American Board of Psychiatry & Neurology Psychiatry Core Competencies Outline

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1 American Board of Psychiatry & Neurology Psychiatry Core Competencies Outline I. Psychiatry Patient Care and Procedural Skills Core Competencies A. General: Physicians shall demonstrate the following abilities: 1. To perform and document a relevant history and examination on culturally diverse patients 1 to include as appropriate: a. Chief complaint b. History of present illness c. Past medical history d. A comprehensive review of systems e. A family history 2 f. A sociocultural history g. A developmental history (especially for children) h. A situationally germane general and neurologic examination 2. To delineate appropriate differential diagnoses 3. To evaluate, assess, and recommend effective management of patients B. For Psychiatry: Based on relevant psychiatric assessment, psychiatrists shall demonstrate the following abilities: 1. To perform a comprehensive diagnostic mental status examination 2. To perform a screening neurologic examination 3. To develop and document: a. An appropriate DSM-IV multiaxial differential diagnosis b. An integrative case formulation that includes neurobiological, phenomenological, psychological, and sociocultural issues involved in diagnosis and management c. An evaluation plan, including appropriate laboratory, imaging, medical, and psychological examinations d. A comprehensive treatment plan addressing biological, psychological, and sociocultural domains 4. To comprehensively assess and document a patient s potential for selfharm or harm to others. This shall include: a. An assessment of risk b. Knowledge of involuntary treatment standards and procedures c. Ability to intervene effectively to minimize risk d. Ability to implement prevention methods against self-harm and harm to others 5. To conduct therapeutic interviews, e.g., enhance the ability to collect and use clinically relevant material through supportive interventions, exploratory interventions, and clarifications 6. To determine if a patient s symptoms are due to a psychiatric disorder or are of another origin, e.g., the result of a systemic or neurologic disease 7. To conduct a range of individual, group, and family therapies using standard, accepted models, and to integrate these psychotherapies in multi- Psychiatry Core Competencies Outline, page 1 of 10

2 modal treatment, including biological and sociocultural interventions 8. To initiate, titrate, and monitor appropriate psychotropic medications 9. To evaluate the indication for, relevance of, and application of the following therapeutic procedures: a. Electroconvulsive therapy b. Light therapy c. Transcranial magnetic stimulation d. Vagal nerve stimulation II. Psychiatry Medical Knowledge Core Competencies A. General: Physicians shall demonstrate the following: 1. Knowledge of general medical conditions, including considerations relating to age, gender, race, and ethnicity, based on the literature and standards of practice. This knowledge shall include: a. The epidemiology of the disorder b. The etiology of the disorder, including medical, genetic, and sociocultural factors c. The phenomenology of the disorder d. An understanding of the impact of physical illness on the patient s functioning e. The experience, meaning, and explanation of the illness for the patient and family, including the influence of cultural factors and culture-bound syndromes f. Effective treatment strategies g. Course and prognosis 2. Knowledge of health care delivery systems, including patient and family counseling 3. Systems-based practice 4. Knowledge of the application of ethical principles in delivering medical care 5. Ability to reference and utilize electronic systems to access medical, scientific, and patient information B. For Psychiatry: Psychiatrists shall demonstrate knowledge of the following: 1. Human growth and development, including normal biological, cognitive, and psychosexual development, as well as sociocultural factors; pathophysiology and neuroanatomy; and psychobiology of psychiatric disorders 2. Behavioral science and social psychiatry, including: a. Learning theory b. Theories of normal family organization, dynamics, and communication c. Theories of group dynamics and process d. Anthropology, sociology, and theology as they pertain to clinical psychiatry Psychiatry Core Competencies Outline, page 2 of 10

