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NCC Certified in NeuroCritical Care (ABEM)

The following are specific diseases, conditions, and clinical syndromes commonly managed by a neurointensivist:

A. Cerebrovascular Diseases

1. Infarction and ischemia

• Massive hemispheric infarction

• Basilar artery occlusion and stenosis

• Carotid artery occlusion and stenosis

• Crescendo TIAs

• Occlusive vasculopathies (Moya-Moya, sickle cell)

• Spinal cord infarction

2. Intracerebral hemorrhage

• Supratentorial

• Cerebellar

• Brainstem

• Intraventricular

3. Subarachnoid hemorrhage - aneurysmal and other Vascular malformations

• Arteriovenous malformations

• AV fistulas

• Cavernous malformations

• Developmental venous anomalies

4. Dural sinus thrombosis

5. Carotid-cavernous fistulae

6. Cervical and cerebral arterial dissections

B.Neurotrauma

1. Traumatic brain injury

• "Diffuse axonal injury"

• Epidural hematoma

• Subdural hematoma

• Skull fracture

• Contusions and lacerations

• Penetrating craniocerebral injuries

• Traumatic subarachnoid hemorrhage

2. Spinal cord injury

• Traumatic injury (transection, contusion, concussion)

• Vertebral fracture and ligamentous instability

C. Disorders, Diseases, Seizures, and Epilepsy

1 . Seizures and epilepsy

• Status epilepticus (SE) Convulsive

Non-convulsive (partial-complex and "subtle" secondarily generalized SE) Myoclonic

2. Neuromuscular diseases

• Myasthenia gravis

• Guillain-Barre syndrome

• ALS

• Rhabdomyolysis and toxic myopathies

• Critical illness myopathy and neuropathy

3. Infections

• Encephalitis (viral, bacterial, parasitic)

• Meningitis (viral, bacterial, parasitic)

• Brain and spinal epidural abscess

4. Toxic-metabolic disorders

• Neuroleptic malignant syndrome/malignant hyperthermia

• Serotonin syndrome

• Drug overdose and withdrawal (e.g., barbiturates, narcotics, alcohol, cocaine, acetaminophen).

• Temperature related injuries (hyperthermia, hypothermia)

5. Inflammatory and demyelinating diseases

• Multiple sclerosis (Marburg variant, transverse myelitis)

• Neurosarcoidosis

• Acute disseminated encephalomyelitis (ADEM)

• CNS vasculitis

• Chemical or sterile meningitis (i.e. posterior fossa syndrome, NSAID induced)

• Central pontine myelinolysis

• Others

6. Neuroendocrine disorders

• Pituitary apoplexy

• Diabetes insipidus (including triple phase response)

• Panhypopituitarism

• Thyroid storm and coma

• Myxedema coma

• Addisonian crisis

D. Neuro-oncology

1 . Brain tumors and metastases

2. Spinal cord tumors and metastases

3. Carcinomatous meningitis

4. Paraneoplastic syndromes

E.Encephalopathies

1. Eclampsia, including HELLP Syndrome

2. Hypertensive encephalopathy

3. Hepatic encephalopathy

4. Uremic encephalopathy

5. Hypoxic-ischemic and anoxic encephalopathy

6. MELAS

F.Clinical syndromes

1.Coma

2. Herniation syndromes with monitoring & ICP

3. Elevated intracranial pressure and Intracranial hypotension/hypovolemia

4. Hydrocephalus detection & treatment

5. Cord compression

6. Death by neurologic criteria, end of life issues, and organ donation

7. Vegetative state

8. Dysautonomia (cardiovascular instability, central fever, hyperventilation)

9. Reversible posterior leukoencephalopathy

10. Psychiatric emergencies (psychosis)

G. Perioperative Neurosurgical Care

H.Pharmacotherapeutics

II. General Critical Care: Pathology, Pathophysiology, and Therapy

A. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy

1. Shock (hypotension) and its complications (vasodilatory and cardiogenic)

2. Myocardial infarction and unstable coronary syndromes

3. Neurogenic cardiac disturbances (ECG changes, stunned myocardium)

4. Cardiac rhythm and conduction disturbances; use of antiarrhythmic medications; indications for and types of
pacemakers

5. Pulmonary embolism

6. Pulmonary edema: cardiogenic versus noncardiogenic (including neurogenic)

7. Acute aortic and peripheral vascular disorders (dissection, pseudoaneurysm)

8. Recognition, evaluation and management of hypertensive emergencies and urgencies

9. Calculation of derived cardiovascular parameters, including systemic and pulmonary vascular resistance,
alveolararterial gradients, oxygen transport and consumption

B.Respiratory Physiology, Pathology, Pathophysiology and Therapy

1.Acute respiratory failure

• Hypoxemic respiratory failure (including ARDS)

• Hypercapnic respiratory failure

• Neuromuscular respiratory failure

2. Aspiration

3. Bronchopulmonary infections

4. Upper airway obstruction

5. COPD and status asthmaticus, including bronchodilator therapy

6. Neurogenic breathing patterns (central hyperventilation, Cheyne-Stokes respirations)

7. Mechanical ventilation

• Positive pressure ventilation (BIPAP)

• PEEP, CPAP, inverse ratio ventilation, pressure support ventilation, pressure control, and non- invasive ventilation

• Negative pressure ventilation

• Barotrauma, airway pressures (including permissive hypercapnia)

• Criteria for weaning and weaning techniques

8. Pleural Diseases

• Empyema

• Massive effusion

• Pneumothorax

9. Pulmonary hemorrhage and massive hemoptysis

10. Chest X-ray interpretation

11. End tidal C02 monitoring

12. Sleep apnea

13. Control of breathing

C. Renal Physiology,Pathology, Pathophysiology and Therapy

1.Renal regulation of fluid and water balance and electrolytes

2.Renal failure: Prerenal, renal, and postrenal

3.Derangements secondary to alterations in osmolality and electrolytes

4. Acid-base disorders and their management

5.Principles of renal replacement therapy

6. Evaluation of oliguria and polyuria

7.Drug dosing in renal failure

8. Management of rhabdomyolysis

9. Neurogenic disorders of sodium and water regulation (cerebral salt wasting and SIADH).

D. Metabolic and Endocrine Effects of Critical Illness

1. Enteral and parenteral nutrition

2. Endocrinology

• Disorders of thyroid function (thyroid storm, myxedema coma, sick euthyroid syndrome)

• Adrenal crisis

• Diabetes mellitus

Ketotic and hyperglycemic hyperosmolar coma Hypoglycemia

3. Disorders of calcium and magnesium balance

4. Systemic Inflammatory Response Syndrome (SIRS)

5. Fever, thermoregulation, and cooling techniques

E.Infectious Disease Physiology, Pathology, Pathophysiology and Therapy

1. Antibiotics

• Antibacterial agents

• Antifungal agents

• Antituberculosis agents

• Antiviral agents

• Antiparasitic agents

2. Infection control for special care units

• Development of antibiotic resistance

• Universal precautions

• Isolation and reverse isolation

3. Tetanus and botulism

4. Hospital acquired and opportunistic infections in the critically ill

5. Acquired Immune Deficiency Syndrome (AIDS)

6. Evaluation of fever in the ICU patient

7. Central fever

8. Interpretation of antibiotic concentrations, sensitivities

F.Physiology, Pathology, Pathophysiology and therapy of Acute Hematologic Disorders

1 . Acute defects in hemostasis

• Thrombocytopenia, thrombocytopathy

• Disseminated intravascular coagulation

• Acute hemorrhage (GI hemorrhage, retroperitoneal hematoma)

• Iatrogenic coagulopathies (warfarin and heparin induced)

2. Anticoagulation and fibrinolytic therapy

3. Principles of blood component therapy (blood, platelets, FFP)

4. Hemostatic therapy (vitamin K, aminocaproic acid, protamine, factor VIla)

5. Prophylaxis against thromboembolic disease

6. Prothrombotic states

G. Physiology, Pathology, Pathophysiology and Therapy of Acute Gastrointestinal (GI) and Genitourinary (GU)

Disorders

1. Upper and lower gastrointestinal bleeding

2. Acute and fulminant hepatic failure (including drug dosing)

3. Ileus and toxic megacolon

4. Acute perforations of the gastrointestinal tract

5. Acute vascular disorders of the intestine, including mesenteric infarction

6. Acute intestinal obstruction, volvulus

7. Pancreatitis

8. Obstructive uropathy, acute urinary retention

9. Urinary tract bleeding

H. Immunology and Transplantation

1. Principles of transplantation (brain death, organ donation, procurement, maintenance of organ donors, implantation)

2. Immunosuppression, especially the neurotoxicity of these agents

I. General Trauma and Burns

1. Initial approach to the management of multisystem trauma

2. Skeletal trauma including the spine and pelvis

3. Chest and abdominal trauma - blunt and penetrating

4. Burns and electrical injury

J. Monitoring

1. Neuromonitoring

2. Prognostic, disease severity and therapeutic intervention scores

3. Principles of electrocardiographic monitoring

4. Invasive hemodynamic monitoring

5. Noninvasive hemodynamic monitoring

6. Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space,
compliance, resistance, capnography)

7. Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient)

8. Use of computers in critical care units for multimodality monitoring

K. Administrative and Management Principles and Techniques

1. Organization and staffing of critical care units

2. Collaborative practice principles, including multidisciplinary rounds and management

3. Emergency medical systems in prehospital care

4. Performance improvement, principles and practices

5. Principles of triage and resource allocation, bed management

6. Medical economics: health care reimbursement, budget development

L. Ethical and Legal Aspects of Critical Care Medicine

1. Death and dying

2. Forgoing life-sustaining treatment and orders not to resuscitate

3. Rights of patients, the right to refuse treatment

4. Living wills, advance directives; durable power of attorney

5. Terminal extubation and palliative care

6. Rationing and cost containment

7. Emotional management of patients, families and caregivers

8. Futility of care and the family in denial

M. Principles of Research in Critical Care

1. Study design

2. Biostatistics

3. Grant funding and protocol writing

4. Manuscript preparation

5. Presentation preparation and skills

6. Institutional Review Boards and HIPAA

Ill. Procedural Skills

A. General Neuro-Critical Care

1 . Central venous catheter placement; dialysis catheter placement

2. Pulmonary artery catheterization

3. Management of mechanical ventilation, including CPAP/BiPAP ventilation

4. Administration of vasoactive medications (hemodynamic augmentation and hypertension lysis)

5. Maintenance airway and ventilation in nonintubated, unconscious patients

6. Interpretation and performance of bedside pulmonary function tests

7. Direct laryngoscopy

8. Endotracheal intubation

9. Shunt and ventricular drain tap for CSF sampling

10. Performance and interpretation of transcranial Doppler

11. Administration of analgosedative medications, including conscious sedation and barbiturate anesthesia

12. Interpretation of continuous EEG monitoring

13. Interpretation and management of ICP and CPP data

14. Jugular venous bulb catheterization

15. Interpretation of Sjv02 and Pbt02 data

16. Management of external ventricular drains

I 7. Management of plasmapheresis and IVIG

18. Administration of intravenous and intraventricular thrombolysis

19. Interpretation of CT and MR standard neuroimaging and perfusion studies and biplane contrast neuraxial
angiography

20. Perioperative and postoperative clinical evaluation of neurosurgical and interventional neuroradiology patients

21. Performance of lumbar puncture and interpretation of cerebrospinal fluid results

22. Induction and maintenance of therapeutic coma and hypothermia
Certified in NeuroCritical Care (ABEM)
Certification-Board NeuroCritical test format

