100+ Free ABEM Neurocritical Care Practice Questions
Pass your Neurocritical Care Subspecialty Certification (UCNS/ABMS multidisciplinary; ABEM-issued for EM diplomates) exam on the first try — instant access, no signup required.
A 62-year-old presents with right hemiparesis and aphasia, last known well 2 hours ago. Non-contrast CT shows no hemorrhage, no large established infarct. BP is 172/96 mmHg. Which dose of IV alteplase is correct?
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Key Facts: ABEM Neurocritical Care Exam
~200
Multiple-Choice Questions
ABPN NCC Multidisciplinary Exam Information
~4 hours
Computer-Based Test Length at Pearson VUE
ABPN / Pearson VUE
~$2,200-$2,500
Multidisciplinary Subspecialty Exam Fee
ABMS Multidisciplinary Subspecialty Fee Schedule
~85-90%
First-Time Pass Rate (Historical UCNS/ABMS)
UCNS / ABPN Public Pass Rate Data
2 years
ACGME-Accredited NCC Fellowship Required
ACGME Neurocritical Care Program Requirements
5 boards
Participating ABMS Boards (ABPN, ABNS, ABA, ABIM, ABEM)
ABMS Multidisciplinary Subspecialty Structure
The Neurocritical Care (NCC) subspecialty certification is a multidisciplinary ABMS exam administered by ABPN, with ABEM credentialing and issuing the certificate to its emergency medicine diplomates who complete an ACGME-accredited two-year NCC fellowship. The exam is approximately 200 multiple-choice questions delivered over ~4 hours at Pearson VUE testing centers in a single computer-based session, with a criterion-referenced pass/fail score determined by ABMS/ABPN standard-setting. Eligible candidates must hold primary ABMS certification (Neurology, Neurosurgery, Anesthesiology, Internal Medicine, or Emergency Medicine) and have completed an ACGME-accredited Neurocritical Care fellowship (typically two years). The exam fee is approximately $2,200-$2,500. Content blueprints follow the United Council for Neurologic Subspecialties (UCNS) historical Core Curriculum, now harmonized with the ABMS multidisciplinary blueprint, and emphasize: acute ischemic stroke (IV alteplase 0.9 mg/kg within 4.5 h, mechanical thrombectomy up to 24 h via DAWN/DEFUSE-3), intracerebral hemorrhage (SBP 130-150 mmHg per INTERACT3 / ATACH-2 / ANNEXA-I, anticoagulant reversal), aneurysmal subarachnoid hemorrhage (oral nimodipine 60 mg q4h x 21 days, vasospasm screening with TCD and CTA/CTP, delayed cerebral ischemia), traumatic brain injury (BTF guidelines: ICP <22 mmHg, CPP 60-70 mmHg, hyperosmolar therapy with 23.4% saline or mannitol 0.25-1 g/kg), refractory and super-refractory status epilepticus (continuous EEG, midazolam/propofol/pentobarbital infusions per NCS guidelines), neuromuscular respiratory failure (NIF <-20, FVC <15 mL/kg → intubate; IVIG 2 g/kg or PLEX), brain death determination per AAN 2023 evidence-based update (apnea test, ancillary studies), neurosurgical emergencies (EVD management, decompressive craniectomy criteria), neuromonitoring (ICP, brain tissue oxygen, microdialysis, continuous EEG), post-cardiac arrest targeted temperature management 32-36°C per AHA/ILCOR, and ethics/prognostication (multimodal hypoxic-ischemic prognostication: NSE, SSEP, MRI, EEG reactivity).
Sample ABEM Neurocritical Care Practice Questions
Try these sample questions to test your ABEM 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 62-year-old presents with right hemiparesis and aphasia, last known well 2 hours ago. Non-contrast CT shows no hemorrhage, no large established infarct. BP is 172/96 mmHg. Which dose of IV alteplase is correct?
2Per the DAWN and DEFUSE-3 trials, mechanical thrombectomy for anterior-circulation large vessel occlusion can be considered up to how many hours from last known well in selected patients with favorable imaging mismatch?
3Before IV alteplase administration, blood pressure should be lowered to below which threshold per AHA/ASA guidelines?
4After IV alteplase, blood pressure should be maintained below which threshold for the first 24 hours?
