Free BNNP Practice Questions

Question 1

An adult with established left-hemisphere language dominance develops a striking asymmetry after a stroke: an object placed in the right hand is named immediately, but the same object placed in the left hand cannot be named. Testing is performed with the eyes closed. Elementary touch and joint-position sensation are preserved in both hands. Which additional finding would most strongly support a callosal disconnection rather than impaired tactile object recognition?

Accepted Answer

Accurate demonstration of each unseen object's use with the left hand

Answer

Accurate repetition of the object's name after the examiner says it aloud

Answer

Normal two-point discrimination over the fingertips of the left hand

Answer

Accurate naming of the same objects when they are presented visually

Question 2

A 73-year-old retired architect has gradually lost the ability to manage finances and navigate familiar buildings. For eight months, she has repeatedly seen unfamiliar children in her kitchen while fully awake. Her husband describes no fluctuations in alertness or dream enactment, and examination shows no spontaneous parkinsonism. Medications, visual impairment, and acute illness do not explain the hallucinations. Which additional finding would change her classification from possible to probable dementia with Lewy bodies under the 2017 consensus criteria?

Accepted Answer

Reduced striatal dopamine-transporter uptake on SPECT

Answer

Relative preservation of medial temporal structures on MRI

Answer

Occipital hypometabolism with a cingulate-island pattern on FDG-PET

Answer

Posterior EEG slowing with pre-alpha/theta fluctuations

Question 3

Routine monitoring detects an absolute neutrophil count of 1,220/µL in a patient who has remained well for 18 months on clozapine after several unsuccessful antipsychotic trials. A repeat sample the next morning is 1,260/µL. Previous counts were normal, and there is no documented Duffy-null associated neutrophil count. The patient is afebrile and clinically well. Which management plan follows current U.S. prescribing recommendations?

Accepted Answer

Continue clozapine; check the ANC three times weekly until at least 1,500/µL.

Answer

Interrupt clozapine; check the ANC daily until it reaches at least 1,500/µL.

Answer

Continue clozapine; retain monthly ANC checks while the count stays above 1,000/µL.

Answer

Halve the clozapine dose; check the ANC weekly until the previous baseline returns.

Question 4

On arrival from a care facility, an 81-year-old with dementia is markedly drowsy, cannot give meaningful orientation answers, and is too inattentive to begin months backward. Staff had reported that “something is different,” but baseline records are incomplete and the caregiver cannot yet be reached. With acute change not yet established, the recorded 4AT total is 8/12. This result should lead the receiving clinician to:

Accepted Answer

Initiate a delirium evaluation while seeking collateral evidence of the patient's baseline and recent time course.

Answer

Attribute the result to advanced dementia because both cognitive tasks were untestable and acute fluctuation is unverified.

Answer

Defer investigation for delirium until collateral information establishes a definite acute departure from the patient's baseline.

Answer

Classify delirium as severe from the total score and use that severity category to determine treatment intensity.

Question 5

A 12-year-old with age-appropriate vocabulary and grammar has longstanding difficulty sustaining reciprocal conversation, coordinating gaze with gestures, and understanding friendships. These difficulties impair peer relationships. No repetitive movements or unusually restricted interests are evident during several office visits. The clinician is distinguishing autism spectrum disorder from social (pragmatic) communication disorder. Which collateral observation would most strongly favor autism spectrum disorder?

Accepted Answer

Preschool records describe recurrent distress when daily routes changed and prolonged repetitive spinning of toy wheels.

Answer

He misses implied meanings and rarely repairs misunderstandings, even when speaking with familiar peers.

Answer

He used complex sentences early but consistently failed to adapt his speech to the listener or setting.

Answer

He has wanted friends since early childhood but often fails to recognize when classmates lose interest.

Question 6

Bradykinesia and rigidity develop after sustained dopamine D2-receptor blockade. In the classic indirect motor pathway, loss of dopaminergic inhibition increases the activity of striatal projection neurons. Which downstream activity pattern follows from this change?

