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Exam Review

Key Facts: ABA Neurocritical Care Exam

270

Exam Questions

Five 54-question sections, single-best-answer MCQ

320 min

Scheduled Testing Time

Plus up to 40 min optional pooled breaks

$2,500

Standard Fee

ABA — December to April

2018

ABMS Recognized

Multi-board subspecialty

Pearson VUE

Test Provider

Admin by ABPN

Every other year

Exam Frequency

Even-numbered years; next 2028

The NCC exam is a computer-based test at Pearson VUE: 270 one-best-answer multiple-choice questions in five 54-question sections, with 320 minutes of scheduled testing time plus up to 40 minutes of optional pooled breaks, administered by ABPN on behalf of the ABA. Candidates must hold an ABA primary certification, maintain MOCA, and satisfy fellowship or practice pathway eligibility. Standard registration is $2,500 (late $3,000). The exam is offered every other year in even-numbered years (2026 exam Oct 5-9; next in 2028). ABMS approved the multi-board subspecialty in 2018 and ABPN gave the first exam in 2021; UCNS still offers its own separate, non-ABMS NCC certification.

Sample ABA Neurocritical Care Practice Questions

Try these sample questions to review concepts for the ABA Neurocritical Care exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old man presents with acute right hemiparesis and aphasia. Last known well was 90 minutes ago. CT head shows no hemorrhage. BP is 172/96, glucose 142, platelets 220,000. NIHSS is 14. Which is the MOST appropriate next step?
A.Withhold tPA until BP is <140/90
B.Administer IV alteplase 0.9 mg/kg
C.Administer tenecteplase 0.5 mg/kg IV bolus
D.Proceed directly to mechanical thrombectomy without IV thrombolysis
Explanation: Patient is within the 3-hour window with no contraindications. BP <185/110 is acceptable for tPA administration per AHA/ASA guidelines. Alteplase dose is 0.9 mg/kg (max 90 mg) with 10% bolus. Tenecteplase 0.25 mg/kg (not 0.5) is an acceptable alternative in some centers, but 0.9 mg/kg alteplase remains the standard. IV tPA should not be delayed for thrombectomy when eligible.
2Which NIHSS score range is generally considered moderate stroke severity?
A.1-4
B.5-15
C.16-20
D.21-42
Explanation: NIHSS is stratified as: 0 = no stroke, 1-4 = minor, 5-15 = moderate, 16-20 = moderate-severe, 21-42 = severe. Scores >=6 generally qualify for thrombectomy consideration with large vessel occlusion.
3A patient presents 4 hours after stroke onset with NIHSS 12 and no hemorrhage on CT. Which is an ABSOLUTE contraindication to IV alteplase in the 3-4.5 hour window per original ECASS III exclusions?
A.Age >80
B.Prior ischemic stroke 6 months ago
C.NIHSS >25
D.Mild diabetes
Explanation: Original ECASS III extended window (3-4.5 hrs) exclusions included NIHSS >25, age >80, combined prior stroke + diabetes, and anticoagulation regardless of INR. AHA/ASA 2019 guidelines have relaxed age >80 and prior stroke criteria, but severe stroke (NIHSS >25) remains a relative contraindication with variable practice.
4A patient is eligible for IV alteplase. Current BP is 198/112. What is the MOST appropriate management?
A.Administer alteplase immediately since BP is <220/120
B.Lower BP to <185/110 with IV labetalol or nicardipine before alteplase
C.Withhold alteplase permanently
D.Administer sublingual nifedipine
Explanation: Pre-tPA BP must be <185/110. Use IV labetalol 10-20 mg boluses or nicardipine 5-15 mg/hr infusion. Post-tPA BP target is <180/105 for 24 hours. Sublingual nifedipine causes precipitous drops and is contraindicated. Withholding tPA is inappropriate if BP can be safely lowered.
5DAWN trial criteria for thrombectomy in the 6-24 hour window require which of the following?