5A 48-year-old with a complete MCA territory infarct develops worsening obtundation and 6 mm of midline shift on CT at hour 36. Which intervention has demonstrated mortality benefit per pooled DESTINY/DECIMAL/HAMLET data?
6Which trials extended endovascular therapy to acute basilar artery occlusion?
7The NIH Stroke Scale (NIHSS) ranges from what minimum to maximum score?
8Tenecteplase as an alternative to alteplase for acute ischemic stroke is typically administered as which dose and route?
9Per the INTERACT3 care bundle for spontaneous intracerebral hemorrhage, what is the recommended early systolic blood pressure target?
10A patient on dabigatran develops a 30 mL parenchymal hemorrhage. The most appropriate specific reversal agent is:
About the ABEM Neurocritical Care Exam
Neurocritical Care (NCC) is a multidisciplinary subspecialty certification covering critically ill patients with primary neurologic or neurosurgical disease, or systemic illness with neurologic complications. ABPN administers the exam under the ABMS multidisciplinary structure; ABEM is one of the participating boards that credentials and issues certification to its emergency medicine diplomates who complete an ACGME-accredited Neurocritical Care fellowship. Content reflects the daily practice of a neurointensivist: ischemic stroke (tPA, thrombectomy, post-procedural care), intracerebral hemorrhage (BP control, reversal of anticoagulants), aneurysmal subarachnoid hemorrhage (vasospasm, delayed cerebral ischemia, nimodipine), traumatic brain injury (ICP-directed therapy, CPP targets), status epilepticus (continuous EEG, refractory and super-refractory management), neuromuscular respiratory failure (Guillain-Barré, myasthenic crisis), brain death determination, and post-cardiac arrest targeted temperature management.
Questions
200 scored questions
Time Limit
~4 hours (computer-based at Pearson VUE; one-day administration)
Passing Score
Criterion-referenced pass/fail (scaled score by ABMS/ABPN standard-setting)
Exam Fee
~$2,200-$2,500 (multidisciplinary subspecialty exam fee) (ABMS multidisciplinary subspecialty (ABPN administers; ABEM credentials for EM-trained diplomates) / Pearson VUE)
ABEM Neurocritical Care Exam Content Outline
Acute Ischemic Stroke
IV alteplase 0.9 mg/kg (10% bolus, 90% over 60 min) within 4.5 h of last-known-well; tenecteplase emerging alternative. Mechanical thrombectomy for LVO up to 24 h via DAWN/DEFUSE-3. Pre-tPA BP <185/110 (labetalol, nicardipine). Post-tPA BP <180/105 x 24 h. Decompressive hemicraniectomy for malignant MCA stroke <48-72 h (DESTINY/DECIMAL/HAMLET). Posterior circulation/basilar occlusion (BAOCHE, ATTENTION trials).
Intracerebral & Intraventricular Hemorrhage
SBP target 130-150 mmHg within 1 h (INTERACT3 care bundle). Anticoagulant reversal: warfarin → 4F-PCC + vitamin K; dabigatran → idarucizumab; apixaban/rivaroxaban → andexanet alfa or 4F-PCC; heparin → protamine. ICH score for prognosis. EVD for IVH with hydrocephalus; CLEAR III intraventricular alteplase. Surgical evacuation for cerebellar ICH >3 cm or with brainstem compression/hydrocephalus (STICH/MISTIE III).
Subarachnoid Hemorrhage & Vasospasm/DCI
Aneurysmal SAH: secure aneurysm <24-72 h (clip vs coil per ISAT). Hunt-Hess and modified Fisher grading. Oral nimodipine 60 mg q4h x 21 days (improves outcomes, not vasospasm). Vasospasm peaks day 4-14: daily TCD (MCA mean velocity >120 or Lindegaard ratio >3), CTA/CTP for screening. DCI treatment: induced hypertension, intra-arterial verapamil/milrinone, balloon angioplasty. Hydrocephalus → EVD. Hyponatremia (CSW vs SIADH; treat CSW with salt + fludrocortisone, avoid fluid restriction).
