LATEST BRAIN INJURY MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 25-year-old male sustains a severe traumatic
brain injury (TBI) after a motor vehicle accident.
Initial Glasgow Coma Scale (GCS) score was 6.
Which neuroimaging finding is most associated with
poor long-term functional outcome?
A) Subdural hematoma <5 mm
B) Traumatic subarachnoid hemorrhage
C) Diffuse axonal injury (DAI) on MRI
D) Isolated epidural hematoma
Correct answer: C
Rationale: Diffuse axonal injury, particularly involving
the corpus callosum and brainstem, is strongly
associated with prolonged impaired consciousness
and poor functional outcomes after severe TBI.
2. A 45-year-old male with moderate TBI (GCS 11) is
evaluated 6 months post-injury. He reports persistent
headaches, dizziness, and difficulty concentrating.
,Neurologic exam is normal. Which is the most
appropriate next step?
A) Repeat head CT
B) Lumbar puncture
C) Neuropsychological testing
D) Trial of amitriptyline for post-concussive syndrome
Correct answer: D
Rationale: Post-concussive syndrome is common
after mild-to-moderate TBI. Amitriptyline (low dose) is
effective for headache and sleep disturbance.
Neuropsychological testing is not first-line.
3. A 60-year-old female with a fall and mild TBI (GCS
15) presents 3 hours after injury. She is on warfarin
for atrial fibrillation (INR 2.5). Which is the most
appropriate next step?
A) Discharge home with observation
B) Repeat head CT in 6 hours
C) Admit for observation and reverse anticoagulation
D) Non-contrast head CT now
Correct answer: D
Rationale: Patients on anticoagulation with any TBI
require immediate non-contrast head CT due to risk
,of delayed intracranial hemorrhage. Admission and
reversal depend on CT findings.
4. A 30-year-old male with severe TBI (GCS 5) is
admitted to the ICU. His intracranial pressure (ICP)
monitor reads 25 mmHg. Which is the first-line
intervention to lower ICP?
A) Hyperventilation to PaCO2 25 mmHg
B) Mannitol 1 g/kg IV
C) Elevate head of bed to 30 degrees
D) Pentobarbital coma
Correct answer: C
Rationale: Head elevation (30 degrees) improves
venous drainage and is first-line for mild ICP
elevation. Hyperventilation is reserved for herniation.
Mannitol for sustained ICP >20.
5. A 22-year-old female with severe TBI is 2 weeks
post-injury. She opens eyes to noxious stimulation,
localizes to pain, and has inconsistent verbalizations
(moans). What is her Coma Recovery Scale-Revised
(CRS-R) score most consistent with?
A) Coma
, B) Vegetative state (unresponsive wakefulness
syndrome)
C) Minimally conscious state (MCS)
D) Emergence from MCS
Correct answer: C
Rationale: Localization to pain and inconsistent
verbalizations indicate minimally conscious state
(MCS). Vegetative state has reflexive movements
only.
6. A 55-year-old male with chronic TBI (5 years post-
injury) presents with progressive gait disturbance,
urinary incontinence, and cognitive decline over 6
months. Head CT shows ventricular enlargement out
of proportion to atrophy. Which is the most likely
diagnosis?
A) Alzheimer's dementia
B) Normal pressure hydrocephalus (NPH)
C) Chronic subdural hematoma
D) Progressive supranuclear palsy
Correct answer: B
Rationale: NPH can occur after TBI. The triad of gait
disturbance, incontinence, and cognitive decline with
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 25-year-old male sustains a severe traumatic
brain injury (TBI) after a motor vehicle accident.
Initial Glasgow Coma Scale (GCS) score was 6.
Which neuroimaging finding is most associated with
poor long-term functional outcome?
A) Subdural hematoma <5 mm
B) Traumatic subarachnoid hemorrhage
C) Diffuse axonal injury (DAI) on MRI
D) Isolated epidural hematoma
Correct answer: C
Rationale: Diffuse axonal injury, particularly involving
the corpus callosum and brainstem, is strongly
associated with prolonged impaired consciousness
and poor functional outcomes after severe TBI.
2. A 45-year-old male with moderate TBI (GCS 11) is
evaluated 6 months post-injury. He reports persistent
headaches, dizziness, and difficulty concentrating.
,Neurologic exam is normal. Which is the most
appropriate next step?
A) Repeat head CT
B) Lumbar puncture
C) Neuropsychological testing
D) Trial of amitriptyline for post-concussive syndrome
Correct answer: D
Rationale: Post-concussive syndrome is common
after mild-to-moderate TBI. Amitriptyline (low dose) is
effective for headache and sleep disturbance.
Neuropsychological testing is not first-line.
3. A 60-year-old female with a fall and mild TBI (GCS
15) presents 3 hours after injury. She is on warfarin
for atrial fibrillation (INR 2.5). Which is the most
appropriate next step?
A) Discharge home with observation
B) Repeat head CT in 6 hours
C) Admit for observation and reverse anticoagulation
D) Non-contrast head CT now
Correct answer: D
Rationale: Patients on anticoagulation with any TBI
require immediate non-contrast head CT due to risk
,of delayed intracranial hemorrhage. Admission and
reversal depend on CT findings.
4. A 30-year-old male with severe TBI (GCS 5) is
admitted to the ICU. His intracranial pressure (ICP)
monitor reads 25 mmHg. Which is the first-line
intervention to lower ICP?
A) Hyperventilation to PaCO2 25 mmHg
B) Mannitol 1 g/kg IV
C) Elevate head of bed to 30 degrees
D) Pentobarbital coma
Correct answer: C
Rationale: Head elevation (30 degrees) improves
venous drainage and is first-line for mild ICP
elevation. Hyperventilation is reserved for herniation.
Mannitol for sustained ICP >20.
5. A 22-year-old female with severe TBI is 2 weeks
post-injury. She opens eyes to noxious stimulation,
localizes to pain, and has inconsistent verbalizations
(moans). What is her Coma Recovery Scale-Revised
(CRS-R) score most consistent with?
A) Coma
, B) Vegetative state (unresponsive wakefulness
syndrome)
C) Minimally conscious state (MCS)
D) Emergence from MCS
Correct answer: C
Rationale: Localization to pain and inconsistent
verbalizations indicate minimally conscious state
(MCS). Vegetative state has reflexive movements
only.
6. A 55-year-old male with chronic TBI (5 years post-
injury) presents with progressive gait disturbance,
urinary incontinence, and cognitive decline over 6
months. Head CT shows ventricular enlargement out
of proportion to atrophy. Which is the most likely
diagnosis?
A) Alzheimer's dementia
B) Normal pressure hydrocephalus (NPH)
C) Chronic subdural hematoma
D) Progressive supranuclear palsy
Correct answer: B
Rationale: NPH can occur after TBI. The triad of gait
disturbance, incontinence, and cognitive decline with
