ABAT Examination Study Guide

Tips for Success

  • Start studying at least 8-12 months prior to the examination, devoting a minimum of 1-2 times per week to exam preparation.
  • Plan a systematic review of the vast amount of topics that require study. Consider creating a table comprised of an extensive list of topics (the List of Potential Exam Topics is below). Review and study as many topics (e.g.: toxicological, occupational, environmental) as possible. It is important to include topics rarely encountered as well as the more common topics. Individuals who have taken the exam repeatedly say that ‘you need to know everything about everything.’ The expectation is that for an individual to pass the ABAT exam, he or she should possess extensive toxicology knowledge, among other skills.
  • After studying specific toxicology topics, the self-assessment chapter quizzes in Goldfrank’s Toxicologic Emergencies can be used to test your knowledge and test taking ability. These self-assessment quizzes are good examples of the depth of detail typical of the multiple choice section of the ABAT exam. The URL link is: http://www.goldfrankstoxicology.com/self-assessment.html
  • Take notes of important points for each topic during your review. Write down the main points in a notebook; flashcards, or whatever method works for you. Periodically, review these notes as you are continuing to study new topics. Additionally, these notes are very useful for the final review during the week prior to the examination.
  • Join or form a study group of other individuals studying for the ABAT or ACMT exam to meet weekly with the goal of studying and discussing various toxicology topics. If in-person meetings are not possible, a teleconference may work well in some situations. [ACMT = American College of Medical Toxicology]
  • Be prepared to critically evaluate a scientific journal article including appropriateness of the statistical analysis. If you are not able to do this proficiently, then take steps to accomplish this goal. Some suggestions include: take a refresher course on the application of biostatistics for the medical literature, and/or initiate a self-tutorial program using reputable medical statistics references (see ABAT Study Guide Reference List). Participate in a journal club that reviews current scientific literature. Review should involve a critical analysis of the citations including appropriateness of the study design, methodology, statistical application and validity of the authors’ conclusions.
  • Routinely participate in bedside consultations of overdose patients in a hospital setting in order to become competent in clinical case management skills of poisoned patients including formal written consultation. Utilize the case studies in Goldfrank’s Toxicologic Emergencies to test your case management skills of poisoned patients.
    The URL link is: http://www.goldfrankstoxicology.com/cases.html
  • Make a list of all the U.S. governmental agencies (eg: NIOSH, EPA) pertinent to toxicology. Know each agency’s mission and scope, Congressional acts responsible for their creation; standards they establish, monitor or are responsible for enforcing (eg: TLV, PEL, MCL, etc).
  • Be familiar with major historical toxicological events and disasters as well as current events and emerging trends in toxicology.
  • Review and study the ATSDR Case Studies in Environmental Medicine [ATSDR = Agency for Toxic Substances and Disease Registry]. These case study units contain much valuable information that is pertinent to successfully passing the ABAT exam; however, be aware that the section questions are much less challenging than the questions typically found on the ABAT exam. The URL link is: http://www.atsdr.cdc.gov/csem/csem.html
  • When taking the ABAT exam, remember it is a timed test. Bring a watch and budget your time well. Each of the four essay questions consists of multiple parts (see ABAT Study Guide Table of Specifications below). Efficient time management is of utmost importance. Write legibly and organize your responses to highlight the main points you want to convey to the person grading your exam (e.g.: when appropriate consider organizing your responses using bulleted phrases rather than full sentences). Follow the exam instructions. For example, when the instructions state to LIST your responses, organize your responses as a list; Do Not respond in full sentences or paragraph format.
  • Obtain guidance from an ABAT Diplomate in good standing.
  • Reserve the week before the exam to review.
  • Get a good night’s sleep prior to test days.

 

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List of Potential Exam Topics

The attached list of topics provides some direction as to what types of topics are usually tested. While this list may seem exhaustive, it truly reflects the wide knowledge base required of ABAT Diplomates.