Traumatic Brain Injury & ICP Management
BTF 4th edition: ICP threshold <22 mmHg, CPP target 60-70 mmHg. Tiered ICP therapy: HOB 30°, sedation/analgesia, normothermia, normocapnia (PaCO2 35-40), hyperosmolar (23.4% saline 30 mL bolus or mannitol 0.25-1 g/kg q6h - watch osm gap, serum Na <160), CSF drainage via EVD, neuromuscular blockade, decompressive craniectomy (DECRA/RESCUEicp). Avoid prophylactic hyperventilation. Levetiracetam 7-day seizure prophylaxis for severe TBI. Progesterone NOT effective (PROTECT III/SYNAPSE).
Status Epilepticus & Continuous EEG
NCS algorithm: stabilization 0-5 min, initial therapy 5-20 min (lorazepam 0.1 mg/kg IV or midazolam 10 mg IM if no IV), second-line 20-40 min (fosphenytoin 20 mg PE/kg, levetiracetam 60 mg/kg, valproate 40 mg/kg per ESETT). Refractory SE (>40 min or 2 failed agents): continuous infusions - midazolam 0.2 mg/kg load + 0.05-2 mg/kg/h, propofol 1-2 mg/kg + 30-200 mcg/kg/min, pentobarbital. Super-refractory SE (>24 h on infusion): ketamine, isoflurane, immunotherapy. Continuous EEG for NCSE, periodic discharges, ictal-interictal continuum (Salzburg criteria).
Neuromuscular Respiratory Failure
Guillain-Barré: NIF less negative than -20 cmH2O, FVC <15-20 mL/kg, or 20/30/40 rule (VC <20, MIP <-30, MEP <40) → intubate before bulbar collapse; IVIG 0.4 g/kg/day x 5 days OR plasma exchange 5 sessions; avoid steroids; dysautonomia (avoid succinylcholine - hyperkalemia risk after day 3). Myasthenic crisis: IVIG/PLEX, avoid steroid burst initially (transient worsening), hold AChE inhibitors during intubation. ALS, botulism, tick paralysis. Cholinergic vs myasthenic crisis (edrophonium test largely historical).
Brain Death Determination & Ethics
AAN 2023 pediatric and adult brain death/death by neurologic criteria (BD/DNC) consensus: prerequisites (known cause, exclude confounders - hypothermia <36°C, drug intoxication, severe metabolic, NMB), clinical exam (coma, absent brainstem reflexes - pupillary, corneal, oculocephalic/oculovestibular, gag, cough), apnea test (PaCO2 rise ≥20 mmHg above baseline to ≥60 with no respiratory effort), ancillary tests when apnea test cannot be completed (EEG, cerebral angiography, nuclear flow, TCD). Ethics: shared decision-making, surrogate decision-making, withdrawal of life-sustaining therapy, organ donation.
Post-Cardiac Arrest Care & TTM
AHA/ILCOR post-ROSC bundle: targeted temperature 32-36°C x 24 h (TTM, TTM2 - 33°C vs 36°C vs normothermia/fever control showed no mortality difference but 33°C remains acceptable), avoid fever x 72 h, normoxia (SpO2 92-98%), normocapnia, MAP ≥65, treat seizures aggressively. Multimodal neuroprognostication ≥72 h after rewarming: bilateral absent pupillary/corneal reflexes, status myoclonus <72 h with malignant EEG, bilaterally absent N20 SSEP, NSE >60 mcg/L day 1-3, diffuse anoxic injury on MRI/DWI, suppressed/burst-suppressed EEG (ERC/ESICM 2021).
Neurosurgical Emergencies & EVD Management
EVD insertion (Kocher's point), zero at tragus, drainage 10-20 cm H2O above tragus, daily CSF sampling for ventriculitis (cell index, glucose, Gram stain). Decompressive craniectomy for malignant MCA stroke and refractory ICH/TBI. Posterior fossa decompression for cerebellar stroke/hemorrhage. Spinal cord injury: MAP 85-90 mmHg x 7 days, methylprednisolone NOT recommended (NASCIS controversial). Acute hydrocephalus, CSF leak, postoperative complications. Pituitary apoplexy (stress-dose hydrocortisone first, then surgical decompression).
