There are few certifying or recertifying examinations in the medical field that are given in a take-home format. This stems from a concern that examinees may discuss items with peers, or save copies of items on the exam and then pass them on to others. This study examined if item exposure on take-home examinations influences the difficulty of the exam and subsequent performance of examinees. To assess item exposure, sixty items were used repeatedly for three consecutive administrations on a take-home recertification examination. An item parameter drift analysis was conducted for those 60 repeated items as well as the non repeated items by using the differential item function in the computer software Winsteps, as well as a comparison of the p-values and displacement statistics. Results showed that only 12 items out of the 60 study items had significant differential item functioning; only six of these 12 items got easier over repeated administrations. These data suggest that candidates did not use knowledge of these items to their advantage. Given the context of the examination used in this study, reusing items on an unproctered high-stakes examination did not lead to widespread aberrant behavior. (Contains 4 tables.)