LATEST NEUROLOGY – NEUROCRITICAL CARE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY (ABPN) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 55-year-old male presents with sudden onset of
severe headache, nausea, and photophobia. CT head
shows diffuse subarachnoid hemorrhage (SAH). What
is the most appropriate next step?
A) CT angiography (CTA) of the head and neck
B) Lumbar puncture
C) MRI brain
D) Transcranial Doppler
Correct answer: A
Rationale: SAH requires urgent CTA to identify
aneurysm for possible coiling or clipping. Do not
delay for LP.
2. A 45-year-old male with a large left middle cerebral
artery (MCA) stroke develops worsening confusion
and left-sided neglect 48 hours after admission. He is
on aspirin. What is the most likely cause?
,A) Malignant cerebral edema (hemispheric swelling)
B) Hemorrhagic transformation
C) Seizure
D) Recurrent stroke
Correct answer: A
Rationale: Large MCA stroke (≥50% MCA territory)
can cause malignant edema peaking at 48-72 hours.
May require decompressive hemicraniectomy.
3. A 25-year-old male with severe traumatic brain
injury (GCS 6) has an intracranial pressure (ICP) of 32
mm Hg and mean arterial pressure (MAP) of 80 mm
Hg. What is the cerebral perfusion pressure (CPP)?
A) 48 mm Hg (CPP = MAP – ICP)
B) 52 mm Hg
C) 60 mm Hg
D) 112 mm Hg
Correct answer: A
Rationale: CPP = MAP – ICP = 80 – 32 = 48 mm Hg
(target >60 mm Hg). Low CPP causes cerebral
ischemia.
,4. A 68-year-old female with acute ischemic stroke
(NIHSS 20) receives IV tPA 90 minutes after symptom
onset. She develops sudden worsening of headache
and hypertension 3 hours later. CT head shows
hemorrhagic transformation with intraventricular
extension. What is the most appropriate next step?
A) Stop tPA, give cryoprecipitate and platelet
transfusion (if needed), control BP
B) Continue tPA
C) Reverse with vitamin K
D) Emergent surgical evacuation
Correct answer: A
Rationale: tPA-related intracerebral hemorrhage:
stop tPA, reverse coagulopathy (cryoprecipitate for
fibrinogen, platelets if prior antiplatelet), control BP.
5. A 35-year-old male with aneurysmal subarachnoid
hemorrhage (aSAH) is post-coiling. On day 5, he
develops new-onset left arm weakness. Transcranial
Doppler shows elevated flow velocities in the right
MCA. What is the most likely diagnosis?
A) Delayed cerebral ischemia (DCI) from vasospasm
B) Rebleeding
C) Hydrocephalus
, D) Seizure
Correct answer: A
Rationale: Cerebral vasospasm (days 4-14 post-
aSAH) causes delayed cerebral ischemia.
Nimodipine, induced hypertension, and possible
angioplasty.
6. A 72-year-old male with a large left MCA stroke
(NIHSS 22) has cerebral edema with midline shift. He
is intubated and sedated. ICP is 28 mm Hg. What is
the most appropriate next step?
A) Decompressive hemicraniectomy
B) Mannitol 1 g/kg
C) Hyperventilation to PaCO2 25 mm Hg
D) Hypothermia (32-34°C)
Correct answer: A
Rationale: Malignant MCA stroke with elevated ICP
despite medical therapy: decompressive
hemicraniectomy improves survival.
7. A 28-year-old female with acute liver failure (ALF)
from acetaminophen overdose has a GCS of 9 (E2,
V2, M5). Intracranial pressure monitor shows ICP 25
mm Hg. What is the most appropriate next step?
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY (ABPN) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 55-year-old male presents with sudden onset of
severe headache, nausea, and photophobia. CT head
shows diffuse subarachnoid hemorrhage (SAH). What
is the most appropriate next step?
A) CT angiography (CTA) of the head and neck
B) Lumbar puncture
C) MRI brain
D) Transcranial Doppler
Correct answer: A
Rationale: SAH requires urgent CTA to identify
aneurysm for possible coiling or clipping. Do not
delay for LP.
2. A 45-year-old male with a large left middle cerebral
artery (MCA) stroke develops worsening confusion
and left-sided neglect 48 hours after admission. He is
on aspirin. What is the most likely cause?
,A) Malignant cerebral edema (hemispheric swelling)
B) Hemorrhagic transformation
C) Seizure
D) Recurrent stroke
Correct answer: A
Rationale: Large MCA stroke (≥50% MCA territory)
can cause malignant edema peaking at 48-72 hours.
May require decompressive hemicraniectomy.
3. A 25-year-old male with severe traumatic brain
injury (GCS 6) has an intracranial pressure (ICP) of 32
mm Hg and mean arterial pressure (MAP) of 80 mm
Hg. What is the cerebral perfusion pressure (CPP)?
A) 48 mm Hg (CPP = MAP – ICP)
B) 52 mm Hg
C) 60 mm Hg
D) 112 mm Hg
Correct answer: A
Rationale: CPP = MAP – ICP = 80 – 32 = 48 mm Hg
(target >60 mm Hg). Low CPP causes cerebral
ischemia.
,4. A 68-year-old female with acute ischemic stroke
(NIHSS 20) receives IV tPA 90 minutes after symptom
onset. She develops sudden worsening of headache
and hypertension 3 hours later. CT head shows
hemorrhagic transformation with intraventricular
extension. What is the most appropriate next step?
A) Stop tPA, give cryoprecipitate and platelet
transfusion (if needed), control BP
B) Continue tPA
C) Reverse with vitamin K
D) Emergent surgical evacuation
Correct answer: A
Rationale: tPA-related intracerebral hemorrhage:
stop tPA, reverse coagulopathy (cryoprecipitate for
fibrinogen, platelets if prior antiplatelet), control BP.
5. A 35-year-old male with aneurysmal subarachnoid
hemorrhage (aSAH) is post-coiling. On day 5, he
develops new-onset left arm weakness. Transcranial
Doppler shows elevated flow velocities in the right
MCA. What is the most likely diagnosis?
A) Delayed cerebral ischemia (DCI) from vasospasm
B) Rebleeding
C) Hydrocephalus
, D) Seizure
Correct answer: A
Rationale: Cerebral vasospasm (days 4-14 post-
aSAH) causes delayed cerebral ischemia.
Nimodipine, induced hypertension, and possible
angioplasty.
6. A 72-year-old male with a large left MCA stroke
(NIHSS 22) has cerebral edema with midline shift. He
is intubated and sedated. ICP is 28 mm Hg. What is
the most appropriate next step?
A) Decompressive hemicraniectomy
B) Mannitol 1 g/kg
C) Hyperventilation to PaCO2 25 mm Hg
D) Hypothermia (32-34°C)
Correct answer: A
Rationale: Malignant MCA stroke with elevated ICP
despite medical therapy: decompressive
hemicraniectomy improves survival.
7. A 28-year-old female with acute liver failure (ALF)
from acetaminophen overdose has a GCS of 9 (E2,
V2, M5). Intracranial pressure monitor shows ICP 25
mm Hg. What is the most appropriate next step?