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Question: 710
A 55-year-old man, admitted with a Hunt and Hess grade 4aneurysmal subarachnoid hemorrhage (SAH), is now
post bleed day5 with increasing Transcranial Doppler (TCD) velocities. Meanarterial pressure (MAP) is 76 mmHg
on norepinephrine 12mcg/min, up from 5 mcg/min 24 hours earlier, intracranial pressure(ICP) is 12 mmHg, and
heart rate (HR) is 110/min with sinusvolume control mechanical ventilation receiving 7 mL/kg tidalvolume (TV)
with positive end-expiratory pressure (PEEP) of 10White blood cell (WBC) count is 11,000 with a new infiltrate
onchest x-ray (CXR); and serum creatinine has increased to 1.5mg/dL. Fluid balance over the past 24 hours is 2 L
positive withgood urine output. In addition to sending blood cultures, lactate, andstarting antibiotics, how can
volume status be assessed to determinewhether additional fluid is needed for adequate resuscitation?
A. Bolus 2 L normal saline (NS) over 2 hours and assess change in
B. Perform a straight leg raise and assess for change in cardiac
C. Place a Swan-Ganz catheter given the presence of shock and
D. Measure inferior vena cava size change during inspiration and
E. Insert arterial line and measure pulse pressure or stroke volume
G. mmHArterial blood gas (ABG) reveals a PaO2/FiO2 ratio of 250.
Answer: B
Explanation:
Our patient is in septic shock, which requires timely acquisition of cultures, lactic acid, initiating antibiotics, and
fluid resuscitation. This question is focused on how to best determine whether a patient in shock has been
adequately resuscitateda critical question, since too little fluid leads to inadequate preload, reduced cardiac output
(CO) and oxygen delivery, and consequently tissue hypoperfusion. Conversely, excessive volume loading, without
further increase in CO, would lead to hemodilution and tissue edema. Fluid overload has been associated with
worse outcomes in critically ill patients, and current guidelines recommend frequent assessment for ongoing need
for resuscitation prior to fluid administration. Fluid responsiveness can be assessed by several methods. Traditional
static measures of cardiac preload, such as central venous pressure (CVP) and pulmonary capillary wedge pressure
(PCWP) are unreliable for predicting fluid responsiveness. Dynamic measures of cardiac preload, such as stroke
volume variation (SVV) and pulse pressure variability (PPV) require an arterial line, and are excellent measures of
volume responsiveness in shock patients - with some notable exceptions: spontaneous respiration; tidal volume
(TV) <8 mL/kg; PEEP >5; low lung compliance (i.e., ARDS); and when arrhythmias are present. Our patient was
spontaneously breathing, limiting the diagnostic accuracy of SVV/PPV. Variation in inferior vena caval size during
mechanical ventilation, as measured by echocardiography, is another means of assessing fluid responsiveness, but
seems to be less sensitive and specific than SVV/PPV, with similar limitations. A third technique involves an
autotransfusion, by passively raising the legs to 40 degrees in a supine patient, which has been shown to be a
sensitive and specific assessment for volume responsiveness, potentially even in spontaneously breathing patients,
during low-tidal ventilation, and with cardiac arrhythmia.
Question: 711
An 18-year-old man admitted to the hospital with a gunshot woundto the head and intractable intracranial
hypertension is being deescalatedfrom hyperosmolar therapy with hypertonic saline andpotassium is 2.0 mEq/L,
despite having received approximately 120mEq of potassium chloride in replacement that day, and the urineoutput
has been consistently greater than 200 mL/hour. Additionalpertinent labs include Na 153 mEq/L, Mg 1.5 mEq/L,
and HCO3 20mEq/L. You notice a change on the telemetry monitor and order aabnormality?
A. Acute myocardial infarction (MI)
B. Acute pulmonary embolism
C. Hypokalemia
D. Acidosis
E. Hypothermia
G. stat ECWhat is the likely cause of this
Answer: C
Explanation:
These ECG changes are typically seen with severe refractory hypokalemia. The earliest ECG changes associated
with hypokalemia are a decrease in T-wave amplitude followed by a ST segment depression and T-wave
inversions. Subsequently, the PR interval may be prolonged with an increase in amplitude of the P wave. U waves
(a positive deflection after the T wave) may be seen and in severe hypokalemia may fuse with the T wave to form
giant U waves as seen in the ECG. A pseudo-prolonged QT interval may be seen, which is actually a QU interval
in the absence of a T wave. The most common cause of hypokalemia is renal losses after diuretic use (more
commonly thiazide than loop or osmotic diuretics), especially if two diuretics acting on different parts of the
tubular system are used. Patients who develop secondary hypoaldosteronism from liver disease, congestive heart
failure (CHF), or nephrotic syndrome are also at risk. Antibiotics such as penicillins and aminoglycosides can
promote potassium loss. In the neurocritical care setting, patients receiving mannitol or hypertonic saline infusions
have been noted to develop hypokalemia because of the diuretic effect and as a consequence of the high-sodium
load reaching the collecting ducts. For this reason some centers use potassium-sparing diuretics in conjunction with
mannitol to avoid symptomatic hypokalemia in the setting of intracranial pressure (ICP) management. Hypokalemia
can be refractory if concomitant hypomagnesaemia is not corrected. The exact etiology of this is not known, but it
may be multifactorial. Low intracellular magnesium levels may increase potassium wasting from the collecting
tubules, especially in the setting of additional factors such as an increase in distal sodium delivery. ECG changes in
hypomagnesemia include an increased PR and QT interval, widened QRS complex, and flattened T wave. The
findings can be identical to those seen in hypokalemia; however, in this case, the patients potassium level is
much lower than his magnesium level and, given the refractory nature of his disease, hypokalemia is the more
likely cause. Hypothermia at 35C (95F) is associated with sinus tachycardia. As the core body temperature
drops further (<90F or 32C), sinus bradycardia with prolongation of PR interval, QRS widening, and QT
interval are seen. Osborn waves (an upward deflection after the QRS complex) are seen below 86F or 30C.
Question: 712
A 44-year-old morbidly obese woman with hypertension anddiabetes is found slumped over in a bathroom stall. At
the scene, herblood pressure (BP) is documented at 180/90 with a pulse of 78; herblood sugar is 180 mmol/L. CT
scan of the head is shown. What isthe likely cause of this patients findings?
A. Hypertensive intracerebral hemorrhage (ICH)
B. Embolic stroke with hemorrhagic conversion
C. Venous sinus thrombosis
D. Aneurysmal subarachnoid hemorrhage (SAH)
E. Hemorrhagic encephalitis
Answer: D
Explanation:
This axial CT scan of the head shows an intraparenchymal hemorrhage (IPH) with a sylvian SAH and a small
subdural hematoma (SDH), with the outline of an aneurysm visible lateral to the IPH. Approximately 20% of
patients with aneurysmal rupture have associated IPH, occurring more commonly in patients with anterior
communicating artery (AComm), distal anterior cerebral artery, and distal middle cerebral artery (MCA)
aneurysms. These patients present with callosal, interhemispheric, and sylvian/temporal hematomas. In addition,
patients may have concurrent intraventricular hemorrhage (IVH) and SDH. Rarely, patients may present with IPH,
IVH, or SDH without any evidence of SAH. In these cases, a history of thunderclap headache, absence of risk
factors for IPH or IVH, and absence of a history of trauma should raise the suspicion of a saccular aneurysm.
Likely causes of the absence of SAH are the location of the dome of the aneurysm close to the ventricular system
or brain parenchyma and delayed presentation after the hemorrhage, with radiographic resolution of subarachnoid
blood. Another theory is that the IPH/IVH may represent a rebleed after the subarachnoid space has been scarred
down by a sentinel hemorrhage.
Question: 713
A 29-year-old C5C6 quadriplegic patient is being prepared fortransfer to a rehabilitation facility when you are
paged for with thecondition?
A. Permanent pacemaker
B. PRN intravenous (IV) atropine
C. PO albuterol
D. PO theophylline
E. All of the above
G. following findinWhat is an appropriate long-term therapy for this
Answer: E
Explanation:
Patients with acute spinal cord injury suffer a myriad of complications of which pulmonary and cardiac are the
most common. Among the cardiac complications, shock and hypotension occur early and are usually the reason for
ICU admission in the first week after injury. Sinus bradycardia, dysrhythmia, and cardiac arrest can occur
subsequently, usually within the first 14 days after injury. Acute spinal cord injury above T6 can disrupt the
descending sympathetic pathways to the intermediolateral cell column in the T1-L2 spinal cord. This results in loss
of supraspinal sympathetic control and unopposed parasympathetic activity in the respiratory and cardiac systems
in quadriplegic patients, making them prone to prolonged episodes of bradycardia, pauses, and intermittent heart
blocks, especially when suctioned or turned. Atropine should be readily available for patients with bradycardia, and
0.5 to 1 mg should be administered when symptomatic or prophylactically before suctioning. Oral albuterol and
theophylline can be used to increase resting heart rate, although there are no randomized trials to support this. Some
patients with significant heart block or recurrent cardiac arrests may require a permanent pacemaker.
Question: 714
Answer: C
Explanation:
The history of ovarian cancer and the diffuse leptomeningeal enhancement are suggestive of meningeal
carcinomatosis. Meningeal carcinomatosis is seen in 1% to 5% of patients with solid tumors (commonly breast,
nonsmall-cell lung cancer, and melanoma), 5% to 15% of patients with leukemia/lymphoma
(leukemic/lymphomatous meningitis), and 1% to 2% of patients with primary brain tumors. Neurologic symptoms
usually localize to several regions of the neuraxis, with those involving the spinal cord and cauda equina being
most common, followed by cranial neuropathies and hemispheric dysfunction. Patients often present with signs of
hydrocephalus and elevated intracranial pressures (ICP). Diagnosis is made by having a high index of suspicion,
meningeal enhancement (often most prominent in the basal meninges, dorsal spinal column, and cauda equina),
cerebrospinal fluid (CSF) monocytosis, and isolating tumor cells in CSF on cytology. Although the latter is the
gold standard, tumor cells are isolated in only 50% of samples on the first LP, with the yield increasing to 80% on
the second puncture. There is no added benefit of subsequent LPs. Treatment is mostly palliative, with median
survival of 2 to 3 months. Whole brain radiation therapy and intrathecal chemotherapy are the mainstays of
treatment and may prevent further neurologic deterioration and improvement in quality of life. Supportive
treatments such as antiepileptic medications, pain medications, and occasionally corticosteroids in patients with
concomitant parenchymal disease should be prescribed. Miller Fisher syndrome is a demyelinating cranial and
peripheral neuropathy, which is a variant of GuillainBarr syndrome (GBS) and is defined by a triad of areflexia,
ophthalmoplegia, and ataxia. Patients classically do not have signs of encephalitis or encephalopathy. Anti-GQ1b
antibodies are present in 90% of patients. Bickerstaff brainstem encephalitis presents with ataxia, ophthalmoplegia,
hyperreflexia, and alteration of consciousness. Hyperintense lesions are seen in the midbrain, pons, and medulla on
MRI. A significant number of patients have evidence of concurrent axonal GBS, suggesting that this may be
another variant of the disease. The progression of symptoms and MRI findings preclude pontine infarction, and the
EEG does not support a diagnosis of NCSE.
Question: 715
A 67-year-old woman was transferred from an outside facility withoutside hospital with complaints of nausea,
vomiting, ataxia, andprogressive lethargy. The patient had a history of ovarian cancer inremission for 3 years and
was otherwise healthy. CT scan and MRIblood cell (WBC) count of 15 (40% N, 20% L, and 40% M), redblood
cell (RBC) count 250, glucose 40, and protein 100. Allbacterial and viral cultures and polymerase chain reactions
(PCRs)were negative, and she was empirically treated with acyclovir. Uponyour evaluation, the patient was
comatose with sluggish pupillaryresponse, dysconjugate gaze, absent oculocephalic reflexes,extensor posturing
bilaterally, and brisk reflexes. She was breathingrepeated and showed WBC 18 (100% M), RBC 50, glucose 28,
andprotein 150. Serum glucose was 150 mg/dL. EEG revealedgeneralized delta and theta activity without
rhythmicity. Brain MRIwith contrast is shown on the right. What is the most likely cause ofthe patients
condition?
A. MillerFisher syndrome
B. Bickerstaff brainstem encephalitis
C. Meningeal carcinomatosis
D. Pontine infarction
E. Nonconvulsive status epilepticus (NCSE)
Answer: C
Explanation:
The history of ovarian cancer and the diffuse leptomeningeal enhancement are suggestive of meningeal
carcinomatosis. Meningeal carcinomatosis is seen in 1% to 5% of patients with solid tumors (commonly breast,
nonsmall-cell lung cancer, and melanoma), 5% to 15% of patients with leukemia/lymphoma
(leukemic/lymphomatous meningitis), and 1% to 2% of patients with primary brain tumors. Neurologic symptoms
usually localize to several regions of the neuraxis, with those involving the spinal cord and cauda equina being
most common, followed by cranial neuropathies and hemispheric dysfunction. Patients often present with signs of
hydrocephalus and elevated intracranial pressures (ICP). Diagnosis is made by having a high index of suspicion,
meningeal enhancement (often most prominent in the basal meninges, dorsal spinal column, and cauda equina),
cerebrospinal fluid (CSF) monocytosis, and isolating tumor cells in CSF on cytology. Although the latter is the
gold standard, tumor cells are isolated in only 50% of samples on the first LP, with the yield increasing to 80% on
the second puncture. There is no added benefit of subsequent LPs. Treatment is mostly palliative, with median
survival of 2 to 3 months. Whole brain radiation therapy and intrathecal chemotherapy are the mainstays of
treatment and may prevent further neurologic deterioration and improvement in quality of life. Supportive