A.NIHSS <6 and infarct volume >70 mL
B.Clinical-core mismatch (small core on imaging relative to clinical severity)
C.Age <50 only
D.Perfusion deficit <10 mL
Explanation: DAWN enrolled patients 6-24 hours post-stroke with clinical-core mismatch: NIHSS >=10 with small infarct core measured by DWI or CT perfusion (varying by age — <31 mL if <80 yrs with NIHSS >=10; <51 mL if NIHSS >=20). DEFUSE-3 (6-16 hrs) used perfusion mismatch with core <70 mL and mismatch ratio >=1.8.
6A patient presents 8 hours after stroke onset with LVO on CTA. CT perfusion shows core 30 mL, penumbra 90 mL. What is the best next step?
A.IV alteplase only
B.No reperfusion therapy, focus on medical management
C.Mechanical thrombectomy
D.Hemicraniectomy
Explanation: Patient meets DEFUSE-3 criteria (6-16 hrs, core <70 mL, mismatch ratio >=1.8, mismatch volume >=15 mL) for thrombectomy. IV tPA is not indicated beyond 4.5 hours in most cases. Decompressive hemicraniectomy is for established malignant infarction with mass effect, not acute reperfusion.
7Which finding on MRI is used in the WAKE-UP trial to extend tPA eligibility beyond 4.5 hours when stroke onset is unknown?
A.DWI positivity with FLAIR negativity (DWI-FLAIR mismatch)
B.ADC restriction with GRE hyperintensity
C.SWI hemorrhage
D.T2 hyperintensity without DWI
Explanation: WAKE-UP trial used DWI-FLAIR mismatch (positive DWI, negative FLAIR) to identify patients likely within 4.5 hours of stroke onset, extending tPA eligibility to unknown-onset strokes. IV alteplase improved outcomes in this group.
8Post-tPA, what is the recommended BP target for the first 24 hours?
A.<140/90
B.<160/100
C.<180/105
D.<200/110
Explanation: Post-tPA BP should be maintained <180/105 for 24 hours to minimize hemorrhagic transformation risk. Pre-tPA target is <185/110.
9A patient receiving alteplase infusion develops sudden headache, vomiting, and worsening neurologic exam. What is the priority action?
A.Continue alteplase and repeat NIHSS
B.Stop alteplase, obtain STAT CT head, check coagulation panel, prepare cryoprecipitate and platelets
C.Administer mannitol 1 g/kg
D.Start IV heparin to prevent progression
Explanation: Clinical signs of symptomatic ICH post-tPA require immediate cessation of alteplase, STAT noncontrast CT, CBC/PT/PTT/fibrinogen, and type/cross. Reversal: cryoprecipitate (10 units) for fibrinogen, tranexamic acid or antifibrinolytics, platelet transfusion if on antiplatelets. Heparin would worsen bleeding. Mannitol may be used for mass effect but is not first-line.
10What is the preferred anesthetic approach for most patients undergoing mechanical thrombectomy?
A.General anesthesia for all patients
B.Conscious sedation when feasible, given association with better outcomes in some trials
C.Deep sedation with propofol and paralytics
D.Spinal anesthesia
Explanation: Observational data suggest conscious sedation may be associated with better outcomes than general anesthesia for thrombectomy, though GOLIATH and AnStroke RCTs showed no significant difference. Current practice favors conscious sedation when feasible, reserving GA for agitated or airway-compromised patients. BP should be kept >140 systolic intraprocedurally to maintain cerebral perfusion.

About the ABA Neurocritical Care Exam

The ABA Neurocritical Care subspecialty certification validates expertise in managing critically ill patients with acute neurologic and neurosurgical conditions. Since 2018, neurocritical care has been an ABMS-recognized multi-board subspecialty jointly developed by ABA, ABEM, ABIM, ABNS, and ABPN, and administered by ABPN. Diplomates demonstrate mastery of acute stroke, ICH, SAH, TBI, ICP management, status epilepticus, brain death determination, and neuromuscular respiratory failure.

