100+ Free ABPMR Brain Injury Medicine Practice Questions

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Question 1

Score: 0/0

A 16-year-old soccer player sustains a head impact and has a brief loss of consciousness. On the sideline, which tool is the current standard sport-concussion assessment for athletes aged 13 and older?

SCAT6

SCAT3

MACE 2

ImPACT only

to track

2026 Statistics

Key Facts: ABPMR Brain Injury Medicine Exam

~200

Total MCQ Items

ABPMR Brain Injury Medicine Subspecialty Exam

~8 hr

Total Exam Time

1-day computer-based test including breaks

~15%

TBI + Concussion Weight

Largest domains on ABPMR BIM blueprint

$2,000

2026 Subspecialty Fee

ABPMR Brain Injury Medicine certification

1 yr

Required Fellowship

ACGME-accredited Brain Injury Medicine fellowship

Co-Sponsoring Boards

ABPMR + ABPN, ABA, ABN, ABEM, ABFM

The ABPMR Brain Injury Medicine subspecialty exam is a 1-day computer-based test with ~200 single-best-answer MCQs over ~8 hours. The 2026 blueprint emphasizes moderate-severe TBI (~15%), concussion/mild TBI (~15%), behavioral/psychiatric (~10%), disorders of consciousness (~8%), acute neurotrauma management (~8%), cognitive rehab (~8%), outcomes/comorbidities (~7%), pediatric TBI (~5%), spasticity (~5%), sleep/fatigue/endocrine (~5%), community reintegration (~4%), dysphagia/cranial neuropathies (~4%), post-TBI seizures (~4%), and ethics/scholarship (~2%). Fee ~$2,000; requires primary board certification + 1-year ACGME BIM fellowship.

Sample ABPMR Brain Injury Medicine Practice Questions

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

1A 16-year-old soccer player sustains a head impact and has a brief loss of consciousness. On the sideline, which tool is the current standard sport-concussion assessment for athletes aged 13 and older?

A.SCAT6

B.SCAT3

C.MACE 2

D.ImPACT only

Explanation: The Sport Concussion Assessment Tool 6 (SCAT6), published with the 2022 CISG Amsterdam consensus, is the current standardized sideline and office tool for athletes 13+. Child SCAT6 is used for ages 8-12. SCAT3 is outdated.

2According to the 2022 CISG Amsterdam consensus graded return-to-play protocol, what is the minimum interval between progression steps before advancing an athlete who remains symptom-free?

A.72 hours

B.12 hours

C.At least 24 hours

D.1 week

Explanation: CISG 2022 specifies a 6-step graded return-to-sport progression with at least 24 hours per step, advancing only if the athlete remains symptom-free. A symptomatic flare requires stepping back to the previous level. Full return typically takes at least 1 week in adults.

3Which component of the Vestibular/Ocular Motor Screening (VOMS) evaluates the ability to fixate on a target during head rotation?

A.Vestibulo-ocular reflex (VOR) testing

B.Smooth pursuit

C.Saccades

D.Near-point of convergence

Explanation: VOR testing on VOMS asks the patient to rotate the head horizontally or vertically while maintaining visual fixation on a target. Provocation of symptoms or increased VOR gain dysfunction is common after concussion and responds to vestibular rehabilitation.

4A 14-year-old with ongoing concussion symptoms 4 weeks post-injury reports dizziness and motion sensitivity. Which intervention has the strongest evidence for improving recovery?

A.Hyperbaric oxygen therapy

B.Strict cognitive and physical rest until fully asymptomatic

C.High-dose melatonin monotherapy

D.Targeted vestibular rehabilitation

Explanation: Persistent dizziness and motion sensitivity after concussion respond to active vestibular rehabilitation (Schneider RCT). CISG 2022 no longer recommends strict rest beyond 24-48 hours — relative rest followed by sub-symptom-threshold aerobic exercise is standard.

5A football player sustains a second concussion within a week of an initial concussion and develops rapid cerebral edema and brainstem herniation. This catastrophic syndrome is known as:

A.Chronic traumatic encephalopathy

B.Second impact syndrome

C.Diffuse axonal injury

D.Cerebral fat embolism

Explanation: Second impact syndrome describes catastrophic malignant cerebral edema following a second head injury before full recovery from an initial concussion. It primarily affects adolescents and is the rationale for mandatory removal-from-play and graded return-to-play protocols.

