ABPN Behavioral Neurology and
Neuropsychiatry Certification Examination
Actual Questions with Answers and Rationales|
Instant Download PDF.
Question 1:
A 65-year-old right-handed man suddenly develops an inability to speak. He is awake,
alert, and appears frustrated. He can follow simple commands but his speech output is
non-fluent, consisting of "teh... teh... no" and he cannot repeat the phrase "no ifs, ands,
or buts." His comprehension is intact. Where is the most likely location of his lesion?
A) Left posterior superior temporal gyrus (Wernicke's area)
B) Left inferior frontal gyrus (Broca's area)
C) Left arcuate fasciculus
D) Left angular gyrus
Correct Answer: B) Left inferior frontal gyrus (Broca's area)
Explanation: This classic presentation describes Broca's aphasia (non-fluent, effortful
speech, relatively intact comprehension, poor repetition). The lesion is localized to
Broca's area in the left inferior frontal gyrus. Wernicke's aphasia (A) presents with fluent
but nonsensical speech and poor comprehension. Arcuate fasciculus damage (C) causes
conduction aphasia (poor repetition with fluent speech and intact comprehension). The
angular gyrus (D) is associated with anomic aphasia or alexia with agraphia.
Question 2:
,A 58-year-old man is brought to clinic by his wife for personality changes over the past
two years. He has become disinhibited, making inappropriate sexual comments at
dinner parties. He has developed a sweet tooth and will eat excessively, even taking
food off others' plates. On exam, he is distractible and has difficulty with alternating
sequences on motor tasks. His memory for recent events is relatively intact. What is the
most likely diagnosis?
A) Alzheimer's disease
B) Dementia with Lewy bodies
C) Behavioral variant frontotemporal dementia (bvFTD)
D) Vascular dementia
Correct Answer: C) Behavioral variant frontotemporal dementia (bvFTD)
Explanation: bvFTD typically presents in the presenile period (ages 45-65) with early,
prominent changes in personality and behavior (disinhibition, apathy, loss of empathy)
and hyperorality (eating changes). Executive dysfunction is common, while episodic
memory is often relatively spared early on. This pattern is distinct from the early
memory loss of Alzheimer's disease (A), visual hallucinations/fluctuations of Lewy body
dementia (B), or step-wise decline of vascular dementia (D).
Question 3:
A 32-year-old woman with epilepsy has been on phenytoin for years. She presents with
progressive unsteadiness, nystagmus on lateral gaze, and mild cognitive slowing. Her
phenytoin level is drawn and is within the standard therapeutic range (10-20 mcg/mL).
What is the most appropriate next step?
A) Increase the phenytoin dose
B) Add a second agent
C) Consider reducing the phenytoin dose and switching to an alternative medication
D) Order an MRI brain to rule out a new structural lesion
Correct Answer: C) Consider reducing the phenytoin dose and switching to an
alternative medication
Explanation: This patient is showing signs of cerebellar toxicity (ataxia, nystagmus,
dysarthria) from long-term phenytoin use. Importantly, phenytoin toxicity can occur
even at "therapeutic" serum levels in some individuals. The cornerstone of management
,is to reduce the dose or discontinue the offending agent. Increasing the dose (A) would
worsen the toxicity. Adding a new drug (B) without addressing the side effects of the
current one is not the best first step.
Question 4:
A 21-year-old woman develops subacute onset of psychiatric symptoms including
anxiety, insomnia, and paranoia over two weeks. She then begins having orofacial
dyskinesias and episodes of autonomic instability. An MRI brain is normal. Her CSF
shows lymphocytic pleocytosis. What is the most likely antibody to be associated with
this syndrome?
A) NMDA receptor
B) LGI1
C) GAD65
D) AMPA receptor
Correct Answer: A) NMDA receptor
Explanation: The classic phenotype of anti-NMDA receptor encephalitis is a young
woman presenting with prominent psychiatric symptoms, movement disorders (orofacial
dyskinesias, chorea), seizures, and autonomic dysfunction. While the MRI is often normal
early in the disease, CSF findings of lymphocytic pleocytosis are common. LGI1
antibodies (B) are more associated with faciobrachial dystonic seizures and
hyponatremia in older men. GAD65 antibodies (C) are linked to stiff-person syndrome
and limbic encephalitis.