DRUGS

Analgesics and Anti-inflammatory Medications
Acetaminophen
N-acetylcysteine
Aspirin and salicylates
Sodium bicarbonate
Colchicine
NSAIDs/COX-2 inhibitors
Opioid analgesics
Opioid antagonists

Anticoagulants
Direct thrombin inhibitors
Factor Xa inhibitors Heparin
Protamine
Low molecular weight heparins
Warfarin
Vitamin K

Anticonvulsants
Barbiturates
Carbamazepine
Gabapentin
Levetiracetam
Oxcarbazepine
Phenytoin and fosphenytoin
Tiagabine
Topiramate
Valproic acid
Levocarnitine

Antidiabetics and hypoglycemic

Alpha-glucosidase inhibitors Biguanides
Gliptins
GLP-1 analogues
Insulins
Dextrose
Meglitinides
Sulfonylureas
Octreotide
Thiazolidinediones

Antihistamines and anticholinergics

Physostigmine
Antimicrobial agents
Antibacterials
Antifungals
Antimalarials
Antituberculous medications
Isoniazid
Pyridoxine
Antivirals

Antimigraine medications
Ergot alkaloids
Triptans

Antineoplastics
Methotrexate
Gluparidase
Leucovorin

Cardiopulmonary medications
Antidysrhythmic agents (Class IA; Class IB; Class IC; Class III; Class IV)
Beta-adrenergic antagonists
Glucagon
Calcium channel blockers
Insulin-euglycemia therapy
Cardioactive steroids/Digoxin
Digoxin-specific antibody fragments
Digitalis-like compounds
Methylxanthines and selective beta2-adrenergic agonists
Caffeine
Theophylline
Other antihypertensives
Clonidine
Cathartics
Decongestants
Dietary and Nutritional Agents
Athletic performance enhancers
Diet aids
Herbal products
Iron
Deferoxamine
Vitamins and minerals

Drugs of abuse

Amphetamines
Body stuffers and body packers Cocaine
Designer drugs
Disulfiram and disulfiram-like reactions Ethanol
Gamma hydroxybutyrate
Hallucinogens
Heroin
Inhalants
Marijuana and analogs
Nicotine
Phencyclidine
Synthetic stimulants

 

Extravasation injuries
Inhalational anesthetics
Local anesthetics
Lipid therapy
Neuromuscular blockers
Nonprescription drugs
Psychopharmacologic agents
Antipsychotics
Butyrophenones
Neuroleptic malignant syndrome
Phenothiazines
Atypical antipsychotics
Cyclic antidepressants
Lithium
Monoamine oxidase inhibitors
Sedative-Hypnotics
Barbiturates
Benzodiazepines
Flumazenil
Bromides
Serotonin reuptake inhibitors and atypical antidepressants
Serotonin syndrome
Skeletal muscle relaxants
Thyroid medications

 

CHEMICALS

Borates
Chemical warfare agents
Chlorates
Dioxin (TCDD)
Formaldehyde
Household toxins
Antiseptics and disinfectants
Camphor
Caustics, corrosives (acid and alkali)
Disc batteries
Chlorine and chloramine gas
Essential oils
Fluoride
Hydrocarbons
Pesticides
Hydrofluoric acid
Toxic alcohols
Ethylene glycol and glycol ethers
Methanol
Ethanol
Fomepizole
Barium
Carbamates
Chlorinated hydrocarbons
Herbicides
Insect repellents
Methyl bromide and other fumigants
Organophosphates
Atropine
Pralidoxime
Phosphorous
Pyrethrins/pyrethroids
Rodenticides
Sodium monofluoroacetate
Strychnine
Riot control agents
Solvents

 

