Exam 1

Question 1

A right-handed patient sustains a PCA infarct that results in damage to the left posterior white matter and the splenium of the corpus callosum, with relative gray matter sparing.

What following symptom cluster is most likely to occur

Answer 1

Alexia without agraphia (a.k.a. posterior alexia or associative alexia)

Question 2

Evidence of which form of validity is most needed for a job screening test?

Answer 2

Predictive validity

Question 3

PTA, or Post Traumatic Amnesia, refers to

Answer 3

A period of time following a TBI in which new memories cannot be consistently formed.

Question 3

Anomic aphasia is typically caused by damage to the following area of the left hemisphere?

Answer 3

Angular Gyrus

Question 4

An individual with which type of dementia is most likely to show retrieval rather than retention deficits:

Answer 4

Parkinson’s Disease

Question 5

The primary visual area lies along the ______.

Answer 5

Calcarine fissure

Question 6

The criterion validity of a test is limited by :

Answer 6

The test’s standard deviation

Question 7

Functional neuroimaging (PET, fMRI) in patients with schizophrenia has shown

Answer 7

hypofrontality

Hypofrontality is a significant dysfunction in the activation of the prefrontal cortex, and is associated with deficits in working memory, attention, action planning, and sleep

Question 8

When trying to teach something to a patient with severe memory impairment, you prevent the patient from guessing or making mistakes during the learning phase. This is an example of:

Answer 8

Errorless Learning

Question 9

Frontal memory disorders are characterized by

Answer 9

Confabulation
Limited memory for temporal order of events
Attentional deficits interfere with encoding

they keep autobiographical memory

Question 10

Broca’s aphasia is commonly accompanied by

Answer 10

Right hemiplegia

Question 11

Dysarthria, dysphagia and hypoactive jaw and gag reflexes without associated cognitive or emotional changes is known as:
a) Pseudobulbar palsy
b) Bulbar palsy
c) Suprabulbar palsy
d) Meniere’s Disease

Answer 11

Bulbar palsy

Question 12

differentiating depression from dementia (Alzheimer’s/AD)

Answer 12

Persons with depression may exert less effort on the performance of neuropsychological tests

Cognitive deficits in depression tend to be less severe and extensive than in AD. AD patients show more consistent impairment on memory tests than depressed patients. Persons with depression are less likely than those with AD to show impaired naming ability, verbal fluency, and visuospatial ability. Depressed patient are more likely to appear to exert less effort, and may complain more about their cognitive difficulties.

Question 13

Which brain region is most often affected by hydrocephalus

Answer 13

Posterior regions

when hydrocephalus occurs, the ventricles expand in a posterior to anterior direction and white matter is damaged. Due to these factors, the posterior regions of the brain may be particularly susceptible. This may partially explain the PIQ < VIQ findings… interestingly, children who show proportionally greater thinning of the posterior brain regions relative to anterior tend to show the PIQ < VIQ pattern. When the thinning is comparable, so too are the IQ scores.

Question 14

A lesion of Brodman’s area 44 in the dominant hemisphere is most closely associated with ____

Answer 14

Dysfluent aphasia
Broca’s area

Question 15

What pattern of IQ performance is typically observed in children with early-onset hydrocephalus

Answer 15

VIQ > PIQ

This finding is somewhat controversial. On average, this is true, but there is substantial variability between cases with shunted hydrocephalus.

Question 16

Contralateral superior quadranopia
is caused by legions on the lesions in the ___________.

Answer 16

Lesions of the temporal lobe
Lesions of the temporal lobe can cause contralateral superior quadranopia due to interruption of the lower portions of the optic radiations. This is sometimes referred to as the “pie in the sky” phenomenon

Question 17

Gait difficulties, urinary incontinence, and cognitive decline are highly indicative of which condition

Answer 17

Normal pressure hydrocephalus

Question 18

Which disorder has been most closely linked to degeneration of acetylcholine-synthesizing neurons in the basal forebrain

Answer 18

Alzheimer’s Disease

Although Alzheimer’s is more than a simple degeneration of the nucleus basalis of Meynert, this is a key site of degeneration and likely accounts for the prominent early memory decline. The other disorders may also involve the nucleus basalis of Meynert and/or cholinergic systems at one point or another, but less directly or centrally

Question 19

Cerebellar pathways affect all but one of the following

a) Motor learning
b) Balance
c) Higher-order cognitive processes
d) Anosmia
e) Respiratory movements

Answer 19

anosmia

The cerebellum is involved in both a variety of motor and cognitive processes. Anosmia is a deficit of olfaction, where the sense of smell the is diminished or lost . It is also known as olfactory loss and can occur to single or to both nostrils.

