Free Practice Questions for ABEM Neurocritical Care

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 its emergency-medicine diplomates who meet the training or practice-pathway criteria and sends them their results. The exam is computer-based at Pearson VUE.

ABEM candidates must be ABEM certified and actively participating in ABEM continuing certification and have an active unrestricted medical license. After the 2026 administration, EM candidates need either 1 year of ACGME-accredited critical care fellowship plus 1 year of ACGME-accredited neurocritical care fellowship, or 2 years of ACGME-accredited neurocritical care fellowship. A practice pathway (UCNS/CAST certification, a qualifying fellowship, or attested NCC practice) was accepted for the last time for the 2026 exam (applications closed April 17, 2026); once approved, those candidates have 4 exam cycles within 7 years of board eligibility to test. EM applicants apply through ABEM, which credentials them and issues the multidisciplinary subspecialty certificate after they pass the ABPN-administered exam.

The NCC exam is 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, at Pearson VUE testing centers. The ABEM fee is $470 (application) + $1,745 (exam) = $2,215 total (fees subject to change). Passing requires a criterion-referenced standard score set by ABPN — not norm-referenced, with no percentage cut score published. Continuing certification follows the participating board's MOC pathway (e.g., ABEM diplomates use MyEMCert plus the NCC subspecialty MOC requirements).

ABPN's blueprint has five domains: Principles of neurocritical care (42-48%), Neurocritical care diseases (27-33%), Diagnostic studies and procedural skills (13-17%), and Neurosurgical/perioperative complications and Ethics/research/practice-based learning (3-7% each). High-yield facts: (1) acute ischemic stroke - 2026 AHA/ASA recommends tenecteplase 0.25 mg/kg or alteplase 0.9 mg/kg within 4.5 h (both Class 1), thrombectomy up to 24 h (2026: ASPECTS-based selection including large core; basilar ≤24 h); (2) ICH - 2022 AHA/ASA: SBP 150-220 mmHg lowered to target 140, maintain 130-150 (COR 2b); <130 potentially harmful; anticoagulant reversal with idarucizumab or 4F-PCC (andexanet alfa/Andexxa was withdrawn from the US market effective 2025-12-22); (3) aneurysmal SAH - oral nimodipine 60 mg q4h x 21 days, vasospasm screening with TCD/CTA; (4) TBI - BTF guidelines (ICP <22, CPP 60-70); spinal cord injury MAP lower limit ≥75-80 mm Hg (2024 AO Spine/Praxis), not above 90-95, for 3-7 days; (5) status epilepticus - ESETT-validated second-line agents; (6) brain death determination per the AAN/AAP/CNS/SCCM 2023 update (apnea test requires no respirations, pH <7.30, AND PaCO2 ≥60 and ≥20 above baseline); (7) post-cardiac arrest care - 2025 AHA target temperature 32-37.5 °C for ≥36 h; TTM2 found 33 °C not superior to normothermia; (8) neuromuscular respiratory failure (Guillain-Barré 20/30/40 rule).

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, renal function, and the osmolar gap [NCS 2020 prefers the osmolar gap over a fixed osmolality cutoff; the traditional gap-20 and 320 mOsm/kg thresholds are not evidence-based]). 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).

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, SBP ≥100 mmHg and MAP ≥75 mmHg in adults, 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: the guideline requires ALL three of the following — no respirations occur, arterial pH is <7.30, AND PaCO2 is ≥60 mmHg and ≥20 mmHg above the patient's preapnea baseline. If the apnea test cannot be completed, ancillary tests are limited to 4-vessel catheter angiography, radionuclide perfusion scintigraphy, or TCD (adults only); the 2023 guideline says EEG, evoked potentials, CTA, and MRA should not be used. One examiner is sufficient in adults; two separate exams in children with age-based observation periods.

Anchor your study to the real ABPN blueprint: Principles of neurocritical care (42-48%), Neurocritical care diseases (27-33%), Diagnostic studies and procedural skills (13-17%), and Neurosurgical/perioperative complications and Ethics/research/practice-based learning (3-7% each). 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: 2026 AHA/ASA stroke thrombolytic dosing, thrombectomy 24 h, BTF ICP <22/CPP 60-70, 2022 AHA/ASA ICH BP targets, nimodipine 60 mg q4h x 21 d, GBS 20/30/40 rule, ESETT trial second-line agents, and the AAN/AAP/CNS/SCCM 2023 brain death prerequisites and apnea-test criteria. Take 2 full-length (270-question) practice exams in the final month. Typical successful candidates invest 200-400 hours of dedicated study during/after fellowship.

ABPN publishes first-time pass rates for ABPN examinees only (this exam is developed jointly by ABA, ABEM, ABIM, ABNS, and ABPN, and administered by ABPN to all boards' candidates at the same sitting): 91% (2021), 94% (2022), 96% (2024). ABEM does not separately publish a pass rate for its own candidates. Candidates who fail may retake the exam at the next administration (every other year, in even-numbered years; next in 2028) — ABEM states that once approved, candidates have four exam cycles within seven years of board eligibility. 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.