Chapter 6. Approaches to intellectual and Memory Impairments

Question 1

Question 6-1:
Which of the following statements about
frontal lobe localization are true?
A. Orbitofrontal cortex is involved in
emotional states
B. Frontal cortex has extensive
connections with the limbic system
C. The frontal lobes are involved in
emotional states, appetites, and
drives
D. Frontal lobes have connections with
autonomic systems
E. All of the above

Answer 1

Answer 6-1: E.
All of these are true. All of these pertain
directly to the orbitofrontal cortex, thought to
be integrally involved in emotional states,
appetites, and drives. The close connections
with limbic and autonomic structures are
important for these functions. (P66)

Question 2

Question 6-2:
Which of the following statements are true
regarding the effects of cerebral lesions on
cognitive functioning?
A. Broca's aphasia is produced by a left
temporal lesion
B. Wernicke's aphasia is produced by a
left frontal lesion
C. Multiple lesions have a greater
cognitive impact than solitary lesions
D. Gerstmann's syndrome is produced
by a right parietal lesion
E. All are true

Answer 2

Answer 6-2: C.
Multiple lesions are more likely to be
associated with cognitive deficits than single
lesions, although single lesions can produce
significant intellectual deficit Broca’s aphasia
is due to a left frontal lesion. Wernicke’s
aphasia is due to a left temporal lesion.
Gerstmaoo’s syndrome is produced by a left
parietal lesion. (P67)

Question 3

Question 6-3:
Which of the following are typical features of
Gerstmann's syndrome?
A. Acalculia
B. Finger agnosia
C. Left-right confusion
D. Agraphia
E. All of the above

Answer 3

Answer 6-3: E.
All of these are features of Gerstmann’s
syndrome, which is due to a lesion in the left
. parietal region. This is an important parietal
cortical localizing feature. This is a clinical
syndrome rather than a specific diagnosis and
is usually due to stroke. (p67)

Question 4

Questions 6-4 and 6-5:
Folstein’s mini-mental status examination is
probably the most commonly used bedside
mental status assessment. A patient scores
perfectly on all of the components except as
noted for the following two questions. Select
the answer for the mini-vignettes.
Question 6-4:
Misses two of the serial-7 calculations and
does not know the city. What is the MMSE
score?
A. 25
B. 26
C. 27
D. 28

Answer 4

Answer 6-4: C.
Missing: two of the calculations and one aspect
of orientation results in a maximum score of
27.(p72)

Question 5

Questions 6-4 and 6-5:
Folstein’s mini-mental status examination is
probably the most commonly used bedside
mental status assessment. A patient scores
perfectly on all of the components except as
noted for the following two questions. Select
the answer for the mini-vignettes.
Question 6-5:
Misses one element on registration but then is
able to recall all three objects at five minutes.
On the three-stage command, fails to place
paper on the table but rather hands it back to
the examiner. What is the MMSE score?
A. 26
B. 27
C. 28
D. 29

Answer 5

Answer 6-5: C.
The patient loses one point for initial -
registration even though he remembers all
three subsequently. The patient also loses the
point for failing to place the paper on the
table; this is the most Common error in this
task. (P72)

Question 6

Question 6-6:
Which of the following features is
characteristic of the split-brain patients?
A. Alien hand syndrome
B. Akinetic mutism
C. Conduction aphasia
D. Left-right confusion

Answer 6

Answer 6-6: A.
The alien band syndrome refers to the
seeming independent moveDlent of the left
hand which may oppose the volitional
movements of the right hand, and is typically
seen in split-brain patients. Other important
causes include strokes involving projections
through the corpus callosum and cortical-basal
ganglionic degeneration. (P68)

Question 7

Question 6-7:
A 26-year-old man with a history of severe
head injury presents with an awake
appearance but he does not respond to the
environment. There is little movement of the
extremities. which of the following are likely
to be true?
1. The predominant lesion is in the
temporal lobes bilaterally
2. If he recovers, he is likely to have
disinhibition
3. He has the locked-in syndrome
4. He exhibits akinetic mutism
Select: A = 1,2,3. B = \,3. C = 2, 4. D = 4 only. E = All

Answer 7

Answer 6-7: C.
The patient exhibited akinetic mutism, which
typically presents with an awake appearance,
unable to respond to the environment The
most likely area of maximum damage is in the
orbitofrontal cortex. Intelligence is often at or
near nonnal although some neuropsychological tests have a tendency to be abnormal. (P67)