3 e. Transcultural psychiatry f. Community mental health g. Epidemiology h. Research methodology and statistics i. Psychodynamic theory 3. Patient evaluation and treatment selection, including diagnostic and therapeutic studies, including: a. Diagnostic interviewing b. Mental status examination c. Psychological and educational testing d. Laboratory testing e. Imaging studies f. Treatment comparison and selection g. Various treatments, including: (1) Specific forms of psychotherapies (a) Brief therapy (b) Cognitive behavioral therapy (c) Interpersonal therapy (d) Psychodynamic therapy (e) Supportive therapy (2) All delivery systems of psychotherapies (a) Individual (b) Group (c) Family (3) Recognition and treatment of psychosexual dysfunctions (4) Somatic treatments, including: (a) Pharmacotherapy, including antidepressants, antipsychotics, anxiolytics, mood stabilizers, hypnotics, and stimulants, including their: i) Pharmacologic actions ii) iii) iv) Clinical indications Side effects Drug interactions, including over-thecounter, herbal, and alternative medications v) Toxicities vi) Appropriate prescribing practices, including age, gender, and ethnocultural variations vii) Cost-effectiveness Electroconvulsive therapy Light therapy Transcranial magnetic stimulation Vagal nerve stimulation (b) (c) (d) (e) h. Emergency psychiatry, including: (1) Suicide (2) Homicide and other violent behavior (3) Child, domestic, and elder abuse Psychiatry Core Competencies Outline, page 3 of 10

4 (4) Crisis intervention (5) Differential diagnoses in emergency situations (6) Treatment methods in emergency situations i. Substances of abuse, including the: (1) Pharmacologic actions of substances of abuse (2) Signs and symptoms of toxicity (3) Signs and symptoms of withdrawal (4) Management of toxicity and withdrawal (5) Epidemiology, including sociocultural factors (6) Prevention and treatment 4. Psychiatric subspecialties and other areas of psychiatric endeavor, including: a. Addiction psychiatry b. Child and adolescent psychiatry c. Clinical neurophysiology d. Forensic psychiatry e. Geriatric psychiatry f. Pain medicine g. Psychosomatic medicine h. Sleep medicine i. End-of-life and palliative care 5. Psychopathology, epidemiology, diagnostic criteria, and clinical course for common psychiatric disorders and diseases across the lifespan, including treatment, for the following: a. Disorders usually first diagnosed in infancy, childhood, or adolescence b. Delirium, dementia, amnestic, and other cognitive disorders c. Mental disorders due to general medical conditions d. Substance-related disorders e. Schizophrenic and other psychotic disorders f. Mood disorders g. Anxiety disorders h. Somatoform disorders i. Factitious disorders j. Dissociative disorders k. Sexual and gender identity disorders l. Eating disorders m. Sleep disorders n. Impulse control disorders not elsewhere classified o. Adjustment disorders p. Other conditions that may be a focus of clinical attention q. Paranoid personality disorder r. Schizoid personality disorder s. Schizotypal personality disorder t. Antisocial personality disorder u. Borderline personality disorder Psychiatry Core Competencies Outline, page 4 of 10

5 v. Histrionic personality disorder w. Narcissistic personality disorder x. Avoidant personality disorder y. Dependent personality disorder z. Obsessive-compulsive personality disorder aa. Personality disorder not otherwise specified bb. Mental retardation cc. Drug dependence and substance abuse dd. Interplay between psychosomatic and neurologic clinical manifestations, including somatization and conversion ee. Recognition of the range of clinical presentations in child and adult ff. victims of abuse Management of uncomplicated psychiatric disorders and indications for consultation 6. Neurology, including: a. Pathophysiology, epidemiology, diagnostic criteria, and clinical course for common neurologic disorders, including: (1) Movement disorders, stroke, dementia, and seizure disorders (2) Neurologic manifestations/complications of common psychiatric disorders (3) Psychiatric manifestations of common neurologic disorders b. Neuropharmacology (1) Major medications, e.g., anticonvulsants, antiparkinsonian agents (2) Side effects, e.g., delusions, mood changes (3) Neurologic complications of somatic therapies, e.g., movement disorders 7. Employment of principles of quality improvement in practice III. Psychiatry Interpersonal and Communications Skills Core Competencies A. Psychiatrists shall demonstrate the following competencies: 1. To listen to and understand patients and to attend to nonverbal and electronic communication 2. To communicate effectively with patients using verbal, nonverbal, and written skills as appropriate 3. To develop and maintain a therapeutic alliance with patients by instilling feelings of trust, honesty, openness, rapport, and comfort in their relationships with psychiatrists 4. To partner with patients to develop an agreed-upon health care management plan 5. To transmit information to patients in a clear and meaningful fashion 6. To understand the impact of the psychiatrist s own feelings and behavior so that it does not interfere with appropriate treatment 7. To communicate effectively and work collaboratively with other health Psychiatry Core Competencies Outline, page 5 of 10