Question 5:
A 72-year-old man with moderate Alzheimer's disease is started on a cholinesterase
inhibitor. This medication is designed to enhance cognitive function by increasing the
availability of acetylcholine. In which part of the brain is the primary source of
cholinergic projections to the cortex and hippocampus located?
, A) Locus coeruleus
B) Raphe nuclei
C) Nucleus basalis of Meynert
D) Substantia nigra pars compacta
Correct Answer: C) Nucleus basalis of Meynert
Explanation: The nucleus basalis of Meynert, located in the basal forebrain, is the
primary source of cholinergic projections to the entire cerebral cortex and hippocampus.
Degeneration of this nucleus is a key neuropathological feature of Alzheimer's disease.
The locus coeruleus (A) is the primary source of norepinephrine. The raphe nuclei (B) are
the primary source of serotonin. The substantia nigra pars compacta (D) is the primary
source of dopamine.
Question 6:
A 67-year-old man is referred for a sleep evaluation. His wife reports that for the past
year, he has been acting out his dreams. He will punch, kick, and shout while asleep, and
has accidentally struck her on several occasions. He recalls vivid, action-packed dreams
when awakened. What is the most significant long-term risk associated with this
condition?
A) Obstructive sleep apnea
B) Narcolepsy
C) Development of a synucleinopathy (e.g., Parkinson's disease or dementia with Lewy
bodies)
D) Restless legs syndrome
Correct Answer: C) Development of a synucleinopathy (e.g., Parkinson's disease or
dementia with Lewy bodies)
Explanation: REM sleep behavior disorder (RBD) is a parasomnia characterized by loss
of normal skeletal muscle atonia during REM sleep, leading to dream enactment. It is a
very strong prodromal marker for the development of α-synucleinopathies, including
Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy, often
preceding the neurodegenerative syndrome by years or even decades.
Neuropsychiatry Certification Examination
Actual Questions with Answers and Rationales|
Instant Download PDF.
Question 1:
A 65-year-old right-handed man suddenly develops an inability to speak. He is awake,
alert, and appears frustrated. He can follow simple commands but his speech output is
non-fluent, consisting of "teh... teh... no" and he cannot repeat the phrase "no ifs, ands,
or buts." His comprehension is intact. Where is the most likely location of his lesion?
A) Left posterior superior temporal gyrus (Wernicke's area)
B) Left inferior frontal gyrus (Broca's area)
C) Left arcuate fasciculus
D) Left angular gyrus
Correct Answer: B) Left inferior frontal gyrus (Broca's area)
Explanation: This classic presentation describes Broca's aphasia (non-fluent, effortful
speech, relatively intact comprehension, poor repetition). The lesion is localized to
Broca's area in the left inferior frontal gyrus. Wernicke's aphasia (A) presents with fluent
but nonsensical speech and poor comprehension. Arcuate fasciculus damage (C) causes
conduction aphasia (poor repetition with fluent speech and intact comprehension). The
angular gyrus (D) is associated with anomic aphasia or alexia with agraphia.
Question 2:
,A 58-year-old man is brought to clinic by his wife for personality changes over the past
two years. He has become disinhibited, making inappropriate sexual comments at
dinner parties. He has developed a sweet tooth and will eat excessively, even taking
food off others' plates. On exam, he is distractible and has difficulty with alternating
sequences on motor tasks. His memory for recent events is relatively intact. What is the
most likely diagnosis?
A) Alzheimer's disease
B) Dementia with Lewy bodies
C) Behavioral variant frontotemporal dementia (bvFTD)
D) Vascular dementia
Correct Answer: C) Behavioral variant frontotemporal dementia (bvFTD)
Explanation: bvFTD typically presents in the presenile period (ages 45-65) with early,
prominent changes in personality and behavior (disinhibition, apathy, loss of empathy)
and hyperorality (eating changes). Executive dysfunction is common, while episodic
memory is often relatively spared early on. This pattern is distinct from the early
memory loss of Alzheimer's disease (A), visual hallucinations/fluctuations of Lewy body
dementia (B), or step-wise decline of vascular dementia (D).
