ABPN Psychiatry Board Certification Exam 2026: Comprehensive
Physician Practice Test — Psychiatric Diagnosis,
Psychopharmacology, Psychotherapy, Neuropsychiatry, Emergency
Psychiatry & Clinical Decision-Making — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
SECTION 1: NEUROCOGNITIVE DISORDERS (Questions 1–19)
Question 1
A 72-year-old man is brought by his family for evaluation of progressive memory decline
over 18 months. He frequently repeats questions, forgets appointments, and has difficulty
managing finances. His wife notes he has become irritable but his personality remains
otherwise stable. Mini-Mental State Examination score is 22/30. Which cognitive domain is
most characteristically affected FIRST in Alzheimer's disease?
A. Executive function
B. Episodic memory
C. Language fluency
D. Visuospatial ability
Correct Answer: B
Explanation: Alzheimer's disease classically begins with episodic memory impairment due to
early hippocampal involvement; executive and visuospatial deficits typically emerge later.
Clinical Pearl: Early memory loss with preserved motor function strongly suggests
Alzheimer's over Lewy body dementia.
Question 2
,A 68-year-old woman presents with visual hallucinations of small animals, fluctuating
attention, and parkinsonism. Her symptoms began 10 months ago. She experienced a severe
reaction to haloperidol. Which diagnosis is most likely?
A. Alzheimer's disease
B. Vascular dementia
C. Dementia with Lewy bodies
D. Frontotemporal dementia
Correct Answer: C
Explanation: Dementia with Lewy bodies features visual hallucinations, cognitive
fluctuations, parkinsonism, and severe neuroleptic sensitivity; these core features
differentiate it from Alzheimer's. Clinical Pearl: Avoid typical antipsychotics in DLB due to
potentially fatal sensitivity reactions.
Question 3
A 58-year-old man develops progressive personality changes, disinhibition, and socially
inappropriate behavior over 2 years. Memory remains relatively intact. MRI shows frontal
and temporal atrophy. Which diagnosis is most consistent?
A. Frontotemporal dementia
B. Alzheimer's disease
C. Huntington's disease
D. Creutzfeldt-Jakob disease
Correct Answer: A
,Explanation: Frontotemporal dementia presents with early behavioral/personality changes
and relatively preserved memory, with frontal-temporal atrophy on imaging. Clinical Pearl:
FTD often presents before age 65 and is frequently misdiagnosed as a primary psychiatric
disorder.
Question 4
A 65-year-old man with hypertension and diabetes has stepwise cognitive decline, focal
neurological signs, and gait disturbance. MRI reveals multiple infarcts. Which type of
dementia is most likely?
A. Alzheimer's disease
B. Vascular dementia
C. Dementia with Lewy bodies
D. Normal pressure hydrocephalus
Correct Answer: B
Explanation: Stepwise decline, focal deficits, and vascular risk factors with infarcts on
imaging characterize vascular dementia. Clinical Pearl: Vascular dementia often shows
executive dysfunction and processing speed deficits earlier than memory loss.
Question 5
A 70-year-old woman has a rapidly progressive dementia over 3 months with myoclonus,
ataxia, and periodic sharp waves on EEG. Which diagnosis should be suspected?
A. Alzheimer's disease
B. Creutzfeldt-Jakob disease
C. Vascular dementia
, D. Lewy body dementia
Correct Answer: B
Explanation: Rapid progression, myoclonus, ataxia, and periodic sharp wave complexes on
EEG are classic for Creutzfeldt-Jakob disease. Clinical Pearl: CJD progresses over weeks to
months; 14-3-3 protein in CSF supports diagnosis.
Question 6
A 78-year-old man with Alzheimer's disease becomes increasingly agitated and accusatory
toward his wife, believing she is stealing from him. He has no prior psychiatric history. What
is the most likely explanation for his delusions?
A. Late-onset schizophrenia
B. Delusional disorder
C. Psychosis due to Alzheimer's disease
D. Substance-induced psychosis
Correct Answer: C
Explanation: Psychosis is a common neuropsychiatric symptom of moderate-to-severe
Alzheimer's disease, often presenting as persecutory delusions. Clinical Pearl: Treat
underlying causes first; atypical antipsychotics used cautiously at low doses if needed.
Question 7
Which medication is FDA-approved for moderate-to-severe Alzheimer's disease and works
by modulating glutamatergic transmission?
