Applied Neuroscience Flashcards
Alexia without agraphia (pure alexia) is seen in lesions of
Select one:
- Middle meningeal artery
- Posterior inferior cerebellar artery
- Middle cerebral territory
- Posterior cerebral territory
- Anterior cerebral territory
Posterior cerebral territory
The posterior cerebral artery arises from basilar artery and supplies the inferomedial temporal lobe and the
occipital lobe, and some parts of the posterior parietal cortex. Lesions in this arterial supply can cause
alexia without agraphia.
A patient tells you that he has done poorly in the Hayling’s test. What do you infer?
Select one:
1. He is jumping to conclusions
2. He has black and white thinking
3. He has verbal memory deficits
4. He has visuospatial deficits
5. He has set-shifting deficits
He has set-shifting difficulties
The Hayling Sentence Completion test measures both response initiation and suppression. Two sets of 15
sentences each having the last word missing is presented to the subject. In the first part of the test, the subject has to fill the missing word to complete the sentence in a meaningful manner. The speed of completion of this task is the measure of response initiation. The second part requires subjects to complete the test sentences with nonsensical finishing word and thus require an effective suppression of sensible words. This gives a measure of response suppression. A poor performance suggests frontal deficits.
A 47-year-old man presented to the neurology clinic with a diagnosis of bitemporal hemianopia. A lesion
affecting which part of the brain or eye could be attributed to this presentation?
Select one:
1. Thalamus
2. Optic nerve
3. Optic radiation
4. Optic chiasma
5. Geniculate body
Optic chiasma
A lesion affecting optic chiasma e.g., pineal tumours and craniopharyngioma can cause bitemporal
hemianopia.
A better preserved letter fluency but poor category fluency is noted in
Select one:
1. Korsakoff’s syndrome
2. Alexia with agraphia
3. Semantic dementia
4. Frontal lobe damage
5. Normal young adults
Semantic dementia
With respect to the memory for word meaning and general knowledge (semantic memory), the key neural
substrate is the anterior temporal lobe. The ability to generate categories based on semantic memory is
tested in category fluency tests; thus these tests tap on semantic memory as well as fluency. In
frontotemporal dementia (semantic dementia) this memory domain is affected earlier than phonological or letter (verbal) fluency.
Which of the following structure is most commonly affected in alexia without agraphia?
Select one:
1. Corpus callosum
2. Arcuate fasciculus
3. Wernicke’s area
4. Broca’s area
5. Right visual cortex
Corpus callosum
Alexia without agraphia (pure word blindness) almost always involves an infarct to the left posterior cerebral
artery affecting splenium of the corpus callosum and left visual cortex. So the affected person, who is still
able to see with right visual cortex, cannot undertake lexical word processing making him unable to read.
But he or she can still normally write.
A 73-year-old man is presenting with one-year history of progressive cognitive decline. He retains full
insight into his cognitive difficulties. The most likely diagnosis is
Select one:
1. All of the above
2. Vascular dementia
3. Frontotemporal dementia
4. CJD
5. Huntington’s dementia
Vascular dementia
In people with vascular dementia, the impairment of cognitive function is often patchy or uneven; there may be memory loss, intellectual impairment, and focal neurological signs. Insight, judgement and personality may be relatively well preserved.
Loss of verbal fluency is associated with which of the following lesions?
Select one:
1. Right frontal
2. Right parietal
3. Left temporal
4. Left parietal
5. Left frontal
Left frontal
Motor speech disorder is a feature of left frontal lesions due to damage to Broca’s area located in this
region.
Cerebellar dysfunction is associated with all of the following except
Select one:
1. Dysdiadochokinesia
2. Intention tremor
3. Micrographia
4. Truncal ataxia
5. Past pointing in finger-nose test
Micrographia
Cerebellar dysfunction is characterised by truncal ataxia, dysequilibrium, reduced muscle tone, decreased reflexes, incoordination of movements which manifest by poor ability to perform rapid alternating movements (Dysdiadochokinesia), past pointing in finger-nose test (dysmetria) and intention tremor.
Micrographia is a feature of basal ganglia damage seen in Parkinson’s.
An 18-year-old girl presents with sudden blindness. Fundoscopy, visual evoked potentials and MRI brain
are normal and no organic cause could be found. On perimetry, which of the following findings will support a diagnosis of conversion disorder?