6 care and other professionals involved in the lives of patients and their families 8. To educate patients, their families, and professionals about medical, psychosocial, and behavioral issues 9. To preserve patient confidentiality B. Psychiatrists shall demonstrate the ability to obtain, interpret, and evaluate consultations from other medical specialties. This shall include: 1. Knowing when to solicit consultation and having the sensitivity to assess the need for consultation 2. Formulating and clearly communicating the consultation question 3. Discussing the consultation findings with the consultant 4. Discussing the consultation findings with the patient and family C. Psychiatrists shall serve as effective consultants to other medical specialists, mental health professionals, and community agencies by demonstrating the abilities to: 1. Communicate effectively with the requesting party to refine the consultation question 2. Maintain the role of consultant 3. Communicate clear and specific recommendations 4. Respect the knowledge and expertise of the requesting professionals D. Psychiatrists shall demonstrate the ability to communicate effectively with patients and their families by: 1. Matching all communication to the educational and intellectual levels of patients and their families 2. Demonstrating sociocultural competence to patients and their families 3. Providing explanations of psychiatric disorders and treatment that are jargon free and matched to the educational/intellectual levels of patients and their families 4. Providing preventive education that is understandable and practical 5. Respecting patients cultural, ethnic, religious, and economic backgrounds 6. Developing and enhancing rapport and a working alliance with patients and their families 7. Ensuring that the patient and/or family have understood the communication 8. Responding promptly to electronic communications when used as a communication method agreed upon by psychiatrists and their patients and patients families E. Psychiatrists shall maintain up-to-date medical records and write legible prescriptions. These records must capture essential information while simultaneously respecting patient privacy, and they must be useful to health professionals outside psychiatry. Psychiatry Core Competencies Outline, page 6 of 10

7 F. Psychiatrists shall demonstrate the ability to work effectively within a multidisciplinary treatment team, including being able to: 1. Listen effectively 2. Elicit needed information from team members 3. Integrate information from different disciplines 4. Manage conflict 5. Clearly communicate an integrated treatment plan G. Psychiatrists shall demonstrate the ability to communicate effectively with patients and their families while respecting confidentiality. Such communication may include: 1. The results of the assessment 2. Use of informed consent when considering investigative procedures 3. Genetic counseling, palliative care, and end-of-life issues when appropriate 4. Consideration and compassion for the patient in providing accurate medical information and prognosis 5. The risks and benefits of the proposed treatment plan, including possible side effects of medications and/or complications of non-pharmacologic treatments 6. Alternatives (if any) to the proposed treatment plan 7. Appropriate education concerning the disorder, its prognosis, and prevention strategies IV. Psychiatry Practice-Based Learning and Improvement Core Competencies A. Psychiatrists shall recognize limitations in their own knowledge base and clinical skills, and understand and address the need for lifelong learning. B. Psychiatrists shall demonstrate appropriate skills for obtaining and evaluating upto-date information from scientific and practice literature and other sources to assist in the quality care of patients. This shall include, but not be limited to: 1. Use of medical libraries 2. Use of information technology, including Internet-based searches and literature databases 3. Use of drug information databases 4. Active participation, as appropriate, in educational courses, conferences, and other organized educational activities at both local and national levels C. Psychiatrists shall evaluate caseload and practice experience in a systematic manner. This may include: 1. Case-based learning 2. Use of best practices through practice guidelines or clinical pathways 3. Review of patient records 4. Obtaining evaluations from patients, e.g., outcomes and patient satisfaction Psychiatry Core Competencies Outline, page 7 of 10

