Book Exam 3 Flashcards
In North America, abuse of a single drug is ____.
(a) common among women but not men
(b) uncommon
(c) not likely with comorbid depression
(d) characteristic of individuals with stimulant use
B—uncommon The large majority of individuals with substance abuse disorders misuse muliple
You are seeing a former National Football League player who is seeking compensation for memory problems that he believes are related to playing professional football. Concerns about symptom feigning/exaggeration are apparent on multiple symptom validity tests. On the Test of Memory Malingering, he earns a 28 on Trial 1, a 46 on Trial 2, and a 45 on the retention trial. Performance on all other performance validity tests is unremarkable. According to the Slick criteria for malingered neurocognitive dysfunction (MND), the diagnosis of malingering is most likely to be ____.
(a) definite
(b) probable
(c) possible
(d) unlikely
C—possible
The score of 28 on Trial 1 is invalid per post-publication research on the TOMM, but the other scores (46, 45) fall just within the valid range, hence this is likely an indeterminate PVT finding. In the context of a clear external incentive to do poorly, indeterminate results on a single PVT along with multiple SVT abnormalities results in a diagnosis of “possible” MND according to the Slick criteria. Please refer to Chapter 12.
On an inpatient rehabilitation unit, a 58-year-old woman has reportedly been walking into the wall on her left side during physical therapy, and the occupational therapist notices that the items placed on the left side of her lunch tray always remain untouched. Of the following, which is most consistent with this clinical presentation, and what would be the etiology?
(a) prosopagnosia; right occipital cerebrovascular accident (CVA)
(b) ideomotor apraxia; left parietal CVA
(c) right-left disorientation; left parietal CVA
(d) neglect; right parietal CVA
D—neglect; right parietal CVA
The behavior is indicative of a left neglect which is consistent with right CVA. Please refer to Chapter 5.
The foremost risk factor for cerebral palsy is ____.
(a) low Apgar score
(b) birth asphyxia
(c) premature birth
(d) neonatal infection
C—premature birth
The other choices are actual risk factors but not as major. Please refer to Chapter 19.
A 48-year-old man is status post-surgical resection of a large right frontal glioblastoma. During the course of your evaluation, significant visual scanning deficits, executive dysfunction, impulsivity, and impaired social skills become apparent. It is your opinion that he should not be driving and likely has a reduced capacity to make informed medical decisions. Midway through the examination, the patient becomes frustrated, refuses to continue, and storms out. Before he leaves the office, he instructs you to destroy his healthcare record and never share findings with anyone, especially his wife and the physician who referred him. What do you do first?
(a) Call later and inform the patient that you cannot destroy the record, but that you will respect his autonomy and not write a report.
(b) Call later and try to convince the patient that it is in his best interest to share the information with the referring provider and his wife.
(c) Anonymously report the patient to the department of motor vehicles indicating your concern about his ability to drive.
(d) Contact your state ethics committee and the referring provider to discuss the situation and review options.
D—Contact your state ethics committee and the referring provider to discuss the situation and review options.
In situations in which safety is of immediate concern, confidentiality can be breached in the interest of protecting the patient or others from imminent harm. In this vignette the patient has clear impairments which likely will place him and others at high risk. Although in some states it might be appropriate to contact the Department of Motor Vehicles (DMV), in other states psychologists are not allowed to do so. Thus, the most appropriate first step would be to collaborate with the referring provider and or an ethics committee to discuss options to address the situation. Although B is a reasonable option with some patients, in this case the patient has already left the building, and his presentation indicates that attempts to contact him are unlikely to be successful and will not adequately address the safety concern. Please refer to Chapter 7.
High-functioning adolescents with Autism spectrum disorder tend to exhibit age-appropriate ____ but struggle with ____.
(a) spelling skills; multiplication and division
(b) decoding skills; reading comprehension
(c) sentence composition; letter formation
(d) math problem solving; written expression
B—decoding skills; reading comprehension
Academic abilities among middle to high school students with high-functioning autism are generally in the average range, but difficulties are most commonly observed on tasks that require inferential reasoning. Most commonly, students have difficulty with reading comprehension, written expression and mathematical problem solving. Please refer to Chapter 14.
Of the medications listed, which carries the highest risk for the development of delirium following prolonged use at the prescribed dosage?
(a) beta blockers (b) serotonin reuptake inhibitors (c) corticosteroids (d) anticonvulsants
C —corticosteroids
Patients on beta blockers and or anticonvulsants often complain of sedation, difficulty concentrating, or memory problems, but these medications are not often associated with delirium. SSRI’s are quite safe relative to TCA’s and much less likely to result in confusion unless overused or multiple agents are prescribed (i.e., serotonin syndrome). The term steroid psychosis has been used to describe conditions in which patients develop delirium and or mania often following prolonged use of corticosteroids to treat chronic illness (e.g., lupus, rheumatoid arthritis, lympho
Which imaging modality would be most useful in the diagnosis of Parkinson’s disease versus other Parkinson-plus disorders?
