100+ Free ABNS Neurological Surgery Practice Questions

The ABNS Primary Examination is the written board examination administered by the American Board of Neurological Surgery to assess fundamental neurosurgical knowledge. It consists of 375 single-best-answer multiple-choice questions across eight content categories: Neuroanatomy, Neurosciences, Neuropathology, Neuroimaging, Neurology, Neurosurgery, Critical Care/Fundamental Clinical Skills, and Core Competencies. It is administered annually every March at participating ACGME-accredited neurosurgery residency programs (next test: March 13, 2026). Passage for credit is required by the Neurological Surgery RRC prior to completion of residency training and is a prerequisite to sitting for the ABNS Oral Examination.

The ABNS Primary Exam consists of 375 single-best-answer multiple-choice questions administered in a single day (approximately 8 hours, typically split into morning and afternoon sessions). The 2026 content distribution allocates 84 questions to Neurosurgery (22%), 65 to Critical Care/Fundamental Clinical Skills (17%), 57 to Neuroimaging (15%), 49 to Neuroanatomy (13%), 43 to Neuropathology (12%), 40 to Neurology (11%), 30 to Neurosciences (8%), and 7 to Core Competencies (2%). Question stems and keywords are released annually by the ABNS to support study.

The passing standard is criterion-referenced and set through NBME-based standard-setting procedures. In 2023, the passing standard was approximately 72% correct, and the ABNS has noted it is gradually increasing with more frequent standard-setting collaboration with the NBME. Historical first-time pass rates for candidates taking the exam 'for credit' toward certification average approximately 71%. Self-assessment takers typically have lower pass rates. Score reports provide pass/fail status plus diagnostic performance by category and percentile rank.

Candidates must be active residents in an ACGME-accredited neurological surgery residency program (PGY-1 and above are eligible). Residents may take the exam for self-assessment starting PGY-1; most programs require passage 'for credit' toward certification prior to the chief resident year or before completion of training. Effective July 1, 2025, passage of the ABNS Neuroanatomy Exam is a prerequisite to register for the Primary Exam for either credit or self-assessment. Candidates must be in good standing with their residency program and maintain active enrollment.

The ABNS application fee is $1,000 when taking the exam 'for credit' toward certification, or $500 when taking the exam for self-assessment. These are set per the ABNS MOC/Continuing Certification fee schedule. Most residency programs cover the self-assessment fees through educational allowances, while the credit attempt is often the resident's responsibility. The single annual administration window (every March) means candidates should plan early; late registration carries additional fees.

The ABNS Primary Examination is administered once per year every March at participating ACGME-accredited neurosurgical residency programs across the United States. The next administration is scheduled for March 13, 2026. Residents typically take the exam at their home program under proctored conditions. Individual programs have local policies governing when residents must pass for credit (commonly before the PGY-6 chief year).

The ABNS certification pathway has two summative examinations. The Primary Exam is a 375-question written exam taken during residency — it tests fundamental knowledge across neuroanatomy, neurosciences, neuropathology, neuroimaging, neurology, neurosurgery, critical care, and core competencies. Passage for credit must occur before residency completion. The Oral Exam is taken AFTER ≥36 months of independent neurosurgical practice with an approved case log. It consists of three 1-hour sessions: intracranial pathology, spine/peripheral nerve, and a comprehensive session. Both exams must be passed for full initial ABNS certification. Historical first-time oral exam pass rate is approximately 82%.

Neurosurgery (22%) is the largest domain — master Spetzler-Martin AVM grading, BTF 4th-edition ICP threshold (22 mmHg), Stupp protocol for GBM, Simpson meningioma grades, aneurysm management (early clipping/coiling), cervical myelopathy surgery, Chiari decompression, DBS targets (VIM for essential tremor, STN/GPi for Parkinson), and pediatric management (PECARN, myelomeningocele, ETV vs shunt). Critical Care (17%) emphasizes ICP management (mannitol vs hypertonic saline), CSW vs SIADH, postop DI, brain death (AAN), and ventriculitis. Neuroimaging (15%) requires DWI/ADC, CTP penumbra, SWI, and MR spectroscopy interpretation. Neuropathology centers on WHO 2021 molecular classifications (IDH, 1p/19q, H3 K27M, medulloblastoma subgroups, ZFTA-RELA).

Use a structured 12-24 month plan during residency with intensified review in the 3-6 months preceding the March exam. Begin with Neuroanatomy mastery (including passing the ABNS Neuroanatomy Exam prerequisite) and Neurosciences foundations. Build through Neuropathology (WHO 2021), Neuroimaging patterns, and Neurology. Focus on Clinical Neurosurgery using major textbooks (Greenberg's Handbook, Youmans, Schmidek & Sweet) and review courses (CNS SANS Written Board Review Course, SANS modules). Complete thousands of practice questions across all eight categories proportional to blueprint weights. Take at least two timed full-length practice exams in the final 6 weeks. Integrate current guidelines: AHA/ASA stroke 2023, BTF TBI 4th edition (2016), AAN brain death 2023, WHO 2021 CNS classification.