6The pathologic hallmark of chronic traumatic encephalopathy (CTE) on neuropathologic examination is:

A.Beta-amyloid plaques diffusely in the neocortex

B.Lewy bodies in the substantia nigra

C.Perivascular p-tau neurofibrillary tangles at the depths of cortical sulci

D.TDP-43 inclusions in motor neurons

Explanation: The 2015 NINDS/NIBIB neuropathologic criteria define CTE by perivascular p-tau neurofibrillary tangles and astrocytic tangles clustered at the depths of cortical sulci, most prominent in frontal and temporal lobes. Diagnosis remains post-mortem.

7A college wrestler has had 4 concussions with prolonged recovery. Which Consensus Statement recommendation best guides retirement-from-sport discussions?

A.Continued play if symptom-free for 24 hours

B.Automatic retirement after 3 concussions

C.Shared decision-making incorporating individual risk factors, not a rigid concussion count

D.Retirement only after structural MRI abnormality

Explanation: CISG 2022 explicitly rejects a fixed concussion-count threshold for retirement. Decisions involve shared discussion considering symptom burden, recovery trajectory, age, modifiers (mental health, prior injury), and sport, individualized per patient.

8Which of the following best defines persistent post-concussive symptoms (PPCS) by current consensus definitions?

A.Symptoms lasting longer than 4 weeks in children/adolescents or longer than 2 weeks in adults

B.Symptoms persisting beyond 48 hours only

C.Symptoms plus MRI findings

D.Symptoms after any TBI severity lasting 1 year

Explanation: CISG 2022 defines PPCS as concussion symptoms persisting beyond the expected recovery window — more than 4 weeks in children/adolescents or more than 2 weeks in adults. Earlier targeted rehab (vestibular, cervical, exertion) improves outcomes.

9In a subacute concussion clinic, a patient with persistent headaches and exertional intolerance undergoes Buffalo Concussion Treadmill Test (BCTT). What does BCTT identify?

A.Oculomotor dysfunction

B.Vestibular dysfunction

C.Symptom-limited aerobic exercise threshold to guide sub-threshold training

D.Cervical origin of symptoms

Explanation: The Buffalo Concussion Treadmill Test (Leddy) identifies the heart rate at which symptoms flare. Patients then train at 80% of that threshold for sub-symptom-threshold aerobic exercise, which accelerates recovery in adolescents (RCT evidence).

10A 15-year-old with a recent concussion returns to school. Which is the first step of a return-to-learn protocol?

A.Standardized testing

B.Full school day with no accommodations

C.Half day of school with a test

D.Daily activities at home that do not provoke symptoms (e.g., reading in short bouts)

Explanation: CISG 2022 return-to-learn is also graded: Step 1 is daily home activities that do not worsen symptoms, Step 2 is school activities at home (homework), Step 3 is part-time school with accommodations, Step 4 is full school with accommodations, Step 5 is full return.

About the ABPMR Brain Injury Medicine Exam

The ABPMR Brain Injury Medicine Subspecialty Certification validates expert-level knowledge in the evaluation and rehabilitation of acquired brain injury across the severity spectrum — from mild TBI/concussion (SCAT6, CISG 2022 return-to-play, VOMS, PPCS, CTE) to moderate-severe TBI (GCS, Rancho Los Amigos Levels I-VIII, post-traumatic amnesia via GOAT/Westmead, diffuse axonal injury), disorders of consciousness (coma, UWS, MCS-/MCS+, emergence criteria, CRS-R, amantadine per Giacino 2012), acute neurotrauma management (ICP, CPP, decompressive craniectomy, PSH), cognitive rehabilitation (ACRM INCOG 2.0), behavioral/psychiatric sequelae (agitation, ABS, avoidance of haloperidol), spasticity (ITB, botulinum toxin), post-traumatic seizures, post-traumatic hypopituitarism, pediatric TBI, and community reintegration. Co-sponsored by ABPMR with ABPN, ABA, ABN, ABEM, and ABFM.

Questions

200 scored questions

Time Limit

1-day CBT (~8 hours including breaks)

Passing Score

Criterion-referenced standard set by ABPMR

Exam Fee

~$2,000 subspecialty certification fee (ABPMR 2026) (American Board of Physical Medicine and Rehabilitation (ABPMR) / Pearson VUE)

ABPMR Brain Injury Medicine Exam Content Outline

~15%

Moderate-Severe TBI

GCS (E4V5M6; severe ≤8, moderate 9-12, mild 13-15), Rancho Los Amigos Levels I-VIII (coma → purposeful/appropriate), post-traumatic amnesia assessment via GOAT and Westmead PTA (PTA >7 d = severe), diffuse axonal injury on SWI/DTI, IMPACT and CRASH prognostic calculators, pupillary reactivity, therapeutic hypothermia not routinely recommended per BTF 2016.