Exam sponsor: American Board of Anesthesiology (exam administered by ABPN). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

270 questions

Time Limit

320 minutes scheduled (five 54-question sections; 310 min test time, plus 10 min for the NDA/tutorial and survey) plus up to 40 minutes of optional pooled breaks

Passing Score

Criterion-referenced standard score set by ABPN (not norm-referenced; no percentage cut score published)

Exam / Certification Fees

$2,500 standard ($3,000 late)

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

42-48%

Principles of Neurocritical Care

Neurologic exam in the ICU; cerebral/CSF physiology; neuropharmacology (osmotic agents, antiseizure drugs, anesthetics, vasoactives, sedatives, paralytics, thrombolytics, anticoagulants, and reversal of anticoagulation — 4F-PCC/idarucizumab remain first-line; andexanet alfa/Andexxa was withdrawn from the US market effective 2025-12-22, leaving 4F-PCC as the US option for apixaban/rivaroxaban); airway/ventilator management; hemodynamic support (IABP, VADs, ECMO); ICU prophylaxis; trauma; and systemic (pulmonary, cardiovascular, renal, infectious, endocrine, GI, hematologic) complications

13-17%

Diagnostic Studies and Procedural Skills

Neuroimaging (CT/MRI/perfusion/angiography), EEG, ICP monitoring, transcranial Doppler, brain tissue oxygen and multimodality monitoring, EMG/CSF analysis basics, vascular access, and brain death determination. AAN/AAP/CNS/SCCM 2023: apnea test supports BD/DNC only if no respirations occur, arterial pH is <7.30, AND PaCO2 is ≥60 mm Hg and ≥20 mm Hg above the preapnea baseline

27-33%

Neurocritical Care Diseases

Coma/altered consciousness, intracranial hypertension, acute ischemic stroke (2026 AHA/ASA: tenecteplase 0.25 mg/kg [max 25 mg] or alteplase 0.9 mg/kg [max 90 mg] within 4.5 h, both Class 1), ICH (2022 AHA/ASA: mild-moderate ICH with SBP 150-220 -> target 140, maintain 130-150 [COR 2b]; <130 potentially harmful [COR 3]) and IVH, SAH, TBI, spinal cord injury (2024 AO Spine/Praxis: MAP lower limit ≥75-80 mm Hg, not actively raised above 90-95 mm Hg, for 3-7 days), hydrocephalus, CNS infections, status epilepticus, and neuromuscular disorders. Post-cardiac arrest: 2025 AHA 32-37.5 °C (Class 1) for ≥36 h (Class 2a); TTM2 found 33 °C not superior to normothermia

3-7%

Neurosurgical and Perioperative Complications

Postoperative seizures, pneumocephalus, hemorrhage, ischemia, infections, CSF leak, EVD/lumbar drain complications, and cerebral hyperperfusion

3-7%

Ethics, Research, and Practice-Based Learning

Family communication and conflict resolution, advance directives/DNR, neuroprognostication uncertainty, palliative/end-of-life care, withdrawal of care, futility, surrogate decision-making, and organ donation

Preparing for the ABA Neurocritical Care Exam

What You Need to Know

  • Passing score: Criterion-referenced standard score set by ABPN (not norm-referenced; no percentage cut score published)
  • Exam length: 270 questions
  • Time limit: 320 minutes scheduled (five 54-question sections; 310 min test time, plus 10 min for the NDA/tutorial and survey) plus up to 40 minutes of optional pooled breaks
  • Exam / certification fees: $2,500 standard ($3,000 late) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

ABA Neurocritical Care: Suggested Study Strategy

1Master the 2026 AHA/ASA reperfusion rules: IV thrombolysis within 4.5 hours (tenecteplase 0.25 mg/kg, max 25 mg, or alteplase 0.9 mg/kg, max 90 mg; both Class 1); perfusion-selected IVT at 4.5-9 hours or on waking within 9 hours of the sleep midpoint; DWI-FLAIR mismatch for unknown onset; anterior LVO thrombectomy within 6 hours (ASPECTS 3-10) and at 6-24 hours (ASPECTS ≥6, or 3-5 if age <80); basilar thrombectomy within 24 hours (NIHSS ≥10, PC-ASPECTS ≥6).
2Memorize anticoagulation reversal agents: warfarin -> 4F-PCC + vitamin K; dabigatran -> idarucizumab 5 g; apixaban/rivaroxaban -> 4F-PCC (andexanet alfa/Andexxa was withdrawn from the US market effective 2025-12-22)
3Know the ESETT trial findings cold — fosphenytoin, levetiracetam, and valproate are equivalent second-line options for benzodiazepine-refractory status epilepticus
4Drill the AAN/AAP/CNS/SCCM 2023 brain death protocol: coma of known cause, absent brainstem reflexes, and an apnea test that requires ALL three of no respirations, arterial pH <7.30, AND PaCO2 ≥60 mmHg AND ≥20 mmHg above baseline
5Memorize nimodipine dosing for SAH (60 mg PO q4h x 21 days) and DCI timing (peak days 4-14) — these are high-yield every exam cycle

