Exam #4 BOOK Flashcards
Accelerated cognitive decline in older adults with schizophrenia is ____.
(a) due to Parkinson’s disease
(b) a variant of Lewy body dementia
(c) present in a subgroup of patients, but no single cause has yet been identified
(d) probably early-onset Alzheimer’s disease
C—present in a subgroup of patients, but no single cause has yet been identified There have been suggestions that rapid cognitive decline in older adults with schizophrenia may be due to some unique pathological process but so far, the evidence is equivocal. It is clear that people with schizophrenia have many causes of increased morbidity and mortality, among which are multiple preventable medic
An example of equipotentiality might be ____.
(a) persons with Korsakoff amnesia retaining motor-skill learning
(b) patients with aphasia learning to speak again
(c) double dissociation of language and visual processing
(d) late onset of dementia in highly educated people
B—patients with aphasia learning to speak again Although still somewhat unclear, major theories of aphasia recovery suggest that (1) homologous brain regions from the contralateral hemisphere are thought to assume the functional duties of the damaged brain regions, and/or (2) that adjacent, undamaged cerebral regions are employed to assume functional duties . Please refer to Chapter 3.
You have been intimately involved with the healthcare of a child who experienced significant complications following the development of bacterial meningitis. Her family is extremely grateful for your care, and they bring you a $10 gift certificate to a local restaurant and a thank you card. What should you do?
(a) Accept the gift graciously.
(b) Refuse the gift even if they insist.
(c) Share the gift with the treatment team.
(d) Accept the gift but report it to the hospital.
A—Accept the gift graciously. Small gifts from patients of limited value are ethically acceptable. Refusing such gifts or signs of gratitude would be potentially harmful to the doctor-patient relationship. However, gifts should never be tied to specific expectations such as the completion of a favorable report or disability forms. There is no reporting or disclosure requirement for small gifts of nominal value. The psychologist would also need to be aware of their hospital’s policy regarding gifts as well since these can vary between institutions. Please refer to Chapter 7. General Principles and Ethical Standards: B, C, E; 6.04, 6.05
This type of multiple sclerosis profile involves a continual worsening of baseline functions from the onset, with minor fluctuations but no distinct relapses.
(a) relapsing-remitting
(b) secondary-progressive
(c) primary-progressive
(d) progressive-relapsing
C—primary-progressive The primary-progressive form of the disease is associated with a slow progressive decline in neurologic functioning with no clear relapses. Please refer to Chapter 24.
Which of the following neuropsychological domains has been proposed as an underlying deficit that may explain Autism spectrum disorder symptomatology?
(a) poor visual discrimination
(b) impaired sustained attention
(c) sensory hyper- and hypo-reactivity
(d) deficient executive functioning
D—deficient executive functioning The executive dysfunction theory proposes that deficits in social communication and restricted and repetitive behaviors observed in Autism spectrum disorder are evident because of deficits in cognitive flexibility, planning, self-monitoring, inhibition of ongoing behaviors, and initiation of new behavior. Please refer to Chapter 14.
Which of the following neuropsychological domains has been proposed as an underlying deficit that may explain Autism spectrum disorder symptomatology?
(a) poor visual discrimination
(b) impaired sustained attention
(c) sensory hyper- and hypo-reactivity
(d) deficient executive functioning
D—deficient executive functioning The executive dysfunction theory proposes that deficits in social communication and restricted and repetitive behaviors observed in Autism spectrum disorder are evident because of deficits in cognitive flexibility, planning, self-monitoring, inhibition of ongoing behaviors, and initiation of new behavior. Please refer to Chapter 14.
Two individuals are administered the same test, of which the data are normally distributed. Person 1 scores in the 48th percentile; Person 2 scores in the 93rd percentile. It is later found that there was an error in scoring of the test on these two administrations only, and 3 points are then added to each person’s score. Given this information, which of the following is true?
(a) Both percentile ranks will increase by the same amount.
(b) Person 1’s percentile rank will increase more than Person 2’s.
(c) Person 2’s percentile rank will increase more than Person 1’s.
(d) Neither percentile rank will change.
B—Person 1’s percentile rank will increase more than Person 2’s. These two individuals’ scores will both change in reference to the normative group because of this addition. However, because of the assumption of a normal distribution, score differences in the middle of the distribution of percentiles are exaggerated compared to those at the extremes. Thus, changing a raw score by 3 points will have a larger influence on the percentile ranking close to the middle of the distribution. Please refer to Chapter 8.