~15%

Concussion / Mild TBI

SCAT6 (2023 update, ages 13+), Child SCAT6 (ages 8-12), graded return-to-play per CISG 2022 Amsterdam (6 steps, symptom-limited, 24+ h between steps), vestibular-ocular motor screening (VOMS), persistent post-concussive symptoms, second impact syndrome, CTE (Boston criteria — p-tau at sulcal depths, PSP-like), King-Devick sideline test.

~10%

Behavioral & Psychiatric

Agitation — Agitated Behavior Scale (ABS, cut-off ≥22), non-pharm first (environmental modification, 1:1 sitter), then propranolol (most evidence), amantadine, trazodone, valproate, risperidone; AVOID haloperidol and typical antipsychotics (worsens recovery in animal models). Post-TBI depression (SSRIs — sertraline), PTSD, substance use, neurobehavioral disinhibition.

~8%

Disorders of Consciousness

Coma (no eye opening, no awareness), UWS/vegetative (eye opening, no awareness), MCS-minus (simple reproducible behaviors — visual pursuit, localization), MCS-plus (command-following, intelligible verbalization, intentional communication), emergence (functional object use and functional communication). CRS-R — 23-point scale across 6 subscales. Amantadine 200-400 mg/d (Giacino NEJM 2012 — accelerates recovery 4-16 wk post-severe TBI).

~8%

Acute Neurotrauma Management

ICP target <22, CPP 60-70 mm Hg (BTF 2016). Hyperosmolar therapy — 3% saline 250 mL bolus or mannitol 0.25-1 g/kg. Decompressive craniectomy — DECRA (no benefit early), RESCUEicp (6-mo mortality benefit in refractory ICH but more vegetative), RESCUE-ASDH (2023 — equivalent to craniotomy). Levetiracetam 7 d prophylaxis, PSH (propranolol, gabapentin, clonidine, bromocriptine, morphine/dexmedetomidine).

~8%

Cognitive Rehabilitation

ACRM INCOG 2.0 guidelines (2022) — attention training, memory strategies (errorless learning, spaced retrieval, external aids), executive function (Goal Management Training, metacognitive strategy training), social cognition, awareness (knowledge, emergent, anticipatory per Crosson), neuropsychological assessment, functional cognitive rehabilitation, CBT adaptations.

~7%

Outcome Measures & Comorbidities

Disability Rating Scale (DRS — 0-29), Glasgow Outcome Scale-Extended (GOSE 1-8), Mayo-Portland Adaptability Inventory (MPAI-4), FIM/FAM, Satisfaction with Life Scale, post-traumatic headache (migraine most common — rizatriptan, topiramate; avoid medication overuse), heterotopic ossification (elbow most common post-TBI — etidronate, NSAIDs, radiation), DVT.

~5%

Pediatric TBI

Abusive head trauma / shaken baby syndrome (retinal hemorrhages, bilateral SDH, mandatory reporting), age-specific GCS, return-to-learn protocols (6 steps, symptom-limited), developmental trajectory after pediatric TBI, King-Devick test for sideline screening, Acute Concussion Evaluation (ACE) for pediatrics, PECARN decision rule for head CT.

~5%

Spasticity & Motor

Modified Ashworth Scale (0-4) and Tardieu Scale (velocity-dependent). Oral baclofen, tizanidine (hypotension, LFT), dantrolene (hepatotoxicity). Intrathecal baclofen pump for severe generalized spasticity (dose ~10-100x oral). Focal onabotulinumtoxinA (max total dose 400-600 units), phenol chemoneurolysis. Distinguish spasticity (velocity-dependent) from dystonia (sustained posture).

~5%

Sleep, Fatigue & Endocrine

Post-traumatic hypopituitarism (GH deficiency most common; also ACTH, TSH, gonadotropin) — screen 3-6 mo post-injury with morning cortisol, free T4/TSH, IGF-1, LH/FSH/testosterone. SIADH vs cerebral salt wasting (volume status — CSW volume down) vs diabetes insipidus (polyuria + hypernatremia). Modafinil/armodafinil for fatigue. Methylphenidate for attention (Whyte trials). CBT-I for insomnia.