treatments such as antiepileptic medications, pain medications, and occasionally corticosteroids in patients with
concomitant parenchymal disease should be prescribed. Miller Fisher syndrome is a demyelinating cranial and
peripheral neuropathy, which is a variant of GuillainBarr syndrome (GBS) and is defined by a triad of areflexia,
ophthalmoplegia, and ataxia. Patients classically do not have signs of encephalitis or encephalopathy. Anti-GQ1b
antibodies are present in 90% of patients. Bickerstaff brainstem encephalitis presents with ataxia, ophthalmoplegia,
hyperreflexia, and alteration of consciousness. Hyperintense lesions are seen in the midbrain, pons, and medulla on
MRI. A significant number of patients have evidence of concurrent axonal GBS, suggesting that this may be
another variant of the disease. The progression of symptoms and MRI findings preclude pontine infarction, and the
EEG does not support a diagnosis of NCSE.
Question: 716
A 60-year-old patient with diabetes and hypertension is transferredto your ICU from another facility, where he was
being treated forurosepsis. The patient has been on stable, low-dose vasopressors for4 days, is on antibiotics, and
appears adequately volumenot received nutrition since his admission to the hospital 5 days agobecause he was on
vasopressors. You would:
A. Insert a feeding tube and advance to full dose tube feeds despite
B. Order total parenteral nutrition (TPN)
C. Order peripheral parenteral nutrition (PPN)
D. Start a dextrose solutionit should provide enough calories!
E. Start trophic feeds through the gut at 10 to 20 mL/hour while he
Answer: A
Explanation:
Initiation of enteral nutrition (EN) in critically ill patients is not always clear cut. It is preferable to use EN in
critically ill patients as it reduces infectious complications, promotes enterocyte health while maintaining a strong
mucosal barrier, and has a lesser stress response than parenteral nutrition (PN). However, there is concern that
initiating EN in a patient with hemodynamic compromise and possible splanchnic vasoconstriction may promote
nonocclusive mucosal ischemia (NOMI) due to increased oxygen demand. Turza et al. recommend a four-stage
approach to initiating EN in patients requiring vasopressors: a. Evaluate the patients medical and nutritional
history. Patients with multiple vascular risk factors may be predisposed to NOMI, while those with poor nutritional
response or high metabolic demand will benefit from early nutrition. b. Evaluate the current physiologic state.
Low-dose, nonescalating vasopressors in patients who are volume resuscitated and able to maintain a mean arterial
pressure (MAP) greater than 60 should not deter the initiation of EN. Alternately, patients with dropping urine
output, worsening lactate levels, and base deficit and those requiring frequent transfusions may not be able to
tolerate EN. c. Establish gastrointestinal (GI) access and pick appropriate tube feeds. The use of formulas with
lower osmolarity (<700 mOsm) and fiber content and simpler sugars will reduce metabolic demands, improve
transit time, and reduce dysmotility, thereby alleviating factors which may result in the bacterial overgrowth that
worsens NOMI. d. Postinitiation monitoring includes serial abdominal examinations and gastric residual checks.
Laboratory monitoring of lactate, white blood cell counts, and hemoglobin levels or radiologic testing may be
performed if there is concern for ileus. At times, a combination of trophic EN and supplemental PN is adopted as
an intuitive compromise. This has been shown to increase the risk of nosocomial infections in a retrospective
review of trauma patients.
Question: 717
A 40-year-old woman is admitted to the hospital after witnessedcardiac arrest for 20 minutes. Bystanders
performed CPR untilwas initiated after admission to the hospital, and the patient wasnoted to have frequent
myoclonic jerks during rewarming.Brainstem reflexes were intact and the patient had flexor posturingto painful
stimulation. MRI brain revealed scattered diffusionweightedimaging changes in the cortex but no damage to the
deepstructures. EEG was performed and is shown in the following
A. Have a family discussion regarding irreversible brain damage
B. Load with an antiepileptic agent until myoclonic jerks stop since
C. Continue EEG monitoring and titrate antiepileptic agents until
D. Load with antiepileptic drugs until clinical myoclonus stops and
E. Recool the patient and rewarm more slowly next time
Answer: C
Explanation:
The EEG is consistent with postanoxic status epilepticus (PSE). Although this diagnosis usually portends a poor
prognosis, the administration of therapeutic hypothermia (TH) to postcardiac arrest patients has made the prediction
of outcomes based on American Academy of Neurology (AAN) criteria more difficult. In a prospective study by
Rossetti et al., three clinical variables were demonstrated to have higher false-positive rates compared to the AAN
guidelines: incomplete brainstem reflexes, myoclonus, and absent motor responses to pain. Early lack of reactivity
on continuous EEG, prolonged periods of discontinuity, epileptiform discharges or seizures, and absent cortical
responses on somatosensory evoked potentials (SSEP) were strongly associated with mortality. PSE is
independently associated with a poor outcome after anoxic injury. However, in the presence of brainstem reflexes,
SSEP responses, and EEG reactivity can have a favorable outcome if the condition is treated as status epilepticus
(SE).
Question: 718
A 60-year-old woman with a history of hypertension presented witha cerebellar intraparenchymal hemorrhage
(IPH), fourth ventricleintraventricular hemorrhage (IVH), hydrocephalus with partialbrainstem dysfunction, and
somnolence on examination. She wasemergently taken for surgical decompression and did well. Aconventional
angiogram was subsequently performed and is shownin the following images. Your next steps in management
include allof the following, except:
A. Wean external ventricular drain (EVD) and tightly control blood
B. Use intrathecal tissue plasminogen activator (tPA) to allow quick
C. Take a detailed family history
D. Send genetic testing
E. Continue outpatient, staged management of this condition
Answer: B
Explanation:
The patient has multiple arteriovenous malformations (AVMs) warranting a detailed family history and genetic
workup. Intrathecal tPA is contraindicated in this setting. Intracranial vascular malformations include
developmental venous anomalies (DVA), capillary telangiectasias, AVM, and cavernous malformations, each of
which have different natural histories and treatment options. Capillary telangiectasias are usually
angiographically occult lesions, detected incidentally on contrast-enhanced MRI or CT scans, and are rarely
symptomatic. They are benign, thin-walled capillaries surrounded by normal brain parenchyma, do not need
treatment or follow-up, and account for 4% to 12% of all vascular malformations. De novo development has been
reported. DVA also known as venous angiomas are congenitally enlarged, thickened, hyalinized venous vessels
draining normal brain tissue. They are the most common intracranial vascular malformation, with a prevalence of
2.5%, discovered mostly incidentally and often associated with cavernous malformations. A causative link between
the two has been suggested, with DVAs being a precursor to cavernous malformations. DVAs can be detected on
MRI, CT scan, and angiogram as a single dilated vein or caput medusa. They usually have a benign clinical course
with low morbidity and mortality and do not warrant treatment. AVMs are a collection of abnormal blood
vessels, comprising arteries, veins, and an intervening collection of abnormal vessels called the nidus. They are
congenital lesions with an incidence of 1 per 100,000, often presenting as an intracerebral hemorrhage (ICH) in the
third to fourth decade. The bleeding risk varies according to size, location, draining pattern, and so on. Magnetic
resonance angiography (MRA) and CT angiography (CTA) can both visualize AVMs; however, conventional
angiography remains the gold standard for diagnoses, formulation, and implementation of a treatment plan which
may include a combination of surgery, embolization, and radiation therapy. Cavernous malformations are
acquired or congenital lesions formed by endothelium-lined vascular spaces without intervening brain parenchyma.
They can be seen on CT and MRI as popcorn-shaped dystrophic calcifications or hemosiderin deposits from
prior hemorrhages. They are angiographically occult and most commonly present with seizures. Treatment is not
always warranted, but surgical resection is often necessary if associated with recurrent hemorrhages or intractable
epilepsy. Dural arteriovenous fistulas are malformations located in the meninges fed by dural arteries and drained
by dural or leptomeningeal venous channels. The most common location is the transverse sinus. They can develop
after trauma, venous thrombosis, or spontaneously, and account for 10% to 15% of all cranial malformations.
Clinical presentation includes headache, neurologic deficits, bruits, and hemorrhage, with a cortical drainage
pattern consistent with more aggressive behavior. Sixvessel cerebral angiogram remains the gold standard in
diagnosing a fistula. Treatment includes endovascular or surgical interventions, with surgery being the more
definitive approach.
Question: 719
A 35-year-old, 2 days postpartum woman had sudden onset of thethe ED was 180/90, and she was somnolent but
had a nonfocalneurologic examination. Opening pressure was normal on lumbarpuncture (LP), and cerebrospinal
fluid (CSF) was clear with normalchemistries and cell count. Imaging studies are shown in thefollowing images.
What is the most likely diagnosis?
A. Eclampsia/preeclampsia
B. Posterior reversible encephalopathy syndrome (PRES)
C. Venous sinus thrombosis
D. Reversible cerebral vasoconstriction syndrome (RCVS)
E. Sheehans syndrome
Answer: D
Explanation:
RCVS unifies a group of disorders with similar clinical and radiographic characteristics, such as CallFleming
syndrome, benign angiopathy of the central nervous system (CNS), migrainous angiitis, drug-induced cerebral
angiopathy (selective serotonin reuptake inhibitors [SSRIs], marijuana), and postpartum angiopathy (hormonal
changes, serotonergic surge). Typically, patients present with a thunderclap headache with or without focal
neurologic signs, normal CSF analysis without evidence of CNS inflammation, exclusion of other causes of sudden
severe headache (aneurysm or vascular abnormalities), and presence of segmental cerebral arterial vasoconstriction
on catheter, CT, or magnetic resonance angiography (MRA), which resolves within 12 weeks. Cortical
(nonaneurysmal) subarachnoid hemorrhage (SAH) is the most common radiographic finding. The gold standard for
diagnosis is detecting the presence and subsequent resolution of segmental vasoconstriction on conventional
angiography. In most cases the vascular changes resolve without treatment. Calcium channel blockers (nimodipine,
verapamil), glucocorticoids, and intravenous (IV) magnesium have been tried with limited success. Although the
course is usually benign, severe vasospasm has been reported resulting in transient ischemic attacks (TIAs),
seizures, and ischemic and hemorrhagic infarctions. Intraarterial milrinone and verapamil as well as angioplasty
have been attempted with some success in severe or refractory cases. Preeclampsia is defined as pregnancy-induced
hypertension with proteinuria, but there is no information about urine studies in this case and the condition is not
associated with the imaging findings of cerebral vasoconstriction. Eclampsia, a life-threatening condition occurring
in pregnancy or early puerperium, is the occurrence of a tonicclonic seizure in the setting of preeclampsia.
Treatment includes IV magnesium to a goal of 4 to 7 mEq/L (46 g IV loading dose, then 12 g/hour), BP control
with IV hydralazine or labetalol, and emergent termination of pregnancy. If the patient continues to have seizures,
the dose of magnesium may be increased (with close observation for respiratory failure or heart block). IV
anticonvulsants and mechanical ventilation can be initiated in refractory cases. PRES is characterized by headache,
confusion, seizures, and visual loss with acute subcortical and cortical edema on MRI. Although classically seen in
the parietooccipital lobes, brainstem, and cerebellum, the edema can extend as far anteriorly as the temporal and
frontal lobes. PRES can be seen in the setting of malignant hypertension, eclampsia, hypercalcemia, and due to
drugs such as tacrolimus and cyclosporine. Sheehans syndrome, or postpartum pituitary necrosis, is a
complication of postpartum hypovolemic shock resulting in panhypopituitarism. The most common presenting
symptom is agalactorrhea.
Question: 720
An 18-year-old G1P0 woman presented with a severe headachebehind her right ear, followed by a left-sided
tingling sensation andmonitoring and treatment while she continues to have frequentcomplex partial seizures. On
examination, she is awake, butsomnolent with left-sided hemiparesis. Imaging studies are shown
A. Eclampsia/preeclampsia
B. Posterior reversible encephalopathy syndrome (PRES)
C. Cerebral venous sinus thrombosis (CVST)
D. Reversible cerebral vasoconstriction syndrome (RCVS)
E. Sheehans syndrome
Answer: C
Explanation:
CVST is a rare disorder affecting 3 to 4 adults per million annually. With the increasing use of oral contraceptives
(OCP) in the past few decades, the disease has become more prevalent in adult women of child-bearing age with an
almost sixfold increase in the risk of CVST among OCP users. This is followed by patients with inherited
thrombophilia, hypercoagulability associated with pregnancy and puerperium, and head and neck infections.
Presentation is varied and dependent on the location and extent of venous involvement. Headache is a ubiquitous
presenting complaint, accompanied by seizures in 47% and paresis in 43% of patients. The majority of patients
have an indolent course with symptoms developing over days to months. Rarely, they may resemble an arterial
infarction but with a waxing and waning course. Focal edema and infarctions are often seen when cortical veins are
involved. Larger infarctions and hemorrhages are associated with worsening mental status and coma. Abnormal
signal change in the venous sinus on MRI with concomitant loss of flow on magnetic resonance venography
(MRV) is diagnostic. Treatment includes systemic anticoagulation with weight-based low molecular weight heparin
