100+ Free ABPN Clinical Neurophysiology Practice Questions

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Question 1

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In the standard International 10-20 system of EEG electrode placement, which electrode designation corresponds to the left central region over the sensorimotor cortex?

to track

2026 Statistics

Key Facts: ABPN Clinical Neurophysiology Exam

~200

Total MCQ Items

ABPN Clinical Neurophysiology Subspecialty Exam

1 day

Test Duration

Computer-based exam at Pearson VUE

~18-22%

EEG Fundamentals Weight

Largest domain on 2026 ABPN CNP content outline

$2,200

2026 Initial Fee

ABPN subspecialty certification

1 year

Required Fellowship

ACGME-accredited Clinical Neurophysiology fellowship

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABPN Clinical Neurophysiology exam is a 1-day computer-based test at Pearson VUE containing ~200 single-best-answer MCQs. The 2026 content outline emphasizes EEG fundamentals and normal (~18-22%), epilepsy EEG (~16-20%), sleep medicine/PSG (~14-16%), NCS technical and interpretation (~12-14%), ICU/encephalopathy EEG per ACNS 2021 (~10-12%), needle EMG (~10-12%), disease-specific EMG/NCS (~8-10%), evoked potentials and IONM (~6-8%), and artifacts/normal variants (~6-8%). Initial fee is ~$2,200; requires ABPN primary cert plus ACGME CNP fellowship.

Sample ABPN Clinical Neurophysiology Practice Questions

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

1In the standard International 10-20 system of EEG electrode placement, which electrode designation corresponds to the left central region over the sensorimotor cortex?

A.T3

B.C4

C.Cz

D.C3

Explanation: In the 10-20 system, odd numbers denote left-sided electrodes and even numbers denote right-sided electrodes; 'z' indicates midline. C3 is left central (over left sensorimotor cortex), C4 is right central, Cz is central midline (vertex), and T3 is left mid-temporal (now often T7 in modified 10-10).

2What is the typical frequency range of the adult posterior dominant rhythm (alpha) seen with eyes closed in the awake state?

A.14-30 Hz

B.4-7 Hz

C.8-13 Hz

D.1-3 Hz

Explanation: The posterior dominant rhythm in a normal awake adult is 8-13 Hz (alpha), maximal over occipital regions, attenuating with eye opening. Theta (4-7 Hz), beta (>13 Hz), and delta (<4 Hz) comprise the other standard bands.

3Standard EEG recording parameters in the United States typically use which combination of filter settings?

A.Low-frequency filter 0.01 Hz, high-frequency filter 300 Hz, no notch

B.Low-frequency filter 10 Hz, high-frequency filter 30 Hz, notch 50 Hz

C.Low-frequency filter 1 Hz, high-frequency filter 70 Hz, notch 60 Hz

D.Low-frequency filter 5 Hz, high-frequency filter 15 Hz, notch 100 Hz

Explanation: Standard routine EEG uses LFF of 1 Hz (removes slow DC drift), HFF of 70 Hz (eliminates high-frequency muscle artifact), and a 60 Hz notch filter (removes powerline interference in the US; 50 Hz in Europe). Sensitivity is usually 7 µV/mm with paper speed 30 mm/s.

4What is the typical sensitivity setting for routine adult EEG?

A.50 µV/mm

B.1 µV/mm

C.7 µV/mm

D.100 µV/mm

Explanation: Routine adult EEG is typically recorded at 7 µV/mm sensitivity. Increasing to 10-15 µV/mm is used for low-voltage recordings, while 2 µV/mm may be used in brain death protocols to confirm electrocerebral silence.

5On a bipolar longitudinal (double banana) montage, a phase reversal pointing TOWARD each other between two adjacent channels localizes the maximum potential to:

A.The electrode farthest from the reversal

B.The electrode shared between the two channels showing the reversal

C.The ground electrode

D.The reference electrode

Explanation: In bipolar montages, a phase reversal (deflections pointing toward each other) localizes the maximum potential to the electrode that is common (shared) between the two channels displaying the reversal. Referential montages require identifying the channel with the largest deflection using a relatively inactive reference.