~4%

Community Reintegration

Driving evaluation by certified driving rehabilitation specialist after moderate-severe TBI (behind-the-wheel and cognitive screening), return-to-work vocational rehab, school reintegration with 504/IEP accommodations, family caregiver training and support, peer mentoring, community-based services, independent living skills.

~4%

Dysphagia & Cranial Neuropathies

VFSS (modified barium swallow) and FEES for assessment. Penetration-Aspiration Scale (PAS 1-8). IDDSI framework for diet textures (0-7 scale). Anosmia (CN I — most commonly injured cranial nerve in TBI, cribriform plate shear). Optic neuropathy (CN II — traumatic optic neuropathy). Vestibular dysfunction (CN VIII vs BPPV — Dix-Hallpike). Peripheral facial palsy (CN VII — temporal bone fracture).

~4%

Post-TBI Seizures

Early PTS (<7 d) vs late PTS (>7 d). BTF recommends 7 d levetiracetam prophylaxis (levetiracetam preferred over phenytoin — superior cognitive profile, no drug levels needed). Late PTS not prevented by prophylaxis. Driving restrictions per state (typically 3-12 mo seizure-free). EEG after new PTS.

~2%

Ethics & Scholarship

Capacity assessment and informed consent after brain injury (appreciation, reasoning, understanding, choice), surrogate decision-making hierarchy, withdrawal-of-life-sustaining-treatment decisions in DOC, biostatistics (NNT, sensitivity/specificity, likelihood ratios), research design (RCT vs observational), life care planning.

How to Pass the ABPMR Brain Injury Medicine Exam

What You Need to Know

Passing score: Criterion-referenced standard set by ABPMR
Exam length: 200 questions
Time limit: 1-day CBT (~8 hours including breaks)
Exam fee: ~$2,000 subspecialty certification fee (ABPMR 2026)

Keys to Passing

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

ABPMR Brain Injury Medicine Study Tips from Top Performers

1Memorize Rancho Los Amigos Levels I-VIII by behavioral description: I no response; II generalized response; III localized response; IV confused-agitated; V confused-inappropriate; VI confused-appropriate; VII automatic-appropriate; VIII purposeful-appropriate. Know typical timeline and rehab interventions for each level — e.g., Level IV requires environmental control and agitation management, Level VI begins functional community tasks.

2DOC emergence criteria (Aspen Workgroup): patient must demonstrate EITHER functional object use (uses 2 different objects appropriately on at least 2 occasions) OR functional communication (accurate yes/no responses to 6/6 situational questions across 2 consecutive evaluations). Either one suffices for emergence from MCS. MCS-plus has command-following, intelligible verbalization, or intentional communication; MCS-minus has only simple behaviors (visual pursuit, localization, contingent smiling).

3Agitation pharmacology ladder: non-pharm FIRST (environmental, sitter, reduce stimulation). First-line pharm is propranolol (most evidence; titrate to HR/BP). Second-line: amantadine (also helps arousal), valproate, trazodone (sleep). Risperidone short-term. AVOID haloperidol and typical antipsychotics — animal models show worsened motor recovery. Avoid benzodiazepines (paradoxical agitation, interfere with recovery). Track response with Agitated Behavior Scale (≥22 = agitated).

4BTF/decompressive craniectomy trial landscape: DECRA (2011) — early bifrontal for DIFFUSE injury, no benefit, worse 6-mo GOSE. RESCUEicp (2016) — decompressive craniectomy for refractory ICH: reduces 6-mo mortality but MORE survivors in vegetative/lower-severe-disability states. RESCUE-ASDH (2023) — decompressive craniectomy noninferior to craniotomy for acute SDH. BTF 2016: ICP <22 mm Hg, CPP 60-70 mm Hg, no routine hypothermia, 7-d levetiracetam for early PTS prophylaxis.

5Post-traumatic hypopituitarism screening: screen 3-6 months post-moderate/severe TBI. GH deficiency is MOST COMMON (~15-20%); also ACTH/cortisol, TSH/free T4, LH/FSH/testosterone (men), estradiol/menses (women). Morning cortisol <3 suggests deficiency; ACTH stim test to confirm. Treat ACTH deficiency FIRST before thyroid (giving levothyroxine in untreated adrenal insufficiency can precipitate crisis). GH replacement improves fatigue, cognition, and QOL in deficient patients.