Question 3:
A 32-year-old woman with epilepsy has been on phenytoin for years. She presents with
progressive unsteadiness, nystagmus on lateral gaze, and mild cognitive slowing. Her
phenytoin level is drawn and is within the standard therapeutic range (10-20 mcg/mL).
What is the most appropriate next step?
A) Increase the phenytoin dose
B) Add a second agent
C) Consider reducing the phenytoin dose and switching to an alternative medication
D) Order an MRI brain to rule out a new structural lesion
Correct Answer: C) Consider reducing the phenytoin dose and switching to an
alternative medication
Explanation: This patient is showing signs of cerebellar toxicity (ataxia, nystagmus,
dysarthria) from long-term phenytoin use. Importantly, phenytoin toxicity can occur
even at "therapeutic" serum levels in some individuals. The cornerstone of management
,is to reduce the dose or discontinue the offending agent. Increasing the dose (A) would
worsen the toxicity. Adding a new drug (B) without addressing the side effects of the
current one is not the best first step.
Question 4:
A 21-year-old woman develops subacute onset of psychiatric symptoms including
anxiety, insomnia, and paranoia over two weeks. She then begins having orofacial
dyskinesias and episodes of autonomic instability. An MRI brain is normal. Her CSF
shows lymphocytic pleocytosis. What is the most likely antibody to be associated with
this syndrome?
A) NMDA receptor
B) LGI1
C) GAD65
D) AMPA receptor
Correct Answer: A) NMDA receptor
Explanation: The classic phenotype of anti-NMDA receptor encephalitis is a young
woman presenting with prominent psychiatric symptoms, movement disorders (orofacial
dyskinesias, chorea), seizures, and autonomic dysfunction. While the MRI is often normal
early in the disease, CSF findings of lymphocytic pleocytosis are common. LGI1
antibodies (B) are more associated with faciobrachial dystonic seizures and
hyponatremia in older men. GAD65 antibodies (C) are linked to stiff-person syndrome
and limbic encephalitis.
Question 5:
A 72-year-old man with moderate Alzheimer's disease is started on a cholinesterase
inhibitor. This medication is designed to enhance cognitive function by increasing the
availability of acetylcholine. In which part of the brain is the primary source of
cholinergic projections to the cortex and hippocampus located?
, A) Locus coeruleus
B) Raphe nuclei
C) Nucleus basalis of Meynert
D) Substantia nigra pars compacta
Correct Answer: C) Nucleus basalis of Meynert
Explanation: The nucleus basalis of Meynert, located in the basal forebrain, is the
primary source of cholinergic projections to the entire cerebral cortex and hippocampus.
Degeneration of this nucleus is a key neuropathological feature of Alzheimer's disease.
The locus coeruleus (A) is the primary source of norepinephrine. The raphe nuclei (B) are
the primary source of serotonin. The substantia nigra pars compacta (D) is the primary
source of dopamine.
Question 6:
A 67-year-old man is referred for a sleep evaluation. His wife reports that for the past
year, he has been acting out his dreams. He will punch, kick, and shout while asleep, and
has accidentally struck her on several occasions. He recalls vivid, action-packed dreams
when awakened. What is the most significant long-term risk associated with this
condition?
A) Obstructive sleep apnea
B) Narcolepsy
C) Development of a synucleinopathy (e.g., Parkinson's disease or dementia with Lewy
bodies)
D) Restless legs syndrome
Correct Answer: C) Development of a synucleinopathy (e.g., Parkinson's disease or
dementia with Lewy bodies)
Explanation: REM sleep behavior disorder (RBD) is a parasomnia characterized by loss
of normal skeletal muscle atonia during REM sleep, leading to dream enactment. It is a
very strong prodromal marker for the development of α-synucleinopathies, including
Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy, often
preceding the neurodegenerative syndrome by years or even decades.