Physician Practice Test — Psychiatric Diagnosis,
Psychopharmacology, Psychotherapy, Neuropsychiatry, Emergency
Psychiatry & Clinical Decision-Making — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
SECTION 1: NEUROCOGNITIVE DISORDERS (Questions 1–19)
Question 1
A 72-year-old man is brought by his family for evaluation of progressive memory decline
over 18 months. He frequently repeats questions, forgets appointments, and has difficulty
managing finances. His wife notes he has become irritable but his personality remains
otherwise stable. Mini-Mental State Examination score is 22/30. Which cognitive domain is
most characteristically affected FIRST in Alzheimer's disease?
A. Executive function
B. Episodic memory
C. Language fluency
D. Visuospatial ability
Correct Answer: B
Explanation: Alzheimer's disease classically begins with episodic memory impairment due to
early hippocampal involvement; executive and visuospatial deficits typically emerge later.
Clinical Pearl: Early memory loss with preserved motor function strongly suggests
Alzheimer's over Lewy body dementia.
Question 2
,A 68-year-old woman presents with visual hallucinations of small animals, fluctuating
attention, and parkinsonism. Her symptoms began 10 months ago. She experienced a severe
reaction to haloperidol. Which diagnosis is most likely?
A. Alzheimer's disease
B. Vascular dementia
C. Dementia with Lewy bodies
D. Frontotemporal dementia
Correct Answer: C
Explanation: Dementia with Lewy bodies features visual hallucinations, cognitive
fluctuations, parkinsonism, and severe neuroleptic sensitivity; these core features
differentiate it from Alzheimer's. Clinical Pearl: Avoid typical antipsychotics in DLB due to
potentially fatal sensitivity reactions.
Question 3
A 58-year-old man develops progressive personality changes, disinhibition, and socially
inappropriate behavior over 2 years. Memory remains relatively intact. MRI shows frontal
and temporal atrophy. Which diagnosis is most consistent?
A. Frontotemporal dementia
B. Alzheimer's disease
C. Huntington's disease
D. Creutzfeldt-Jakob disease
Correct Answer: A
,Explanation: Frontotemporal dementia presents with early behavioral/personality changes
and relatively preserved memory, with frontal-temporal atrophy on imaging. Clinical Pearl:
FTD often presents before age 65 and is frequently misdiagnosed as a primary psychiatric
disorder.
Question 4
A 65-year-old man with hypertension and diabetes has stepwise cognitive decline, focal
neurological signs, and gait disturbance. MRI reveals multiple infarcts. Which type of
dementia is most likely?
A. Alzheimer's disease
B. Vascular dementia
C. Dementia with Lewy bodies
D. Normal pressure hydrocephalus
Correct Answer: B
Explanation: Stepwise decline, focal deficits, and vascular risk factors with infarcts on
imaging characterize vascular dementia. Clinical Pearl: Vascular dementia often shows
executive dysfunction and processing speed deficits earlier than memory loss.
Question 5
A 70-year-old woman has a rapidly progressive dementia over 3 months with myoclonus,
ataxia, and periodic sharp waves on EEG. Which diagnosis should be suspected?
A. Alzheimer's disease
B. Creutzfeldt-Jakob disease
C. Vascular dementia
, D. Lewy body dementia
Correct Answer: B
Explanation: Rapid progression, myoclonus, ataxia, and periodic sharp wave complexes on
EEG are classic for Creutzfeldt-Jakob disease. Clinical Pearl: CJD progresses over weeks to
months; 14-3-3 protein in CSF supports diagnosis.
Question 6
A 78-year-old man with Alzheimer's disease becomes increasingly agitated and accusatory
toward his wife, believing she is stealing from him. He has no prior psychiatric history. What
is the most likely explanation for his delusions?
A. Late-onset schizophrenia
B. Delusional disorder
C. Psychosis due to Alzheimer's disease
D. Substance-induced psychosis
Correct Answer: C
Explanation: Psychosis is a common neuropsychiatric symptom of moderate-to-severe
Alzheimer's disease, often presenting as persecutory delusions. Clinical Pearl: Treat
underlying causes first; atypical antipsychotics used cautiously at low doses if needed.
Question 7
Which medication is FDA-approved for moderate-to-severe Alzheimer's disease and works
by modulating glutamatergic transmission?