ENVIRONMENTAL/OCCUPATIONAL

Air pollution (indoor and outdoor)
Botanicals/plants
Carbon monoxide
Hyperbaric oxygen therapy
Chemical warfare agents
Cyanide
Hydroxocobalamin
Sodium and amyl nitrites
Sodium thiosulfate
Hazardous materials, hazardous spills/waste
Heavy metals
Aluminum
Antimony
Arsenic
Dimercaprol
Bismuth
Cadmium
Chromium
Cobalt
Copper
Lead
Calcium disodium EDTA
Succimer
Manganese
Mercury
Nickel
Selenium
Silver
Thallium
Prussian blue
Zinc
High pressure injection injuries
Hydrogen sulfide
Industrial exposures
Inhalation toxicity – gases, fumes, vapors
Metal fume fever
Nitrogen dioxide
Pulmonary irritants
Simple asphyxiants
Smoke inhalation
Isocyanates
Methemeglobin inducers
Methylene blue

Occupational cancer risk

Occupational exposure theory

Radiation

Potassium iodide

Sick building syndrome

TLV’s and other occupational exposure limits

Toxic oil syndrome

Water pollution

 

BIOLOGICALS

Biological warfare agents
Anthrax
Botulism
Botulinum antitoxin
Ciguatera fish poisoning
Food poisoning
Mushrooms
Scombroid fish poisoning
Shellfish poisoning
Tetrodotoxin poisoning
Toxic envenomations
Arthropods
Antivenoms
Marine envenomations
Scorpions & Antivenoms
Snake and reptile envenomations & Antivenoms

Analytical methodology
Anion gap metabolic acidosis
Blood levels of toxic substances
Cancer promoters and carcinogens
Cardiac toxicity of poisons
Dermatologic reactions
Drug induced illness
Drug interactions
Drug metabolism
Enhancing elimination
Epidemiologic study design and interpretation

Epidemiology of poisonings
Evidence based medicine approaches

Extracorporeal drug removal
Extrapolation of animal data to humans
Fetal toxicity of xenobiotics
Hepatotoxicity, toxin induced

Laboratory analysis of toxins Mutagenesis
Neonatal drug withdrawal
Neonatal transplacental toxicity
Nephrotoxicity of toxins
Neuropathies
Toxin induced Pharmacokinetics
Pulmonary toxicity
Teratogens and teratogenicity
Therapeutic drug monitoring
Toxicokinetics
Toxidromes
Withdrawal syndromes

 

GENERAL/OTHER

Agricultural related poisonings
Antidotes
First aid for poisonings
Foreign body ingestions and exposures
Gastric decontamination procedures
History of toxicology
Multiple chemical sensitivity syndrome
Poison prevention
Risk communication
Risk evaluation

If you would like to download a PDF of this, please click here

Last updated March 24, 2014

Suggested references that may prove helpful

The following references have been identified as useful resources used by candidates who have successfully passed the ABAT exam. This reference list does not specifically promote any particular resource but is designed to direct candidates to reputable sources that may be used to tailor their own needs during the exam preparation process. An effort should be made to use current editions.

Toxicology books

Dart RC, Medical Toxicology 3rd edition, Philadelphia, PA. Lippincott Williams & Wilkins,
2003ISBN-13: 978-0781728454

 

Ellenhorn MJ, Shonwald S, Ordog G, Wasserberger J, Ellenhorn’s Medical Toxicology:Diagnosis and Treatment of Human Poisoning 2ND edition. Baltimore: Williams & Wilkins.ISBN-13: 9780683300314

Ford MD, Delaney KA, Ling LJ, Erickson T, ed.s, Clinical Toxicology. Philadelphia: WB Saunders 2000. ISBN-13 978-0721654850

Nelson LS, LewinNA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE,Goldfrank’sToxicologicEmergencies 9th edition, New York : McGraw-Hill, Medical Pub.Division.2010 ISBN: 0071605932

 

Greenberg MI, Hendrickson RG, Morocco AP, Shrestha M, Bryant SD, eds.Toxicology: Pearlsof Wisdom, Lincoln, NE: Boston Medical Publishing CorporationInc; 2002. ISBN-13:9781584090595

 

