100+ Free CGC Practice Questions

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Question 1

Score: 0/0

Which condition is characterized by a trinucleotide repeat (CTG) in the DMPK gene, shows anticipation and autosomal dominant inheritance, and presents with myotonia, muscle weakness, cataracts, and cardiac conduction defects?

Becker muscular dystrophy

Facioscapulohumeral muscular dystrophy

Spinal muscular atrophy

Myotonic dystrophy type 1 (DM1)

to track

2026 Statistics

Key Facts: CGC Exam

200

Total Questions

170 scored + 30 pretest

4 hrs

Exam Time

ABGC

600/800

Passing Score

ABGC scaled score

78.9%

Pass Rate 2025

ABGC public data

$675

Exam Fee

First-time applicants 2026

5 years

Certification Valid

12.5 CEUs to recertify

The CGC exam contains 200 questions (170 scored) over 4 hours. Content spans 5 domains covering genetics science, testing interpretation, risk assessment, counseling skills, and professional practice. Passing scaled score is 600/800. First-time pass rates are approximately 77–79%. Eligibility requires an ACGC-accredited master's degree. The $675 exam fee is paid at application. ABGC certification demonstrates competency in genetic counseling for patients across cancer, prenatal, pediatric, cardiovascular, and adult genetics specialties.

Sample CGC Practice Questions

Try these sample questions to test your CGC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A couple presents for genetic counseling after their first child was diagnosed with cystic fibrosis. Both parents are confirmed carriers of the CFTR p.Phe508del variant. What is the recurrence risk for each subsequent pregnancy?

A.25%

B.50%

C.67%

D.75%

Explanation: Cystic fibrosis follows autosomal recessive inheritance. When both parents are carriers (heterozygous), each pregnancy has a 25% chance of being affected (homozygous), 50% chance of being a carrier, and 25% chance of being unaffected non-carrier.

2Which ACMG variant classification category is assigned to a variant with strong evidence of pathogenicity but insufficient to meet criteria for Pathogenic?

A.Variant of Uncertain Significance (VUS)

B.Likely Pathogenic

C.Likely Benign

D.Benign

Explanation: The ACMG/AMP 2015 framework defines 'Likely Pathogenic' as variants with greater than 90% probability of being disease-causing based on the evidence criteria (PS, PM, PP codes), but not yet meeting the full threshold for 'Pathogenic.'

3A woman at 11 weeks gestation undergoes chorionic villus sampling (CVS). The cytogenetics lab reports confined placental mosaicism for trisomy 16. What is the most appropriate next step?

A.Report the result as diagnostic for fetal trisomy 16

B.Offer amniocentesis to assess true fetal karyotype

C.Reassure the patient that the fetus is unaffected

D.Recommend pregnancy termination immediately

Explanation: Confined placental mosaicism (CPM) occurs when an abnormality is present in placental cells but not in the fetus. Because CVS samples trophoblastic tissue, CPM cannot confirm fetal status. Amniocentesis samples amniotic fluid containing fetal cells and is the appropriate follow-up to clarify whether trisomy 16 is present in the fetus.

4In Hardy-Weinberg equilibrium, if the frequency of a recessive disease allele (q) is 0.01, what is the expected carrier frequency in the population?

A.0.0001 (0.01%)

B.0.0198 (approximately 2%)

C.0.01 (1%)

D.0.02 (2%)

Explanation: Carrier frequency = 2pq, where p = 1 − q = 0.99. Therefore 2 × 0.99 × 0.01 = 0.0198, approximately 2%. This is roughly twice the allele frequency when q is small.

5A 35-year-old woman with a strong family history of breast cancer tests positive for a BRCA1 pathogenic variant. According to NCCP guidelines, at what age should enhanced breast cancer surveillance (annual MRI + mammogram) begin?

A.Age 18

B.Age 25

C.Age 40

D.Age 50

Explanation: NCCN guidelines recommend that BRCA1/2 pathogenic variant carriers begin annual breast MRI at age 25 (or 5–10 years before the earliest first-degree relative diagnosis) and add annual mammography starting at age 30. Early surveillance is critical given the high lifetime risk (up to 72% for BRCA1).

6Which prenatal screening test provides the earliest assessment of fetal chromosomal aneuploidy and can be performed from 10 weeks of gestation?

A.Quad screen (second trimester)

B.Cell-free DNA (cfDNA) / NIPT

C.Nuchal translucency ultrasound alone

D.Maternal serum alpha-fetoprotein

Explanation: Cell-free fetal DNA (cfDNA), also known as NIPT (Non-Invasive Prenatal Testing), can be performed from 10 weeks gestation. It analyzes fetal DNA fragments in maternal plasma to screen for trisomies 21, 18, 13, sex chromosome aneuploidies, and some microdeletions with high sensitivity and specificity.

