Exam #4 BOOK Flashcards

Question

In diagnosing vascular dementia, motor deficits secondary to cortical infarction ____. (a) can explain the significant impairment in complex ADLs (b) suggest silent infarction as an underlying pathophysiologic process (c) suggest leukoaraiosis as an underlying pathophysiologic process (d) are to be excluded when evaluating functional impairment in ADLs

Answer 1

D—are to be excluded when evaluating functional impairment in ADLs The NINDS-AIREN diagnostic criteria require that significant impairment in daily functioning be present, but that this impairment be secondary to deficits in memory and intellectual functions and not due to physical disability secondary to stroke. Please refer to Chapter 31.

Answer 2

B—It is ethically appropriate in some cases. Although there might be more feasible options and the neuropsychologist’s recommendations may not always be appropriate, in this situation B is the best answer because deception can be ethically appropriate in some cases. Use of deception does not uniformly require approval from an ethics committee. Additionally, it is inaccurate to state that deception is “often” necessary with patients who are confused as there are other effective interventions. Notably, in neuropsychological assessment it could be argued that we often deceive patients in the context of performance validity testing when we inform or lead them to believe that a certain test measures a construct such as memory or is difficult, whereas it is in fact a very easy performance validity test that almost everyone should perform well on. However, this may not be considered deception if patients are informed at the outset, during the informed consent process, that such measures or indicators will be used during the evaluation, and they agree to the testing. Please refer to Chapter 7. General Principles and Ethical Standards: A, B, D, E; 3.04, 3.10

Answer 3

C—percentile Expression of scores in percentiles forces the data into a rectangular distribution, forcing artificially even intervals regardless of the underlying values. Use of such transformations are optimal to minimize misinterpretations of tests with non-normal distributions, but the underlying distribution of the data needs to be considered in the context of clinical interpretation (i.e., small changes in raw scores in the middle of the distribution will result in a magnified influence on the percentile ranking). Please refer to Chapter 8.

Answer 4

A—preschool Children who sustain traumatic brain injury during infancy and early childhood have worse neuropsychological and functional outcomes than those injured in later childhood or the teenage years. Please refer to Chapter 29

Answer 5

A—amygdala The central nucleus of the amygdala senses and identifies fear and anxiety-laden stimuli and initiates the emotional response. It has been shown to be strongly involved in the formation of emotional memories, especially fear-related memories. The amygdalocentric model of Posttraumatic stress disorder proposes that it is associated with hyperarousal of the amygdala and insufficient top-down control by the medial prefrontal cortex and the hippocampus, particularly during extinction, which reflects a primary association with anxiety rather than depression. Please refer to Chapter 34.

Answer 6

B—ADHD 60–95% of children with FASD qualify for a diagnosis of ADHD. Externalizing disorders are particularly common in this population. Please refer to Chapter 21.

Answer 7

C—determine the age at onset and severity of hearing loss A deaf older adult may be experiencing late onset hearing loss or may be congenitally deaf. They may use speech and residual hearing or communicate primarily through signs or writing. The approach to assessment will depend on this information. Please refer to Chapter 11.

Answer 8

B—She exhibits borderline intellectual functioning In order to meet diagnostic criteria for intellectual disability, individuals must have an IQ score of 70 or below and exhibit deficits in adaptive functioning. Based on her report of adaptive functioning, Jane best fits in the category of borderline intellectual functioning. Please refer to Chapter 13.

Answer 9

A—visuospatial Neuropsychologically, greater deficits in visuospatial functioning than in other domains may help differentiate Lewy body dementia from Alzheimer’s disease. Please refer to Chapter 33.

Answer 10

B—tuberous sclerosis Tuberous sclerosis complex (TSC) is one of the hereditary genetic syndromes associated with a predisposition for brain tumors. Central nervous system manifestations of TSC include subependymal giant cell astrocytomas. These are considered benign tumors and are commonly treated via surgical resection. Neurologic complications can occur due to intraventricular location. Please refer to Chapter 25.

Answer 11

D—gait ataxia Wernicke’s encephalopathy is an acute neuropsychiatric reaction to thiamine deficiency and is characterized by confusion, ataxia, nystagmus, and ophthalmoplegia. Please refer to Chapter 36.

