10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free BIM questions are organized by exam domain, so you can see how each part of the Certification in Brain Injury Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Central Nervous System Manifestations 30% of exam
Question 1
A referral describes a patient as being in a vegetative state six weeks after severe traumatic brain injury. On three standardized Coma Recovery Scale-Revised assessments without sedative confounding, the total score is 9/23. The patient repeatedly tracks a moving mirror horizontally and vertically without losing fixation but does not follow commands, communicate intentionally, or use objects functionally. What classification is supported by these examinations?
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Correct answer: A - Minimally conscious state
Question 2
The parents of a 16-year-old soccer player ask whether she should remain out of school until every concussion symptom has disappeared. Four days after injury, her mild headache is improving, she tolerates short walks, and she can read for 20 minutes before needing a break. Examination is normal, with no worsening headache, repeated vomiting, or other danger signs. She has completed 48 hours of relative rest. The appropriate recommendation for tomorrow is to:
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Correct answer: B - Resume supported learning and light activity, while withholding contact sport.
Question 3
In a 38-year-old with severe traumatic brain injury, arterial pressure is 126/72 mm Hg and intracranial pressure remains 25 mm Hg for 20 minutes. Monitoring is correctly leveled, and the patient is not coughing or undergoing a procedure. Using the usual bedside estimate of mean arterial pressure and the adult cerebral perfusion pressure target, which interpretation should guide treatment?
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Correct answer: B - CPP is 65 mm Hg; treat raised ICP while preserving adequate perfusion.
Domain 2: Cognitive and Behavioral Dysfunction 20% of exam
Question 4
A patient loses consciousness at the scene of a high-speed rotational collision and remains unconscious after sedatives have cleared. CT shows a small frontal contusion without mass effect. MRI reveals punctate hemorrhages at the gray-white junction, corpus callosum, and dorsolateral upper brainstem. No hypoxemia or hypotension was documented. The profound impairment is best explained by which injury pattern?
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Correct answer: B - Diffuse traumatic axonal injury
Domain 3: Psychiatric Manifestations 15% of exam
Question 5
A family meeting is requested for a 72-year-old who remains unresponsive 96 hours after cardiac arrest. Temperature management at 33 degrees C was used, and rewarming finished 30 hours ago. Midazolam was stopped 12 hours ago; acute kidney injury persists. Pupillary and corneal reflexes are present, but the motor response is extension. Which approach provides the soundest basis for neurologic prognostication?
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Correct answer: A - Wait at least 72 hours after rewarming and longer if drug confounding persists, then integrate multiple modalities.
Domain 4: Pain and Sleep Disorders 15% of exam
Question 6
During rehabilitation after severe traumatic brain injury, serum sodium falls from 138 to 126 mEq/L over four days. Serum osmolality is 266 mOsm/kg, urine osmolality 510 mOsm/kg, and urine sodium 112 mEq/L. Urine output is 4.2 L/day, weight has fallen 2.5 kg, and standing produces tachycardia and a blood-pressure drop. There is no new encephalopathy or seizure. Renal, thyroid, and adrenal function are normal, and no diuretic has been given. Which initial treatment addresses the sodium disorder and volume status?
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Correct answer: D - Replace sodium and volume with 0.9% saline, monitoring sodium frequently.
Question 7
Nursing records describe four daily episodes of tachycardia, hypertension, rapid breathing, sweating, fever, and extensor posturing in a patient three weeks after severe traumatic brain injury. Episodes begin during suctioning or turning and subside in a quiet environment. Continuous EEG captures two episodes without an ictal correlate. Infection evaluation is unrevealing; bladder drainage is adequate, no withdrawal-producing drug has been stopped, and there is no spinal cord injury. What unifying diagnosis fits this pattern?
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Correct answer: D - Paroxysmal sympathetic hyperactivity
Domain 5: Soft Tissue and Orthopedic Conditions 5% of exam
Question 8
Three weeks after a bicycle-related concussion, a woman reports 15-second bursts of spinning when rolling onto her right side in bed. She has no symptoms while sitting still. Right Dix-Hallpike testing produces torsional upbeating nystagmus after a brief latency; it fades within 30 seconds and is weaker on repetition. Her cervical spine has been cleared, and the remainder of the neurologic examination is normal. Which intervention directly treats the demonstrated disorder?
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Correct answer: C - Perform a right posterior-canal canalith repositioning maneuver.
Question 9
Medication reconciliation on day 9 after a nonpenetrating traumatic brain injury reveals continued levetiracetam prescribed solely for early seizure prophylaxis. A small temporal contusion is resolving. The patient has never had a clinical or electrographic seizure, and the acute continuous EEG showed no epileptiform abnormalities. The family requests continuation for six months because they fear future epilepsy. How should the prescription be handled?
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Correct answer: D - Discontinue prophylaxis; extending it has not been shown to prevent late epilepsy.
Question 10
An ankle examination five months after traumatic brain injury shows a catch at 20 degrees of plantar flexion during rapid stretch, but slow passive movement reaches 15 degrees of dorsiflexion. The equinovarus posture prevents orthosis fitting and repeatedly catches the toes during walking. Other muscle groups have little troublesome tone. Oral baclofen previously caused disabling somnolence. Which treatment best matches the examination and functional goal?
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Correct answer: C - Use focal botulinum toxin with orthotic adjustment and gait practice.