100+ Free ABA Neurocritical Care Practice Questions

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A 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?

Withhold tPA until BP is <140/90

Administer IV alteplase 0.9 mg/kg

Administer tenecteplase 0.5 mg/kg IV bolus

Proceed directly to mechanical thrombectomy without IV thrombolysis

to track

2026 Statistics

Key Facts: ABA Neurocritical Care Exam

~200

Exam Questions

Single-best-answer MCQ

~4 hrs

Exam Duration

One computer-based session

$2,500

Standard Fee

ABA — December to April

2018

ABMS Recognized

Multi-board subspecialty

Pearson VUE

Test Provider

Admin by ABPN

Annual

Exam Frequency

Offered every year

The NCC exam is a computer-based test at Pearson VUE, approximately 200 multiple-choice questions over 4 hours, 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 transitioned from UCNS to ABMS recognition in 2018, with ABA offering it to anesthesiologists via the multi-board pathway.

Sample ABA Neurocritical Care Practice Questions

Try these sample questions to test your ABA Neurocritical Care exam readiness. 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 offered through ABA, ABIM, ABPN, ABS, and ABEM. Diplomates demonstrate mastery of acute stroke, ICH, SAH, TBI, ICP management, status epilepticus, brain death determination, and neuromuscular respiratory failure.

Questions

200 scored questions

Time Limit

Approximately 4 hours

Passing Score

Criterion-referenced (ABPN standard-setting)

Exam Fee

$2,500 standard ($3,000 late) (American Board of Anesthesiology (exam administered by ABPN))

ABA Neurocritical Care Exam Content Outline

15%

Acute Ischemic Stroke

NIHSS scoring, tPA eligibility (3/4.5 hr and MRI-based extended), thrombectomy (DAWN/DEFUSE-3), BP management, malignant MCA

15%

Intracerebral Hemorrhage

Hematoma expansion, spot sign, INTERACT-2 BP target, warfarin/DOAC reversal (4F-PCC, idarucizumab, andexanet), ICH score

15%

Subarachnoid Hemorrhage

Hunt-Hess, Modified Fisher, nimodipine 60 mg q4h x 21 days, DCI days 4-14, induced hypertension, hydrocephalus, CSW vs SIADH

10%

Status Epilepticus & EEG

Lorazepam 0.1 mg/kg first-line, ESETT 2nd-line (fosphenytoin 20 PE/kg, LEV 60 mg/kg, valproate), refractory/super-refractory, NCSE

10%

ICP Management

EVD vs parenchymal, CPP >=60, HTS 23.4% vs mannitol 1 g/kg, hyperventilation rescue, herniation, tier-3 therapy

10%

TBI & Spinal Cord Injury

Brain Trauma Foundation guidelines, GCS, decompressive craniectomy, SCI MAP target >=85 for 5-7 days, neurogenic shock

10%

Brain Death & Post-Cardiac Arrest

AAN criteria, apnea test (PaCO2 rise >=20), ancillary testing, TTM (TTM2), multimodal prognostication at 72 hrs

Neuromuscular & Autoimmune

Myasthenic crisis (IVIG/PLEX), GBS, 20/30/40 rule for intubation, anti-NMDAR encephalitis, paraneoplastic

Infections & General ICU

Bacterial meningitis empiric therapy, HSV encephalitis, glucose control, NPE/ARDS, transfusion thresholds, DVT prevention

How to Pass the ABA Neurocritical Care Exam

What You Need to Know

Passing score: Criterion-referenced (ABPN standard-setting)
Exam length: 200 questions
Time limit: Approximately 4 hours
Exam fee: $2,500 standard ($3,000 late)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABA Neurocritical Care Study Tips from Top Performers

1Master the tPA eligibility windows (3 hr standard, 4.5 hr ECASS III extended, MRI-based DWI-FLAIR mismatch for unknown onset) and thrombectomy criteria (DAWN 6-24 hrs, DEFUSE-3 6-16 hrs)

2Memorize anticoagulation reversal agents: warfarin -> 4F-PCC + vitamin K; dabigatran -> idarucizumab 5 g; apixaban/rivaroxaban -> andexanet alfa or 4F-PCC

3Know the ESETT trial findings cold — fosphenytoin, levetiracetam, and valproate are equivalent second-line options for benzodiazepine-refractory status epilepticus

4Drill the AAN brain death protocol: coma of known cause, absent brainstem reflexes, and apnea test with PaCO2 rise >=20 mmHg above baseline or absolute >=60

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 fellowship or meet practice pathway criteria in neurocritical care. Since 2018, the ABA, ABIM, ABPN, ABS, and ABEM jointly recognize 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 approximately 200 multiple-choice single-best-answer questions administered in one computer-based session at Pearson VUE testing centers. Total duration is approximately 4 hours including optional breaks. Exact counts can vary by year — consult the ABPN Format and Scoring document posted each cycle.

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) complete an ACGME-accredited neurocritical care fellowship OR qualify via the practice pathway (attesting to NCC practice at least one day per week for 12 consecutive months over the prior 3 years), OR hold prior UCNS/CAST NCC certification.

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, ABIM, ABPN, ABS, and ABEM. Prior to 2018, the UCNS (United Council for Neurologic Subspecialties) offered certification starting in 2007. UCNS and CAST certifications remain qualifying pathways for the new exam during the transition. ABPN administers the ABMS-recognized exam.

What is the passing score for the ABA NCC exam?

ABPN uses a criterion-referenced standard-setting process (modified Angoff) where content experts determine minimum competency. There is no fixed percentage published; historically, passing performance maps to roughly 70-75% correct, but this varies by form. Scores are reported as scaled scores with pass/fail designation.

How should I prepare for the ABA NCC exam?

Focus first on vascular emergencies (stroke, ICH, SAH) which comprise nearly half the blueprint. Master Brain Trauma Foundation guidelines, AAN brain death criteria, ESETT status epilepticus algorithm, and NCS guidelines for ICH, SAH, and DCI. Use Neurocritical Care Society core curriculum, ENLS protocols, and current AHA/ASA stroke guidelines. Practice with high-yield question banks and cEEG atlas for PLEDs/GPEDs patterns.

What happens if I fail the ABA Neurocritical Care exam?

If unsuccessful, you may reapply for the next annual exam cycle with a reduced retake fee ($2,125 standard / $2,625 late). There is no lifetime attempt limit for the subspecialty exam itself, 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.