Answer 12

C—ADHD-I is more heritable than ADHD-H. Although both symptom dimensions are significantly heritable, ADHD-H is less heritable than ADHD-I. The heritability of ADHD is approximately 75%; nonshared environment (as opposed to shared environment) and measurement error accounts for the rest of the variance. First-degree relatives have a 30–35% chance of having ADHD. Please refer to Chapter 16.

Answer 13

A—transcortical motor aphasia Right leg weakness, grasp reflex and executive function deficits are characteristics of damage in the distribution of the left anterior cerebral artery, which can be associated with transcortical motor aphasia. Please refer to Chapter 26.

Answer 14

D—processing speed, depression, fatigue Individuals with multiple sclerosis experience a host of symptoms that may adversely impact daily functioning. The patient referred to you complains of problems keeping up with work. Reduced processing speed is the most common cognitive problem in multiple sclerosis while language-based skills tend to be preserved in adults with multiple sclerosis. Likewise, depression is commonly associated with multiple sclerosis and literature suggests a relation between depression and cognitive functioning including speed of performance. Fatigue is one of the most common symptoms reported in individuals with multiple sclerosis. Research has shown reduced performance over time with sustained mental effort suggesting that fatigue may play a role. Please refer to Chapter 24.

Answer 15

A—Generalized Anxiety Disorder/Major Depressive Disorder Anxiety and mood disorders are commonly reported by individuals with insomnia. Please refer to Chapter 37.

Answer 16

C—specific learning disorder The BASC-3 provides clinical probability indices for ADHD, autism, and emotional behavior disorder, which can be used to inform diagnostic impressions and behavior intervention recommendations. Please refer to Chapter 10.

Answer 17

B—Essential tremor is secondary to reduced dopamine in the basal ganglia. The pathogenesis of essential tremor is mostly unexplained. There appears to be a strong genetic component, at least for familial cases. Some reports suggest that the neuropathology of essential tremor is localized in the brainstem (locus ceruleus) and cerebellum, but the presence of cerebellar pathology is controversial. Please refer to Chapter 33.

Answer 18

D—Verbal memory deficits in left TLE are more robust than visual memory deficits in right TLE. The extensive body of literature regarding memory deficits in TLE indicates that verbal memory deficits in left TLE are consistently identified using a variety of methods/verbal memory tests. Exacerbation of deficits following dominant temporal lobectomy is predictable based on presurgical memory ability. However, the presence of nonverbal memory deficits in right TLE is not as consistently observed, and, in many cases of right TLE, there are no memory deficits. This may be due to a combination of factors, including methodological differences and a lack of coherence between models of nonverbal memory and tests that are used to assess the construct. Please refer to Chapter 22.

Answer 19

B—appears to be related to the development of amyloid plaques Chromosome 21 is also involved in Down syndrome, and older individuals with Down syndrome typically develop plaques consistent with Alzheimer’s disease. Please refer to Chapter 30.

Answer 20

D—anticonvulsants The symptoms described are highly suggestive of bipolar disorder. Anticonvulsant medications are typically used to manage bipolar disorder. High-potency benzodiazepines are effective for the management of anxiety with few side effects aside from drowsiness. Selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants in anxiety disorder. Tricyclics are used occasionally, and monoamine oxidase inhibitors may be used with close monitoring. Please refer to Chapter 34.

Answer 21

C—Older bodies are less tolerant of changes and although the brain is not directly infected his overall reaction to the infection can cause delirium. With perhaps the exception of urosepsis, delirium in older patients with delirium related to UTI is more likely due to the physiologic effects and response to infection as opposed to the infection directly affecting the brain. The patient may have had underlying cognitive problems prior but this is an assumptive leap and the information provided does not support this conclusion. While certain medications and catheters can increase the risk for delirium it is unlikely that those are the primary cause of delirium in this individual who has already developed an infection. Please refer to Chapter 27.

Answer 22

C—comparably poorly on tests of verbal and nonverbal learning and memory Although discrepancies showing better verbal than nonverbal performance is apparent on some tasks, this pattern is not apparent on learning and memory tasks, possibly because of compression of the hippocampus from hydrocephalus. Please refer to Chapter 20.