Select one:
1. Symmetrically constricted visual field
2. Tunnel vision
3. Paracentral scotoma
4. Macular sparing
5. Bitemporal (heteronymous) hemianopia
Tunnel vision
Tunnel vision refers to an absence of projected disparity between near and far fields of vision. The patients report having patchy spirals of field loss. This is seen in hysteria and malingering.
Which of the following aphasia is characterised by loss of fluency and repetition ability but preserved
comprehension?
Select one:
1. Transcortical motor aphasia
2. Broca’s aphasia
3. Transcortical sensory aphasia
4. Conduction aphasia
5. Wernicke’s aphasia
Broca’s aphasia
In Broca’s aphasia the speech is nonfluent; it often appears laboured with any interruptions and pauses.
Abnormal word order and a characteristic agrammatism are noted. Speech is telegraphic.
A 59-year-old gentleman is being assessed in the memory clinic. He presents with progressive loss of
memory for ‘words’ but has good day-to-day memory for events. What is his most likely diagnosis?
Select one:
1. Lewy body dementia
2. Parkinson disease dementia
3. Alcoholic dementia
4. Frontotemporal dementia
5. Alzheimer’s dementia
Frontotemporal dementia
In patients with frontotemporal dementia, there is a relative preservation of day-to-day memory (episodic).
The temporal lobe variant presents more commonly with semantic dementia, a syndrome of progressive
word finding difficulty, loss of language comprehension, depletion of conceptual knowledge and impairment of object recognition.
Absence of ankle jerks with upgoing plantars is noted in
Select one:
1. Brown Sequard syndrome at T10
2. Peripheral neuropathy related to medications
3. Internal capsule lesions of corticospinal tract
4. Spinothalamic tract lesions
5. Subacute combined degeneration of spinal cord
Subacute combined degeneration of spinal cord
UMN lesion of corticospinal tracts is expected to cause exaggerated ankle reflex (i.e. clonus) with upgoing
plantar normally. But in subacute combined degeneration cord, Syphilitic taboparesis and Friedrich’s ataxia and MND we see absence of ankle jerk as spinal reflex pathway is affected (afferent) while UMN type damage still produces Babinski - upgoing plantar.
A 64-year-old lady presents with acute onset vertigo and double vision. On examination, one sided facial
numbness, diplopia and ataxia are noted with absent gag reflex. Which of the following lesion is most
likely?
Select one:
1. Posterior cerebral artery
2. Anterior choroidal artery
3. Middle cerebral artery
4. Internal carotid artery (left)
5. Posterior inferior cerebellar artery
Posterior inferior cerebellar artery
The symptoms are consistent with Wallenberg or lateral medullary syndrome which is common in posterior inferior cerebellar artery lesions.
On routine examination of eyes, accommodation reflexes were present but pupils were small and irregular with an absence of reaction to light. This type of pupil is called
Select one:
1. Marcus Gunn pupil
2. Senile pupil
3. Anosognosia
4. Kayser-Fleischer pupil
5. Argyll Robertson pupils
Argyll Robertson pupils
Syphilitic or diabetic neural damage can lead to the obliteration of pupillary reaction when stimulated by
light thought the response to near / accommodation reflex is intact. This is called ARP (Argyll Robertson
Pupil) - it is frequently quite miotic with an irregular shape. The Argyll Robertson pupil is also recalcitrant to
pharmacologic dilation.
Which of the following is INCORRECT with regard to vegetative states?
Select one:
1. Language comprehension is absent
2. Cycles of eye closure and opening are absent
3. Spontaneous maintenance of respiration
4. Complete absence of awareness of environment
5. Noxious stimulus elicits no response
Cycles of eye closure and opening are absent
Monti et al. provided a set of criteria for diagnosing vegetative states: “Three main clinical features define
the vegetative state: (a) cycles of eye opening and closing, giving the appearance of sleep-wake cycles; (b)
complete lack of awareness of the self or the environment; and (c) complete or partial preservation of hypothalamic and brain stem autonomic functions.”
Which of the following psychological tests is used in research on animal models of depression?
Select one:
1. Spitz test
2. Radial arm maze task
3. Light-Dark box
4. Morris water maze task
5. Forced swim test
Forced swim test
The behavioural despair test (also called the Porsolt test or forced swimming test) is a test used to measure
the effect of antidepressant drugs on the behaviour of laboratory animals (typically rats or mice). Animals
are initially made to swim in a cylinder filled with water from which they cannot escape even if they swim
vigorously but rescued manually after 15 minutes. After a day, the forced swimming experiment is repeated but only for 5 minutes. The total time for which the animal shows no effort to escape or swim out of the cylinder during the second trial is the immobility time that indexes helplessness. This time is decreased by antidepressants.