or unfractionated heparin with transition to vitamin K antagonists to a goal International Normalized Ratio (INR) of
2 to 3 for 3 to 6 months. Patients with a history of deep vein thrombosis (DVT) or recurrent CVST will need
indefinite treatment. Intraparenchymal hemorrhage (IPH) is not a contraindication to anticoagulation in this
population. Local administration of endovascular thrombolysis has been reported, but there is insufficient efficacy
or safety data available to justify its utility in patients who are not refractory to systemic anticoagulation.
Decompressive hemicraniectomy can be performed in the setting of malignant cerebral edema with reasonable
outcomes. Over 80% of the patients have favorable recovery. Mortality of 7% to 13% is seen within the first
month, usually due to cerebral edema in the acute phase or due to underlying cause on subsequent follow-up.
Question: 721
A 65-year-old alcoholic with traumatic brain injury (TBI), bifrontalcontusions, and right-sided epidural hematoma
with midline shiftand uncal herniation is admitted to your ICU. After initialdecompression, intracranial pressure
(ICP) remained within normallimits. Four days postoperatively, the patient is now off all sedationwithdraws on the
right, and flexes on the left. What is the cause of hispoor mental status?
A. Bifrontal injury
B. Diffuse axonal injury
C. Persistent effects of midline shift after initial injury
D. Nonconvulsive status epilepticus (NCSE)
E. All of the above
Answer: E
Explanation:
The patient has suffered a severe head injury with multiple contusions, cerebral edema, and herniation.
Individually, each of these conditions can result in a persistent comatose state. In addition, the patient is having
nonconvulsive focal seizures, which may be contributing to the encephalopathy. The growing recognition of
nonconvulsive seizures (NCS) in the critically ill population and the need for treatment has been a syllabu of debate
in recent years. Are these seizures a cause of the encephalopathy or simply a manifestation of the dying brain?
Similarly, should they be aggressively treated with the hope of resolution of coma or are they a hallmark of
irreversible brain injury and a poor prognostic sign? Although case reports supporting both arguments exist, these
questions are yet to be answered in a randomized controlled trial. Additionally, many reports of NCSE lump
together patients who are delirious with patients who are deeply comatose in the setting of NCS, making it all the
more difficult to establish prognosis. Until the availability of further evidence, the best way to approach these
situations is to look at the entire clinical picture. Aggressive treatment, with its risks, may be warranted if the
clinical picture looks worse than can be explained by the level of injury. Similarly, in the setting of a devastating
injury, administration of further sedatives to treat focal NCSE may not be worthwhile.
Question: 722
A 46-year-old man is admitted to your ICU after facial assault witha penetrating object through his orbit. You are
called to the bedsideon postop day 1 after removal of the object because the patient is insevere pain. Upon your
examination, the eye is swollen, injected,movements are difficult to assess because of pain. He has lightperception
on visual acuity, which is unchanged from the time ofpresentation. What is the most likely diagnosis?
A. Orbital cellulitis
B. Orbital hematoma
C. Cavernous sinus thrombosis
D. Carotid-cavernous fistula (CCF)
E. Orbital compartment syndrome
G. and pulsatinThe pupil is minimally reactive and extraocular
Answer: D
Explanation:
The patient has a CCF, which is an abnormal communication between the arterial and venous blood within the
cavernous sinus and is characterized by pain, chemosis, pulsatile proptosis, ocular bruit, and progressive vision
loss. The most common form of CCF is a direct communication between the internal carotid artery (ICA) and
cavernous sinus (type A) usually as a result of trauma (young males) or aneurysm rupture (older women).
Traumatic CCFs are the most common type, accounting for 75% of all CCFs, and occur in 0.2% of all head trauma
and 4% of basilar skull fractures. Conventional angiogram is the gold standard for diagnosis. Endovascular
transvenous embolization of the fistula while maintaining patency of the ICA is the mainstay of treatment, with
greater than 80% cure rates at 1 year. Symptoms of chemosis and proptosis usually resolve within hours to days of
intervention, while cranial nerve (CN) palsies may persist for a few weeks. Visual loss may or may not be reversed
depending on the degree of blindness at presentation and the underlying cause. Cavernous sinus thrombosis is a
close differential diagnosis and usually presents with ptosis, chemosis, proptosis, CN palsies, vision loss, and a
dilated, sluggishly reactive pupil. The most common etiology is infectious with direct spread from the nose,
sinuses, or teeth. Diagnosis is made by clinical findings, MRI, and magnetic resonance venography (MRV), and
treatment includes intravenous (IV) antibiotics and close monitoring for complications such as meningitis, vision
loss, sepsis, or septic emboli. Orbital cellulitis is a bacterial infection of the tissues surrounding the eye, including
eyelids, eyebrows, and cheeks, resulting in swelling of the eyelids, pain with eye movements, fever, and decreased
vision if not treated promptly. Orbital hematomas can be preseptal or postseptal. Preseptal hemorrhages are usually
posttraumatic and benign, resulting in extensive ecchymoses of the eyelids. Postseptal hemorrhages may occur due
to trauma, surgical intervention, arteriovenous malformations, or bleeding diathesis, among other causes, and can
lead to orbital compartment syndrome with increase in intraocular pressures and vision loss from orbital nerve
compression.
Question: 723
A 78-year-old man with a history of hypertension, hyperlipidemia,and mild hearing loss is brought to the hospital
by ambulance after amotor vehicle accident. He is intubated in the ED for airwayprotection and undergoes massive
blood transfusion forhemorrhagic shock. He is admitted to the ICU. Which of thefollowing reduces the risk of
delirium in the ICU?
A. Benzodiazepine-induced coma
B. Mechanical ventilation
C. Polytrauma
D. Metabolic acidosis
E. Sedation with dexmedetomidine
Answer: E
Explanation:
A systematic review identified eleven risk factors for developing delirium in the ICU. These included age,
dementia, hypertension, poly-trauma, emergency surgery prior to ICU admission, sedative-induced coma, delirium
on the day prior, use of mechanical ventilation, metabolic acidosis, multi-organ failure and APACHE II score.
Factors that were clearly associated with reduction in delirium were dexmedetomidine. It is unclear if this was a
physiological effect of the drugs itself or because dexmedetomidine use was associated with less benzodiazepine
use.
Question: 724
A 65-year-old man with a history of hypertension andhyperlipidemia is found down at home by his son at 6 p.m.
after hedoes not show up at his granddaughters birthday. He was last seenvital signs are blood pressure (BP)
178/92 mmHg, heart rate (HR)examination, the HR is irregularly irregular. He is awake butaphasic with right lower
facial droop and flaccid right arm. Hisinitial National Institutes of Health Stroke Scale (NIHSS) score is18. A
noncontrast CT scan of the brain shows loss of grey-whitematter differentiation in the left frontal lobe and
hypoattenuation ofCT angiogram of the head shows an occlusion of the first segmentof the middle cerebral artery
(MCA); and perfusion CT estimates aninfarct size of 28 mL. At baseline, the patient is independent withnext step
in management?
A. Start aspirin 325 mg. Patient is not eligible for either intravenous
B. Initiate IV thrombolysis with alteplase based on neuroimaging
C. Proceed with endovascular thrombectomy based on mismatch
D. Initiate IV thrombolysis with alteplase followed by endovascular
E. Need to calculate the ratio of the volume of ischemic tissues on
Answer: C
Explanation:
The patient is out of 4.5-hour time window for IV thrombolysis. However, he is a candidate for endovascular
thrombectomy based on the recent DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and
Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) trial. In this trial, patients with
occlusion of the intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA) who had last
been known to be well 6 to 24 hours earlier and showed evidence of salvageable brain tissue were randomly
assigned to thrombectomy plus standard care (the thrombectomy group) or to standard care alone (the control
group). Enrolled patients had good premorbid baseline defined as modified Rankin scale (mRS), 0 to 1. Infarct
volume was assessed on diffusion-weighted imaging (DWI) sequence of brain MRI or perfusion CT scan using the
automated RAPID software. Presence of salvageable brain tissue was based on a mismatch between severity of
their neurological deficits and the volume of infarcted brain, and not the ratio of the volume of ischemic tissue at
risk to infarct volume: DAWN trial measured utility-weighted mRS at 90 days as the primary outcome. In
contrast to mRS, a lower score in utilityweighted mRS indicates a better outcome (ranges from 0 = death to 10 =
no deficits). At 90 days, the utility-weighted mRS was 5.5 for the thrombectomy group compared to 3.4 in the
control group, and 49% of patients in the thrombectomy group achieved functional independence versus only 13%
in the control group. These translate to number-to-treat (NTT) of 2 and 2.8 for less disability and functional
independence at 90 days, respectively. Rate of procedurerelated complications was very low. Serious adverse events
including mortality and stroke-related death at 90 days as well as and symptomatic intracerebral hemorrhage (ICH)
were similar between the two groups.
Question: 725
A 72-year-old woman with a past medical history of diabetes,hypertension, hyperlipidemia, and atrial fibrillation
on warfarinpresents to the ED with a new severe dysarthria, left-sidedweakness, and neglect (National Institutes of
Health Stroke Scale[NIHSS] score 17). Her vital signs are blood pressure (BP) 169/83mmHg, heart rate (HR)
87/min, respiratory rate (RR) 18/min, and1.3. She was last seen 12 hours prior to presentation. MRI of thebrain
shows an acute stroke in the territory of the right middlecerebral artery (MCA) without evidence of intracranial
hemorrhage.Infarct volume on diffusion-weighted imaging (DWI) is measured48 mL; and volume of ischemic
tissue on MRI perfusion scan iscalculated as 110 mL. Magnetic resonance angiography (MRA)treatment for her
stroke?
A. Start intravenous (IV) alteplase infusion based on clear evidence
B. Start heparin drip with a goal partial thromboplastin time (PTT)
C. Start warfarin for secondary stroke prevention
D. Immediate endovascular thrombectomy
E. Start aspirin 325 mg
Answer: D
Explanation:
The patient is not a candidate for IV alteplase as she presents out of 4.5-hour treatment time window. However, she
is a candidate for endovascular thrombectomy. In DEFUSE 3 trial, patients 6 to 16 hours after they were last
known to be well who had a proximal MCA or internal carotid artery (ICA) occlusion, an initial infarct size of less
than 70 mL, and a ratio of the volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more
were randomly assigned to thrombectomy plus standard medical therapy (thrombectomy group) or standard
medical therapy alone (control group). Thrombectomy was associated with better functional outcomes (odds ratio,
2.77) and lower mortality (14% vs. 26% in the control group) without a difference in symptomatic intracranial
hemorrhage or serious adverse events.
Question: 726
A 70-year-old man is admitted to the neurointensive care unit foraneurysmal subarachnoid hemorrhage (SAH). He
is intubated onmechanical ventilation. On day 3 of admission, he develops septicshock. He is fluid resuscitated and
broad-spectrum antibiotics withearly and aggressive treatment, 12 hours later, he remainshemodynamically
unstable necessitating escalating doses ofnorepinephrine (>1 mg per hour) to maintain a systolic blooddecrease
vasopressor requirement and mortality in septic shock?
A. Switch antibiotics to linezolid plus meropenem
B. Add vasopressin infusion
C. Add intravenous (IV) infusion of hydrocortisone 200 mg per day
D. Add oral fludrocortisone 50 mcg daily
E. Add IV hydrocortisone 50 mg 4 times a day plus fludrocortisone
G. pressure (SBP) >90 mmHWhich intervention has been shown to
Answer: E
Explanation:
Two recent trials (ADRENAL and APROCCHSS) studied the effects of adjunctive glucocorticoid therapy and
glucocorticoid + mineralocorticoid therapy in patients with septic shock. In the former study, 3,800 patients with
septic shock who were undergoing mechanical ventilation were randomized to receive hydrocortisone (at a dose of
200 mg per day) or placebo for 7 days (or until death or discharge from the ICU). Although patients in the
hydrocortisone group had faster resolution of shock (3 days vs. 4 days in the control group), no significant
between-group difference was found in mortality. In APROCCHSS, the effect of hydrocortisone plus
fludrocortisone in patients with septic shock was compared to the placebo. Mortality was significantly lower in the
hydrocortisone-plus-fludrocortisone group than in the placebo group at ICU and hospital discharge, and at 90 and
180 days. In addition, hydrocortisone plus fludrocortisone therapy increased the number of vasopressorfree and
organ-failure-free days without increasing the rate of serious adverse events except for hyperglycemia.
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  • A group of subject matter experts (SMEs) independently rate each test question within a given form of the exam. The ratings are defined as the probability, or likelihood, that an acceptably (minimally) competent person with the requisite education and experience will answer the question correctly. An acceptably (minimally) competent person is defined as someone who adequately performs all job functions safely and requires no further training to do so.
  • The SMEs review each test question as a group. A statistical consensus is reached for the difficulty rating of each test question.
  • After the data is refined, the final step is to calculate the mean, or average, of all the test question ratings. This becomes the overall pass point estimation.
 Fri, 16 Jun 2023 11:37:00 -0500 en text/html https://www.isa.org/certification/exam-procedures Licensure and Certification Disclosures
Alabama