(a) cardiac MIBG scintigraphy
(b) structural MRI
(c) FDG PET
(d) resting state fMRI
A—cardiac MIBG scintigraphy
Cardiac uptake reduction precedes motor impairment and dopamine degeneration in Parkinson’s disease patients, and cardiac MIBG SPECT can accurately distinguish Parkinson’s disease from corticobasal syndrome, progressive supranuclear palsy, and multiple system atrophy. The heart to mediastinum ratio is decreased in Parkinson’s disease, irrespective of disease duration or severity. Please refer to Chapter 33.
What sign is likely due to a disconnection rather than direct damage to a module?
(a) constructional dyspraxia
(b) any transcortical aphasia
(c) specific type of agnosia
(d) modality-specific anomia
D—modality-specific anomia
Any sensory specific cognitive deficit is likely a disconnection problem. In this case, unable to name visual objects, but can name with tactile presentation. Please refer to Chapter 3.
According to most definitions, positive symptoms include ____.
(a) formal thought disorder and bizarre behavior
(b) delusions and hallucinations
(c) pseudobulbar affect and cognitive impairments
(d) attentional impairments and other
B—delusions and hallucinations
The term “positive symptoms” was originally intended to signify an excess of normal function, but has come to be understood more specifically to refer to delusions and hallucinations. This stands in contrast to the negative symptoms (that term originally used to describe the absence of affective expression, motivation, etc.) and disorganization symptoms (which include bizarre behavior, attentional impairment, alogia, and formal thought disorder). Please refer to Chapter 35.
If you want to know the degree to which you can have confidence in a normal result on a psychometric test to rule out a specific condition, you should calculate this ratio:
(a) false negatives/(true negatives + false positives)
(b) true negatives/(false negatives + true positives)
(c) false negatives/(false negatives + true negatives)
(d) true negatives/(true negatives + false negatives)
D—true negatives/(true negatives + false negatives)
This refers to the negative predictive power of the test, or the degree to which a negative test result (i.e., indicative of normal performance) can be relied upon that a particular condition or illness is truly absent. Please refer to Chapter 8.
You are reviewing medical records for a patient who has been in a car accident. During his neurological exam, it is noted that he presents with decreased shoulder shrug on the left and an inability to resist pressure from an examiner’s hand against the right jaw. These findings could suggest ____.
(a) left spinal accessory nerve XI dysfunction
(b) right spinal accessory nerve XI dysfunction
(c) bilateral spinal accessory nerve XI dysfunction
(d) feigned neurologic impairment
A—left spinal accessory nerve XI dysfunction Sternocleidomastoid strength and trapezius muscle lift are innervated by the ipsilateral cranial nerve XI. Please refer to Chapter 6.
A 35-year-old married male has been promoted regularly at work but is experiencing depressive signs and symptoms. During interview, he also reported experiencing intermittent episodes of high productivity and decreased need for sleep for a few days. He finds these episodes useful in terms of his work productivity, but they are followed by periods of increased depression. This presentation is suggestive of ____.
(a) Major Depressive Disorder
(b) Bipolar I Disorder
(c) Bipolar II Disorder
(d) Cyclothymic Disorder
C—Bipolar II Disorder As noted in DSM criteria, bipolar II disorder is unique in that hypomanic episodes are present but do not rise to a level of severity noted in bipolar I and cyclothymic disorders. Please refer to Chapter 34.
A 7-year-old boy presents for evaluation of ADHD symptoms due to “daydreaming” during class and parent reports that he has to have simple instructions repeated over and over. These symptoms have been present since around 5 years of age and have gotten worse over the past few months. Other than concerns with attention, he does well in school and there is no history of learning disability. An EEG shows occasional generalized bursts of 3 hz spike and wave discharges. The most likely diagnosis is ____.
(a) temporal lobe epilepsy
(b) Landau-Kleffner syndrome
(c) self-limiting epilepsy with centrotemporal spikes
(d) childhood absence epilepsy
D—childhood absence epilepsy (CAE)
This type often presents as staring spells, and has a characteristic EEG pattern of 3 Hz spike and wave discharges. Seizures can be brief, and are self-limiting with 65–85% showing remission prior to or during adolescence. Please refer to Chapter 22.