Ability to recognise the number or alphabet scratched on one’s skin without seeing is called
Select one:
1. 2 point discrimination
2. Chromatopsis
3. Stereognosis
4. Nosognosis
5. Graphesthesia
Graphesthesia
Ability to recognise the number or alphabet that is scratched on one’s skin without seeing is called
graphesthesia, and it is a parietal lobe function.
Pauline was found to be wandering on the streets after the sudden death of her husband. What type of
amnesia is she most likely to exhibit?
Select one:
1. Post traumatic amnesia
2. Amnesia for personal information
3. Amnesia for childhood
4. Lacunar amnesia
5. Global amnesia
Amnesia for personal information
This is called as fugue state, a form of dissociative amnesia, which involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. The episodes result from trauma or stress. It is a rare functional disorder characterized by profound but reversible amnesia for personal identity, including changes in one’s personality and other identifying behavioural characteristics
Spelling the word ‘WORLD’ backwards tests which of the following?
Select one:
1. repetition
2. recall
3. attention
4. registration
5. orientation
Attention
Attention can be tested in a number of ways including serial 7s, digit span, spelling “world” backwards, and
recitation of the months of the year in reverse order.
The clinical sign of finger-nose ataxia is seen in lesions of which of the following structures?
Select one:
1. Inferior colliculus
2. Superior colliculus
3. Thalamus
4. Inferior olivary nucleus
5. Pyramidal decussation
Inferior olivary nucleus
Inferior olivary nucleus serves motor coordination via projecting climbing fibers to the cerebellum. Axons
arising from cells in the inferior olive cross and enter the inferior cerebellar peduncle to reach the
contralateral cerebellar cortex. Inferior olivary lesions lead to appendicular ataxia that can be tested using
finger-nose test.
A 78-year-old man fails to eat the food on one side of his plate following recovery from a stroke. When
asked to bisect a straight line, he chooses to bisect it closer to the right end. The brain area most probably
affected is
Select one:
1. Left parietal lobe
2. Right parietal lobe
3. Left occipital lobe
4. Right occipital lobe
5. Left frontal lobe
Right parietal lobe
Neglect of personal and extrapersonal space is usually caused by lesions of the right hemisphere - often
the inferior parietal or prefrontal regions.
Which of the following is noted in dorsolateral prefrontal syndrome?
Select one:
1. Reduced verbal output
2. Poor impulse control
3. Psychopathic dyscontrol
4. Poor planning ability
5. Apathy
Poor planning ability
Cognitive dysfunction, diminished judgment, planning, and insight along with a concrete and inflexible
attitude is seen in DLPFC lesions. Reduced spontaneous behaviours are also notable. (DYSEXECUTIVE SYNDROME). Poor impulse control, explosive outbursts and inappropriate behaviour are seen in orbitofrontal lesions. (PSEUDOPSYCHOPATHIC SYNDROME).
Which of the following best describes Ribot’s law?
Select one:
1. Anxiety decreases with increasing task difficulty
2. Arousal and performance are related in an inverted U shaped correlation
3. The gradient of episodic memory loss starts from the most recent to more remote events
4. Organic memory loss affects remote memories before affecting more recent ones
5. Observation increases degree of conformity
The gradient of episodic memory loss starts from the most recent to more remote events
Ribot’s Law of retrograde amnesia: ‘The dissolution of memory is inversely related to the recency of the
event’. Recent memories are more likely to be lost than the more remote memories in organic amnesia
(though there are some exceptions to this rule).
Simultanagnosia is associated with which of the following syndromes?
Select one:
1. Balint’s syndrome
2. Anton’s syndrome
3. Ekbom’s syndrome
4. Gerstmann syndrome
5. Marchiafava-Bignami disease
Balint’s syndrome
Balint’s syndrome consists of a triad of simultanagnosia (inability to attend to more than one item of a complex scene at a time), optic ataxia (inability to guide reaching or pointing despite adequate vision), and oculomotor apraxia (inability to voluntarily direct saccades to a visual target). Fields may be full when challenged with gross stimuli, and oculocephalic reflexes are intact. This syndrome results from bilateral damage including the superior-parieto-occipital region, which disrupts the dorsal (“where”) visual processing stream linking visual with parietal association areas. Possible causes include carbon monoxide poisoning, watershed infarction, leucodystrophy, and the posterior cortical variant of Alzheimer’s disease
A reduction in the score on the Seashore Musical Aptitude Test may be seen in which of the following type of brain lesions?