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction with a concentration in Education Leadership* (*AL professional leadership certificate-Class A 30-credit masters’ degree and completion of a state-approved approach to certification), MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Secondary Education with STEM Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration 

State Specific Requirements

Alabama participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include documentation of meeting comparable test requirements. Educational administration and instructional support applicants must meet specific experience requirements.

For MEd students - Alabama does not recognize "endorsements". A person may seek additional certification in certain fields if they; 1) currently hold an Alabama Professional Educator Certificate in a teaching field; AND 2) verifies 2-yrs classroom teaching experience in grades P-12; AND 3) passes the appropriate Alabama prescribed Praxis subject area test.

Learn more about Alabama state board teaching certification requirements.

Alaska

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

For MEd students - If an endorsement is completed outside of Alaska, the applicant must be eligible to gain a comparable endorsement or certificate, including any required testing, for that state. This method requires two years of teaching experience in the content area and passing scores on the endorsement-related content area exam. Only where content area exam(s) have been identified may endorsements be added with this method.

Learn more about Alaska state board teaching certification requirements.

Arizona

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Arizona state board teaching certification requirements.

Arkansas

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

For MEd students – When coursework has been completed through an out-of-state university, the area must first be applied to the out-of-state license.

Learn more about Arkansas state board teaching certification requirements.

California

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, BA Middle School Mathematics, BA Middle School Science, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about California state board teaching certification requirements.

Colorado

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Colorado participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements for applicants with less than 3-years' experience include: 1. Educator preparation program approval from an accredited institution; 2. Degree in content area; 3. Supervised student teaching or internship experience; 4. State-approved alternative educator prep program.

SNHU has not completed the program approval process in Colorado.

Learn more about Colorado state board teaching certification requirements.

Connecticut

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

Connecticut participates in the NASDTEC Interstate Agreement and jurisdiction-specific requirements for an inexperienced teacher with less than 30 months of experience within the past 10 years under an appropriate certificate include: 1. Documentation of completion of a bachelor's degree from an accredited college/university; 2. Recommendation from state-approved teacher preparation program documenting completion of a program; 3. Verification of appropriate experience under a teaching certificate from the district(s) where service was provided (if applicable); 4. Copy of an appropriate certificate covering service time (if applicable); and 5. Successful passage of state-adopted or equivalent out-of-state assessments (unless exempted per statute).

For MEd students – Applicants requesting endorsements to serve as an intermediate administrator or supervisor, a superintendent of schools, or a studying and language arts consultant must complete a state-approved planned program of educator preparation at an accredited college or university, leading to a formal institutional recommendation for certification.

The SNHU School of Education works with students to ensure the coursework requirements in Connecticut are met.

Learn more about Connecticut state board teaching certification requirements.

Delaware

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Delaware state board teaching certification requirements.

District of Columbia

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd Leadership

Learn more about District of Columbia state board teaching certification requirements.

Florida

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Florida state board teaching certification requirements.

Georgia

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Georgia participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Moral fitness or character; 2. Acceptable license, as determined by our agency; 3. Assessments; 4. Experience; 5. Course in exceptionalities for certain fields.

For MEd students – Endorsements can only be added from Georgia approved programs.

SNHU has not completed the program approval process in Georgia.

Learn more about Georgia state board teaching certification requirements.

Hawaii

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Education Programs that Cannot Be Determined Meet the Requirements

MEd in Curriculum and Instruction with a concentration in Special Education

Learn more about Hawaii state board teaching certification requirements.

Idaho

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

For MEd students – Endorsements can only be added from Idaho approved programs.

Learn more about Idaho state board teaching certification requirements.

Illinois

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

Illinois participates in the NASDTEC Interstate Agreement and provides a Professional Educator License (PEL) Checklist for Out of State Applicants which states that upon evaluation, additional documentation may be requested by the Illinois State Board of Education (ISBE) prior to the license being issued. The process includes creating an account; consideration for all areas listed on the valid, comparable out of state license; official transcript; and a copy of the valid out of state license. School support personnel (except for school nurse) and administrative endorsements require completion of a master's degree or higher.

Learn more about Illinois state board teaching certification requirements.

Indiana

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Indiana participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include content and pedagogy tests, current CPR/AED/Heimlich certification and suicide prevention training. Once requirements are met, a 2-year license is issued.

For MEd students – Endorsements can only be added from Indiana approved programs.

Learn more about Indiana state board teaching certification requirements.

