone despite intact sensation. This is called:

Astereognosis (Correct answer)
Apraxia
Aphasia
Agnosia for faces

Correct answer: Astereognosis

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

Question 133: What EEG pattern is most characteristic of childhood absence epilepsy?

Hypsarrhythmia
Burst-suppression pattern
Periodic lateralized epileptiform discharges (PLEDs)
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 134: 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)?

Social anxiety disorder
Autism spectrum disorder
Expressive language 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 135: Which of these DOES NOT describe an individual with Autism Spectrum Disorders?

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

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 136: 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?

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

Correct answer: Guardianship or substitute decision-maker appointment

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

Question 137: Which of these DOES NOT correspond to a schizophrenia subtype?

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

Correct answer: Cataleptic Type

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

Question 138: Forensic Psychiatry certification qualifies a diplomate to work primarily at the intersection of psychiatry and what field?

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

Correct answer: The law/legal system

Forensic Psychiatry addresses psychiatric issues within legal contexts.

Question 139: What is the difference between psychosis and delirium?

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

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

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

Question 140: Obstructive sleep apnea is MOST strongly associated with which neuropsychiatric condition?

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

Correct answer: Depression and cognitive impairment

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

Question 141: According to the 2017 ILAE classification, which of the following is correctly categorized as a focal seizure type?

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

Correct answer: Focal aware seizure

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

Question 142: What is the role of neuroimaging in neurological assessment?

Imaging is never needed in neurological assessment
Neuroimaging replaces the clinical examination entirely
CT for acute stroke and trauma; MRI for detailed brain structure; functional imaging for specific clinical questions (Correct answer)
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 143: Which receptors are inhibited by antipsychotics of the second generation?

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

Correct answer: D2 and 5HT2

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

Question 144: Consultation-liaison (C-L) psychiatry focuses on which clinical practice setting?

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

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 145: 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 agranulocytosis
Increased risk of Stevens-Johnson syndrome
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 146: In Weber's tuning fork test, sound lateralizing to the affected ear suggests:

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

Correct answer: Conductive hearing loss in that ear

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

Question 147: Which body accredits the residency and fellowship training programs whose completion the ABPN requires for eligibility?

ACGME (Correct answer)
NBME
ABMS
FSMB

Correct answer: ACGME

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

Question 148: Which term describes a sleep disorder characterized by confusional arousals, sleepwalking, and sleep terrors arising from NREM slow-wave sleep?

Hypnic disorders
REM parasomnias
NREM parasomnias (disorders of arousal) (Correct answer)
Circadian rhythm 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 149: 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 150: 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?

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

Correct answer: Bulimia nervosa

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

Question 151: A physician certified in psychiatry before October 1994 holds what type of certificate?

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

Correct answer: Time-unlimited (lifetime) certificate

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

Question 152: What is the Glasgow Coma Scale and what does it measure?

A measure of cognitive ability
A scale measuring pain levels
A 3-15 point scale measuring consciousness through eye opening, verbal response, and motor response (Correct answer)
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 153: A patient reports excessive daytime sleepiness, sudden loss of muscle tone triggered by strong emotion, sleep paralysis, and hypnagogic hallucinations. What is the MOST likely diagnosis?

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

Correct answer: Narcolepsy type 1

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

Question 154: Which finding is characteristic of neuroleptic malignant syndrome?

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

Correct answer: Lead-pipe rigidity and hyperthermia

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

Question 155: 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
Passing the traditional proctored 10-year exam (Correct answer)
Attending one conference

Correct answer: Passing the traditional proctored 10-year exam

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

Question 156: Which finding is characteristic of a cerebellar rather than a sensory ataxia?

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

Correct answer: Ataxia unchanged by eye closure

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

Question 157: Which receptor does memantine target for the treatment of moderate-to-severe Alzheimer's disease?

Acetylcholine muscarinic M1
NMDA glutamate receptor (Correct answer)
Sigma-1 receptor
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 158: 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 159: Fatal familial insomnia is caused by a mutation in which gene?

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

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 160: 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?

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

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

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

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

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

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

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

Correct answer: An atypical antipsychotic

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

Question 164: Homonymous hemianopia (loss of the same visual field in both eyes) results from a lesion where?

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

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

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

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

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

Question 166: Which agent is used to reverse acute benzodiazepine overdose?

Physostigmine
Flumazenil (Correct answer)
Atropine
Naloxone

Correct answer: Flumazenil

Flumazenil is a benzodiazepine receptor antagonist used to reverse overdose.

Question 167: The DSM-5 uses a categorical approach, but which section introduced dimensional assessment tools for further study?

Section II
Section I
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 168: Which is the most appropriate initial screening tool for cognitive impairment in a clinic setting?

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

Correct answer: Mini-Mental State Examination or MoCA

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

Question 169: Which antiepileptic drug is most strongly associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

Levetiracetam
Lamotrigine (Correct answer)
Valproate
Gabapentin

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

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

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

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

Question 171: Which organization does the ABPN partner with to provide continuing certification for physicians?