6The mu rhythm is best characterized as:

A.A diffuse delta rhythm maximal in deep sleep

B.A 3 Hz generalized spike-and-wave pattern activated by hyperventilation

C.A 14-16 Hz sleep spindle maximal over frontocentral regions

D.A 7-11 Hz arch-shaped rhythm over central regions that attenuates with contralateral movement or thought of movement

Explanation: The mu rhythm is an arch-shaped (wicket-like but physiologic) 7-11 Hz rhythm over central regions (C3/C4), present during wakefulness in about one-third of adults. It blocks with contralateral movement, intent to move, or tactile stimulation, reflecting idling of sensorimotor cortex.

7Lambda waves are physiologic sharp transients maximal over which region, occurring under what condition?

A.Occipital region, during scanning eye movements across a patterned visual field while awake

B.Frontal region, during drowsiness

C.Central region, during voluntary movement

D.Temporal region, during hyperventilation

Explanation: Lambda waves are sharp (saw-toothed) physiologic transients of 100-250 ms duration, maximal in the occipital region, time-locked to scanning eye movements (saccades) across a patterned visual field while the eyes are open. Their sleep correlates are POSTs (positive occipital sharp transients of sleep).

8What is the frequency range of adult sleep spindles?

A.12-14 Hz

B.3-4 Hz

C.6-8 Hz

D.20-30 Hz

Explanation: Sleep spindles are brief (0.5-2 sec) 12-14 Hz rhythmic activity, maximal over frontocentral regions, defining stage N2 sleep along with K-complexes. Frontal spindles tend to be slower (~11 Hz), centroparietal faster (~13-14 Hz). Spindles emerge around age 6-8 weeks postnatally.

9POSTs (positive occipital sharp transients of sleep) are best characterized as:

A.Surface-negative spikes with a slow wave, localized to temporal lobe

B.Surface-positive sharp triangular waves over occipital regions during NREM sleep, usually benign

C.Generalized 3 Hz spike-and-wave discharges during hyperventilation

D.Triphasic waves seen in hepatic encephalopathy

Explanation: POSTs are benign normal variants during NREM sleep: surface-positive (downward in standard polarity) triangular transients maximal over the occipital region, often bilateral and asymmetric. They should not be mistaken for epileptiform discharges.

10What is the expected paper speed (or display equivalent) for routine EEG in the United States?

A.10 mm/sec

B.30 mm/sec

C.100 mm/sec

D.3 mm/sec

Explanation: Routine EEG is displayed at 30 mm/sec (10 sec across a standard page/screen). Compressed views (e.g., 15 mm/sec) are used for long-term monitoring, and expanded views (60 mm/sec) may help resolve fast waveforms.

About the ABPN Clinical Neurophysiology Exam

The ABPN Clinical Neurophysiology Subspecialty Certification Examination tests expertise across EEG (fundamentals, epilepsy, ICU/encephalopathy per ACNS 2021 terminology — LPDs/GPDs/LRDA/GRDA/BIRDs, post-anoxic patterns, brain death), nerve conduction studies and needle EMG (axonal vs demyelinating patterns, entrapment neuropathies, ALS, GBS/CIDP, MG/LEMS, radiculopathy, myopathy), sleep medicine and polysomnography (AASM scoring, OSA/CSA, MSLT/MWT, RBD, RLS/PLMD, narcolepsy pharmacology), evoked potentials (SSEP, BAEP, VEP, MEPs), and intraoperative neuromonitoring. Requires ABPN primary certification in Neurology, Psychiatry, or Child Neurology plus a 1-year ACGME-accredited Clinical Neurophysiology fellowship.