Iowa

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd Leadership, MEd in Secondary Education with STEM Education

Education Programs that Cannot Be Determined Meet the Requirements

MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration

State Specific Requirements

Iowa participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Testing; 2. Specific coursework; 3. Program approval (state-approved).

For MEd students – Endorsements from out-of-state programs require a transcript review and are decided on a case-by-case basis.

SNHU has not completed the program approval process in Iowa.

Learn more about Iowa state board teaching certification requirements.

Kansas

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Kansas participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Valid license; 2. Recency, which equals credit hours or experience within the last 6 years; 3. Testing – similar out-of-state tests accepted.

For MEd students – Endorsements can only be added from Kansas approved programs.

SNHU is unable to determine the similarity of out-of-state tests.

Learn more about Kansas state board teaching certification requirements.

Kentucky

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Kentucky participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. GPA; 2. Mentoring, student teaching or practicum in teacher prep program; 3. Look for approved, accredited teacher-prep program; 4. Holds or has held a valid certificate from state where teacher program was completed; 5. Post-baccalaureate coursework or degrees for advanced level certification; 6. Moral character and fitness; 7. Assessments for new teachers.

For MEd students – Endorsements can only be added from Kentucky approved programs.

SNHU has not completed the program approval process in Kentucky.

Learn more about Kentucky state board teaching certification requirements.

Louisiana

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Education Programs that Cannot Be Determined Meet the Requirements

MEd in Curriculum and Instruction with a concentration in Special Education

State Specific Requirements

For MEd students – Endorsements from out-of-state programs require a transcript review and are decided on a case-by-case basis.

Learn more about Louisiana state board teaching certification requirements.

Maine

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

Maine participates in the NASDTEC Interstate Agreement and has the Jurisdiction-specific requirement of specific coursework.

The SNHU School of Education works with students to ensure the coursework requirements in Maine are met.

Learn more about Maine state board teaching certification requirements.

Maryland

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Maryland participates in the NASDTEC Interstate Agreement, however, it only has full reciprocity for approved out-of-jurisdiction teacher preparation programs. Jurisdiction-specific requirements include: 1. Required degree (transcript); 2. Tests; 3. License; 4. Verification of satisfactory experience less than 3 years.

SNHU has not completed the program approval process in Maryland.

Learn more about Maryland state board teaching certification requirements.

Massachusetts

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

State Specific Requirements

Massachusetts participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Passing the Communication &amp; Literacy MTEL test; 2. Passing any subject matter MTEL test(s.; 3. For core academic licenses, possession of a Sheltered English Immersion (SEI. Endorsement. SEI is required for an Initial (level 3. license, those that pass the test can get a preliminary (level 1. license and advance when they earn SEI.

The SNHU School of Education works with students to help them identify which MTEL exams they need to take that meet both the New Hampshire and Massachusetts testing requirements since Massachusetts does not recognize Praxis, however the New Hampshire Department of Education recognizes MTEL exams in lieu of Praxis.

Learn more about Massachusetts state board teaching certification requirements.

Michigan

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Michigan state board teaching certification requirements.

Minnesota

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Minnesota only requires the passing of content and pedagogy exams for individuals licensed based on teacher preparation from another state. For some licensure areas, specifically in low-incidence special education fields, the content test taken outside of Minnesota may meet our requirement. Additionally, an individual with a professional license from another state that has not completed teacher preparation, may meet the requirements of a Minnesota Tier 3 license if they also have 2 years of teaching experience.

Learn more about Minnesota state board teaching certification requirements.

Mississippi

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Mississippi state board teaching certification requirements.

Missouri

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching

Education Programs that Cannot Be Determined Meet the Requirements

MEd in Curriculum and Instruction with a concentration in Education Leadership, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration

Learn more about Missouri state board teaching certification requirements.

Montana

Education Programs that Meet the Requirements

BA Elementary Education

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd in Secondary Education with STEM Education; MEd Leadership

State Specific Requirements

Montana participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: PRAXIS II scores, degrees, character and fitness, and credit count if not CAEP/NCATE approved EPP.

The SNHU Elementary Education program is CAEP accredited.

Learn more about Montana state board teaching certification requirements.

Nebraska

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Nebraska participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Content test; 2.Human relations course; 3. Special education course; 4. Valid certificate from other state; 5. Transcripts and institutional verification by college of endorsement; 6. Fingerprint clearance.

Learn more about Nebraska state board teaching certification requirements.

Nevada

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Nevada state board teaching certification requirements.

New Hampshire

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Early Childhood Special Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd Leadership CINADM, MEd Leadership in Curriculum Administration, MEd Leadership in School Administration, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about New Hampshire state board teaching certification requirements.

New Jersey

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about New Jersey state board teaching certification requirements.

New Mexico

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

New Mexico participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Bachelor's degree or higher; 2. Completion of a standard or alternative educator preparation program; 3. Current license; 4. Must take New Mexico assessments if they have not used their license to teach in another state.

Learn more about New Mexico state board teaching certification requirements.

New York

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

New York participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Must have completed a comparable state approved program in the subject and grade level; 2. Bachelor's degree; 3. Undergraduate GPA of 2.5; 3. Paid full-time experience of 3 years within the last 5 years in the cert area and grade level; 4. New York State exams and workshops; 5. Moral character.

SNHU has not completed the program approval process in New York.

Learn more about New York state board teaching certification requirements.

North Carolina

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd in Secondary Education with STEM Education

Education Programs that Cannot Be Determined Meet the Requirements

MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Education Leadership, MEd in Curriculum and Instruction with a concentration in Special Education

State Specific Requirements

North Carolina participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: Completion of an approved educator preparation program.

SNHU has not completed the program approval process in North Carolina.

Learn more about North Carolina state board teaching certification requirements.

North Dakota

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about North Dakota state board teaching certification requirements.

Ohio

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Ohio participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Testing or other forms of assessment; 2. Supervised and evaluated pre-service or professional experience; 3. Program approval comparability.

SNHU has not completed the program approval process in Ohio.

Learn more about Ohio state board teaching certification requirements.

Oklahoma

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Oklahoma state board teaching certification requirements.

Oregon

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Oregon participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Bachelor's degree; 2. An active, valid license from the state where teacher preparation was completed; 3. Fingerprint-based background check; 4. Content area assessment; 5. The Protecting Student and Civil Rights in the Educational Setting requirement; 6. Official transcripts.

Learn more about Oregon state board teaching certification requirements.

Pennsylvania

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Pennsylvania participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Grade point average; 2. Content assessment(s); 3. Basic skills if undergraduate; 4. GMC questions; 5. State-approved program

SNHU has not completed the program approval process in Pennsylvania.

Learn more about Pennsylvania state board teaching certification requirements.

Rhode Island

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Rhode Island participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Testing; 2. Program approval comparability; 3. Valid teaching license.

SNHU has not completed the program approval process in Rhode Island.

Learn more about Rhode Island state board teaching certification requirements.

South Carolina

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

South Carolina participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Valid Stage 1 or 2 license; 2. Passing score on a content examination; 3. Clear federal and state background reports; 4. Comparable area of certification.

Learn more about South Carolina state board teaching certification requirements.

South Dakota

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Reading, MEd Leadership, MEd in Secondary Education with STEM Education

Education Programs that Cannot Be Determined Meet the Requirements

M.Ed. in Curriculum and Instruction with a concentration in Technology Integration

State Specific Requirements

South Dakota participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Testing (Praxis); 2. Educational program comparability; 3. State statutorily required coursework; 4. Moral fitness; 5. Citizenship; 6. Valid experience in classroom; 7. Valid license in other state ; 8. Post-baccalaureate coursework/degrees; 9. National Board Certification; 10. Pedagogy verification.

SNHU has not completed the program approval process in South Dakota.

Learn more about South Dakota state board teaching certification requirements.

Tennessee

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Tennessee state board teaching certification requirements.

Texas

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Texas participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Completion of a state-approved preparation program; 2. Minimum of a bachelor's degree issued by an accredited institution of higher education; 3. Issuance of a standard certificate by the state department of education.

SNHU has not completed the program approval process in Texas.

Learn more about Texas state board teaching certification requirements.

Utah

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

Education Programs that Cannot Be Determined Meet the Requirements

MEd in Curriculum and Instruction with a concentration in Reading

State Specific Requirements

Utah participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Passage of the appropriate Utah approved content knowledge assessment at Utah's established passing score OR passage of a reasonably equivalent assessment used for this purpose by another state; 2. Content and pedagogy coursework reasonably equivalent to Utah's required coursework; 3. Completion of some type of student teaching, internship or employment placement.

SNHU has not completed the program approval process in Utah.

Learn more about Utah state board teaching certification requirements.

Vermont

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Cannot Be Determined Meet the Requirements 

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Education Leadership, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration

Learn more about Vermont state board teaching certification requirements.

Virginia

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Cannot Be Determined Meet the Requirements 

MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Education Leadership, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration

State Specific Requirements

Virginia participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Be at least 18 years of age; 2. The appropriate fees as determined by the Virginia Board of Education and complete the application process; 3. Have earned a baccalaureate degree; 4. Possess good moral character and be free of conditions outlined in Part VII (8VAC20-23-720 et seq.) in the Licensure Regulations for School Personnel; 5. Official student transcripts; 6. Out-of-state license(s), the endorsement area and any additional documentation received with the license(s); 7. Certification of Child Abuse and Neglect Recognition and Intervention Training. An individual may request a waiver must submit a “Request for a Waiver Form”; 8. Individuals seeking initial licensure shall complete awareness training on the indicators of dyslexia, as that term is defined by the Board pursuant to regulations, and the evidence-based interventions and accommodations for dyslexia; 9. Individuals Seeking an Initial License with Endorsement(s) in an Area of Career and Technical Education: Industry Certification Credential (Career and Technical Educators Only); 10. Individuals Seeking an Initial License with an Endorsement as a School Counselor: Training in the Recognition of Mental Health Disorder and Behavioral Distress (School Counselors Only); 11. Individuals seeking initial licensure with an endorsement as a school counselor must include verification of this statutory required training in the recognition of mental health disorder and behavioral distress, including depression, trauma, violence, youth suicide and substance abuse. Refer to Superintendent’s Memo #313-17 for additional information on training options to meet this requirement; 12. Effective August 23, 2019, a school leader's licensure assessment prescribed by the Virginia Board of Education shall be met for all individuals who are seeking an endorsement authorizing them to serve as principals and assistant principals in the public schools; 13. Every teacher seeking an initial license in the Commonwealth with an endorsement in the area of career and technical education shall have an industry certification credential, as defined in 8VAC20-23-10, in the area in which the teacher seeks endorsement. If a teacher seeking an initial license in the Commonwealth has not attained an industry certification credential in the area in which the teacher seeks endorsement, the Virginia Board of Education may, upon request of the employing school division or educational agency, issue the teacher a provisional license to allow time for the teacher to attain such credential.

Learn more about Virginia state board teaching certification requirements.

Washington

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Washington participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include: 1. Transcripts showing bachelor's or higher degree; 2. Verification of teacher preparation program completion; 3. Basic skills and endorsement area testing; 4. Fingerprinting submitted to Washington State Patrol and FBI for background check.