Answer 23

D—spontaneous seizure with no known precipitating event or risk factor Epilepsy was previously diagnosed when there were at least two unprovoked seizures. However, the current definition indicates diagnosis with epilepsy can be made after a single seizure, if the risk of recurrence is high based on other medical factors. Spontaneous seizure with no known precipitating event is not sufficient for diagnosis with epilepsy, and may often be found to be related to transient factors (e.g., systemic medical illness, ETOH or substance use). Please refer to Chapter 22.

Answer 24

A—primarily ubiquitin-based pathology Frontotemporal dementia with motor neuron disease is characterized by ubiquitin-based pathology rather than tau pathology, involving the frontal and temporal lobes. Please refer to Chapter 32.

Answer 25

B—fragile X syndrome Fragile X syndrome is the most common single gene disorder associated with autism. It is also the leading cause of inherited intellectual disability. Please refer to Chapter 18.

Answer 26

A—lesion of the anterior thalamus affecting the internal medullary lamina A is the only alternative that involves damage to both limbic circuits or reference to the preponderance of anterior thalamic lesions as necessary for the production of

Answer 27

D—18–24 months This is currently the most reliable time at which an Autism spectrum disorder can be diagnosed and remain stable across time. Please refer to Chapter 14.

Answer 28

D—middle-aged adults Although severe TBI would be expected to result in cognitive impairments in all four groups, children, adolescents, and young adults would be expected to experience some progressive functional improvements. Middle-aged adults would be at higher risk for early-onset dementia following severe TBI and thus functional decline. Please refer to Chapter 29.

Answer 29

C—1.0 to 1.5 Although there is some variation across meta-analyses of patients with schizophrenia, there is consensus that most fluid intellectual abilities and complex cognitive functions (such as memory and executive and attentional functions, as defined by neuropsychological tests) show a deficit in the range of 1–1.5 SD relative to healthy peers. The average deficit may be slightly lower (<1.0 SD) if tests of crystallized functions are included, as these are typically less impaired. Please refer to Chapter 35.

Answer 30

A—gestational age, availability of NICU care, birth weight, and presence of neurological/medical complications Each of these factors contributes to functional outcome for the preterm infant. Please refer to Chapter 17.

Answer 31

C—lumbar puncture During a lumbar puncture, the patient is often in a lying or seated position and a needle is inserted below the spinal cord (often between L4 or L5 intervertebral space). Evoked potential tests are not invasive, EMG is a diagnostic procedure to assess the health of muscles and nerve cells, and central lines are used to administer medicine. Please refer to Chapter 6.

Answer 32

D—NMDA receptor antibodies are found in the CSF or blood All other options are false; however, the presence of NMDA antibodies in CSF or blood is diagnostic. Please refer to Chapter 23.

Answer 33

B—hypomanic states Hypomania is a condition similar to mania but less severe. The symptoms are similar, but do not cause significant distress or impair one’s work, family, or social life in an obvious way whereas manic episodes do. Obsessive-compulsive disorder symptoms/traits have been associated with a number of medical conditions, including Tourette syndrome, ADHD, Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), and other conditions. Please refer to Chapter 34.

Answer 34

C—false positive Comparison groups with actual problems are critical to control for false positive error (i.e., identifying a valid impairment as an indication of invalid performance). Please refer to Chapter 12.

Answer 35

A—low IQ as a proxy for widespread neuropathology Large-scale studies have shown that persons with low IQ tend to have seizure free outcomes from surgery less frequently than persons with higher IQ. This is believed to be due to low IQ as a proxy for more widespread pathology. Please refer to Chapter 22.

Answer 36

C—multiple system atrophy Multiple system atrophy typically involves autonomic dysfunction (urinary incontinence or orthostatic hypotension) and cerebellar syndrome early in the course of the disease. Please refer to Chapter 33.