Select one:
Frontal lobe damage
Left parietal lobe damage
Right parietal lobe damage
Right temporal area damage
Left temporal area damage
Right temporal lobe
Right temporal area damage may result in a reduction of the score on the seashore musical aptitude test
and receptive amusia. In Seashore Rhythms test, thirty pairs of tape-recorded, non-verbal sounds are
presented. For each pair, individuals decide if the two sounds are the same or different, marking ‘S’ or ‘D’
respectively on their answer sheets. The pairs are grouped into three subtests.This is based on the
Seashore Tests of Musical Ability. It evaluates auditory attention and concentration, and the ability to
discriminate between non-verbal sounds
Which of the following is noted when the temporal order of memory is disturbed leading to out-of-context
retrieval?
Select one:
1. Confabulation
2. Blackouts
3. Transient global amnesia
4. Anomia
5. Disorientation
Confabulation
Confabulation is seen in Korsakoff’s syndrome and also in dementias. Confabulation often involves the
misordering and fusion of real memories that end up being retrieved out of context.
Following a traumatic brain injury, a 41-year-old woman loses the ability to recognize her husband’s face. But she is able to recognize him from his ‘voice’ and his ‘preferential routines’. The brain area most likely to be damaged by the injury is
Select one:
1. Left inferior temporal
2. Bilateral medial prefrontal
3. Right dorsolateral prefrontal
4. Right inferior temporal
5. Bilateral occipito-temporal
Bilateral occipito-temporal
Acquired prosopagnosia is usually associated with bilateral or right-sided lesions of the occipital - temporal junction (FUSIFORM GYRUS). In rare cases of prosopagnosia after left-sided lesions in left-handed
subjects, it is attributed to a reversed hemispheric specialization for face processing
An increase in oral and sexual behaviours, placidity and a loss of fear or anger with apathy is a feature of
which of the following conditions?
Select one:
1. Kluver-Bucy syndrome
2. Ganser syndrome
3. Frontal lobe syndrome
4. Gerstmann syndrome
5. Cerebellar syndrome
Kluver-Bucy
Kluver-Bucy syndrome results from bilateral ablation of temporal lobes and destruction of the uncus,
amygdala and hippocampus in monkeys. A similar syndrome is seen in humans in association with a
number of disorders such as Alzheimer’s dementia, Pick’s disease, herpes simplex encephalitis and
cerebral tumours when medial temporal lobe is involved.
A construction worker sustains a head injury after a sudden fall. Following this he presents with a change in behaviour, violent outbursts, impulsivity and reduced speech fluency. Which of the following could be the most likely MRI finding in this patient?
Select one:
1. Bilateral occipital contre-coup injury
2. Diffuse axonal injury
3. Bilateral parietal contusion
4. Bilateral orbito-frontal contre-coup injury
5. Bilateral temporal contre-coup injury
Bilateral orbito-frontal contre-coup injury
There are four regions of the prefrontal corex that are frequently mentioned in the scientific literature. These
are orbitofrontal, dorsolateral prefrontal, anterior cingulate cortex and ventromedial cortex (the latter two together form the medial frontal surface). Pseudopsychopathy is a result of orbitofrontal damage.
A 53-year-old woman has alexia and agraphia. She is likely to exhibit
Select one:
1. Impaired auditory comprehension
2. Normal speech
3. Right visual field defect
4. Intact writing
5. Color agnosia
Right visual field defect
Alexia without agraphia occurs in occipitotemporal lesions (Note: alexia with agraphia often results from a
left angular gyral lesion). Right homonymous hemianopia is commonly associated with alexia; speech includes anomic disturbances but color recognition and auditory comprehension are often intact.
Which feature is not associated with supranuclear palsy?
Select one:
1. Loss of balance
2. Dementia
3. Spared eye movements
4. Tau proteins
5. Brainstem degeneration
Spared eye movements
The most common early complaint in progressive supranuclear palsy (PSP) is unsteadiness of gait and
unexplained falling (retropulsion). It may take a year or longer for the characteristic syndrome-comprising
supranuclear ophthalmoplegia, pseudobulbar palsy, and axial dystonia to develop fully. They may have
difficulty in voluntary vertical movement of the eyes (vertical gaze palsy). The principal areas of the brain
affected are: the basal ganglia, the brainstem, particularly the portion of the midbrain where “supranuclear” eye movement resides, the cerebral cortex and the dentate nucleus of the cerebellum. The neurons display neurofibrillary tangles, which are clumps of tau protein.