Questions

200 scored questions

Time Limit

1-day CBT at Pearson VUE

Passing Score

Criterion-referenced scaled score set by ABPN (modified Angoff)

Exam Fee

~$2,200 initial subspecialty certification fee (ABPN 2026) (American Board of Psychiatry and Neurology (ABPN) / Pearson VUE)

ABPN Clinical Neurophysiology Exam Content Outline

~18-22%

EEG Fundamentals and Normal

10-20 electrode system, bipolar vs referential montages, filters (LFF 1 Hz, HFF 70 Hz, notch 60 Hz), sensitivity 7 µV/mm, paper speed 30 mm/s, time constant. Frequency bands: alpha 8-13 Hz (posterior dominant rhythm), beta >13 Hz, theta 4-7 Hz, delta <4 Hz, mu central, lambda occipital. Drowsiness: POSTs, V-waves, K-complexes, sleep spindles 12-14 Hz, hypnagogic hypersynchrony. Neonatal: tracé alternant/discontinu, encoches frontales, hypsarrhythmia.

~16-20%

Epilepsy EEG

Interictal epileptiform discharges — spikes, sharp waves, polyspikes, spike-and-wave. Absence 3 Hz spike-wave; JME 4-6 Hz polyspike-wave; LGS slow spike-wave 1.5-2.5 Hz; West syndrome hypsarrhythmia; benign rolandic epilepsy with centrotemporal spikes activated in sleep; temporal lobe epilepsy (anterior temporal sharps, mesial temporal sclerosis); frontal lobe seizures; status epilepticus (convulsive, non-convulsive, electrographic). Pre-surgical video-EEG, sEEG/subdural grids, Wada test.

~14-16%

Sleep Medicine and Polysomnography

AASM PSG scoring — N1/N2/N3/REM 30-sec epochs. OSA (AHI ≥5 mild, ≥15 moderate, ≥30 severe; CPAP first-line). CSA (Cheyne-Stokes, high-altitude, opioid-induced; ASV contraindicated in HFrEF EF<45% per SERVE-HF). MSLT (mean sleep onset <8 min + ≥2 SOREMPs = narcolepsy). MWT. Parasomnias: NREM sleepwalking/terrors; REM sleep behavior disorder (alpha-synuclein, melatonin/clonazepam). RLS (ferritin <75 → iron; alpha-2-delta ligands first-line). Narcolepsy (modafinil, pitolisant, sodium oxybate, solriamfetol). Insomnia CBT-I.

~12-14%

NCS — Technical and Interpretation

Supramaximal stimulation, temperature ≥32°C (cold = prolonged latency, slow CV, higher amp), CMAP (amplitude — axonal; distal latency — distal demyelination; conduction velocity — proximal demyelination), SNAP (small, 1-20 µV), F-wave (late motor response, proximal), H-reflex (S1 monosynaptic). Axonal vs demyelinating patterns; entrapments — median at wrist (CTS — distal motor latency >4.4 ms, sensory >3.5 ms), ulnar at elbow (CV drop >10 m/s across segment), radial at spiral groove, peroneal at fibular head, tarsal tunnel.

~10-12%

ICU / Encephalopathy EEG (ACNS 2021)

Toxic-metabolic diffuse slowing, triphasic waves (hepatic/uremic/anoxic encephalopathy), burst suppression (pentobarbital coma; post-anoxic), alpha coma (post-anoxic, poor prognosis), spindle coma. ACNS 2021 terminology: LPDs (formerly PLEDs), GPDs (formerly GPEDs), BIRDs, LRDA (lateralized) / GRDA (generalized). Post-cardiac arrest: myoclonic status, burst suppression, flat EEG, SSEP bilateral absent N20 = poor prognosis. Brain death EEG = electrocerebral silence.

~10-12%

Needle EMG

Insertional activity (normal brief increase; reduced in fibrosis/fatty replacement; increased in denervation/myotonia). Spontaneous activity — fibrillations and positive sharp waves (active denervation or severe myopathy), fasciculations, myotonic discharges (dive-bomber — myotonic dystrophy, myotonia congenita), myokymia (radiation plexopathy, MS brainstem), neuromyotonia (Isaacs). MUAP morphology — short/polyphasic/low-amp = myopathy; long/high-amp/polyphasic = chronic neurogenic reinnervation. Recruitment (normal, neurogenic reduced, myopathic early). Single-fiber EMG jitter and blocking (MG).