Question 20

Lateral cerebellar lesions primarily affect:

Answer 20

Motor planning

The lateral cerebellar hemisphere affects distal limb coordination and motor planning. Trunk control, posture and balance, and gait result from medial cerebellar lesions.

Question 21

Which of the following statements is true?

a) The left hemisphere has more association cortex than the right hemisphere.
b) The left hemisphere has more gray matter/less white matter relative to the right hemisphere.
c) The two hemispheres have equal amounts of gray and white matter.
d) The right hemisphere has fewer interconnections than the left hemisphere.

Answer 21

The right hemisphere has more white matter, less gray matter, more association cortex, and more interconnections

Question 22

what is Astereognosis?
What is Associative Agnosia?

Answer 22

can’t identify an item by touch

visual agnosia where you can’t recognize the meaning of a stimulus presented

Question 23

Autopsy studies of dementia pugilistica (CTE) typically reveal _____

Answer 23

Prominent neurofibrillary tangles
Astrocyte proliferation
Neuronal loss

Question 24

characteristics of normal aging

Answer 24

Decreased verbal fluency
Decreased working memory skills
Somewhat poorer initial learning but intact delayed recall of what they learned

Remote memory = intact

Question 25

Neglect can occur with lesions in all of the following areas except

a) Right internal capsule
b) Right frontal lobe
c) Right thalamus or basal ganglia
d) Right midbrain

Answer 25

a) Right internal capsule

Question 26

The structure involved in the “master clock” for circadian rhythms is the_____

Answer 26

Suprachiasmatic nucleus

each of a pair of small nuclei in the hypothalamus of the brain, above the optic chiasma, thought to be concerned with the regulation of physiological circadian rhythms.

Question 27

What are the:

Arcuate nucleus
Median eminence
Dentate gyrus

Answer 27

The arcuate nucleus of hypothalamus (ARH) consists of neuroendocrine neurons and centrally-projecting neurons. The ARH is the center where the homeostasis of nutrition/metabolism and reproduction are maintained. As such, dysfunction of the ARH can lead to disorders of nutrition/metabolism and reproduction

The median eminence is the structure at the base of the hypothalamus where hypothalamic-releasing and –inhibiting hormones converge onto the portal capillary system that vascularizes the anterior pituitary gland.

The dentate gyrus is an integral region of the hippocampal formation. It is responsible for the formation of our episodic memory as well as the exploration of new environments. It is, therefore, part of the system that gives us autobiographical and episodic memories.

Question 28

A test designed as a general screening for brain impairment should have….

a) High specificity
b) High sensitivity
c) Face validity
d) Low sensitivity but high specificity

Answer 28

High sensitivity

Sensitivity refers to a test’s ability to designate an individual with disease as positive. A highly sensitive test means that there are few false negative results, and thus fewer cases of disease are missed

Question 29

Infarction of the inferior portion of the pons or medulla can cause:

Answer 29

Locked in syndrome

Eyes and Eyelids can move only.

The most common cause is a vascular complication in the form of a hemorrhagic or ischemic stroke.

Locked-in syndrome is caused by any lesion affecting the ventral pons, and midbrain; this includes vascular lesions, masses, infections, traumas, and demyelinating disorder

Question 30

What is:

“Man in barrel” syndrome

“Pie in sky” visual defect

Answer 30

Man in a barrel syndrome is a neurological syndrome involving bilateral upper extremity weakness with preserved facial and lower extremity strength. This syndrome can result from injury to the bilateral cerebral hemispheres, the cervical spinal cord, or bilateral brachial plexuses

Superior Homonymous Quadrantanopia: This visual defect is often referred to as pie in the sky. This visual defect happens when the inferior optic radiating fibers (Meyer’s loop) are damaged in the temporal lobe of the brain. Strokes involving the middle cerebral artery (MCA) can result in this presentation. Lesions to the temporal lobe produce other neurologic manifestations including aphasia, memory deficits (if dominant hemisphere), seizures, and auditory and visual hallucinations.