A 79-year-old man with a history of progressive cognitive decline for the last year has difficulty in remembering names but is good at day-to-day functioning. The most likely diagnosis is;
Select one:
1. CJD
2. Picks disease
3. Vascular dementia
4. Alzheimer’s dementia
5. Binswanger’s disease
Alzheimer’s disease
In the early stages of Alzheimer’s disease, people often present with cognitive difficulties such as forgetting
trivial details, names, faces, etc. but will show largely preserved functional abilities.
Gerstmann syndrome is associated with lesions of which of the following structures?
Select one:
1. Dominant parietal lobe
2. Non dominant temporal lobe
3. Dominant temporal lobe
4. Occipital lobe
5. Non dominant parietal
Dominant parietal lobe
Gerstmann syndrome is associated with lesions of the dominant parietal lobe. It consists of finger agnosia,
right-left disorientation, agraphia and dyscalculia. Lesions in the non-dominant parietal lobe hemisphere
result in anosognosia, hemisomatognosia, dressing apraxia and prosopagnosia.
Lesion of ventromedial frontal cortex is associated with
Select one:
1. Apathy
2. Disorganisation
3. Apraxia
4. Increased gambling
5. Memory problems
Apathy
This results in pseudodepressive syndrome
A 25-year-old man sustains a severe head injury in a motor cycle race event. On recovery, he is noted to
have grasp reflex, poor judgement and impaired reasoning with impulsivity. Which of the following tests is highly likely to be abnormal?
Select one:
1. Wisconsin card sorting test
2. Wechsler adult intelligence scale IQ score
3. Paragraph retention test
4. Wechsler memory scale
5. National adult reading test
Wisconsin card sorting test
The Wisconsin Card Sorting Test (WCST) contains stimulus cards of different colour, form, and number.
These are presented to patients to sort into groups according to a single principle (e.g., to sort by colour,
ignoring form and number). Persons with damage to the frontal lobes or the caudate and some persons
with schizophrenia give abnormal responses.
Following a traumatic brain injury, a 41-year-old woman loses the ability to identify her body parts correctly.
She is not able to use numbers for simple calculations. The brain area most likely to be damaged is
Select one:
1. Right inferior parietal
2. Left angular gyrus
3. Left inferior temporal
4. Bilateral occipito-temporal
5. Right supplementary motor
Left angular gyrus
Gerstmann syndrome is characterized by four primary symptoms: Dysgraphia/agraphia, Dyscalculia/acalculia, Finger agnosia and Left-right disorientation. This is rarely seen as full presentation of tetrad; It is often associated with brain lesions in the dominant (usually left) side of the angular and supramarginal gyri (parietal lobe).
Which of the following tests can differentiate organic from psychiatric stuporous states?
Select one:
1. Caloric testing
2. Electromyography
3. Wada test
4. Behavioural memory test
5. Dichotic listening
Caloric testing
Caloric testing in organic stupor will usually reveal tonic deviation whereas in a psychiatric stupor
(catatonia/depression) ocular nystagmus will be present. This is because the fast phase reflects the
correction following tonic deviation, and this requires the patient to be conscious
In a patient with right-sided brain lesion resulting from a head injury which of the following is most likely?
Select one:
1. Finger agnosia
2. Language comprehension deficits
3. Limb apraxia
4. Visuospatial neglect
5. Motor aphasia
Visuospatial neglect
Visuospatial disorders, dressing and constructional apraxias and anosognosia may occur with lesions of
either hemisphere but are observed more frequently and are of greater severity with lesions of the
nondominant one.
A 74-year-old man who recently suffered a vascular stroke, refers to apples as ‘oranges’. This is called
Select one:
1. Word blindness
2. Lingual apraxia
3. Wernicke’s aphasia
4. Semantic paraphrasia
5. Cortical blindness
Semantic paraphrasia
Semantic paraphasia refers to the mis-selection of words due to semantic confusion, where the actual
utterance bears some conceptual relationship to the intended utterance (e.g.bread for food). In contrast, phonemic paraphasia refers to the mis-selection due to phonemic confusion, where the actual utterance bears a sound similarity to the intended utterance (e.g. shark for sharp).
Which one of the following is a test of frontal lobe function?