~8-10%

NCS/EMG Disease Patterns

ALS (widespread active + chronic denervation in ≥3 regions, normal sensory — Awaji/El Escorial), GBS/AIDP (demyelinating, facial/bulbar weakness, areflexia, albuminocytologic dissociation), CIDP (demyelinating >8 weeks), MG (decremental 3-Hz RNS, ↑ jitter on SFEMG, AChR-Ab), LEMS (incremental >60% at 30-50 Hz RNS, VGCC-Ab, SCLC), radiculopathy (spontaneous activity in paraspinals — myotome specific), myopathy, myotonic dystrophy DM1/DM2.

~6-8%

Evoked Potentials and Intraoperative Monitoring

SSEP (median, tibial; N20 post-central primary sensory cortex; prognostication post-cardiac arrest — bilateral absent N20 = poor). BAEP (waves I-V: I = CN VIII, III = superior olivary complex, V = lateral lemniscus; MS, acoustic neuroma, brainstem). VEP (P100 latency — optic neuritis/MS). MEPs (TcMEPs). Intraoperative monitoring for scoliosis (SSEP + MEP), brain/spine tumor, neck dissection (facial nerve EMG).

~6-8%

EEG Artifacts and Normal Variants

Artifacts — EKG, pulse, glossokinetic, muscle, lateral rectus spike, photomyogenic, electrode pop, 60 Hz, ventilator. Normal variants — wicket spikes, benign sporadic sleep spikes (BSSS), psychomotor variant (rhythmic midtemporal theta of drowsiness — RMTD), phantom spike-wave, 14&6 positive spikes, subclinical rhythmic electroencephalographic discharge of adults (SREDA). Breach effect over skull defect.

How to Pass the ABPN Clinical Neurophysiology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABPN (modified Angoff)
Exam length: 200 questions
Time limit: 1-day CBT at Pearson VUE
Exam fee: ~$2,200 initial subspecialty certification fee (ABPN 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

ABPN Clinical Neurophysiology Study Tips from Top Performers

1ACNS 2021 terminology — know the new names: PLEDs → LPDs (lateralized periodic discharges), GPEDs → GPDs (generalized periodic discharges), plus LRDA (lateralized rhythmic delta activity), GRDA (generalized rhythmic delta activity), and BIRDs (brief potentially ictal rhythmic discharges <10 sec). These describe rhythmic/periodic patterns on the ictal-interictal continuum in critically ill patients and drive treatment decisions.

2Post-cardiac arrest prognostication: bilateral absent cortical N20 on median-nerve SSEP at ≥24 hours (after targeted temperature management and sedation hold) strongly predicts poor neurologic outcome. Other poor-prognosis EEG features: persistent burst suppression with identical bursts, status myoclonus, alpha coma unreactive, and sustained suppression. Use multimodal prognostication — never rely on a single finding.

3Narcolepsy on MSLT: mean sleep latency <8 minutes PLUS ≥2 sleep-onset REM periods (SOREMPs) across 5 naps. A SOREMP on the preceding overnight PSG can count as one of the two. Type 1 = with cataplexy and/or CSF hypocretin deficiency; Type 2 = without cataplexy and normal hypocretin. First-line wake-promoting agents: modafinil/armodafinil; others — pitolisant, solriamfetol, sodium oxybate, methylphenidate.

4Demyelinating NCS features (support GBS or CIDP): prolonged distal motor latency >150% ULN, conduction velocity <75% LLN, conduction block (>50% CMAP amplitude drop across a segment), abnormal temporal dispersion (>30% duration increase), prolonged F-waves or absent F-waves. CIDP requires >8 weeks of progression/relapsing course. MG: decremental response >10% on low-frequency (2-3 Hz) RNS; LEMS: incremental response >60% after 10 seconds of exercise or at 30-50 Hz RNS.

5EEG maturation pearls: tracé discontinu (discontinuous bursts with long interburst intervals) is NORMAL in preterm neonates; tracé alternant (alternating bursts and lower-voltage activity, interburst ~5-8 sec) is NORMAL in term quiet sleep. Hypsarrhythmia (very-high-amplitude chaotic slow waves + multifocal spikes) = West syndrome — treat with ACTH, vigabatrin (especially for tuberous sclerosis), or prednisolone. Benign rolandic epilepsy centrotemporal spikes markedly activate during drowsiness/sleep.