Question 31

________ is the neurotransmitter primarily found in neurons of the raphe nuclei.

Answer 31

Serotonin

Question 32

Where is Dopamine produced?

Answer 32

Dopamine is a neurotransmitter that is produced in the substantia nigra, ventral tegmental area, and hypothalamus of the brain.

Question 33

Where is ACH produced?

Answer 33

Acetylcholine originates from two major places in the brain:
1) basal forebrain – from basal nucleus of Meynert (works on M1 receptors in neocortex) & medial spetal nucleus.
2) the mesopontine tegmentum area.

Question 34

Where is GABA produced?

Answer 34

GABA is synthesized in the cytoplasm of the presynaptic neuron from the precursor glutamate by the enzyme glutamate decarboxylase, an enzyme which uses vitamin B6 (pyridoxine) as a cofactor. After synthesis, it is loaded into synaptic vesicles by the vesicular inhibitory amino acid transporter

Question 35

Where is glutamate produced?

Answer 35

Glutamate is recycled and made by glial cells in your brain. Glial cells convert “used” glutamate to glutamine, which is converted back again into glutamate when delivered back to the terminal area of nerve cells

Question 36

phonological Alexia (give an example)

a) Reads “ought” for “thought”
b) Reads “think” for “thought”
c) Reads “hot” for “thought”
d) Reads “though” for “thought”

Answer 36

Phonological alexia and agraphia are acquired disorders characterized by an impaired ability to convert graphemes to phonemes. This is a reading disorder.

reads “though” for “thought”
reading “fling” for FLIG

This is due to an impaired non-lexical reading route, but relatively preserved lexical reading route.

Symptoms: problems sounding out words esp. unfamliar words, problems spelling based on sounds heard, labored reading aloud with hesitations/errors, trouble rhyming, impaired pseudo word reading

Question 37

Analysis of motion and spatial relationships between objects and between the body and visual stimuli is most likely to occur in the ________________.

Answer 37

Parietal-occipital association cortex

The parietal-temporal-occipital (PTO) association area, also referred to as the temporo-parieto-occipital (TPO) junction, is an area within the cerebral cortex where the parietal, temporal and occipital lobes meet. High level of interpreting meaningful signals in the surrounding sensory area.

Question 38

myelination
(motor or sensory is myelinated first?)

Answer 38

sensory areas of the brain are myelinated before motor areas

This myelin sheath allows electrical impulses to transmit quickly and efficiently along the nerve cells. If myelin is damaged, these impulses slow down

In humans, the motor roots begin to myelinate in the fifth fetal month, and the brain is almost completely myelinated by the end of the second year of life. It is generally true that pathways in the nervous system become myelinated before they become completely functional.

Question 39

lesions of the dominant inferior parietal lobe, centering on the angular gyrus

Answer 39

The angular gyrus syndrome is a constellation of neuropsychological deficits in patients with damage to the dominant angular gyrus and surrounding regions.

Symptoms: transcortical sensory aphasia, alexia with agraphia, impaired visuoconstruction, hemisensory loss, contralateral homonymous visual field deficit, and components of Gerstmann’s syndrome.

Gerstmann’s syndrome includes acalculia, agraphia, difficulty in distinguishing left from right, and finger agnosia.

Question 40

The pattern of “dementia with psychomotor slowing” occurs in all except which of the following disorders?

a) HIV-related dementia
b) Progressive supranuclear palsy
c) Huntington’s disease
d) Alzheimer’s dementia

Answer 40

Alzheimer’s dementia

Question 41

The type of memory deficit most apparent in patients with alcoholic Korsakoff amnesia is a deficit in

Answer 41

Initial encoding of new material

Korsakoff syndrome (also known as Korsakoff’s amnesic syndrome) is a memory disorder that results from vitamin B1 deficiency and is associated with alcoholism. Korsakoff’s syndrome damages nerve cells and supporting cells in the brain and spinal cord, as well as the part of the brain involved with memory

Question 42

A right MCA stroke in the distribution of the inferior division would most likely cause

Answer 42

Left hemineglect, decreased voluntary movements, and relatively normal left-sided strength

MCA strokes typically present with the symptoms individuals associate most commonly with strokes, such as unilateral weakness and/or numbness, facial droop, and speech deficits ranging from mild dysarthria and mild aphasia to global aphasia.