Hathaway GJ, Proctor NH, Proctor and Hughes’ Chemical Hazards of the Workplace 5th edition,Hoboken New Jersey: Wiley Interscience. 2005ISBN-13: 9780471268833

 

Henderson DA author, Inglesby TV &O’Toole T, eds., Bioterrorism: Guidelines for Medical and Public Health Management. Chicago, IL: The American Medical Association, 2002 Jul.ISBN-13: 978-1579472801

 

Klaassen CD, Casarett LJ, Doull J, Casarett and O’Doull’s Toxicology: The Basic Science of Poisons 8th edition. New York: McGraw-Hill Professional Publishing Pergamon Press 2013ISBN: 0071769234

 

Krenzelok EP, ed.,Biological and Chemical Terrorism: A Pharmacist’s Preparedness Guide.Bethesda, MD, American Society of Health-System Pharmacists, 2003. ISBN-13:9781585280483

 

O’Donnell JT. Drug Injury: Liability, Analysis and Prevention 3rd edition. Tucson AZ, Lawyers and Judges Publishing 2012; ISBN-13: 9781936360086

 

Olson KR, ed, Poisoning & Drug Overdose 6th edition, New York : McGraw-Hill Companies,ISBN: 0071668330

 

Rom WN, Markowitz S ed, Environmental and Occupational Medicine 4th edition. Boston: Little Brown and Company 2006 ISBN-13: 9780781762991

 

Shannon MW, Borron SW, Burns MJ, Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose. Philadelphia: WB Saunders, Elsevier Health Sciences. 2007 ISBN: 0721606938

 

Sidell FR, Takafuji ET, Franz DR, eds., Textbook of Military Medicine, Part 1. Medical Aspects of Chemical and Biological Warfare. Washington DC: Office of the Surgeon General, Walter Reed Army Medical Center. 1997 ISBN: 9789997320919

 

Sullivan JB, Krieger GR, eds. Clinical Environmental Health and Toxic Exposures, 2nd edition, Philadelphia: Lippincott Williams and Wilkins. 2001. ISBN-13: 9780683080278

 

Literature Review Textbooks and Resources

 

Guyatt G, Rennie D, Meade M, Cook D. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 2nd edition.New York, NY: McGraw Hill Professional-Medical, 2008. ISBN-13: 978-0071590341

 

Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, Designing Clinical Research,3rd edition.Philadelphia, PA, Lippincott Williams & Wilkins.2006 ISBN-13: 978-0781782104

 

Glantz SA. Primer of Biostatistics, Seventh Edition.McGraw-Hill Medical, 2011. ISBN-13: 978-0071781503

 

Six part series, Introduction to Biostatistics, in Annals of Emergency Medicine. Gaddis ML, Gaddis GM, Ann Emerg Med. 1990:Gaddis ML, Gaddis GM. Introduction to BiostatisticsPart 1; Basic Concepts.Ann Emerg Med. 1990 Jan, 19(1):86-9. PMID: 2297161

Gaddis ML, Gaddis GM. Introduction to BiostatisticsPart 2; Descriptive Statistics. Ann Emerg Med. 1990 Mar;19(3):309-15. PMID 2310070

Gaddis ML, Gaddis GM. Introduction to BiostatisticsPart 3; Sensitivity, Specificity, Predictive Value, and Hypothesis Testing. Ann Emerg Med. 1990 May;19(5):591-7. PMID 2331107

Gaddis ML, Gaddis GM. Introduction to BiostatisticsPart 4; Statistical Inference Techniques In Hypothesis Testing,Ann Emerg Med. 1990 Jul;19(7):820-5. PMID 2389867

Gaddis ML, Gaddis GM. Introduction to Biostatistics Part 5; Statistical Inference Techniques for Hypothesis Testing with Nonparametric Data Ann Emerg Med. 1990 Sep; 19(9):1054-9. PMID: 2203291

Gaddis ML, Gaddis GM. Introduction to Biostatistics Part 6; Correlation and Regression. Ann Emerg Med. 1990 Dec;19(12):1462-8. PMID: 2240762 Three Part Series on Biostatistics, Pharmacotherapy, 2010-2011.