Answer 37

B—Angelman syndrome Limited or lack of speech is characteristic of Angelman syndrome; even higher functioning individuals develop up to only twenty words and never develop conversational language. Despite this, individuals with Angelman syndrome are socially curious and seek out social interactions. Although individuals with Prader-Willi syndrome do exhibit language deficits, these are typically consistent with overall IQ. They also tend to have social difficulties suggestive of AutismIndividuals with which of the following disorders exhibit absent or limited speech, but are socially interested in others? (a) Prader-Willi syndrome (b) Angelman syndrome (c) Turner syndrome (d) 22q11.2 deletion syndrome spectrum disorders. In Turner syndrome and 22q11.2 deletion syndrome, language is a relative strength, whereas social skills are a relative weakness. Please refer to Chapter 18.

Answer 38

A—not the typical middle cerebral artery pattern Global aphasia involves the entire perisylvian region and the typical middle cerebral artery pattern commonly involves hemiparesis as well. If the primary motor cortices are not involved, then two distinct, noncontiguous lesions affecting both Broca’s and Wernicke’s areas should be suspected. Please refer to Chapter 5.

Answer 39

D—ratio of individuals the test identifies as having the disease who truly have the disease in a population that is factored by the likelihood ratio of having the disease Post-test (positive) odds is the pretest odds multiplied by the likelihood ratio of a positive test result. The post-test odds is the additional improvement in positively identifying a member of the population as having the disease using a test that includes the pre-test probability (risk) of having the disease in the The post-test odds is derived in part from the tests sensitivity and specificity and is not affected by the prevalence rate of the disease in the reference group. Please refer to Chapter 9.

Answer 40

A—in the early stages In addition, patients with Lewy body dementia sometimes present with greater impairment in attention, letter/word-list generation, and prominent visuospatial impairment (e.g., deficient visuoperceptual organization and visuoconstructional skills), as well as extrapyramidal symptoms and visual hallucinations. Please refer to Chapter 30.

Answer 41

C—No amount of alcohol use during pregnancy is considered safe. The United States Surgeon General recommends complete abstinence from alcohol during pregnancy. Please refer to Chapter 21.

Answer 42

B—may delay cognitive decline The AHA/ASA Scientific Statement on Vascular Contributions to Cognitive Impairment and Dementia provides a review of pharmacological therapy for vascular dementia and concludes that the benefits of donepezil and galantamine for delaying progression of cognitive impairment are supported by the available evidence. Neither rivastigmine nor memantine find similar support in the literature. Please refer to Chapter 31.

Answer 43

D—ordinal data Data can be nominal, ordinal, interval, or ratio in type. Only interval and ratio data are appropriate for applying parametric statistics. Both nominal and ordinal data can cross broad categories such as extremely low, very low, and below average, which do not have equal distance between intervals on the scale and do not have a beginning or end point. This makes them inappropriate for use with standard scores. Please refer to Chapter 9.

Answer 44

B—dyslexia Children math learning disabilities have higher rates of co-occurring dyslexia. Children with dyslexia also have higher rates of co-occurring ADHD and math learning disabilities. Additionally, speech-sound disorder and language difficulties have been commonly found in children with dyslexia. The DSM-5 definition of a learning disability states that learning disabilities are not better accounted for by intellectual disabilities. Please refer to Chapter 15.

Answer 45

D—combination therapy A single uncomplicated concussion would not be expected to result in long standing cognitive symptoms and thus Major Depressive Disorder is the more likely culprit in sustaining this patient’s symptoms. Although antidepressant medications, psychotherapy, and ECT have all been shown to be effective in treating mood disorders, the combination of medications and psychotherapy has consistently been shown to produce the best outcomes. Although stimulant medications are sometimes used in intractable mood disorders they are not considered to be a first line treatment . Please refer to Chapter 34.

Answer 46

A—Medication led to improvement in symptoms but with effect sizes smaller than those observed in the MTA studies. However, effect sizes were smaller than those observed in the MTA trials and there were greater side effects in the younger children including slowed growth rate. A 6-year follow-up of these children found stability of the symptoms. All of which have led prescribing physicians to promote behavioral therapy first in preschool-age children. Please refer to Chapter 16.

Answer 47

D—intellectual disabilities Meta-analysis demonstrated an increased risk for intellectual disabilities in children with neonatal hypoxia, and, to a lesser extent, Autism spectrum disorders. Please refer to Chapter 28.

