Study guide
1.3 Format, Scoring, Pearson VUE, and Score Reports
ABIM Neurocritical Care Subspecialty Certification Exam
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1 Introduction & Exam Overview
1.1 Current Exam Facts 1.2 Eligibility, Practice Pathway, and the IM Training Route 1.3 Format, Scoring, Pearson VUE, and Score Reports 1.4 How to Use This Independent Study Guide
2 ICU Neurologic Exam, Cerebral Physiology, and CSF
2.1 Neurological Examination in the ICU 2.2 Cerebral Physiology, ICP, CBF, and Autoregulation 2.3 CSF Physiology
3 Core Neuropharmacology
3.1 Osmotic Agents 3.2 Anti-Seizure Drugs 3.3 Anesthetics, Sedatives, Analgesia, and Paralytics 3.4 Antihypertensives, Vasopressors, and Inotropes
4 Reperfusion Drugs, Airway, and Ventilation
4.1 Thrombolytics, Anticoagulants, and Antiplatelets 4.2 Reversal of Anticoagulation After Acute Hemorrhage 4.3 Airway Management and Tracheostomy 4.4 Mechanical Ventilation
5 Hemodynamics and Shock
5.1 Hemodynamic Monitoring 5.2 IABP, Temporary VADs, LVAD, and ECMO 5.3 Diagnosis and Management of Shock
6 Nutrition, Temperature, and ICU Prophylaxis
6.1 Nutrition (01.J) 6.2 Temperature Control (01.K) 6.3 ICU Prophylaxis, Delirium, and Early Mobility (01.L)
7 General Trauma
7.1 Emergency Evaluation of Polytrauma, Chest, and Abdominal Trauma 7.2 Long-Bone Fractures and Fat Embolism 7.3 Burns, Electrical Injury, and Hanging/Strangulation
8 Pulmonary Critical Care
8.1 Pulmonary Physiology and ARDS (01.N.1–2) 8.2 PE, Pneumonia, and Pulmonary Edema (01.N.3, 7–8) 8.3 COPD, Asthma, PAH, and Bronchoscopy Basics (01.N.4–6, 9)
9 Cardiovascular Critical Care
9.1 Cardiovascular Physiology, Stress Cardiomyopathy, ACS, and Valves 9.2 Arrhythmias and Pacing 9.3 Acute Aortic Dissection and Cardiac Ultrasound
10 Renal and Infectious Disease
10.1 AKI, RRT, and Renal Drug Dosing 10.2 Acid-Base and Electrolyte Disorders 10.3 Severe Sepsis, Septic Shock, and Infective Endocarditis 10.4 Antimicrobial Use and Infection in the Immunosuppressed
11 Endocrine and Salt-Water Disorders
11.1 Pituitary Apoplexy, DI, and Panhypopituitarism (01.R.1–4) 11.2 SIADH and Cerebral Salt Wasting (01.R.5–6) 11.3 Thyrotoxicosis, Myxedema, Adrenal Crisis, and Dysglycemia (01.R.7–9)
12 Gastrointestinal Critical Care
12.1 GI Physiology, Acute Abdomen, Bleed, Ileus, and Perforation (01.S.1–5) 12.2 Mesenteric Ischemia and Abdominal Compartment Syndrome (01.S.6–7) 12.3 Fulminant Liver Failure, Cirrhosis Decompensation, and Hepatic Dosing (01.S.8–10)
13 Hematologic Disorders
13.1 Anemia, Transfusion, Thrombocytopenia, Coagulopathy, and DIC (01.T.1–4) 13.2 VTE in the Neuro ICU (01.T.5) 13.3 Chemo/Immune, SCT, CAR-T, Sickle Cell, and TMA (01.T.6–10)
14 Neuroimaging
14.1 CT of Brain and Spine 14.2 MRI and CT/MR Perfusion 14.3 Noninvasive Angiography and Catheter Angiography
15 EEG, EMG, and CSF Analysis
15.1 EEG, Standard and Processed (02.B) 15.2 Basic EMG Interpretation (02.G) 15.3 CSF Analysis (02.H)
16 ICP, TCD, and Multimodality Monitoring
16.1 ICP Monitoring (02.C) 16.2 Transcranial Doppler (02.D) 16.3 Brain-Tissue Oxygen and Multimodality Monitoring (02.E–F)
17 Brain Death and Bedside Procedures
17.1 Brain Death Prerequisites and Clinical Exam (02.I) 17.2 Apnea Testing and Ancillary Studies (02.I) 17.3 Vascular Access, Thoracic Echo, and Lung Ultrasound (02.J–L)
18 Coma, Anoxia, and Intracranial Hypertension
18.1 Coma and Other States of Altered Consciousness (03.A) 18.2 Global Anoxia-Ischemia and Post-Resuscitation Encephalopathy (03.A.1) 18.3 Toxidromes, ICU Delirium, and Hypertensive Encephalopathy (03.A.2–4) 18.4 Intracranial Hypertension as a Disease State (03.B)
19 Acute Ischemic Stroke
19.1 IV Reperfusion Therapy (03.C.3) 19.2 Mechanical Thrombectomy Windows and Imaging Selection (03.C.3) 19.3 Malignant Hemispheric Infarction and Basilar Artery Occlusion (03.C.1–2)
20 Intraparenchymal Hemorrhage
20.1 Intracerebral Hematoma (03.D.1) 20.2 Cerebellar Hematoma (03.D.2) 20.3 Intraventricular Hemorrhage (03.D.3)
21 SAH, CVST, and Spinal Cord Infarction