Frequently Asked Questions

What is the ABA Neurocritical Care certification?

The ABA Neurocritical Care (NCC) subspecialty certification is an ABMS-recognized credential for anesthesiologists who have completed a fellowship or meet practice pathway criteria in neurocritical care. Since 2018, the ABA, ABEM, ABIM, ABNS, and ABPN jointly developed NCC as a multi-board subspecialty, with the exam administered by ABPN. Diplomates are qualified to direct neurocritical care units and manage acute brain and spinal cord emergencies.

How many questions are on the ABA Neurocritical Care exam?

The NCC exam is 270 one-best-answer multiple-choice questions delivered in five 54-question sections at Pearson VUE testing centers. Scheduled testing time is 320 minutes (5 min NDA/tutorial, 310 min for the 270 questions, 5 min survey), plus up to 40 minutes of optional pooled breaks between sections. See the ABPN Neurocritical Care Certification Format and Scoring document for details.

What are the eligibility requirements for the ABA NCC exam?

Candidates must (1) hold an unrestricted medical/osteopathic license; (2) maintain at least one primary ABA certification in good standing with MOCA compliance; (3) attest to current NCC privileges and practice averaging at least one day per week during 12 consecutive months in the prior 3 years; and (4) meet a training pathway — after 2026, 1 year of ACGME-accredited critical care fellowship plus 1 year of ACGME-accredited NCC fellowship, or 2 years of ACGME-accredited NCC fellowship (the temporary practice pathway covered only the 2021-2026 exams).

How much does the ABA Neurocritical Care exam cost?

Standard registration (typically December through early April) is $2,500 for first-time takers and $2,125 for retakes. Late registration (about one week after standard closes) is $3,000 / $2,625 for retakes. Payment is made through the ABA portal. Fees are separate from fellowship and other credentialing costs.

When did Neurocritical Care become ABMS-recognized?

Neurocritical Care became ABMS-recognized in 2018 through a co-sponsored multi-board pathway involving the ABA, ABEM, ABIM, ABNS, and ABPN. Prior to 2018, the UCNS (United Council for Neurologic Subspecialties) offered certification starting in 2007. UCNS and CAST certifications remain qualifying pathways for the practice-pathway period through 2026. ABPN administers the ABMS-recognized exam.

What is the passing score for the ABA NCC exam?

ABPN reports a standard (scaled) score for the total test. The standard is criterion-referenced, not norm-referenced — there is no predefined passing rate for any group of examinees, and ABPN does not publish a percentage-correct cut score. Examinees also receive a graphic diagnostic report showing performance by content domain.

How should I prepare for the ABA NCC exam?

Weight your study to the real ABPN blueprint: Principles of neurocritical care (42-48%) and Neurocritical care diseases (27-33%) together make up most of the exam, with Diagnostic studies and procedural skills (13-17%) and smaller Neurosurgical/perioperative complications and Ethics domains (3-7% each). Master Brain Trauma Foundation guidelines, the AAN/AAP/CNS/SCCM 2023 brain death criteria, current AHA/ASA stroke and ICH guidelines, and NCS status epilepticus and SAH guidelines. Practice with high-yield question banks and a cEEG pattern atlas.

What happens if I fail the ABA Neurocritical Care exam?

If unsuccessful, you may reapply for the next exam administration (every other year; next in 2028) with a reduced retake fee ($2,125 standard / $2,625 late). ABPN states there is currently no limit on the number of times an applicant may apply, but certificates are time-limited and you must remain in good standing with your primary ABA certification to sit again. Review your performance report to target weak domains before retaking.