Answer 48

B—reading at a 9th grade level Individuals with mild intellectual disability may acquire academic skills up to a sixth grade level. Please refer to Chapter 13.

Answer 49

A—some individuals being less vulnerable to brain insult It is unclear precisely why, though some studies indicate that individuals with higher educations, greater accomplishments, specific talents, etc., are at reduced risk of developing dementia. Please refer to Chapter 3.

Answer 50

C—50% Many follow-up studies show a 50% relapse rate among substance users whether or not they receive psychosocial intervention. Please refer to Chapter 36.

Answer 51

D—no clear evidence of effectiveness for any one class of drugs Only modest effects from low quality trials have indicated benefits of antidepressant medications, with no clear evidence of any class being more effective. Please refer to Chapter 37.

Answer 52

A—Turner syndrome Fertility problems and short stature are only associated with Turner syndrome. While individuals with Klinefelter syndrome can have fertility problems, this disorder is only seen in males. Individuals with neurofibromatosis type 1 and Williams syndrome can have difficulties with math, but do not have the other characteristics posed in the question. Please refer to Chapter 18.

Answer 53

D—memory problems The first three choices are not common late effects from chemotherapy. However, changes in memory can be apparent in select patients post-chemotherapy. Please refer to Chapter 25.

Answer 54

B—The patient is male, African American, and was born very low birth weight. Male gender, African American race, and multiple birth are associated with increased risk for cerebral palsy (CP). Very low birthweight, particularly in African American babies, increases risk for CP. Spastic diplegia is the most common form of CP associated with preterm birth. Children with CP are at increased risk of intellectual disability, although rates of intellectual disability severity have been declining. Please refer to Chapter 17.

Answer 55

C—right frontal lobe The combination of left sided weakness (implying a lesion close or deep to the frontally-located motor system and attentional disturbance implies a lesion to the frontal lobe, which participates in both motor and attentional/intentional activities. Please refer to Chapter 4.

Answer 56

D—frontal and temporal areas Frontotemporal subdural hematoma, subarachnoid hemorrhage, and focal contusions are much more common following acceleration-deceleration injuries. Please refer to Chapter 29.

Answer 57

C—VRIN-r and TRIN-r scales Given that study samples tend to be cooperative and able to respond to item content appropriately, large variations in response invalidity would not be anticipated in normative samples; low reliability (test-retest) values would not be expected. In keeping with this expectation, the MMPI-2-RF test-retest validity scale reliability scores (VRIN-r and TRIN-r in particular) are generally less than those of other scales. Please refer to Chapter 10.

Answer 58

D—subdural hematoma Rupture of bridging veins between sulci on the upper surface of the brain causes subdural hematoma. A subarachnoid hemorrhage occurs when there is a rupture in blood vessels between the arachnoid and pia. An intracerebral hemorrhage (also called intraparenchymal hemorrhage) lies within the brain parenchyma due to many potential causes. Epidural hematomas develop in the potential space between the dura and the skull. Please refer to Chapter 29.

Answer 59

B—processing speed While memory, attention, and executive function are commonly affected in multiple sclerosis, processing speed is the most common cognitive problem. Please refer to Chapter 24.

Answer 60

C—repetitive self-injurious behavior Studies examining age-related patterns of RRBs among individuals with ASD have shown that repetitive self-injurious behaviors are the least prevalent RRBs across all ages. Stereotyped motor movements are common among young children with ASD and among individuals with ASD and intellectual disability. Ritualistic and compulsive behaviors are more commonly observed in adolescence and adulthood. Restricted interests are commonly observed in childhood and adolescence

Answer 61

A—Alzheimer’s disease Several studies have also found an increased risk for Alzheimer’s disease in individuals with a history of HSV and presence of anti-HSV IgM antibodies suggestive of re-activated infection. Please refer to Chapter 23.

Answer 62

B—left visual cortex and splenium of the corpus callosum Alexia without agraphia relies on disconnecting visual input to the left parietal regions that are critical for the processes of reading. In contrast, writing is not so dependent on visual input; patients with alexia without agraphia can write but cannot read what they have written. Please refer to Chapter 26.

Answer 63

D—transcortical motor aphasia This aphasic syndrome resembles Broca’s aphasia, but because it involves the extrasylvian region, repetition is intact. Please refer to Chapter 5.