Accepted Answer

External pallidum decreases; subthalamic nucleus increases; internal pallidum increases

Answer

External pallidum increases; subthalamic nucleus decreases; internal pallidum decreases

Answer

External pallidum decreases; subthalamic nucleus decreases; internal pallidum decreases

Answer

External pallidum increases; subthalamic nucleus increases; internal pallidum increases

Question 7

A 69-year-old develops progressive disinhibition, loss of empathy, and repetitive behaviors over two years, with comparatively preserved episodic memory. MRI shows predominant frontal and anterior-temporal atrophy. Amyloid PET is positive, and an available genetic result shows APOE ε3/ε4. Which diagnostic formulation best accounts for the different kinds of evidence?

Accepted Answer

Behavioral cognitive syndrome with Alzheimer biomarker evidence: the scan does not establish which pathology chiefly drives the symptoms.

Answer

Behavioral Alzheimer disease: amyloid PET identifies the etiology, while the frontal atrophy explains its atypical clinical expression.

Answer

Frontotemporal degeneration with incidental amyloid: the ε4 allele accounts for amyloid deposition without implicating Alzheimer pathology in the behavioral syndrome.

Answer

Mixed Alzheimer and frontotemporal degeneration: amyloid PET identifies one pathological substrate, while the regional atrophy identifies the other.

Question 8

A 59-year-old with Parkinson disease has disabling motor fluctuations despite optimized medication and a substantial levodopa response. A multidisciplinary evaluation finds deep-brain stimulation appropriate. Neuropsychological testing shows reduced processing speed and working memory, but no dementia; recurrent depression is in remission. The patient prioritizes motor improvement while preserving cognition and mood and is comfortable continuing medication. Which operative strategy best matches these priorities?

Accepted Answer

Favor globus pallidus internus stimulation, considering the cognitive deficits and history of depression.

Answer

Favor subthalamic nucleus stimulation, emphasizing the opportunity to reduce dopaminergic medication.

Answer

Favor ventral intermediate thalamic stimulation to address the full range of fluctuating motor symptoms.

Answer

Defer stimulation until processing speed and working-memory scores have returned to the normal range.

Question 9

Over the first 18 months of a progressive illness, a previously considerate 58-year-old teacher becomes indifferent to her husband's serious illness, spends hours sorting the same papers into fixed arrangements, and begins eating several desserts at each meal. She subsequently loses her job and needs help managing household affairs. MRI shows frontal and anterior temporal atrophy. Neuropsychological testing also reveals substantial episodic-memory impairment. No primary psychiatric, nondegenerative medical, or competing biomarker explanation is identified. Under the 2011 international criteria, which formulation is best supported?

Accepted Answer

Probable behavioral variant frontotemporal dementia; memory sparing is not mandatory.

Answer

Possible behavioral variant frontotemporal dementia; memory impairment precludes a probable classification.

Answer

Alzheimer dementia; episodic-memory impairment outweighs the early behavioral features.

Answer

Behavioral variant frontotemporal dementia with definite pathology, established by the MRI pattern.

Question 10

A memory clinic is evaluating a hypothetical triage test for a neurodegenerative cognitive disorder. In the referral population, the pretest probability of that disorder is 20%. At the chosen cutoff, sensitivity is 85% and specificity is 90%; assume these estimates apply to the patient being assessed. The patient's result is positive. Which interpretation correctly combines the probability of disease after testing with the role of the result in care?

Accepted Answer

About 68% probability of disease; despite increased suspicion, the chance that this result is false warrants further clinical and etiologic assessment.

Answer

About 89% probability of disease; most positive results represent disease, although imperfect specificity leaves a residual need for clinical confirmation.

Answer

About 85% probability of disease; the result provides strong evidence, although the clinical phenotype still requires assessment before assigning an etiologic diagnosis.

Answer

About 32% probability of disease; disease remains less likely than its absence, although a positive result still warrants clinical and etiologic assessment.

Free BNNP Practice Questions

Domain 1: Structural and Functional Neuroanatomy

Question 1

Question 2

Domain 2: Neuropsychiatric Assessment

Question 3

Question 4

Question 5

Domain 3: Treatments

Question 6

Question 7

Domain 4: Neurobehavioral and Neuropsychiatric Syndromes

Question 8

Question 9

Question 10

That's 10 of 1,030