21.1 Aneurysmal Subarachnoid Hemorrhage (03.E.1) 21.2 Non-Aneurysmal SAH (03.E.2) 21.3 Cerebral Venous Sinus Thrombosis (03.F) 21.4 Spinal Cord Infarction (03.G)
22 Vascular Anomalies and Traumatic Brain Injury
22.1 Unruptured Aneurysm, Cavernoma, AVM, and Dural AVF (03.H) 22.2 Diffuse Axonal Injury and Cerebral Contusions (03.I.1–2) 22.3 Epidural Hematoma, Subdural Hematoma, and Penetrating Injury (03.I.3–4, 7) 22.4 Arterial Dissection and Carotid-Cavernous Fistula (03.I.5–6)
23 Spine, Hydrocephalus, and CNS Infection
23.1 Spinal Cord Injury, Central Cord, and Neurogenic Shock (03.J) 23.2 Unstable Spine Fractures (03.K) 23.3 Hydrocephalus and CSF Diversion (03.L) 23.4 Acute CNS Infections (03.M)
24 Seizures and Neuromuscular Emergencies
24.1 Status Epilepticus and Seizures (03.N) 24.2 Guillain-Barré Syndrome (03.O.1) 24.3 Myasthenic Crisis (03.O.2) 24.4 Motor Neuron Disease, Acute Myopathies, Rhabdomyolysis, and CINM (03.O.3–6)
25 Inflammatory Disease, Neuro-Oncology, and Special Populations
25.1 Fulminant Demyelinating Diseases (03.P) 25.2 Autoimmune Encephalitis and Acute Autonomic Hyperactivity (03.Q–R) 25.3 Neuro-Oncology and Treatment Complications (03.S) 25.4 Pregnancy/Post-Partum, Post-Transplant, and Pediatric Patients (03.T–U)
26 Neurosurgical and Perioperative Complications
26.1 Postoperative Seizures, Hemorrhage, Ischemia, and Hyperperfusion (04.A, C, D, H) 26.2 Infection, CSF Leak, and Pneumocephalus (04.B, E, F) 26.3 Complications of EVD and Lumbar Drain (04.G, I)
27 Ethics, Prognostication, and Organ Donation
27.1 Communication, Decision-Makers, Advance Directives, and DNR (05.A, B, G) 27.2 Uncertainties of Prognostication and the Self-Fulfilling Prophecy (05.C) 27.3 Palliative Care, Withdrawal, Withholding, and Futility (05.D–F) 27.4 Donation After Cardiac Death and Care of the Organ Donor (05.H–I)
1.3 Format, Scoring, Pearson VUE, and Score Reports
Key Takeaways Explain This Topic AI
The Format and Scoring PDF updated December 15, 2021, describes 270 one-best-answer questions in five stand-alone sections of 54.
Timed structure is 5 minutes for the NDA and tutorial, 310 minutes (5 hours 10 minutes) of test time, and 5 minutes for an end-of-examination survey, plus up to 40 minutes of pooled breaks between sections.
Questions may be flagged or skipped; there is no penalty for guessing; research and pretest items are unscored.
Passing requires an acceptable criterion-referenced total standard score; no percent-correct cut score is published, and pass/fail is on the total rather than on each section.
ABIM mails neurocritical care score reports within three months of the last exam date in that area; a rescore may be requested through ABIM for $250.
Last updated: September 2026
Format, scoring, Pearson VUE, and ABIM score reports
Quick Answer: The ABPN Format and Scoring PDF, updated December 15, 2021 , describes 270 one-best-answer items in five stand-alone sections of 54 . The clock is 5 minutes for the nondisclosure agreement (NDA) and tutorial, 310 minutes (5 hours 10 minutes) of test time, 5 minutes for a survey, and up to 40 minutes of pooled breaks. Scoring is a criterion-referenced total standard score . ABIM mails neurocritical care score reports within three months of the last exam date; a rescore is $250 through ABIM.
Do not study from a stale logistics line that says 100 questions or 8.5 hours . Those numbers are not in the Format and Scoring PDF and they are not in the Content Specifications. They usually come from copying a practice-bank inventory or from adding break time, tutorial time, and testing time into a single unofficial "day length" and then rounding. The operational test you pace is 310 minutes for 270 questions , in five sections of 54.
The three segments of the appointment
The computer-delivered examination has three segments:
NDA and on-screen tutorial/instructions — 5 minutes .
270 test questions in five sections — 310 minutes of test time.
End-of-examination survey — 5 minutes .