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

Correct answer: American Board of Medical Specialties (ABMS)

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

Question 172: 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
Vascular Neurology
Nuclear Medicine

Correct answer: Hospice and Palliative Medicine

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

Question 173: A patient on phenelzine (MAOI) eats aged cheese and develops a hypertensive crisis. Which mechanism explains this reaction?

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

Correct answer: Tyramine displaces norepinephrine causing massive sympathetic discharge

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

Question 174: Which antidepressant is CONTRAINDICATED in patients with a seizure disorder or eating disorders due to lowered seizure threshold?

Bupropion (Correct answer)
Sertraline
Mirtazapine
Escitalopram

Correct answer: Bupropion

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

Question 175: Which of the following is a current ABPN-recognized subspecialty requiring additional fellowship training and certification?

Integrative psychiatry
Neuropsychiatry
Addiction medicine
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 176: Ascending symmetric weakness with areflexia following an infection suggests which diagnosis?

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

Correct answer: Guillain-Barré syndrome

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

Question 177: On average, how long does the active phase of schizophrenia last?

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

Correct answer: 1 Month

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

Question 178: 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 179: A 4-year-old child does not make eye contact, does not respond to his name, lacks joint attention, and engages in repetitive hand-flapping. What is the MOST likely diagnosis?

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

Correct answer: Autism spectrum disorder (ASD)

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

Question 180: A 14-year-old boy has a persistent eye-blinking tic and throat-clearing for more than 1 year, with onset before age 18. What diagnosis does this MOST likely represent?

Stereotypic movement disorder
Tourette disorder
Persistent (chronic) motor or vocal tic disorder (Correct answer)
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 181: In the ABPN certification process, what is the PRIMARY purpose of the Clinical Skills Verification (CSV) requirement for psychiatry residents?

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

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

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

Question 182: Geriatric Psychiatry as an ABPN subspecialty focuses on the mental health of which population?

Adolescents
Older adults (Correct answer)
Pregnant patients
Children

Correct answer: Older adults

Geriatric Psychiatry addresses mental health in older adults.

Question 183: Which sleep stage is characterized by high-amplitude, slow (< 2 Hz) delta waves on EEG and is considered essential for physical restoration?

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

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

Beta-blockers
Antipsychotics
Benzodiazepines
SSRIs (Correct answer)

Correct answer: SSRIs

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

Question 185: Which legal standard is used to determine whether a defendant is competent to stand trial in the United States?

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

Correct answer: Dusky standard

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

Question 186: A patient repeats the interviewer's questions verbatim instead of answering. This speech abnormality is called:

Perseveration
Neologism
Echolalia (Correct answer)
Clang association

Correct answer: Echolalia

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

Question 187: A patient presents with sudden right-sided weakness and expressive aphasia. Which arterial territory is most likely involved?

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

Correct answer: Left middle cerebral artery

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

Question 188: Which condition is characterized by sudden onset of severe OCD symptoms and motor or vocal tics in a child following group A streptococcal infection?

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

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

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

Question 189: What is the biopsychosocial model in psychiatry?

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

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

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

Question 190: 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 191: How often must a diplomate complete a self-assessment activity under the ABPN Continuing Certification program (3-year block)?

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

Correct answer: Every 3 years

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

Question 192: Which condition classically presents with the triad of dementia, gait apraxia, and urinary incontinence?

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

Correct answer: Normal pressure hydrocephalus

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

Question 193: Where can the public verify a physician's ABPN certification status?

The local pharmacy
The physician's business card only
The ABPN 'Verify a Physician' online tool (Correct answer)
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 194: Which medication is FDA-approved as FIRST-LINE pharmacotherapy for ADHD in children aged 6 and older?

Guanfacine
Atomoxetine
Clonidine
Methylphenidate (Correct answer)

Correct answer: Methylphenidate

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

Question 195: What is the difference between upper motor neuron (UMN) and lower motor neuron (LMN) lesions?

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

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

Research methodology and biostatistics
Procedural skills and clinical simulation
Medical knowledge through multiple-choice questions (Correct answer)
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 197: Which neurotransmitter deficiency is associated with narcolepsy type 1?

Hypocretin (orexin) (Correct answer)
Acetylcholine
Dopamine
Serotonin

Correct answer: Hypocretin (orexin)

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

Question 198: Which neurotransmitter/hormone is MOST involved in regulating the sleep-wake circadian rhythm and is secreted by the pineal gland?

Serotonin
Cortisol
Adenosine
Melatonin (Correct answer)

Correct answer: Melatonin

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

Question 199: The ABPN certifies subspecialists in which of the following fields?

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

Correct answer: Child and Adolescent Psychiatry

Child and Adolescent Psychiatry is an ABPN-recognized subspecialty.

Question 200: The most common cause of dementia in older adults is:

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

Correct answer: Alzheimer disease

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

Question 201: In schizophrenia, which of the following is the best prognostic sign?

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

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

Vyvanse
Strattera
Concerta (Correct answer)
Daytrana

Correct answer: Concerta

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

Question 203: Which antiepileptic drug is considered the preferred first-line agent for juvenile myoclonic epilepsy?

