Applied Neuroscience

Question 1

Alexia without agraphia (pure alexia) is seen in lesions of
Select one:

1. Middle meningeal artery
2. Posterior inferior cerebellar artery
3. Middle cerebral territory
4. Posterior cerebral territory
5. Anterior cerebral territory

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

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

Answer 3

Optic chiasma

A lesion affecting optic chiasma e.g., pineal tumours and craniopharyngioma can cause bitemporal
hemianopia.

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

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.

Question 7

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

Answer 7

Left frontal

Motor speech disorder is a feature of left frontal lesions due to damage to Broca’s area located in this
region.

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

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

Answer 11

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.

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

Posterior inferior cerebellar artery

The symptoms are consistent with Wallenberg or lateral medullary syndrome which is common in posterior inferior cerebellar artery lesions.

Question 13

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

Answer 13

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.

Question 14

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

Answer 14

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.”

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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

Question 18

Spelling the word ‘WORLD’ backwards tests which of the following?

Select one:
1. repetition
2. recall
3. attention
4. registration
5. orientation

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

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).

Question 22

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

Answer 22

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).

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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.

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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.

Question 28

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

Answer 28

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.

Question 29

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

Answer 29

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.

Question 30

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

Answer 30

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.

Question 31

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

Answer 31

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.

Question 32

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

Answer 32

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.

Question 33

Lesion of ventromedial frontal cortex is associated with Select one: 1. Apathy 2. Disorganisation 3. Apraxia 4. Increased gambling 5. Memory problems

Answer 33

Apathy This results in pseudodepressive syndrome

Question 34

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

Answer 34

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.

Question 35

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

Answer 35

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).

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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.

Question 38

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

Answer 38

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`).

Question 39

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

Answer 39

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.

Question 40

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

Answer 40

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

Question 41

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

Answer 41

Visuospatial defecits Inability to draw shapes or construct geometrical patterns is seen in those with visuospatial defects. Mostly nondominant hemisphere is damaged.

Question 42

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

Answer 42

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").

Question 43

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

Answer 43

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.

Question 44

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

Answer 44

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.

Question 45

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

Answer 45

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.

Question 46

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

Answer 46

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.

Question 47

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

Answer 47

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).