Answer 64

D—high serum anticholinergic activity Elavil (Amitriptyline) is a tricyclic antidepressant and does not have a significant impact on dopaminergic activity. Serum anticholinergic activity (SAA) at a high level is strongly associated with delirium while low levels often correspond with resolution of delirium. Please refer to Chapter 27.

Answer 65

A—mild Descriptions of Martin’s behavior and performance on intelligence testing are consistent with a diagnosis of mild intellectual disability. Please refer to Chapter 13.

Answer 66

B—The MMSE de-emphasizes working memory and executive functions and may lack sensitivity to subcortical-frontal dysfunction The MMSE de-emphasizes working memory and executive functions, and therefore may lack sensitivity to subcortical-frontal dysfunction. Both the MMSE and the MoCA are commonly used by physicians. Scoring below cut-off is clinically significant, but “within normal limits” may not reflect true neurocognitive status. Please refer to Chapter 6.

Answer 67

A—frequent crying spells and despondency Children typically present with somatic or behavioral changes more so than stereotypical complaints of sadness and despondency. Older children and adolescents tend to sulk, develop behavioral problems at school, become more negative and irritable, and feel misunderstood or unappreciated. Please refer to Chapter 34.

Answer 68

C—Sensitivity will be increased and specificity will be decreased. Moving the cut-off closer to the mean will identify more children as having ADHD, including some who indeed have the condition (leading to higher sensitivity) but also some who do not (leading to lower specificity). Please refer to Chapter 9.

Answer 69

A—malingering by proxy The base rate of noncredible performance in children being seen for Social Security disability evaluations has been found to be quite high (40+%). Failure is most often driven by the caregivers in cases of “malingering by proxy.” Both malingering and factitious disorder involve an attempt at deceiving others. In cases of malingering, the motivation is deemed to be related to an external incentive such as that seen in this situation. In cases of factitious behavior, the motivation is deemed to be related to internal psychological factors such as adopting a “sick role” for attention-seeking purposes. Please refer to Chapter 12.

Answer 70

C—There is a higher rate of epilepsy in children with CP overall, and this includes the hemiplegic subtype. Learning disabilities also occur at a higher rate. Most walk before the age of 3 years and develop functional language. Please refer to Chapter 19.

Answer 71

D—middle cerebral artery stroke Hypoxic-ischemic injury and periventricular leukomalacia are associated with dyskinetic and spastic diplegic CP, respectively. Please refer to Chapter 19.

Answer 72

A—average IQ with dysarthria but otherwise normal language; weaknesses in attention and visuospatial skills Individuals with CP demonstrate a full spectrum of IQ. Apart from the motor aspects of speech, language skills are near normal or normal in many individuals withmild to moderate CP. The most robust neuropsychological finding in CP is visuospatial impairment. Attentional weakness is another common finding. Please refer to Chapter 19.

Answer 73

C—19 There is a reported 29% lifetime risk of developing Alzheimer’s disease in patients with the apolipoprotein E-ε4 allele, relative to 9% in patients without this allele. Please refer to Chapter 30.

Answer 74

B—80–85% General consensus from a large number of twin studies of schizophrenia place estimates of heritability for the disorder at 80–85%. Please refer to Chapter 35.

Answer 75

C—processing speed In a multiple deficit model framework, there can be both unique and shared cognitive predictors of ADHD, dyslexia and math disability. Shared cognitive predictors can account for some or all of the comorbidity seen at the phenotypic level. Recent evidence shows that processing speed is a shared cognitive predictor of reading and attention, and that its inclusion in a latent trait model accounts for the entire phenotypic correlation between the two domains. Please refer to Chapter 16.

Answer 76

D—at a later age because the symptoms are not reported until later despite presenting with more impairment It is believed that this is the case because those working in the medical systems in Greece and Turkey are not sufficiently informed about FTD symptomatology. Please refer to Chapter 32.

Answer 77

D—at a later age because the symptoms are not reported until later despite presenting with more impairment It is believed that this is the case because those working in the medical systems in Greece and Turkey are not sufficiently informed about FTD symptomatology. Please refer to Chapter 32.