Learn more about Washington state board teaching certification requirements.

West Virginia

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

West Virginia participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements if licensed in another state include: 1. Minimum grade point average; 2. Official transcripts; 3. graduation from an accredited institution of higher education; 4. Student teaching experience or equivalent documented experience.

Learn more about West Virginia state board teaching certification requirements.

Wisconsin

Education Programs that Do Not Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership, MEd in Secondary Education with STEM Education

State Specific Requirements

Wisconsin participates in the NASDTEC Interstate Agreement, however, jurisdiction-specific requirements include the following: 1. Teachers can bypass jurisdiction-specific requirements if they have a valid license from another jurisdiction and one-year of licensed experience; 2. Teachers who hold a valid license from another jurisdiction but do not have a year of licensed experienced are strongly encouraged to obtain the experience on a 1-year Wisconsin license and then apply for a 3-year provisional license, which leads to a lifetime license.

Learn more about Wisconsin state board teaching certification requirements.

Wyoming

Education Programs that Meet the Requirements

BA Early Childhood Education, BA Elementary Education, BA English Education, BA Middle School Mathematics, BA Middle School Science, BA Secondary Mathematics, BA Social Studies &amp; Education, BA Special Education, MEd Clinical Dual Certification Early Childhood Education &amp; Early Childhood Special Education, MEd Clinical Dual Certification Elementary Education &amp; Special Education, MEd in Secondary Education with STEM Education

Education Programs that Do Not Meet the Requirements

Cert of Advanced Grad Studies in Curriculum and Instruction, Cert of Advanced Grad Studies in District Leadership, Cert of Advanced Grad Studies in Educational Leadership, MEd in Curriculum and Instruction, MEd in Curriculum and Instruction with a concentration in Dyslexia Studies and Language Based Learning Disabilities, MEd in Curriculum and Instruction with a concentration in Online Teaching, MEd in Curriculum and Instruction with a concentration in Reading, MEd in Curriculum and Instruction with a concentration in Special Education, MEd in Curriculum and Instruction with a concentration in Technology Integration, MEd Leadership

Learn more about Wyoming state board teaching certification requirements.

All jurisdictions that participate in the NASDTEC Interstate Agreement may choose to have additional requirements for educators who are coming from another jurisdiction. The additional requirements are known as "Jurisdiction Specific Requirements" (JSRs). When applicable these are noted in the State Specific Requirements column.

 Thu, 30 Jul 2020 16:51:00 -0500 en text/html https://www.snhu.edu/consumer-information/state-authorizations/licensure-and-certification-disclosures Office of Doctoral Studies

All doctoral students must take a certification examination or examinations as part of their Certification (towards the Ed.D. and Ed.D. CTAS degree) or Master of Philosophy (towards the Ph.D. degree) requirements.

Most Certification Examinations are taken on dates set by the college in February, June, and October, proctored by the Office of Doctoral Studies, however, some programs have take-home or internal examination requirements.

Please click your Department's link on the left to find the Certification Examination requirements for your program.

For those programs that require a Certification Examination Application form, it can be downloaded in the Forms section of our website. Please review our calendar to see when the next examination is being held and when the deadline for submission of the application form is.

Please see the following link for information on the college policy for Certification Examination retakes.

https://www.tc.columbia.edu/policylibrary/associate-provost-enrollment-services/doctoral-certification-examination-retakes/

 Wed, 13 Jun 2018 04:32:00 -0500 en text/html https://www.tc.columbia.edu/doctoral/certification-exam/ Best CFP test Prep Courses of 2023

We independently evaluate all recommended products and services. If you click on links we provide, we may receive compensation. Learn more.

A Certified Financial Planner (CFP) is a professional designation for the financial planning profession. Financial planners can earn the CFP designation after completing the CFP Board's education, exam, experience, and ethics requirements.

One of the more challenging steps in the process, the CFP exam, is a pass-or-fail test. You may register for the CFP test after meeting the CFP Board's education requirements. Once you pass the exam, you will be one step closer to becoming a CFP professional, one of the most elite financial planning designations.

To create our list of the best CFP test prep courses, we compared each program's features, including reputation, cost, guarantees, course materials, in-person classes, special features, and more. These are the best CFP test prep courses for aspiring CFP professionals.

 Tue, 12 Jan 2016 02:00:00 -0600 en text/html https://www.investopedia.com/best-cfp-exam-prep-courses-5094913 Certification Testing

Taking an test is the final step to earning an ISA certification. Upon paying the test fee, the application process is complete, and you have acknowledged that you meet the requirements listed below in numbers 1–3.

  1. Commit to the ISA Code of Conduct.
  2. Meet the education and work experience requirements for the specific certification for which you are applying.
  3. Acknowledge that you are subject to a random application verification audit.
  4. Agree to provide the supporting documents proving your qualifications if you are audited.
  5. Pay the test fee. (See “Exam Fee” section below for more information.)

Next Steps

  1. Watch for an email from coming from our testing provider, Meazure Learning (candidatesupport@meazurelearning.com). Expect to receive it fifteen days before your test window. The email will include information about how to schedule your test online or at a test center. NOTE: If you have attended a CCST review course and wish to apply for CCST certification, you must also meet the requirements listed above in numbers 1–3. Since the application fee is included in the cost of all CCST review courses, you will receive an test invitation within three business days after completing the review course.
  2. Schedule and take your exam. You will be notified whether you pass or not immediately upon completing the exam.
  3. Watch for an email summarizing your test results. If you pass your exam, you will also receive your digital badge and you will be listed in the ISA Credential Directory.
  4. Watch for an email from certification@isa.org regarding an audit. You will only receive this email if you have been randomly selected to be audited. If you do not receive this email, you do not need to do anything. Audits are conducted three times per year, so it may take several months after completing your test to receive an email if you have been selected for an audit.

Certification Exams Available

All ISA certification exams are closed book and have multiple choice questions. The CCST Specialist—Level 2 certification test is three hours long and all other certification exams are four hours long. See the information below for the number of questions in each exam.

Exam Questions
Certified Automation Professional® (CAP ®) 175
Certified Control System Technician® (CCST®) Level 1 150
Certified Control System Technician (CCST) Specialist—Level 2 125
Certified Control System Technician (CCST) Master—Level 3 150

Exam Fees 

Submit payment to apply for the chosen certification when you can confirm that you meet the certification requirements to sit for the test and can test within the deadline of the test window of your choosing. You will be notified by email with the next steps to schedule your exam.

CAP 

  • CAP Requirements
  • CAP Application Fee
    • 347 USD — ISA Members
    • 467 USD — Non-members 

CCST 

Apply for CCST Certification for Free

Register for one of the CCST review courses and apply for certification for no additional fee. The following courses qualify: Level I Review Course (TS00), Level II Review Course (TS02) or Level III Review Course (TS03). You will automatically receive an test invitation once you start the course. By paying for the review course, you are confirming that you are aware of, have met and can document the requirements for the certification level for which you are applying.

Payment Methods

ISA accepts payment for test fees by check, certified check, money order, PayPal payment, wire transfer in US Dollars, or credit card. Make checks payable to ISA. For wire transfer account information, please contact ISA Customer Service. The following credit cards are accepted: AMEX, Discover card, Master Card, and VISA. Purchase orders are not accepted.

Fees are nonrefundable. It is your responsibility as the applicant to thoroughly review the requirements of the certification for which you are applying. No refunds will be made for applicants who do not appear for testing on the appropriate test date. There are no group discounts for certification application fees.

Exam Scheduling

After you pay your test fee to complete the application process, you will receive an test invitation (Notice to Schedule Exam) email from candidatesupport@meazurelearning.com 15 days before the beginning of your assigned test window with steps to schedule the exam. Follow the instructions in the email to schedule your exam—online or at a test center—through the online test scheduling system. You can get more information about your test window deadline by accessing the “My Credentials” tab in your ISA account.

If you have not received your test invitation within that time frame, please check your spam or junk folder for an email from candidatesupport@meazurelearning.com, as some server firewalls may block the receipt of the email. If you still are unable to find your test invitation, please email certifications@isa.org for assistance.

See further related details on the Exam Procedures page.

Exam Windows

If you are applying for CAP or CCST certification, you have a twelve-month test window. You may take the test at a Exam Center or online during one of three test windows (see chart below). Each test window will have a deadline for applications to be submitted. Eligible candidates will only be able to take the test during the following exam windows.

Exam Window Application Submission Deadline
2023 Window 3: 
1 November 2023 – 31 October 2024		 15 September 2023
2024 Window 1:
1 March 2024 – 28 February 2025		 15 January 2024
2024 Window 2:
1 July 2025 – 30 June 2025		 15 May 2024
2024 Window 3:
1 November 2025 – 31 October 2025		 15 September 2024


Review Course Testing: If you have attended a review course (paid for by you or sponsored by a company), you will receive your test invitation near the end of your review course and have a twelve (12) month test eligibility period based on the date of your review course.

Digital Badging

After passing the CAP or CCST certification exam, you will earn a digital badge. To access, manage, and/or share your secure digital badge, use your email address and password to enter your BadgeCert portfolio. If it is the first time accessing your portfolio, click “Request new password?” on their login page to create your password. More information about using your digital badge can be found here.

Grievances Appeal Process

If you feel you were wrongly denied certification, either original or renewal, from the CAP or CCST programs, then you have the right to appeal. Review the Grievances Appeal Process.

 

Special Test Accommodations

Candidates who request special test accommodations under the Americans with Disabilities Act (or a similar international standard) must submit their test scheduling requests at least 30 days prior to their preferred test dates. Note that some special test accommodations may not be available for online testing.

If you have a request, email certifications@isa.org.

Contact Meazure Learning

You can contact Meazure Learning by phone at +1 919-572-6880 or email candidatesupport@meazurelearning.com.

Meazure Learning's business hours are Monday through Friday from 8:30 a.m. to 5:30 p.m. and Saturday from 8:30 a.m. to 4:00 p.m. Eastern Time, excluding holidays. Voice mail will accept candidate inquiries outside of these business hours.

Note: Meazure Learning, Scantron, and ProctorU are all one-and-the-same organization.

Important update: Scantron is changing to Meazure Learning. The names Scantron, Examity, and ProctorU may be continue to be used in communications from Meazure Learning during the transition period.

 Sat, 11 Feb 2023 22:50:00 -0600 en text/html https://www.isa.org/certification/certification-testing Board of Certification for Emergency Nursing debuts new specialty

Eligible nurses can now become certified in burn nursing through the Board of Certification for Emergency Nursing. 

To earn the new specialty certification, eligible RNs and APRNs must pass a national exam that covers all aspects of the care continuum for burn patients, spanning from prehospital care through aftercare, education and family support, according to an Oct. 17 news release from BCEN. 

BCEN began developing the Certified Burn Registered Nurse certification in the summer of 2021 in collaboration with the American Burn Association. The American Nurses Association recognized burn nursing as a speciality in August 2020. 

BCEN recommends two years of experience as a burn nurse before taking the exam, though it's not a requirement. 