7A pedigree shows a condition affecting both males and females in every generation, with an affected father passing the condition to an affected son. Which inheritance pattern is most consistent?

A.Autosomal recessive

B.X-linked recessive

C.Autosomal dominant

D.Mitochondrial

Explanation: Autosomal dominant inheritance is characterized by: the condition appearing in every generation (vertical transmission), males and females equally affected, and father-to-son transmission. X-linked recessive cannot show father-to-son transmission of the condition; mitochondrial is maternally inherited.

8A genetic test for Lynch syndrome detects a pathogenic variant in the MLH1 gene. Which cancer type is most characteristically associated with Lynch syndrome?

A.Breast cancer

B.Colorectal cancer

C.Ovarian cancer

D.Lung cancer

Explanation: Lynch syndrome (hereditary nonpolyposis colorectal cancer, HNPCC) is caused by pathogenic variants in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2, EPCAM). Colorectal cancer is the most common cancer, with a lifetime risk of 52–82%. Endometrial cancer is the second most common in females.

9During a genetic counseling session, a client becomes visibly distressed after receiving a positive BRCA2 result. The genetic counselor pauses the information delivery and says, 'It sounds like you're feeling overwhelmed right now. Is that right?' This technique is best described as:

A.Psychoeducation

B.Empathic reflection

C.Directive counseling

D.Facilitated disclosure

Explanation: Empathic reflection involves mirroring back the client's emotional state to demonstrate understanding and create a therapeutic alliance. This is a core technique in the Reciprocal Engagement Model (REM) of genetic counseling, which emphasizes the counselor–client relationship and emotional processing alongside information delivery.

10Chromosomal microarray analysis (CMA) detects which class of genomic variants that is NOT reliably detected by conventional karyotype?

A.Trisomy 21

B.Balanced reciprocal translocations

C.Copy number variants (CNVs) <5 Mb

D.Triploidy

Explanation: CMA (array comparative genomic hybridization or SNP array) detects submicroscopic copy number variants (deletions and duplications) typically <5 Mb in size that are below the resolution of conventional karyotype (~5–10 Mb). It significantly increases diagnostic yield in developmental delay, autism, and congenital anomalies.

About the CGC Exam

The CGC certification validates specialized knowledge and skills required to enter professional practice as a genetic counselor. The exam covers five domains: Clinical Information and Genetic Conditions (Domain 1, 34 questions), Risk Assessment and Human Genetics (Domain 2), Testing Interpretation and Reproductive Risk Management (Domain 3), Counseling Skills and Communication (Domain 4), and Professional, Legal, and Financial Frameworks (Domain 5, 39 questions). The 200-question exam (170 scored, 30 pretest) is administered over 4 hours at Prometric centers or via remote proctoring. Eligibility requires graduation from an ACGC-accredited master's program. Certification is valid 5 years; recertification requires 12.5 CEUs or re-examination.

Questions

200 scored questions

Time Limit

4 hours

Passing Score

Scaled 600/800

Exam Fee

$675 (first-time) / $500 (repeat) (American Board of Genetic Counseling (ABGC) / Prometric)

CGC Exam Content Outline

34 questions

Clinical Information, Human Development, and Genetic Conditions

Genetic condition phenotypes, diagnostic criteria, natural history, cancer syndromes (BRCA1/2, Lynch, FAP, Li-Fraumeni, NF1/NF2, VHL, MEN2), metabolic disease (PKU, Gaucher, Tay-Sachs, CAH), chromosomal syndromes (Down, Turner, Klinefelter, DiGeorge, Williams, PWS, Angelman), neuromuscular disease (DMD, DM1, SMA, Fragile X), and human embryology.

Variable

Risk Assessment and Principles of Human Genetics and Genomics

Autosomal dominant/recessive, X-linked, mitochondrial and imprinting-related inheritance; pedigree analysis and symbols; Hardy-Weinberg equilibrium; Bayesian probability calculations; carrier frequency; locus and allelic heterogeneity; penetrance and expressivity; anticipation; consanguinity risk; population genetics.

Variable

Testing Interpretation, Testing Options, and Reproductive Risk Management

NIPT/cfDNA, CVS, amniocentesis, quad screen; karyotype, FISH, CMA, NGS panels, WES, WGS; ACMG/AMP 5-tier variant classification (PS/PM/PP/BS/BP codes); VUS management and reclassification; newborn screening; linkage analysis; preimplantation genetic testing (PGT-M, PGT-A, PGT-SR); secondary findings (ACMG SF v3).

Variable

Counseling Skills, Communication, and Education

Reciprocal Engagement Model (REM); Counseling Trajectory Model; client-centered/non-directive counseling; empathic reflection; result disclosure protocols; predictive testing (Huntington protocol); psychosocial support; facilitated family communication; countertransference and reflective practice; culturally sensitive counseling; DTC testing counseling; VUS disclosure; pediatric testing ethics.