Select one:
1. Complex figure of Rey
2. Speech sound perception test
3. Benton visual retention test
4. Benton verbal fluency test
5. Seashore rhythms test
Benton verbal fluency test
Frontal lobe function tests include verbal fluency tests, category tests, trail making test and Wisconsin card
sorting test, Stroop colour word interference test etc. Temporal lobe tests: Benton visual retention test,
speech sound perception test, seashore rhythms test and revised Wechsler memory scale. Rey Osterreith
complex figure is not a frontal lobe test.
Double vision that is present only on horizontal gaze is seen in
Select one:
1. Myasthenia gravis
2. Isolated 6th nerve lesion
3. Exophtholmos of hyperthyroidism
4. Isolated 3rd nerve lesion
5. Bilateral 4th nerve lesion
Isolated 6th nerve lesion
The nucleus of the abducens (6th) nerve is located in the paramedian pontine region in the floor of the
fourth ventricle. It innervates the lateral rectus, which abducts the eye. Patients complain of double vision
on horizontal gaze only. This finding is referred to as horizontal homonymous diplopia
When performing the Mini Mental Status Examination (MMSE), an inability to copy intersecting polygons is
suggestive of
Select one:
1. Visuospatial deficits
2. Attentional deficits
3. Visual agnosia
4. Ideomotor apraxia
5. Comprehension deficits
Visuospatial defecits
Inability to draw shapes or construct geometrical patterns is seen in those with visuospatial defects. Mostly nondominant hemisphere is damaged.
While testing executive functions of frontal lobe, response inhibition can be specifically tested using
Select one:
1. Go-No Go test
2. Category fluency test
3. Cognitive estimates test
4. Digit span test
5. Proverb interpretation
Go/ No Go Test
Impulsivity is thought to reflect a failure of response inhibition, and is seen in inferior frontal pathology. It can be assessed using the Go-No-Go task. The examiner instructs the patient to tap once in response to a single tap and to withhold a response for two taps. This test can be made more difficult by changing the initial rule after several trials (for example, “tap once when I tap twice, and not at all when I tap once”).
Which part of the brain is associated with forced utilisation behavior?
Select one:
1. Ventromedial part of frontal lobe
2. Temporal lobe
3. Orbitofrontal lobe
4. Parietal lobe
5. Dorsolateral frontal lobe
Orbitofrontal lobe
If the frontal lobe region that is superior to the eye is damaged, forced utilization may be seen. When
objects are placed in front of the subject, the subject with forced utilization will pick an object and make
attempts to use it even when he/she is instructed not to do so. This behaviour is attributed to the damage of
the orbital frontal structures and the caudate nuclei.
The type of amnesia seen in Korsakoff’s syndrome is
Select one:
1. Implicit
2. Procedural
3. Episodic
4. Working memory deficits
5. Infantile memory deficits
Episodic
Korsakoff’s syndrome is characterized by anterograde amnesia, retrograde amnesia with episodic memory
impairment, confabulation, lack of insight and apathy. The retrograde amnesia extends back at least 25 to
30 years and includes loss of memory for remote information and autobiographical memory for incidents or events from the patient’s past.
Which of the following subtests of Wechsler Adult Intelligence Scale (WAIS) declines with aging?
Select one:
1. Information
2. Vocabulary
3. Block design
4. Picture completion
5. Object assembly
Block design
In WAIS, hold tests are vocabulary, information, object assembly and picture completion. Non-hold tests are
block design, digit span, similarities and digit symbol. A deterioration quotient is derived from the difference
between ‘don’t hold’ and ‘hold’ test scores. Hold tests are supposed to be resistant to age-related decline;
so they may be sensitive for organic brain damage such as dementia. But this is disputed.
A 66-year-old patient is incidentally diagnosed to have a carotid bruit. Which of the following can be
expected if he develops a thromboembolism?
Select one:
1. Nystagmus
2. Amaurosis
3. Ataxia
4. Transient global amnesia
5. Diplopia
Amaurosis
Amaurosis fugax is loss of vision in one eye due to a temporary lack of blood flow to the retina. It may be a
sign of an impending stroke.
In delirium, which of the following domains of orientation is the first to be affected?
Select one:
1. Orientation to age
2. Orientation to language
3. Orientation to person
4. Orientation to place
5. Orientation to time
Orientation to time
Orientation is usually assessed for time, place and person; it is not a particularly sensitive cognitive test. Intact orientation does not exclude a significant memory disorder, particularly if there is concern about memory in the history from an informant. Time orientation is the most helpful, affected early in delirium and the test should include a question on the time of the day (Kipps and Hodges (2006).