Neuromonitoring (ICP, EEG, Multimodal)
ICP monitoring: external ventricular drain (gold standard, also therapeutic) vs intraparenchymal (Camino, Codman) vs subarachnoid bolt. PbtO2 (brain tissue oxygen) goal >20 mmHg (BOOST-II/III trials). Cerebral microdialysis (lactate/pyruvate ratio >40 = ischemia). Jugular venous oxygen saturation (SjvO2 55-75%). Continuous EEG indications (NCS): unexplained altered mental status, refractory SE, post-cardiac arrest, SAH for vasospasm/DCI. Quantitative EEG, ictal-interictal continuum.
Sedation, Analgesia, & Delirium
Sedation in NeuroICU: prefer light sedation with frequent neuro exams (RASS -1 to 0). Propofol (rapid offset, watch PRIS - bradycardia, metabolic acidosis, rhabdomyolysis if >4 mg/kg/h >48 h), dexmedetomidine (light sedation, no respiratory depression), avoid benzodiazepines when possible (delirium risk). Analgesia-first sedation (fentanyl, hydromorphone). Daily SAT/SBT (ABCDEF bundle). CAM-ICU for delirium, treat precipitants, avoid haloperidol/quetiapine routinely (MIND-USA negative).
Spinal Cord Emergencies & Misc Neurology
Acute traumatic SCI: MAP 85-90 mmHg x 7 days; methylprednisolone NOT recommended per AANS/CNS guidelines. Cauda equina syndrome (urgent MRI, decompression <48 h). Autonomic dysreflexia (T6 and above, treat trigger, sit upright, antihypertensive). Acute transverse myelitis. NMOSD, MS pseudoexacerbation. Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). CNS infections (HSV encephalitis - acyclovir; bacterial meningitis empirics).
How to Pass the ABEM Neurocritical Care Exam
What You Need to Know
- Passing score: Criterion-referenced pass/fail (scaled score by ABMS/ABPN standard-setting)
- Exam length: 200 questions
- Time limit: ~4 hours (computer-based at Pearson VUE; one-day administration)
- Exam fee: ~$2,200-$2,500 (multidisciplinary subspecialty exam fee)
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
ABEM Neurocritical Care Study Tips from Top Performers
Frequently Asked Questions
What is the Neurocritical Care subspecialty exam and who administers it?
Neurocritical Care (NCC) is a multidisciplinary ABMS subspecialty certification for physicians who care for critically ill patients with primary neurologic or neurosurgical disease, or systemic illness with neurologic complications. The American Board of Psychiatry and Neurology (ABPN) administers the exam under the multidisciplinary structure on behalf of five participating ABMS boards: ABPN (Neurology), American Board of Neurological Surgery, American Board of Anesthesiology, American Board of Internal Medicine, and the American Board of Emergency Medicine (ABEM). ABEM credentials and issues the certificate to its emergency-medicine diplomates who complete an ACGME-accredited NCC fellowship. The exam is computer-based at Pearson VUE.
Who is eligible to take the ABEM/ABPN Neurocritical Care exam?
Candidates must hold current primary ABMS certification in one of the five participating boards (Neurology, Neurosurgery, Anesthesiology, Internal Medicine, or Emergency Medicine), have an active unrestricted medical license, and have successfully completed an ACGME-accredited Neurocritical Care fellowship (typically two years). The fellowship pathway replaced the prior UCNS practice-track and grandfathering options, which closed in 2022. EM applicants apply through ABEM, which credentials them and issues the multidisciplinary subspecialty certificate after they pass the ABPN-administered exam.
How is the NCC exam structured and how much does it cost?
The NCC exam is approximately 200 single-best-answer multiple-choice questions delivered over approximately 4 hours in a single computer-based session at Pearson VUE testing centers. The fee is approximately $2,200-$2,500 (multidisciplinary subspecialty exam fee, set annually). Passing requires a criterion-referenced scaled score determined by ABMS/ABPN standard-setting. Continuing certification follows the participating board's MOC pathway (e.g., ABEM diplomates use MyEMCert plus the NCC subspecialty MOC requirements).
What are the highest-yield topics on the Neurocritical Care exam?