Question 43

What is the most likely cause for transient global amnesia?

Answer 43

Basilar artery TIA

Transient global amnesia is an episode of confusion that comes on suddenly in a person who is otherwise alert. This confused state isn’t caused by a more common neurological condition, such as epilepsy or stroke.

Most commonly, patients experiencing basilar artery occlusion exhibit acute neurologic signs including motor deficits, hemiparesis or quadriparesis, and facial palsies, dizziness, headache, and speech abnormalities–especially dysarthria and difficulty articulating words.

The condition most often affects people in middle or older age. With transient global amnesia, you do remember who you are, and you recognize the people you know well. Episodes of transient global amnesia always get better slowly over a few hours. During recovery, you may begin to remember events and circumstances. Transient global amnesia isn’t serious, but it can still be frightening.

Question 44

Alexia without agraphia is most likely due to damage to what region(s)?

Answer 44

Infarction of left posterior artery territory (occipital) and the splenium (posterior part) of the corpus callosum.

Alexia w/o agraphia is “pure word blindness” or pure alexia- inability to read.

Question 45

Research has shown that right-sided brain damage can lead to subtle language deficits in…

Answer 45

Prosody
Articulation
Use of abstract constructs

not Grammatical rules and structure

Question 46

Research has shown that individuals with mild cognitive impairment will develop dementia at a rate of….

Answer 46

10-15% per year, at a greater prevalence than the general population

Question 47

Which of the following is true about Lewy Body Dementia?

a) It presents with Parkinsonian motor symptoms but the cognitive functioning more similarly looks like Alzheimer’s dementia.
b) It is a variant of Parkinson Dementia in which Lewy Bodies are present in the substantia nigra.
c) Patients are responsive to l-dopa like Parkinson’s dementia, but are insensitive to DA blocking agents.
d) Auditory hallucinations are frequently present

Answer 47

It presents with Parkinsonian motor symptoms but the cognitive functioning more similarly looks like Alzheimer’s dementia

Protein deposits called Lewy bodies develop in nerve cells in the brain. The protein deposits affect brain regions involved in thinking, memory and movement.

Question 48

Which statement is false?

a) Rolandic epilepsy occurs nocturnally and is usually in remission by age 15
b) Landau-Kleffner syndrome is characterized by an acquired aphasia, and seizures are most commonly generalized motor seizures.
c) Febrile seizures occur in 2-4% of all children, and most go on to develop temporal lobe epilepsy.
d) Lennox-Gastaut is a mixed seizure disorder in which the seizures are difficult to control, and status epilepticus is common

Answer 48

(c)

Most kids outgrow febrile seizures by age 5 or 6.

Kids with benign rolandic epilepsy have seizures that involve twitching, numbness, or tingling of the face or tongue. They typically happen in the early morning or just before bedtime. They also can happen during sleep. Kids almost always stop having these seizures by the time they reach their teen years

Question 49

Difficulty recalling events prior to amnesia onset is called ________________, while difficulty recalling previously learned information because new information interfered with it is called __________________

Answer 49

Retrograde amnesia; retroactive interference

Question 50

Which of the following would not be expected from frontal lobe damage

a) Acute eye deviation with persistent neglect
b) Contralateral hemiplegia
c) Anosmia
d) Acalculia

Answer 50

Acalculia- damage particularly on the left side of the parietal lobe

Contralateral hemiplegia is the result of brain damage where the paralyzed side of the body is the opposite side from where the brain damage occurred.

Patients with anosmia presented a significant decrease of GM volume mainly in the nucleus accumbens with adjacent subcallosal gyrus, in the medial prefrontal cortex (MPC) including the middle and anterior cingulate cortices, and in the dorsolateral prefrontal cortex (dlPFC).