Answer 78

A—potentiating GABA-ergic transmission Benzodiazepines exert their sedative and antianxiety properties by enhancing GABA receptor binding. Please refer to Chapter 4.

Answer 79

C—occur with a higher frequency than in typically developing children About one third of children with spina bifida and hydrocephalus meet rating scale cut-offs for inattention. Please refer to Chapter 20.

Answer 80

D—postural instability The Movement Disorder Society Clinical Diagnostic Criteria for Parkinson’s disease revised the criteria for Parkinsonism in 2015 to have only three cardinal motor manifestations, bradykinesia, in combination with either rest tremor, rigidity, or both. These features cannot be attributed to other factors. Postural instability can be seen in Parkinson’s disease, but typically later in the disease, whereas it is often an early symptom in the Richardson syndrome subtype of progressive supranuclear palsy, contributing to falls. The Parkinson subtype of progressive supranuclear palsy can involve asymmetric rest tremor and rigidity. Please refer to Chapter 33.

Answer 81

B—hippocampus is not an essential component of the system for naming Historically there have been varying degrees of cognitive change on naming and memory tasks following temporal lobectomy. However, many have been confounded with surgical technique, outcome-related factors, and baseline performance. In a study of patients undergoing selective laser ablation compared with patients undergoing open craniotomy, Drane and colleagues found that there was no change to improved performance on measures of naming and recognition in patients undergoing laser, while patients undergoing open craniotomy showed significant declines. Seizure outcome, baseline performance, and presence or absence of hippocampal sclerosis were not associated with the outcomes. The authors concluded that the absence of change indicated that other networks that are disrupted by traditional surgery but not laser ablation are responsible for the declines. Please refer to Chapter 22.

Answer 82

D—retrograde Retrograde amnesia is for memories of events prior to the illness or injury. Anterograde amnesia is for new memories. Global amnesia is acute-onset memory loss that typically lasts for less than 10 hours (but can last days) and results in profound anterograde amnesia and variable retrograde amnesia. Psychogenic amnesia is often triggered by a traumatic event and involves retrograde amnesia which can include personal identity and/or be limited to autobiographical memory. Please refer to Chapter 5.

Answer 83

B—greater cognitive impairments than girls Average IQ scores for boys with fragile X syndrome are in the mid-40s, whereas IQ scores for girls range from mild intellectual disability to the average range. Boys do not show improvement in cognitive skills over time. Although boys’ scores on IQ measures may decline over time, this typically is due to lack of expected progress rather than regression or loss of skills. Please refer to Chapter 18.

Answer 84

B—greater cognitive impairments than girls Average IQ scores for boys with fragile X syndrome are in the mid-40s, whereas IQ scores for girls range from mild intellectual disability to the average range. Boys do not show improvement in cognitive skills over time. Although boys’ scores on IQ measures may decline over time, this typically is due to lack of expected progress rather than regression or loss of skills. Please refer to Chapter 18.

Answer 85

B—hepatic dysfunction Vitamin B12 deficiency, diabetes mellitus and ApoE ε4 genotype are all known to be associated with increased risk for VCI. However, hepatic dysfunction has not been shown to be such a risk factor. Gorelick and colleagues (2011) provide a comprehensive review of risk factors for VCI, as does Iadecola (2013). Please refer to Chapter 31.

Answer 86

A—work with a reading specialist and 50% additional time on tests Given that this is a first-time diagnosis and assuming the problems are not severe, these would be the best recommendations. Recommendations should always include intervention and not just accommodations, so that the student can improve her skills. Vision therapy and Irlen lenses have been shown to not be effective. Individual testing and additional breaks are more appropriate accommodations for students with attentional disorders. Please refer to Chapter 15.

Answer 87

C—attention/concentration skills Attention problems are among the most commonly reported of all cognitive symptoms, particularly in individuals with functional somatic syndromes. Please refer to Chapter 37.

Answer 88

B—formication hallucinations These are also sometimes referred to as tactile hallucinations and can occur during drug withdrawal, usually in alcohol and cocaine withdrawal. Typically patients complain of bugs crawling on or under the skin. Please refer to Chapter 27.