Question 8

Question 6-8:
Amnestic syndrome is characterized by which
of the following features?
I. Impaired recent memory
2. Impaired immediate memory
3. Preserved long-term memory
4. Impaired cognitive function
Select: A = 1,2,3. B = 1,3. C = 2, 4. D = 4 only. E = All

Answer 8

Answer 6-8: B. 242
Anmestic syndrome is due to bilateral
hippocampal damage and is profound loss of
recent or short term memory. Immediate and
long term memory are preserved as is
cognitive function. Recent memory is
impaired. (P69)

Question 9

Question 6-9:
The Wada test is perfomled before temporal
lobe surgery for epilepsy. What is the main
purpose of this procedure?
A. Identification of which side of the brain is most important for memory
B. Detemlination of whether resection of the tested brain tissue will control seizures
C. Identification of pre-existing temporal lobe damage which would predispose to the amnestic syndrome in the event of temporallobeclomy
D. All of these

Answer 9

Answer 6-9: C.
The Wada test is used prior to temporal
lobectomy to determine whether the patient is
at risk of amnestic syndrome from the surgery.
This is based on clinical and pathological
information which indicated that bilateral
hippocampal damage produces the memory
deficits typical of the amnestic syndrome. It is
also used to determine the cerebral
lateralization of language function. (p69)

Question 10

Question 6-10:
Which if the following are features of
transient global amnesia?
I. Anterograde and retrograde amnesia
2. Repeats questions
3. Is anmestic for the episode after
recovery
4. May have DWI abnormalities on
MRI during the episode.
Select: A = 1, 2.3. B.-I, 3. C = 2, 4. D = 4 only. E=AII

Answer 10

Answer 6-10: E.
All of these features are typical of transient
global amnesia. Patients have features of the
amnestic syndrome albeit transient
Anterograde and retrograde amnesia is typical.
The amnesia contracts with recovery until the
patient has a small amount of retrograde
amnesia for the time just prior to the episode,
and apparently did not learn during the
episode. MRI may show DWl abnormalities,
but frank signs of infarction are unexpected.
PET can also be abnonnal, although these
. MRI and PET findings do not indicate
ischemia as a cause, since alterationS in
function of the regions without ischemia may
produce the same cbanges. Not all patients
show these imaging abnormalities. (P71)

Question 11

Questions 6-11 through 6-13:
The following lists some structures which are
integral to memory for certain types of tasks.
For the following questions staring types of
memory, select the best answer for the brain
region integral to that type of memory.
A. Neocortex
B. Medial temporal lobe
C. Basal ganglia
D. Cerebellum
E. C&D
Question 6-11:
Memory for riding a bicycle.

Answer 11

Answer 6-11: E.
Memory for motor tasks such as riding a
bicycle is organized in the basal ganglia and
cerebellum. This type of memory is relatively
immune to temporal lobe lesions. This type of
memory is termed procedural or
nondeclarative memory. (P71)

Question 12

Questions 6-11 through 6-13:
The following lists some structures which are
integral to memory for certain types of tasks.
For the following questions staring types of
memory, select the best answer for the brain
region integral to that type of memory.
A. Neocortex
B. Medial temporal lobe
C. Basal ganglia
D. Cerebellum
E. C&D
Question 6-12:
Classical conditioning. Association of a
specific stimulus with a specific response.

Answer 12

Answer 6-12: D.
Classical conditioning is the association of a
specific stimulus with a specific response. The
conditioning involves the cerebellum, although the emotional response to reward or punishment may reside in the amygdala. (P 71 )

Question 13

Questions 6-11 through 6-13:
The following lists some structures which are
integral to memory for certain types of tasks.
For the following questions staring types of
memory, select the best answer for the brain
region integral to that type of memory.
A. Neocortex
B. Medial temporal lobe
C. Basal ganglia
D. Cerebellum
E. C&D
Question fr13:
Probabilistic classification memory - such as
predicting the weather from associated cues

Answer 13

Answer 6-13: C.
Probabilistic classification memory is
insensitive to temporal lobe damage, but is
sensitive to basal ganglia dysfunction.
Parkinson’s disease and Huntington’s disease
manifest this deficit. (P71)