Question 51

Which of the following is most consistent with a mild traumatic brain injury?

a) Galveston Orientation and Amnesia Test (GOAT) score of 15
b) Glascow Coma Scale (GCS) score of 8
c) Post-Traumatic Amnesia (PTA) of 12 hours
d) Loss of consciousness of 2 hour

Answer 51

Post-Traumatic Amnesia (PTA) of 12 hours

Ranges for the GOAT: Score of ≥ 75 for two consecutive days, no longer in the post-traumatic amnesia phase. Score between 66 and 75 for two consecutive days, borderline status. Score < 66, the patient for two consecutive days, patient still in the post-traumatic amnesia phase

The highest possible GCS score is 15, and the lowest is 3. A score of 15 means you’re fully awake, responsive and have no problems with thinking ability or memory. Generally, having a score of 8 or fewer means you’re in a coma

PTA may last for a few minutes, hours, days, weeks or even, in rare cases, months. Certain types of medication have been used to try to improve the condition, with varying degrees of success

A further category of very severe injury is defined by a period of unconsciousness of 48 hours or more, or a period of PTA of 7 days or more. The longer the length of coma and PTA, the poorer will be the outcome

Question 52

Anosodiaphoria
vs
Anosognosia

Answer 52

Anosognosia: no insight; unaware of the condition,

Anosodiaphoria: insight about symptoms, lacks concern. The pt fails to appreciate the significance of the brain lesion deficit.
*Often from lesion in right frontal lobe; impaired emotional processing.
*May be seen in frontal stroke or FTD.

Question 53

Simultangnosia
Cortical blindness
Apperceptive Visual Agnosia
Phonagnosia
Auditory affective agnosia
Verbal auditory agnosia
Environmetnal Sound Agnosia
Amusia

Answer 53

Simultagnosia is the lack of ability to perceive more than a single object at a time. For example, when provided with a picture of a spoon and fork in different parts of visual space, they can attend to only 1 item at a time; worse when items are at different depths

Cortical blindness (CB) is defined as loss of vision without any ophthalmological causes and with normal pupillary light reflexes due to bilateral lesions of the striate cortex in the occipital lobes.

Apperceptive visual agnosia refers to an abnormality in visual perception and discriminative process, despite the absence of elementary visual deficits. These people are unable to recognize objects, draw, or copy a figure. They cannot perceive correct forms of the object, although knowledge of the object is intact

Phonagnosia: a dissociation between familiar and unfamiliar voices.

Auditory Affective Agnosia: impaired comprehension of emotional tone in speech. Linked to right temporal-parietal lesions.

Verbal auditory agnosia, also known as “word deafness,” is when you can’t comprehend words spoken aloud. You can still read and write them, and you have no problem speaking words yourself.

Nonverbal auditory agnosia is when speech comprehension is intact, but you can’t recognize human non-speech sounds.

Environmental Sound Agnosia: Cannot comprehend non-speech non-human sounds

Amusia: Cannot comprehend music sounds

Question 54

What % of pediatric tumors are in posterior fossa versus supratentorial

Answer 54

70% posterior fossa
30% supratentorial

Question 55

Pesticide and toxic exposures typically cause what symptoms
a) mental slowing, mood
b) visual-spatial issues
c) agraphia, alexia
d) peripheral neuropathy, optic ataxia

Answer 55

a) mental slowing, anxiety/depression

Question 56

Chemotherapies: Do they cross BBB?
Do they cause mental status changes?

Answer 56

Most chemos do not cross BBB and therefore do not change mental status.

Exception = methotrexate if it’s administered into spinal canal (aka intrathecally).

Toxic effects of MTX: cortical thinning, reduced neuron density; “chemo brain”

Question 57

Side effects of cranial radiotherapy

Answer 57

Effects can be latent
Radiation necrosis

Question 58

“Pie in the Sky” [homonymous superior quadrantanopsia] can be caused by what type of lesion/damage

Answer 58

stroke – MCA or PCA, must effect the lower branches of the optic tracts, lower branches of the myers loop.
tumor
aneurysm
demyelinating disease
temporal lobectomy/surgery
radiation necrosis
trauma
advanced degenerative disease affecting temporal lobe