8 5. Employment of principles of quality improvement in practice 6. Obtaining appropriate supervision and consultation 7. Maintaining a system for examining errors in practice and initiating improvements to eliminate or reduce errors D. Psychiatrists shall demonstrate the ability to critically evaluate relevant medical literature. This may include: 1. Using knowledge of common methodologies employed in psychiatric research 2. Researching and summarizing a particular problem that derives from their own caseloads E. Psychiatrists shall demonstrate the abilities to: 1. Review and critically assess scientific literature to determine how quality of care can be improved in relation to one s practice, e.g., reliable and valid assessment techniques, treatment approaches with established effectiveness, practice parameter adherence. Within this aim, psychiatrists shall be able to assess the generalizability or applicability of research findings to their patients in relation to their sociodemographic and clinical characteristics 2. Develop and pursue effective remediation strategies that are based on critical review of the scientific literature V. Psychiatry Professionalism Core Competencies A. Psychiatrists shall demonstrate responsibility for their patients care, including: 1. Responding to communication from patients and health professionals in a timely manner 2. Establishing and communicating back-up arrangements, including how to seek emergent and urgent care when necessary 3. Using medical records for appropriate documentation of the course of illness and its treatment 4. Providing coverage if unavailable, e.g., when out of town or on vacation 5. Coordinating care with other members of the medical and/or multidisciplinary team 6. Providing for continuity of care, including appropriate consultation, transfer, or referral if necessary B. Psychiatrists shall demonstrate ethical behavior, integrity, honesty, compassion, and confidentiality in the delivery of care, including matters of informed consent/assent, professional conduct, and conflict of interest. C. Psychiatrists shall demonstrate respect for patients and their families, and their colleagues as persons, including their ages, cultures, disabilities, ethnicities, genders, socioeconomic backgrounds, religious beliefs, political leanings, and sexual orientations. Psychiatry Core Competencies Outline, page 8 of 10

9 D. Psychiatrists shall demonstrate understanding of and sensitivity to end-of-life care and issues regarding provision of care and clinical competence. E. Psychiatrists shall review their professional conduct and remediate when appropriate. F. Psychiatrists shall participate in the review of the professional conduct of their colleagues. VI. Psychiatry Systems-Based Practice Core Competencies A. Psychiatrists shall have a working knowledge of the diverse systems involved in treating patients of all ages, and understand how to use the systems as part of a comprehensive system of care in general and as part of a comprehensive, individualized treatment plan. This shall include the: 1. Evaluation and implementation, where indicated, of the use of practice guidelines 2. Ability to access community, national, and allied health professional resources that may enhance the quality of life of patients with chronic psychiatric and neurologic illnesses 3. Demonstration of the ability to lead and work within health care teams needed to provide comprehensive care for patients with psychiatric and neurologic disease and respect professional boundaries 4. Demonstration of skills for the practice of ambulatory medicine, including time management, clinical scheduling, and efficient communication with referring physicians 5. Use of appropriate consultation and referral mechanisms for the optimal clinical management of patients with complicated medical illness 6. Demonstration of awareness of the importance of adequate cross-coverage 7. Use of accurate medical data in the communication with and effective management of patients B. In the community system, psychiatrists shall: 1. Recognize the limitation of health care resources and demonstrate the ability to act as an advocate for patients within their sociocultural and financial constraints 2. Demonstrate knowledge of the legal aspects of psychiatric diseases as they impact patients and their families 3. Demonstrate an understanding of risk management. C. Psychiatrists shall demonstrate a working knowledge of different health care systems, including: 1. Working within the system of care to maximize cost-effective utilization of resources 2. Participating in utilization review communications and, when appropriate, Psychiatry Core Competencies Outline, page 9 of 10