Answer 89

D—laceration of the middle meningeal artery Epidural hematomas develop in the potential space between the dura and the skull typically due to rupture of the meningeal artery following fracture of the temporal bone. Please refer to Chapter 29.

Answer 90

C—37 weeks gestation and birth weight below 5 pounds, 8 ounces Please refer to Chapter 17.

Answer 91

A—executive functions Several studies have documented weaknesses in attention and executive functions in children and adults with encephalitis. The other domains have not been consistently documented as problematic. Please refer to Chapter 23.

Answer 92

D—ApoE ε4 is a known risk for Alzheimer’s disease ApoE ε4 is the primary known genetic risk factor for the development of Alzheimer’s disease, as carriers of one ApoE ε4 allele have an increased risk versus the general population, and those with two copies of the ε4 allele are at greatest risk. Please refer to Chapter 30.

Answer 93

B—greater white matter than gray matter hypoplasia Compared with controls, white matter volumes in individuals with severe prenatal exposure were more affected than gray matter volumes in the cerebrum, and parietal lobes were more affected than temporal and occipital lobes. Please refer to Chapter 21.

Answer 94

D—loose associations Disorganized speech is not a negative symptom of schizophrenia, it is part of the disorganization syndrome. All other choices represent negative symptoms. Please refer to Chapter 35.

Answer 95

C—arterial ischemic Arterial ischemic stroke accounts for about 85% of all ischemic strokes in children. Ischemic and hemorrhagic stroke are about equally common, but arterial ischemic stroke accounts for the vast majority of ischemic stroke in children. Traumatic and non-traumatic etiologies of hemorrhage are more equally divided. Please refer to Chapter 26.

Answer 96

C—hippocampus and entorhinal cortex in the earliest stages, and temporal, frontal, and parietal association areas as the disease progresses Disease progression follows a temporal-to-frontal spread, but eventually involves multiple brain systems, with the primary sensory cortices and aspects of subcortical structures relatively unaffected until quite late in the disease process. Please refer to Chapter 30.

Answer 97

B—higher dose radiation and neurologic complications Treatment with higher dose craniospinal and larger boost volume radiation therapy are at increased risk of neurocognitive decline. Neurological complications (posterior fossa mutism, hydrocephalus) also increase this risk. Please refer to Chapter 25.

Answer 98

C—intellectual functioning Hold tests are not typically affected, but overall scores may be reduced due to impairments in processing speed and efficiency. Please refer to Chapter 28.

Answer 99

D—often shows marked improvement with treatment Please refer to Chapter 16.

Answer 100

B—an ordinal scale and describing test performance categorically Tests with a skewed distribution are not appropriate for evaluation using parametric statistics such as standard scores. Tests with skewed distributions violate the central limit theorem. Such tests can be clinically useful in describing if a deficit is present or grossly how atypical or concerning a performance is, but the degree of precision that can be ascribed to a performance is limited to a category rather than a more precise percentile or standard score. Please refer to Chapter 9.

Answer 101

C—ADHD occurs more often with comorbid conditions than without. Childhood ADHD without comorbidities is the exception rather than the rule. Please refer to Chapter 13.

Answer 102

A—anosodiaphoria Patients with Broca’s aphasia, multiple sclerosis, and Huntington’s disease all frequently exhibit depression, while those with anosodiaphoria (or la belle indifference) are unconcerned regarding their impairments. Please refer to Chapter 5.

Answer 103

B—magnetic resonance imaging Magnetic resonance imaging uses high field magnetization and radiowave pulses. Computed tomography, SPECT, and PET all use ionizing radiation in the form of radioactively tagged binding agents. Please refer to Chapter 6.

Answer 104

A—slowly developing subdural hematoma In this case the clinician would want a CT scan of the brain to rule out the possibility of a right-sided chronic subdural hematoma. This occurs more frequently in the elderly population following TBI secondary to stretching of bridging veins, which are often a consequence of atrophy, but older veins are also more prone to shearing effects or rupture. Another less likely possibility would be recent or remote right hemisphere stroke and CT scan would most likely identify this as well. Answer c is not a viable option as a remote lacunar infarction would have a low probability of resulting in this type of profile. Please refer to Chapter 29.