A clinical psychologist wants to use a brief instrument to screen for possible suicidal thoughts in adolescents. For this purpose, the instrument should have high ____.
(a) sensitivity (b) specificity (c) face validity (d) concurrent validity
A—sensitivity Because of the condition of interest, it is more important to avoid false positive than false negative errors. Please refer to Chapter 9.
Which of the following is a typical side effect of psychostimulant medication?
(a) depression
(b) insomnia
(c) hallucinations
(d) lowered blood pressure
B—insomnia Common side effects of psychostimulant medication include decreased appetite, increased heart rate and blood pressure, and insomnia. Please refer to Chapter 16.
A patient with amnesia has a large lesion affecting many brain structures. In each item below, a pair of structures is listed. Damage to which of these pairs is most likely to produce dense amnesia?
(a) mammillary bodies and dorsomedial thalamus
(b) amygdala and dorsomedial thalamus
(c) hippocampus and cingulate gyrus
(d) mammillothalamic tract and anterior thalamus
A—mammillary bodies and dorsomedial thalamus
The two-system theory of amnesia states that amnesia results from damage to some element of the medial and lateral limbic circuit. This alternative is the only one that contains an element from the medial system (mammillary bodies) together with an element from the lateral system (dorsomedial thalamus). Please refer to Chapter 4.
What is the most important factor to consider when assessing prognosis for mortality after stroke?
(a) size of infarct
(b) location of infarct
(c) hemorrhagic etiology
(d) time since stroke
C—hemorrhagic etiology Hemorrhagic stroke has a much higher mortality rate in the first 6 months (about 50%) than ischemic stroke. Please refer to Chapter 26.
In a neuropsychological evaluation of patients with functional somatic syndromes, what measure is most likely to show clinically relevant elevations?
(a) Beck Depression Inventory
(b) Patient Health Questionnaire-9
(c) MMPI-2 Restructured Clinical Scale 3
(d) MMPI-2 Restructured Clinical Scale 1
D—MMPI-2 Restructured Clinical Scale 1
Although many studies examining patients with FSS suggest specific deficits in attention, psychomotor speed, and working memory, these deficits attenuate or disappear when emotional stress factors are considered. Please refer to Chapter 37.
A 7-year-old boy presents for evaluation. Upon meeting him, you note that he has elf-like features. Despite IQ in the range of moderate ID, he is very social. He is most likely to have which of the following?
(a) fragile X syndrome
(b) adrenoleukodystrophy
(c) Klinefelter syndrome
(d) Williams syndrome
D—Williams syndrome
Individuals with Klinefelter syndrome and adrenoleukodystrophy typically do not have IQ in the range of moderate intellectual disability. While fragile X syndrome is associated with moderate intellectual disability, elf-like features are only associated with Williams syndrome. Please refer to Chapter 18.
A 25-year-old presents with aphasia 8 months after a severe traumatic brain injury. The most likely mechanism of injury was a ____.
(a) slip and fall
(b) bicycle crash
(c) gunshot wound
(d) sports collision
C—gunshot wound Language disorders can occur in the acute stage of recovery following TBI due to acceleration-deceleration type injury but they rarely continue long term. On the other hand, penetrating injuries often result in focal or more circumscribed impairments. Please refer to Chapter 29.
Which of the following is least likely to be seen following hypoxic/ischemic damage?
(a) amnestic syndrome
(b) visuospatial deficits
(c) speed of processing impairment
(d) impaired attention/working memory
B—visuospatial deficits Impaired memory, processing speed, and attention are common cognitive problems following hypoxia/ischemia. Visuospatial deficits are less commonly seen. Please refer to Chapter 28.
A brain MRI performed on a 5-year-old female with a history of preterm birth is abnormal. What are the most likely findings on imaging associated with this birth history?
(a) intraventricular hemorrhage and post-hemorrhagic hydrocephalus
(b) periventricular leukomalacia and focal neuronal injury
(c) periventricular hemorrhagic infarction and periventricular leukomalacia
(d) periventricular hemorrhagic infarction and cerebral ischemic lesions
C—periventricular hemorrhage infarction and periventricular leukomalacia
These injuries are the most common neurologic complications of premature birth and result from hypoxia-ischemia and intraventricular hemorrhage, and impaired cerebral blood flow. Please refer to Chapter 17.
Which of these neurological conditions is relatively most frequently associated with frontotemporal dementia?
(a) amyotrophic lateral sclerosis
(b) multiple sclerosis
(c) multisystem atrophy
(d) primary lateral sclerosis
A—amyotrophic lateral sclerosis
FTD is known to occur in about 9% of patients with ALS and does not commonly co-occur with the other conditions listed. Please refer to Chapter 32.