Frequently Asked Questions

What is the ABPN Clinical Neurophysiology Subspecialty Examination?

The ABPN Clinical Neurophysiology (CNP) subspecialty exam is a certification test administered by the American Board of Psychiatry and Neurology for physicians with primary certification in Neurology, Psychiatry, or Child Neurology who have completed a 1-year ACGME-accredited Clinical Neurophysiology fellowship. The 1-day computer-based exam covers EEG (including epilepsy and ICU applications), EMG/NCS, polysomnography and sleep medicine, evoked potentials, and intraoperative neuromonitoring. Passing confers subspecialty certification valid under the ABPN 10-year continuing certification cycle.

Who is eligible to take the ABPN CNP exam?

Candidates must hold current ABPN certification in Neurology, Psychiatry, or Child Neurology (or equivalent) and must have satisfactorily completed a 1-year ACGME-accredited Clinical Neurophysiology fellowship. A valid unrestricted medical license is required at the time of examination, and the fellowship program director must attest to satisfactory completion. Applications are submitted through the ABPN website within the designated eligibility window.

What is the format of the ABPN CNP exam?

The exam is a 1-day computer-based test delivered at Pearson VUE centers, containing approximately 200 single-best-answer multiple-choice questions. Many items include EEG tracings, polysomnogram epochs, nerve conduction study traces, needle EMG waveforms, and evoked potential recordings. Content is distributed across the 2026 ABPN CNP content outline emphasizing EEG, epilepsy, sleep, EMG/NCS, and evoked potentials.

How much does the 2026 ABPN CNP exam cost?

The 2026 initial ABPN Clinical Neurophysiology subspecialty certification fee is approximately $2,200. Cancellation and refund policies follow the ABPN schedule with decreasing refunds as the exam date approaches. Continuing Certification (MOC) requires annual activities and a 10-year certification cycle with associated fees. Retakes within the eligibility window require full re-registration and fee payment.

When is the 2026 exam administered?

ABPN subspecialty exams are typically offered in testing windows at Pearson VUE. Applications generally open in the spring with deadlines prior to the fall testing window. Candidates schedule specific Pearson VUE appointments after application approval. Exact 2026 dates should be confirmed on the ABPN Clinical Neurophysiology certification page.

How is the exam scored?

ABPN uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail outcome depends on performance relative to a fixed content-expert standard rather than on other test-takers. Score reports include subdomain performance to guide future study. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics include: EEG frequency bands and normal variants (wickets, BSSS, psychomotor variant, SREDA), epilepsy patterns (3 Hz absence, JME 4-6 Hz polyspike-wave, LGS slow spike-wave, West/hypsarrhythmia, benign rolandic centrotemporal spikes), ACNS 2021 ICU EEG terminology (LPDs, GPDs, LRDA, GRDA, BIRDs) and post-anoxic prognostication (bilateral absent N20 SSEP), EMG/NCS recognition of axonal vs demyelinating patterns, entrapments (CTS distal motor latency >4.4 ms, ulnar across elbow >10 m/s drop), ALS Awaji criteria, MG decremental RNS vs LEMS incremental, AASM sleep scoring, OSA/CSA, MSLT criteria for narcolepsy, REM sleep behavior disorder, and RLS (alpha-2-delta first-line over dopamine agonists).

How should I study for ABPN CNP?

Use a structured 12-month plan during CNP fellowship. Map to the ABPN CNP content outline: lead with EEG fundamentals and normal variants, then epilepsy EEG, ICU EEG (ACNS 2021 terminology), EMG/NCS technical and disease patterns, evoked potentials and intraoperative monitoring, then sleep medicine and polysomnography. Core resources: Ebersole and Pedley's Current Practice of Clinical Electroencephalography, Preston and Shapiro's Electromyography and Neuromuscular Disorders, Kryger/Roth/Dement's Principles and Practice of Sleep Medicine, AASM Scoring Manual, ACNS 2021 critical-care EEG terminology, AANEM monographs. Drill high-volume MCQs with timed sets and complete 2-3 full-length timed mock exams.