Gabapentin
Valproate (Correct answer)
Carbamazepine
Phenytoin

Correct answer: Valproate

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

Question 204: Which is a first-line treatment for obsessive-compulsive disorder?

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

Correct answer: SSRIs with exposure and response prevention

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

Question 205: Which side effect is most specifically associated with valproate use in pregnancy?

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

Correct answer: Neural tube defects

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

Question 206: Which class of medication is first-line for acute mania?

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

Correct answer: Mood stabilizers or second-generation antipsychotics

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

Question 207: 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 increases respiratory muscle strength during sleep
It provides pneumatic splinting to maintain upper airway patency (Correct answer)

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

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

Question 208: A positive Babinski sign in an adult indicates a lesion of which pathway?

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

Correct answer: Corticospinal tract

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

Question 209: Which developmental milestone should RAISE concern if absent in a 12-month-old child?

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

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

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

Correct answer: Not meeting Continuing Certification requirements

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

Question 211: A patient with a lesion of Broca's area would most likely have:

Complete inability to hear
Normal speech and comprehension
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 212: What is the primary mechanism of action of phenytoin?

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

Correct answer: Blocks voltage-gated sodium channels

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

Question 213: 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 214: REM sleep behavior disorder (RBD) is characterized by which polysomnographic finding?

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

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

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

Question 215: Which psychotherapy is MOST effective for adolescent depression according to evidence-based guidelines?

Psychoanalysis
Interpersonal therapy for adolescents (IPT-A) or CBT (Correct answer)
Art therapy alone
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 216: What is the most common metabolic cause of neonatal seizures?

Hyperthyroidism
Hypernatremia
Hypoglycemia (Correct answer)
Hypercalcemia

Correct answer: Hypoglycemia

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

Question 217: What is the legal standard used in most US states for civil involuntary psychiatric commitment?

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

Correct answer: Clear and convincing evidence

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

Question 218: Which neurotransmitter system is the PRIMARY target of typical antipsychotic medications?

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

Correct answer: Dopamine (D2)

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

Question 219: A patient with a resting tremor, cogwheel rigidity, and bradykinesia most likely has:

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

Correct answer: Parkinson disease

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

Question 220: Which finding on assessment most strongly suggests malingering rather than a genuine psychiatric disorder?

Symptoms that improve with treatment
Symptoms consistent across interviews
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 221: What is the mechanism by which acetylcholinesterase inhibitors improve symptoms in Alzheimer's disease?

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

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

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

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

Marketing communications
Sharing records with an employer for hiring decisions
Disclosure to family members for non-emergency purposes
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 224: The Neurodevelopmental Disabilities subspecialty of the ABPN is jointly certificated with which other specialty board?

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

Correct answer: American Board of Pediatrics (ABP)

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

Question 225: 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?

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

Correct answer: Juvenile myoclonic epilepsy

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

Question 226: A patient experiences neuroleptic malignant syndrome (NMS). Which combination of features is MOST characteristic?

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

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

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

Question 227: What are the common types of headache and their distinguishing features?

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

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

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

Question 228: Which medication requires monitoring for agranulocytosis with regular blood counts?

Fluoxetine
Sertraline
Lithium
Clozapine (Correct answer)

Correct answer: Clozapine

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

Question 229: A 10-year-old is brought in for evaluation after 8 months of irritability, severe outbursts, and persistently dysphoric mood that is not episodic. What DSM-5 diagnosis BEST fits?

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

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

Neurodevelopmental disabilities
Consultation-liaison psychiatry
Behavioral neurology and neuropsychiatry (Correct answer)
Geriatric 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 231: Under ABPN rules, a psychiatry resident who has NOT yet passed the ABPN examination may legally practice psychiatry under which condition?

Only in research settings without direct patient care
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)
Only for 2 years after residency completion before mandatory re-examination

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

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

Question 232: Which condition is characterized by sudden brief loss of muscle tone triggered by emotion?

Cataplexy (Correct answer)
Myoclonus
Absence seizure
Syncope

Correct answer: Cataplexy

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

Question 233: According to current operational guidelines, status epilepticus is defined as a seizure lasting at least how long, or two seizures without return to baseline?

30 minutes
5 minutes (Correct answer)
2 minutes
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 234: What is the recommended FIRST-LINE psychotherapy for separation anxiety disorder in children?

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

Correct answer: Cognitive-behavioral therapy (CBT)

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

Question 235: Addiction psychiatry as an ABPN subspecialty addresses which clinical area?

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

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

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

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

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

Question 237: What is the standard duration of an ABPN certification cycle before continuing certification requirements reset?

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

Correct answer: 10 years

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

Question 238: Which neurological condition is characterized by brief, involuntary jerks of the legs during sleep and is associated with periodic leg movements on polysomnography?

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

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 239: 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)
Submit patient outcome data to a national registry
Attend mandatory annual symposia

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

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

Correct answer: Persistent worthlessness and guilt

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

ABPN Psychiatry Certification Exam

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

300

Questions

450 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

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

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

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

abpn.org — Fees, test delivery, renewal, exam dates, registration deadline, registration, passing score, exam format, time limit · verified Oct 2026