10 advocating for quality patient care 3. Educating patients concerning such systems of care D. Psychiatrists shall demonstrate knowledge of community systems of care and assist patients to access appropriate care and other support services. This requires knowledge of treatment settings in the community, which include ambulatory, consulting, acute care, partial hospital, skilled care, rehabilitation, nursing homes and home care facilities, substance abuse facilities, and hospice organizations. Psychiatrists shall demonstrate knowledge of the organization of care in each relevant delivery setting and the ability to integrate the care of patients across such settings. E. Psychiatrists shall be aware of safety issues, including acknowledging and remediating medical errors, should they occur. 1 Cultural diversity includes issues of race, gender, language, age, country of origin, sexual orientation, religious/spiritual beliefs, sociocultural class, educational/intellectual levels, and physical disability. Working with a culturally diverse population requires knowledge about cultural factors in the delivery of health care. For the purposes of this document, all patient and peer populations are to be considered culturally diverse. 2 For the purposes of this document, family is defined as those having a biological or otherwise meaningful relationship with the patient. Significant others are to be defined from the patient s point of view. Approved by the ABPN Board of Directors, July 22, 2011 Psychiatry Core Competencies Outline, page 10 of 10

11 AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY Examination Schedule (rev. 10/4/11) Go to for the most up to date schedule. Psychiatry, Neurology, Neurology with Special Qualification in Child Neurology - Computer-administered Examinations Examination Choice of Dates Application Deadline Late Deadline ** Psychiatry PART I May 7-11, 2012 November 1, 2011 December 1, 2011 Psychiatry CERTIFICATION September 13-14, 2012 February 1, 2012 March 1, 2012 Neurology, Child Neurology CERT. September 20-21, 2012 March 1, 2012 April 2, 2012 Psychiatry PART I May 1-3, 2013 January 21, 2013 N/A Neurology, Child Neurology CERT. September 19 & 20, 2013 February 15, 2013 March 15, 2013 Psychiatry CERTIFICATION September 23-25, 2013 February 1, 2013 March 1, 2013 Psychiatry, Neurology, and Neurology with Special Qualification in Child Neurology Part II (Oral) Examinations* Date Headquarters Hotel Location January 13-15, 2012 Hilton Palacio del Rio San Antonio, TX May 18-20, 2012 Hilton Omaha Omaha, NE September 21-23, 2012 Indianapolis Marriott Downtown Indianapolis, IN January 18-20, 2013 (Psychiatry only) Hilton Miami Downtown Miami, FL April 19-21, 2013 (Psychiatry only) Palmer House Hilton Chicago, IL October 4-6, 2013 (Psychiatry only) The Westin Crown Center Kansas City, MO Subspecialty of Child and Adolescent Psychiatry Part II (Oral) Examinations* Date Headquarters Hotel Location November 11-13, 2011 Hyatt Regency Milwaukee Milwaukee, WI November 2-4, 2012 Hilton Palacio del Rio San Antonio, TX November 9-11, 2012 JW Marriott Houston Houston, TX November 15-17, 2013 San Antonio Marriott Riverwalk San Antonio, TX Certification in the Subspecialties Examinations Subspecialty Choice of Dates Application Deadline Late Deadline** Sleep Medicine October 27, 2011 & November 10, 2011*** April 1, 2011 May 1, 2011 Child and Adolescent Psychiatry Part I June 4-8, 2012 December 1, 2011 January 3, 2012*** Neuromuscular Medicine August 13-17, 2012 January 