DiPietro NA, Methods in Epidemiology: Observational Study Designs Pharmacotherapy. 2010 Oct;30(10):973-84. PMID: 20874034

Shields KM, DiPietro NA, Kier KL. Principles of Drug Literature Evaluation for Observational Study Designs.Pharmacotherapy. 2011 Feb;31(2):115-27. PMID:21275490

Kier KL, Biostatistical Applications in Epidemiology Pharmacotherapy. 2011 Jan;31(1):9-22 PMID: 21182354

 

Other Useful References/ URL Links

ATSDR Case Studies in Environmental Medicine: http://www.atsdr.cdc.gov/csem/csem.html

Goldfrank’sToxicologic Emergencies 9th edition – SELF ASSESSMENT QUIZZES

http://www.goldfrankstoxicology.com/self-assessment.html

Goldfrank’sToxicologic Emergencies 9th edition – POISONING CASES

http://www.goldfrankstoxicology.com/cases.html

If you would like to download a PDF of this, please click here

 

Last updated March 24, 2014

 

 

 

 

Examination Specifications

The ABAT examination contains two sections: Multiple choice questions and Problem Solving. 

Specifications for Multiple Choice Questions

The questions will measure the candidate’s ability to recall certain general facts about specific agents within the above categories. More importantly, the candidate will apply this basic factual knowledge to make clinical decisions presented within the framework of the questions. The multiple choice questions will be of a type with 4 possible choices with one correct answer. This multiple-choice examination lasts five (5) hours.

Topic Number of Questions
Drugs 40
Chemicals 35
Environmental/Occupational 15
Biologicals 15
Theory (eg: toxicokinetics; interactions; laboratory) 10
General (eg: antidotes; history) 10
Total 125

Specifications for the Problem Solving Section

The clinically-oriented, problem solving cases (3) are geared to assess the ability of the candidate to assess a patient scenario provided in a layered pattern (with no regression to the earlier section) typically providing a diagnostic (eg. differential diagnosis based on history and clinical findings, assessment strategies to include  laboratory, radiologic, and use of pharmacologic antagonists), stabilization (eg. initial supportive care, empiric therapies), and therapeutic plan (eg specific interventions to include antidotes, methods of enhanced elimination) to work the problem through to resolution in an evidenced-based approach.  In addition, the candidate should be able explain the underlying rationale and mechanisms of action for all assessment and management interventions, as well as organ-specific pathophysiology and sequelae for potential toxins.  . A second type of problem (1) will assess a more non-clinical role in addressing a statistical review of a toxicology literature article (critiquing a published study with regards to its study design strengths and weaknesses, and interpretation with extrapolation of results to practice).

The candidate is given a brief introductory vignette of each of the four topics and is allowed to decide the order in which they choose to answer each of the four topics. Each topic is comprised of  two to  four separate sections which are further broken down to specific questions that focus on information provided in that section, as well as, past sections. Once a candidate completes a section of the case study, the questions, responses as well as the exam book are turned into the proctor before receiving the next section of the case study.  Once each part of the exam is completed and submitted to the proctor, there is no regression to the earlier section. Once all sections of a case study are completed, the individual is free to start any of the remaining case studies during the six (6) hour examination period.

Topic Number of Questions
Clinically oriented problems to include a toxin(s) that fall in each of the categories of biological, drug, and chemical/environmental 3
Literature critique 1

 

Last Updated March 2016

Important Information Regarding the ABAT Examination

Overview

The ABAT exam is a comprehensive examination that evaluates a candidate’s breadth of toxicology knowledge, problem solving skills pertinent in the management of poisoning case studies, proficiency in diagnosing the unknown poisoned patient; and the ability to critically evaluate scientific literature including the proper application of statistics.  This study guide is designed to help candidates have an overall understanding of the rigorous nature and format of the exam. In addition, it includes many useful tips during the preparation process.  However, it is important to note that use of this guide is not a guarantee of exam success.