Those three pieces are 320 minutes on the examination clock (5 hours 20 minutes). Pooled break time is additional , up to 40 minutes , and is not part of the 310 minutes of test time if you stay within 40 minutes of breaks.
- Segment Questions Time
- NDA + on-screen instructions 0 5 minutes
- Section 1 54 (stand-alone) Shares the 310 -minute test pool
- Optional break — From the 40 -minute pooled break bank
- Section 2 54 Shares the 310-minute test pool
- Optional break — From the 40-minute pooled break bank
- Section 3 54 Shares the 310-minute test pool
- Optional break — From the 40-minute pooled break bank
- Section 4 54 Shares the 310-minute test pool
- Optional break — From the 40-minute pooled break bank
- Section 5 54 Shares the 310-minute test pool
- End-of-examination survey 0 5 minutes
Stand-alone means you cannot jump from Section 3 back into Section 1 once that section is closed. Pace each 54-item block as its own exam. Flagging and skipping work inside a section; they do not reopen a finished section.
Pooled breaks: 40 minutes total, not five paid lunches
Optional breaks sit between sections. You may take none, or you may use as much or as little of the remaining bank as you want on any one break. Lunch is inside the 40-minute pool , not a separate hour. If you exhaust the 40 minutes early, later break time comes out of remaining examination time . The break screen shows Total Break Time Remaining . A negative number means the bank is gone and the displayed amount is being deducted from test time.
A workable internist plan is often three short breaks (for example 8–10 minutes) and one slightly longer stop, watching the remaining field after each return. A 25-minute lunch after Section 2 plus two 10-minute walks leaves almost nothing for the last gap. Pearson proctors must log you in after breaks . You sign in and out each time you enter or leave the testing room. That logistics friction is part of the day; it is not extra scored time.
310 minutes for 270 items is about 69 seconds per question if you never review. Dense ICU stems (ventilator settings, a blood gas, a CT description, and a "next step" close) will steal more than 69 seconds if you let them. Budget a first pass nearer to 60 seconds , and protect the last minutes of each 54-item section for flagged items. There is no penalty for guessing . A blank is a gift to the cut score; a reasoned guess is not.
Question type, flagging, and pretest items
Every operational item is one-best-answer multiple choice . You may flag questions for review or skip them and return within the section . ABPN states that questions included solely for research or pretesting are not included in the examinee's score . You will not be told which screens are pretest. Treat every item as if it counts.
ABPN also notes that no examinee is expected to obtain a perfect score, but each examinee should have some familiarity with the subject matter of each question. That sentence is how a 42–48% Principles domain reaches medical ICU topics an internist already knows and still asks neurosurgical perioperative complications an internist sees less often. Guessing is still required when you are down to two remaining options in an unfamiliar corner.
ABPN hosts an online Subspecialty Certification Demonstration Examination so you can see the interface. It is a representation of the operational examination, not an operational form. You will not receive a score or a review of your demonstration answers. Use it to learn navigation, not to predict your standard score.
Scoring: criterion-referenced total standard score
Examinees receive a standard score for the total test . An acceptable level of performance on that total standard score is required to pass. The standards are not norm-referenced . There is no predefined passing rate for any group of examinees. In plain language: you are not competing for a fixed number of passing slots against the other internists in the room, and you cannot look up a published "70% correct" cut because no percent-correct cut score is published .
Pass/fail is on the total , not on each of the five sections. A weak ethics block will not independently fail you if the total standard score is acceptable, and a brilliant stroke block will not independently pass you if the total is not. You also receive a graphic diagnostic report by subtopic. That report is the document to use if you must retest; a global feeling that "the SAH items were hard" is not.
ABIM score reports and the $250 rescore
Most ABIM assessments post score reports in the Physician Portal. Neurocritical care is an exception , grouped with adolescent medicine: a score report will be mailed to you within three months of the last date of the exam in that area. Pass/fail status may still appear in the Physician Portal, but the mailed report is the neurocritical care pathway ABIM publishes. Do not expect an on-screen scaled score at Pearson VUE the way some nursing CBTs display pass/fail immediately. Do not expect a 48-hour ABPN portal dump. The clock is three months from the last exam date in that administration, which for October 5–9, 2026, is measured from the end of that window, not from your personal Tuesday appointment.
While scoring errors are described as highly unlikely, ABIM allows a rescore for $250 . The usual ABIM instruction is a written request within six months , with payment to the American Board of Internal Medicine. A rescore is a scoring check, not a content appeal and not a free second examination. It is also not the $2,995 examination fee and not ABPN's neurologist miscellaneous fee list.
Pearson VUE day-of traps
The examination is entirely computer-based at Pearson VUE . Bring the identification ABIM and Pearson list in your authorization. Unauthorized notes, a second phone, or a smartwatch are how appointments end before Section 1. If you miss the appointment, you contact ABIM to reschedule and may owe a new examination fee; do not call ABPN's neurologist desk about an ABIM file.
Official format document: Neurocritical Care Certification Format and Scoring (updated December 15, 2021) .