3, 2012 March 1, 2012 Vascular Neurology August 13-17, 2012 January 3, 2012 March 1, 2012 Pain Medicine August 18, 2012 January 3, 2012 February 1, 2012 Addiction Psychiatry August 27-31, 2012 January 3, 2012 March 1, 2012 Geriatric Psychiatry August 27-31, 2012 January 3, 2012 March 1, 2012 Child and Adolescent Psychiatry CERT. October 2-3, 2012 April 1, 2012 May 1, 2012 Hospice and Palliative Medicine October 4, 2012 April 1, 2012 May 1, 2012 Child and Adolescent Psychiatry Part I June 3-7, 2013 January 2, 2013 February 1, 2013 Child and Adolescent Psychiatry CERT. September 23-25, 2013 March 1, 2013 May 1, 2013 Forensic Psychiatry October 15-18, 2013 April 1, 2013 May 1, 2013 Psychosomatic Medicine October 15-18, 2013 April 1, 2013 May 1, 2013 Clinical Neurophysiology October 28, 2013-November 1, 2013 April 15, 2013 May 15, 2013 Neurodevelopmental Disabilities October 28, 2013-November 1, 2013 April 15, 2013 May 15, 2013 Epilepsy October 28, 2013-November 1, 2013 April 15, 2013 May 15, 2013 Maintenance of Certification Examinations Examination Choice of Dates Application Deadline Late Deadline** Pain Medicine Oct. 8-22, 2011 (not available as a module) April 1, 2011 May 1, 2011 Psychiatry February 6-10, 2012 September 1, 2011*** October 14, 2011 Neurology February 27-March 2, 2012 September 1, 2011 November 1, 2011 Neurology w/ Special Qual. Child Neuro. February 27-March 2, 2012 September 1, 2011 November 1, 2011 Addiction Psychiatry April 2-6, 2012 November 1, 2011 December 1, 2011 Child & Adolescent Psychiatry April 2-6, 2012 November 1, 2011 December 1, 2011 Forensic Psychiatry April 2-6, 2012 November 1, 2011 December 1, 2011 Geriatric Psychiatry April 2-6, 2012 November 1, 2011 December 1, 2011 MOC Modular (w/o CNP &/or NDD) April 23-27, 2012 (all modules except CNP/NDD) November 1, 2011 December 1, 2011 Clinical Neurophysiology May 14-18, 2012 December 1, 2011 January 3, 2012*** Neurodevelopmental Disabilities May 14-18, 2012 December 1, 2011 January 3, 2012*** MOC Modular (w/ CNP &/or NDD) May 14-18, 2012 November 1, 2011 December 15, 2011 Pain Medicine August 18-Sept. 1, 2012 (not available as a module) February 1, 2012*** March 1, 2012*** Psychiatry February 18-March 1, 2013 September 3, 2012 November 15, 2012 Neurology February 18-March 1, 2013 September 3, 2012 November 15, 2012 Neurology w/ Special Qual. Child Nuero. February 18-March 1, 2013 September 3, 2012 November 15, 2012 Addiction Psychiatry April 15-19, 2013 November 1, 2012 December 3, 2012 Child & Adolescent Psychiatry April 15-19, 2013 November 1, 2012 December 3, 2012 Forensic Psychiatry April 15-19, 2013 November 1, 2012 December 3, 2012 Geriatric Psychiatry April 15-19, 2013 November 1, 2012 December 3, 2012 MOC Modular (w/o CNP &/or NDD) April 22-26, 2013 November 1, 2012 December 3, 2012 Clinical Neurophysiology May 6-10, 2013 December 17, 2012 January 15, 2013 Neurodevelopmental Disabilities May 6-10, 2013 December 17, 2012 January 15, 2013 MOC Modular (w/ CNP &/or NDD) May 6-10, 2013 December 17, 2012 January 15, 2013 *All Part II Oral Examinations are weekend examination format. ** Late Deadline - $500 late fee required after application deadline but before late deadline. *** Dates Changed or Added. MOC Modular Examinations must be two or three examinations combined from the MOC examinations listed during the year except CNP. MOC CNP and/or NDD examination as a modular examination in combination with other modules may only be taken during dates listed. NOTE: All dates are subject to change