 Wed, 18 Oct 2023 02:03:00 -0500 en-gb text/html https://www.beckershospitalreview.com/nursing/board-of-certification-for-emergency-nursing-debuts-new-specialty.html Acing the GI Board Exam

In today’s fast-paced world, gastroenterology and hepatology residents, fellows, and clinicians struggle to find the time to study for the board exams, prepare for the recertification exam, prepare for teaching rounds, or just plain read. What is the best way to effectively prepare and study, if studying multiple resources can’t seem to fit into your daily schedule?

The answer to your study questions (and study time!) can be found here.

Acing the GI Board test fills the unmet need in board review by presenting time-tested and high-yield information in a rational, useful, and contextually appropriate format suitable for studying for the board exams and preparing for the recertification exam.

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 Sat, 29 Jan 2022 16:32:00 -0600 text/html https://www.healio.com/books/acing-the-gi-board-exam AANP Vs. ANCC: Choosing An NP Certification

Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations.

Becoming a nurse practitioner (NP), a type of advanced practice registered nurse (APRN), requires significant education and training, as well as knowledge, skills and competencies. Aspiring NPs must be licensed registered nurses (RNs), hold a bachelor of science in nursing and complete a masters in nursing or a doctorate of nursing program graduate programs.

The last step on the long journey to becoming an NP is passing a national nursing certification test in your specialization. Passing the right test demonstrates your advanced clinical knowledge and skills and shows employers you can succeed as an NP in your specialty.

Two national organizations, the American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC), offer nurse practitioner certifications. You must pass a board certification test from either AANP or ANCC to become an NP.

NPs specializing in family or adult-gerontology primary care can take either an AANP test or an ANCC exam. For other practice specialties, like psychiatric-mental health, only one organization offers the relevant test and credential.

Learn more about AANP vs. ANCC nursing certifications, and figure out which path is right for you.

AANP vs. ANCC

AANP and ANCC both offer NP certifications and board certification exams. AANP is a membership organization representing more than 121,000 nurse practitioners across North America. Its credentialing arm is the AANP Certification Board (AANPCB), which only offers NP certifications.

ANCC is an offshoot of the American Nurses Association (ANA), a professional group with 4 million members in the United States. ANCC administers certifications to both NPs and registered nurses with an associates degree or bachelor’s degree in nursing.

If you’re pursuing NP certification in family or adult-gerontology primary care, you can do so through AANPCB or ANCC. Other NP specializations do not offer a choice; you must take the relevant certification test from whichever organization offers it.

For example, aspiring emergency nurse practitioners can only pursue certification through AANPCB. NPs seeking to specialize in psychiatric mental health, on the other hand, must earn their credentials through ANCC.

What Is the American Academy of Nurse Practitioners Certification Board (AANPCB)?

AANP created AANPCB, a nonprofit credentialing organization for nurse practitioners, to offer NP certifications in the following specialties:

  • Adult-Gerontology Primary Care Nurse Practitioner (A-GNP)
  • Family Nurse Practitioner (FNP)
  • Emergency Nurse Practitioner (ENP)

AANP members receive a $75 discount on AANPCB certification applications.

Certifications Offered by AANPCB

Adult-Gerontology Primary Care Nurse Practitioner (A-GNP)

The A-GNP certification demonstrates clinical knowledge of adults from age 13 until advanced age and end-of-life. This certification qualifies you for NP licensure specializing in adult patients. A-GNPs have demonstrated expertise and competencies in health assessment, pathophysiology, pharmacology, treatment and management of acute and chronic conditions, and evidence-based practice.

The certification’s competency-based test includes 150 questions, including 15 pre-test questions that do not count toward your score. The test covers assessment, diagnosis, plan and evaluation domains, including questions about all age parameters. Online applications cost $240 for AANP members and $315 for nonmembers. Prices may change over time and discounts may be available for members of specific nursing organizations. Members should check with their association membership offices to see if discounts are applicable.

A-GNP applicants must hold an active RN license. Other eligibility requirements include a minimum of 500 graduate level clinical practicum hours and successful completion of a graduate or postgraduate adult-gerontology primary care nurse practitioner program at an accredited school of nursing.

To find out more about earning RN licensure, review our guide on how to become an RN.

Family Nurse Practitioner (FNP)

The FNP certification qualifies holders to apply for a state license to practice as an FNP offering primary care across the life span, from prenatal patients to older adults.

The competency-based test includes 150 questions (135 scored questions and 15 unscored pretest questions). The test assesses knowledge of various age and practice domains like assessment, evaluation, diagnosis and planning. It covers courses like cultural competence, crisis management, pain management and anatomy.

FNP applicants with AANP memberships pay $240 to apply online, while nonmembers pay $315. Eligibility requirements for the FNP include an active RN license, completion of a graduate or postgraduate family nurse practitioner program at an accredited school and at least 500 clinical hours.

To learn more, see our guide on how to become a family nurse practitioner.

What Is the American Nurses Credentialing Center (ANCC)?

As part of ANA, ANCC offers various certifications to help NPs and RNs advance their careers. ANCC’s NP certifications include:

  • Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP-BC®)
  • Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC®)
  • Family Nurse Practitioner Certification (FNP-BC™)
  • Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC™)

In addition to providing certifications, ANCC also accredits healthcare organizations that offer or approve continuing education for nurses. ANCC recognizes healthcare organizations that encourage safe and effective nursing practice as well. ANA members can save $100 on ANCC’s NP certification application fees.

NP Certifications Offered by ANCC

Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC)

ANCC’s AGPCNP-BC credential qualifies you to practice as an entry-level adult-gerontology primary care nurse practitioner. To qualify for the AGPCNP-BC, you must hold RN licensure and pass a national certification exam.

To obtain this credential, you must earn an accredited AGPCNP master’s in nursing, a DNP or a postgraduate certificate including at least 500 supervised clinical hours. Applicants must complete three APRN core graduate courses in advanced physiology or pathophysiology, advanced health assessment and advanced pharmacology.

The Accreditation Board for Specialty Nursing Certification provides accreditation for this certification, which requires renewal every five years. For initial certification, ANA members pay $295, and nonmembers pay $395. AANP members, AANP student members and Gerontological Advanced Practice Nurses Association (GAPNA) members also receive discounts.

The AGPCNP test assesses competency in clinical knowledge and skills for this specialty. The competency-based test lasts 3.5 hours and includes 175 questions (150 scored and 25 unscored pretest questions). Questions cover the patient assessment process, plan of care and professional practice, spanning different age groups, body systems and drug agents.

You can take ANCC’s Adult-Gerontology Primary Care Nurse Practitioner Readiness Test to assess your preparedness for the official exam. You can use ANCC’s study aids to prepare for the test.

Family Nurse Practitioner Certification (FNP-BC)

ANCC’s FNP-BC credential qualifies you to apply for state licensure to work as a family nurse practitioner. This certification requires renewal every five years.

To earn this credential, you must pass the competency-based FNP-BC test to demonstrate that you have the clinical skills and knowledge necessary for FNP work. The 3.5-hour test includes 175 questions (150 scored questions and 25 unscored pretest questions). test content covers assessment, diagnosis, planning, implementation and evaluation with questions about different age groups, drug agents and body systems.

ANA members pay $295 for initial certification; nonmembers pay $395. AANP members, AANP student members and GAPNA members also receive discounts.

Eligibility requirements for the FNP-BC certification include a current RN license and an FNP master’s, postgraduate certificate or DNP from an accredited school. The FNP program must include 500 faculty-supervised clinical hours. Applicants must also complete three graduate-level APRN core courses covering advanced physiology or pathophysiology, advanced health assessment and advanced pharmacology.

You can take ANCC’s FNP readiness test to assess your test readiness and to get a better idea of what to expect. ANCC also provides other study aids, including sample questions and a test content outline.

Frequently Asked Questions (FAQs) About AANP vs. ANCC

What is the difference between AANP and ANCC?

AANP and ANCC both offer national certification exams for nurse practitioners. AANP, a professional organization for nurse practitioners, only offers NP certifications. ANCC is a wing of ANA and offers certifications for RNs at various levels, including NPs.

What does certification for an NP mean?

NPs must earn certification to apply for a state license to practice their specialty. To obtain certification, you must pass a national board test in your NP specialty area. You must also meet other requirements, including holding an RN license, earning a BSN degree and completing a graduate NP program with at least 500 clinical hours.

 Thu, 03 Aug 2023 02:49:00 -0500 Liz Simmons en-US text/html https://www.forbes.com/advisor/education/ancc-vs-aanp-nursing/ Certification test Change Policy

On occasion, the best-laid plans need to be changed. Please understand that changes incur administrative costs both for ABA and our test partner, Meazure Learning.

Should you need to cancel or reschedule your test after application, please review the fee schedule and procedures below.

Please note that fees and refunds are based on the dates applicable to your current test registration.


 Before Application Due Date After Application Due Date 2 Business Days or Less Prior to Scheduled test Date or End of the test Window

Transfer

to a future test date/window

 No fees $175 fee to ABA Entire test Fee Forfeited - No Changes Permitted

Reschedule

within the same test window

 No fees $50 fee to Meazure Learning if a testing date had been selected Entire test Fee Forfeited  - No Changes Permitted

Cancel

 Refund of test Fee minus $100 application fee Refund of test Fee minus $275 Entire test Fee Forfeited - No Changes Permitted

ABA will consider waiving fees in case of a medical emergency. Requests will be reviewed on a case-by-case basis and supporting documentation may be required. If you would like to transfer your certification test registration to a future test window (or to entirely cancel), please submit the Exam Window Change/Cancellation Form. Fees are subject to change without notice.

Transfer to a Future test Date/Window

  • ABA will permit up to two (2) consecutive transfer requests for any reason. Should you not take the test after the second transfer request, ABA will cancel your registration and provide a partial refund of your test fee per the fee schedule above. Should you wish to take the test in the future, a new application and full fee is required.
  • If you would like to transfer your certification test registration to a future test window (or to entirely cancel), please submit the Exam Window Change/Cancellation Form. A $175 fee applies.
  • Requests to transfer will not be honored with less than 2 business days prior to the scheduled test date or the end of the test window and the entire test fee will be forfeited.

Reschedule Within the Same test Window

  • To reschedule your test date within the same test window, access Meazure Learning's online scheduling system (referenced in your Notice to Schedule). Your request must be made 2 business days or more prior to your testing date appointment or the entire test fee will be forfeited. A $50 fee applies.

Cancel

  • Send your cancellation request by completing the Exam Window Change/Cancellation Form.
  • ABA will refund the test fee minus $275 up until 2 business days prior to the scheduled test date or end of the test window.
  • The entire test fee is forfeited if you cancel less than 2 business days prior to the scheduled test date or end of the test window.

View all test FAQs

 Fri, 14 Aug 2020 05:34:00 -0500 en text/html https://www.aba.com/training-events/certifications/certification-exam-change-policy Take My Online Exam: How Entireclasshelp.com Can Help You With All Your Certification Online Exams No result found, try new keyword!However, along with the benefits come various challenges, especially when it comes to taking online exams. The lack of face ... and fill out the inquiry form or visit the order form to order ... Fri, 21 Jul 2023 22:17:00 -0500 en-US text/html https://www.outlookindia.com/outlook-spotlight/take-my-online-exam-how-entireclasshelp-com-can-help-you-with-all-your-certification-online-exams-news-304887




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