In order to become a Diplomate of the American Board of Applied Toxicology (DABAT), a candidate must successfully complete the credential review process and pass the ABAT examination. The ABAT examination is offered annually at the North American Congress of Clinical Toxicology (NACCT) meeting typically held in September or early October.

The ABAT exam is a two part examination administered over a two day period.   

The first day of the exam is comprised of four multi-part, essay-formatted topics.  The candidate is given a brief introductory vignette of each of the four topics and is allowed to decide the order in which they answer each of the four topics. Once each part of the exam is completed and submitted to the proctor, there is no regression to the earlier section of the exam question. Three of the topics are toxicology-related, problem-solving case studies. These case studies encompass a wide variety of topics including acute and chronic exposures to drugs, biological agents, environmental toxins, and chemicals.  The fourth topic is designed to evaluate the candidate’s ability to critically evaluate a published scientific journal article.  Candidates are expected to complete all four questions in six (6) hours.

The second day of the exam is comprised of 125 multiple-choice questions covering a variety of toxicology topics in a five (5) hour time frame. These questions are designed to measure diversity of knowledge.

Please contact the President of ABAT if you have any additional questions.

Logistics of the Examination

The following describes some pertinent logistics of the examination. These guidelines are subject to change. The candidates will be instructed regarding the current test taking rules on the day of the examination.

 

* You must be a member in good standing with AACT 

* Remember that the members of the Board will read your writing. Use legible writing. You may use pencils or pens to write your responses.    

* You may take as many breaks of 10 minutes or less out of the exam room as you desire, but observe these rules:

  1. Do not discuss the test with anyone outside of the exam area
  2. Do not call anyone for assistance with the test
  3. Do not use references to assist in taking the test
  4. Only one person can leave the exam room at one time
  5. You will be required to turn in your exam at the end of the exam period, regardless of the time you spend on breaks.

* Drinks and/or snacks are permissible if desired. Water is typically supplied for test takers.

* A calculator will be provided by the exam Proctor and collected at the end of each day.  Please turn off the audible tones of cell phones and pagers.

* You must submit all test materials to the Proctor before you leave the exam area.

Last updated: March 24, 2014

Examination Survey

In the spring of 2013 all American Board of Applied Toxicology Diplomates (who had successfully passed the ABAT exam) were invited to complete an online survey regarding their experience and resources utilized to prepare for the ABAT exam. Fifty-seven (57) responses were recorded when the survey closed. Thirty-three percent (33%) of respondents had passed the exam in the last 7 years. The following summarizes pertinent information from the survey that current exam candidates may find useful.

  1. The length of time Diplomates started preparing for the ABAT exam prior to the exam date:

                23% started more than 12 months prior to the exam
                44% started 6 to 12 months prior to the exam
                33% started 2 to 6 months prior to the exam

  1. The frequency of time spent studying for the exam:

                77% studied more than once a week
                17% studied once a week
                 2% studied once every other week
                 4% studied once a month

  1. Diplomates rated the following items/activities to be the most useful (selected from a list of 18 choices) in their ability to successfully pass the ABAT exam:

                – The amount of time devoted to study

                – Textbooks

                – Formal postgraduate training (Post-Doc, residency, fellowship, etc.)

                – Comprehensive review of toxicologic topics (see the ABAT List of Exam Topics)

                – Goldfrank’s Toxciologic Emergencies-Self Assessment Quizzes

                – Study groups

                – Regular journal reading/journal review articles

 

  1. Diplomates identified the following methods useful when preparing for the literature review section:

                – Regular participation in a journal club

                – Studying a biostatistics review book

                – Studying a comprehensive review of biostatistics published in medical journal article

                 (see the ABAT Reference List for suggestions)