12 The ABPN Physician Folios offers a single source for information pertinent to a physician at all the various stages of a relationship with the ABPN - from resident through seasoned diplomate engaged in MOC. Likewise, ABPN Physician Folios provides a dynamic conduit for important data exchange such as making updates to personal contact information, updating medical license information, and applying and paying for an examination. Please visit the ABPN website at click the ABPN Physician Folios button and follow the instructions to activate your account. Over time, more functions will be added into the ABPN Physician Folios such as an area for residents to view their status toward completion of credentialing activities for initial certification, and an area for diplomates to record their maintenance of certification activities. What's in the site? The ABPN Physician Folios site gives you access to two main functions: Views and Actions. Views are simply displays of information. The actionable items that can be performed are typically stated as such and appear in an underlined dark red font like these examples: Apply for an Examination or Update License Information. Be sure to look for little "Info" symbols like this throughout the web site. Move your cursor over these symbols and pop up boxes or bubbles display important information regarding "views" or "actions" for that page. Please Note: Due to specific credentialing requirements, not all applications can be made available through ABPN Physician Folios. Some applications, based on the examination schedule, will be posted as pdf files on How do I activate an account? In order to log in to the secure portal, you must have an established relationship with the ABPN through one of the following methods: You have previously applied for an ABPN examination. You have previously taken an ABPN examination. 1) Go to You may wish to bookmark ("ctrl D") the login page for future quick reference. 2) Click the "Activate Account" button. 3) A secondary authentication page will be launched asking for your current address, first name, last name, birth date, and the last four digits of your social security number. (If the system is not able to authenticate you using these pieces of information, you will be prompted to submit other documentation via fax). 4) Upon authentication and activation, a unique case-sensitive password will be ed to you. 5) Return to enter your address and your password, click login. Need Help? Send to: Folios_help@abpn.com 2011 American Board of Psychiatry and Neurology, Inc East Lake Cook Road, Suite 900, Buffalo Grove, IL /4/11

13 Sample Questions for Part I Examinations Type A question from Psychiatry: According to recent epidemiologic studies, the incidence of dementia of the Alzheimer type is decreased in individuals who have been treated with which of the following agents? A. Acetaminophen B. Hydergine C. Ibuprofen D. Vitamin B 6 (pyridoxine) E. Vitamin C Type A question from Neurology: Which of the following primary nervous system tumors occurs more frequently in women than in men? A. Ependymoma B. Germinoma C. Medulloblastoma D. Meningioma E. Choroid plexus papilloma Vignette question from Neurology: A nine-year-old girl has had gait difficulty and poor balance since she started walking. Her coordination has deteriorated over the past few years, but her gait difficulty appears unchanged. Early development was normal. She has had sinusitis frequently. On examination, her speech is dysarthric. She has appendicular dysmetria and truncal titubation, as well as some choreoathetosis and dystonic movements in the upper extremities. Muscle stretch reflexes are trace in the upper extremities and absent in the lower extremities. She has diffuse hypotonia with mild distal weakness. Pin and joint position sensation is intact, but vibratory sensation is reduced. Based on the history and neurologic examination, the best description of this patient's disorder is A. peripheral neuropathy B. autonomic failure C. congenital myopathy D. neuromuscular junction disorder E. spinocerebellar degeneration A cranial MRI in this patient is most likely to show A. frontal lobe atrophy B. cerebellar atrophy C. T1-weighted intensities in basal ganglia D. T2-weighted intensities in globi pallidi E. calcification of the basal ganglia The laboratory test most likely to be abnormal in this patient is A. blood vitamin B 12 (cobalamin) level B. blood folic acid level C. blood alpha fetoprotein level D. blood very long chain fatty acids E. CSF oligoclonal bands 2008 American Board of Psychiatry and Neurology, Inc E. Lake Cook Road, Suite 900, Buffalo Grove, IL