Frequently Asked Questions

What is the ABPMR Brain Injury Medicine subspecialty certification?

The ABPMR Brain Injury Medicine (BIM) subspecialty certification validates expert-level knowledge in the evaluation, acute care, and rehabilitation of acquired brain injury across the severity spectrum. It is co-sponsored by the American Board of Physical Medicine and Rehabilitation (ABPMR) with ABPN (Neurology/Psychiatry), ABA (Anesthesiology), ABN (Neurological Surgery), ABEM (Emergency Medicine), and ABFM (Family Medicine), enabling specialists from multiple disciplines to certify. Scope includes concussion/mild TBI, moderate-severe TBI, disorders of consciousness, neurotrauma acute management, cognitive rehabilitation, behavioral management, spasticity, post-traumatic seizures, post-traumatic hypopituitarism, and pediatric TBI.

Who is eligible to take the ABPMR Brain Injury Medicine exam?

Candidates must hold primary board certification in good standing from ABPMR or one of the co-sponsoring boards (ABPN, ABA, ABN, ABEM, ABFM) and have completed 12 months of full-time training in an ACGME-accredited Brain Injury Medicine fellowship. A valid unrestricted medical license is required. Fellowships typically include rotations in acute inpatient TBI rehabilitation, DOC programs, outpatient concussion clinic, neurotrauma ICU, pediatric TBI, and research.

What is the format of the ABPMR Brain Injury Medicine exam?

The exam is a 1-day computer-based examination administered at Pearson VUE test centers, comprising approximately 200 single-best-answer multiple-choice questions over roughly 8 hours (including breaks). Question stems frequently include imaging (CT/MRI/SWI/DTI), clinical vignettes with Rancho level descriptions, GCS calculations, CRS-R subscales, SCAT6 findings, and ECG/EEG tracings. Content is aligned to the ABPMR BIM blueprint spanning concussion, moderate-severe TBI, DOC, acute management, cognitive/behavioral rehab, spasticity, pediatric TBI, and community reintegration.

How much does the 2026 ABPMR Brain Injury Medicine exam cost?

The 2026 ABPMR Brain Injury Medicine subspecialty certification fee is approximately $2,000 (confirm current fee at abpmr.org). Cancellation and refund policies follow the ABPMR schedule with decreasing refunds as the exam date approaches. Ongoing Continuing Certification fees apply after passing. Retakes within the 7-year qualification window require re-registration and full fee payment.

When is the 2026 exam administered?

ABPMR Brain Injury Medicine is typically offered annually during a fall testing window. Applications generally open in winter/early spring with a submission deadline in late spring. Candidates schedule specific appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABPMR examinations page.

How is the exam scored?

ABPMR uses criterion-referenced scoring with a passing standard set by subject-matter experts. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports include subdomain performance to guide future learning. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics: Rancho Los Amigos Levels I-VIII (memorize behavioral descriptions), GCS calculation and severity stratification, GOAT/Westmead PTA, SCAT6 and CISG 2022 6-step return-to-play, CRS-R and DOC emergence criteria (functional object use + functional communication), amantadine per Giacino 2012, BTF ICP/CPP targets and decompressive craniectomy trials (DECRA, RESCUEicp), PSH pharmacology, agitation management (propranolol, amantadine; AVOID haloperidol), ACRM INCOG 2.0 cognitive rehab, post-traumatic hypopituitarism screening, intrathecal baclofen for spasticity, and 7-day levetiracetam seizure prophylaxis.

How should I study for this exam?

Use a structured 8-12 month plan during and after the BIM fellowship. Lead with foundations (GCS, Rancho, PTA, classification) and TBI pathophysiology. Then move to concussion (SCAT6, CISG 2022, VOMS), DOC (CRS-R, amantadine), acute management (ICP, CPP, decompressive craniectomy evidence, PSH). Cover cognitive rehab (ACRM INCOG 2.0), behavioral (ABS, agitation pharmacology), spasticity (ITB, botox), pediatric TBI, and community reintegration. Integrate the Brain Injury Medicine: Principles and Practice textbook (Zasler/Katz/Zafonte), BTF 2016 guidelines, CISG Amsterdam 2022, and AAN practice guidelines. Complete high-volume MCQs and take 2-3 timed mock exams.