39 questions

Professional, Legal, Financial, and Regulatory Frameworks

GINA (health insurance + employment protections only); HIPAA privacy; informed consent (written, elements); duty to warn; right not to know; ACMG secondary findings return policy; ACGC program accreditation; NSGC Code of Ethics; scope of practice; documentation standards; therapeutic privilege; reimbursement and billing; genetic counselor licensure.

How to Pass the CGC Exam

What You Need to Know

Passing score: Scaled 600/800
Exam length: 200 questions
Time limit: 4 hours
Exam fee: $675 (first-time) / $500 (repeat)

Keys to Passing

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

CGC Study Tips from Top Performers

1Master the 5 ABGC exam domains using the 2023 CGC Exam Content Outline as your blueprint

2Practice Bayesian probability calculations for X-linked carrier risk assessment — these appear regularly

3Know ACMG/AMP variant classification evidence codes: PS1/PS3/PS4/PM2/PP3 for pathogenic; BS/BP codes for benign

4Understand the key differences between CVS and amniocentesis — timing, cell type, and confined placental mosaicism

5Study NIPT: detection rates, fetal fraction requirements, and causes of false positives (CPM, vanishing twin, maternal malignancy)

6Review cancer surveillance guidelines (NCCN) for BRCA1, BRCA2, Lynch syndrome, and other high-risk genes

7Know GINA protections (health insurance + employment only) and what it does NOT cover (life, disability, LTCI)

8Understand the Reciprocal Engagement Model (REM) and how it underpins non-directive, client-centered counseling

9Study imprinting disorders: PWS vs. Angelman syndrome (paternal vs. maternal 15q11-q13 loss)

10Know predictive testing protocols for Huntington disease — required pre-test counseling before disclosure

Frequently Asked Questions

What is the CGC exam?

The CGC (Certified Genetic Counselor) is a board certification offered by the American Board of Genetic Counseling (ABGC). It validates that a genetic counselor has the knowledge, skills, and expertise to enter professional practice in medical genetics and counseling. The CGC credential is required or preferred for employment in most genetic counseling positions in the U.S. and Canada.

What are the CGC eligibility requirements?

To sit for the CGC exam, you must be a graduate of an ACGC-accredited genetic counseling master's program in the U.S. or Canada (or hold an equivalent credential from an ABGC-recognized international body). Candidates may sit within 5 years of degree conferral under Category 1 or 2 eligibility. Official transcripts confirming degree and conferral date must be submitted.

How many questions are on the CGC exam?

The CGC exam contains 200 multiple-choice questions total — 170 scored questions and 30 unscored pretest items. You have 4 hours to complete the exam. The exam is administered via computer-based testing at Prometric test centers in the U.S. and Canada, or via remote proctoring.

What is the CGC passing score?

The CGC exam uses a scaled scoring system from 200 to 800. The passing scaled score is 600 — any score of 600 or greater is a pass. The passing score is established through a standard-setting process using minimally qualified candidate performance criteria and is reviewed every 5 years.

What content areas are covered on the CGC exam?

The CGC exam covers 5 domains per the 2023 Content Outline: (1) Clinical Information, Human Development, and Genetic Conditions (34 scored questions); (2) Risk Assessment and Principles of Human Genetics and Genomics; (3) Testing Interpretation, Testing Options, and Reproductive Risk Management; (4) Counseling Skills, Communication, and Education; and (5) Financial/Reimbursement Issues, Legal and Regulatory Requirements, and Professional Frameworks (39 scored questions).

What is the CGC pass rate?

First-time CGC exam pass rates have ranged from 70–82% in recent years: 78.9% in 2025, 77.2% in 2024, 70.3% in 2023, and 82.1% in 2022 (ABGC public data). As of April 2025, there are 7,514 certified genetic counselors. The 2023 decrease prompted ABGC to review exam outcomes and publish updates; 2024–2025 rates have recovered.

How long is CGC certification valid and how do I recertify?

CGC certification is valid for 5 years. Recertification requires earning 12.5 Continuing Education Units (CEUs) within the certification period, including completion of 25 Continuing Competence Learning Scenarios (0.1 CEU each) starting January 1, 2026 for new recertification cycles. Professional Activity Credits (PACs) for supervision, research, teaching, and leadership may supplement CEUs. Alternatively, recertification can be achieved by retaking and passing the CGC exam.

What is the CGC exam fee and when are exams offered?

The CGC exam fee is $675 for first-time applicants and $500 for repeat applicants. Exams are offered twice yearly: an August window (applications open May 1, deadline July 15) and a February window (applications open September 1, deadline January 15). Only one attempt is allowed per exam window.