High-yield areas: (1) acute ischemic stroke - IV alteplase within 4.5 h, thrombectomy up to 24 h via DAWN/DEFUSE-3, decompressive hemicraniectomy for malignant MCA <48-72 h; (2) ICH - SBP 130-150 mmHg per INTERACT3, anticoagulant reversal (idarucizumab, andexanet, 4F-PCC); (3) aneurysmal SAH - oral nimodipine 60 mg q4h x 21 days, vasospasm screening with TCD/CTA, DCI treatment (induced hypertension, intra-arterial vasodilators); (4) TBI - BTF guidelines (ICP <22, CPP 60-70), 23.4% saline or mannitol, decompressive craniectomy (DECRA/RESCUEicp); (5) status epilepticus - lorazepam first-line, ESETT-validated second-line agents (fosphenytoin/levetiracetam/valproate), midazolam/propofol/pentobarbital infusions for refractory SE; (6) brain death determination per AAN 2023 update; (7) post-cardiac arrest TTM 32-36°C and multimodal neuroprognostication; (8) neuromuscular respiratory failure (Guillain-Barré 20/30/40 rule).
How do BTF guidelines and recent trials affect ICP management on the exam?
Brain Trauma Foundation (BTF) 4th edition guidelines: treat ICP >22 mmHg, target CPP 60-70 mmHg. Tier 1 measures: head of bed 30 degrees, sedation/analgesia, normothermia, normocapnia (PaCO2 35-40 mmHg), CSF drainage via EVD. Tier 2: hyperosmolar therapy (23.4% saline 30 mL bolus or mannitol 0.25-1 g/kg q6h, follow serum sodium and osm gap, hold mannitol if osm gap >20). Tier 3: neuromuscular blockade, brief mild hyperventilation as a bridge, decompressive craniectomy (RESCUEicp showed reduced mortality but more disability vs medical management; DECRA showed early bifrontal craniectomy was harmful). Avoid prophylactic hyperventilation. Levetiracetam for 7-day seizure prophylaxis in severe TBI. Steroids contraindicated in TBI (CRASH trial - increased mortality).
What does the 2023 AAN brain death/death by neurologic criteria update change?
The 2023 AAN/AAP/CNS/SCCM consensus practice guideline harmonized adult and pediatric BD/DNC determination into a single framework. Prerequisites: established cause of catastrophic brain injury, exclude confounders (core temperature ≥36°C, normal MAP, no neuromuscular blockade, no severe metabolic/endocrine derangement, drug clearance ≥5 half-lives or therapeutic levels). Clinical exam: coma, absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag, cough). Apnea test: PaCO2 rises ≥20 mmHg above baseline to ≥60 mmHg with no respiratory effort. If apnea test cannot be completed, ancillary tests include EEG (electrocerebral silence), 4-vessel cerebral angiography (no intracranial flow), nuclear cerebral perfusion scan (no flow), or TCD (oscillating/reverberating waveform). One examiner is sufficient in adults; two separate exams in children with age-based observation periods.
How should I prepare for the Neurocritical Care board exam?
Anchor your study to the multidisciplinary NCC blueprint (harmonized from the historical UCNS Core Curriculum). Core texts: 'Neurocritical Care' by Suarez or 'Textbook of Neurointensive Care' by Layon/Gabrielli; 'The NeuroICU Book' by Lee for high-yield review; Continuum Lifelong Learning Neurology issues on neurocritical care. Question banks: Neurocritical Care Society SAE (self-assessment exam), BoardVitals NCC, and Rosh-style review resources. Practice 30-50 questions/day for 3-4 months. Master guideline-based numerics: tPA window 4.5 h, thrombectomy 24 h, BTF ICP <22/CPP 60-70, INTERACT3 SBP 130-150, nimodipine 60 mg q4h x 21 d, GBS 20/30/40 rule, ESETT trial second-line agents, AAN 2023 brain death prerequisites. Take 2 full-length practice exams in the final month. Typical successful candidates invest 200-400 hours of dedicated study during/after fellowship.
What is the pass rate and how does continuing certification work for NCC?
Historical UCNS first-time pass rates ran approximately 85-90% in the multidisciplinary NCC cohort. ABMS-administered first-attempt rates have been similar in early administrations. Candidates who fail may retake the exam at the next administration. Continuing certification follows the candidate's primary ABMS board's MOC pathway plus subspecialty MOC requirements: ABEM diplomates participate in MyEMCert (4 of 8 modules per 5-year cycle including the Neurology module) plus periodic NCC subspecialty MOC activities. Maintenance requires an annual fee, active license, practice improvement, and Code of Professionalism agreement.