Depression and anxiety in persons with epilepsy are ____.
(a) not consistently reported due to poor insight
(b) typically not severe enough to warrant treatment
(c) more common than in other chronic illnesses
(d) not as common as in other chronic illnesses
C—more common than in other chronic illnesses Higher rates of depression and anxiety are consistently reported among persons with epilepsy. When compared with other chronic illnesses, including those having a high incidence of childhood onset (e.g., diabetes), patients with epilepsy have a higher rate of depression. Severe depression, including suicidality, is not uncommon, and treatment of depression is a key component of maintaining quality of life. Please refer to Chapter 22.
Individuals using MDMA at raves or dance clubs are at high risk for ____.
(a) dehydration
(b) hypothermia
(c) hallucinations
(d) intention tremor
A—dehydration Dehydration often occurs with MDMA use at dance clubs or raves because users engage in long periods of dancing without adequate water intake. Please refer to Chapter 36.
Which of the following is most commonly comorbid with Tourette syndrome?
(a) ADHD
(b) Bipolar Disorder
(c) eating disorder
(d) Oppositional Defiant Disorder
A—ADHD ADHD, learning disabilities, obsessive-compulsive disorder, depression, generalized anxiety, panic attacks, sleep disorders, and migraines are comorbid conditions that can be seen in Tourette syndrome. While rage attacks can also be seen, and a diagnosis of intermittent explosive disorder is possible, this is different than an oppositional defiant disorder. Please refer to Chapter 33.
Patients with Alzheimer’s disease exhibit impairment most profoundly in this type of memory.
(a) source memory
(b) procedural memory
(c) long-term memory
(d) episodic memory
D—episodic memory Knowledge of temporal events and declarative memory is severely impaired in individuals with Alzheimer’s disease. Please refer to Chapter 5.
The pattern of stronger verbal than spatial skills in early hydrocephalus is ____.
(a) primarily apparent in spina bifida myelomeningocele and aqueductal stenosis
(b) an anomaly related to the motor demands of the Wechsler performance scales
(c) seen across all levels of economic disadvantage and ethnicity in spina bifida
(d) a correlate of very low birth weight and associated perinatal anoxia
A—primarily apparent in spina bifida myelomeningocele and aqueductal stenosis Fine motor impairment may contribute to the pattern but impairment is also noted on visuospatial tasks without significant motor demands or time bonuses. Please refer to Chapter 20.
The American Heart Association guidelines and current clinical practice for using tissue plasminogen activator (tPA) in adults after stroke include evidence of deficits, ____.
(a) brain hemorrhage on CT, and symptom duration of 3 to 4.5 hours or less
(b) no brain hemorrhage on CT, and symptom duration of 3 to 4.5 hours or less
(c) brain hemorrhage on CT, and symptom duration of 3 hours or less
(d) no brain hemorrhage on CT, and symptom duration of 3 hours or less
B—no brain hemorrhage on CT, and symptom duration of 3 to 4.5 hours or less Because TPA is a powerful thrombolysis agent American Heart Association guidelines require that all three criteria are met. Please refer to Chapter 26.
What can be said with regard to cognitive restitution/restorative training methods following traumatic brain injury?
(a) They outperform compensatory strategy training in all phases following injury.
(b) They have lasting benefits primarily in the recovery of simple attention skills.
(c) They have limited empirical support at any phase and typically do not generalize.
(d) They are typically only efficacious in addressing prospective memory skills.
C—They have limited empirical support at any phase and typically do not generalize. Cognitive restitution training methods have limited empirical support, especially as the time since injury increases. Please refer to Chapter 29.
Patients with Alzheimer’s disease are more likely to produce what type of errors on confrontation naming?
(a) semantic
(b) echolalic
(c) phonemic
(d) perseverative
A—semantic In addition, patients with Alzheimer’s disease are less likely to benefit from semantic cues. Please refer to Chapter 30.
A 10-year-old girl is involved in a car accident in which her mother and brother are badly injured, but she is not. Shortly afterward on the scene she becomes tachycardic, short of breath, and can’t stop shaking. Which neurotransmitter is most likely involved?
(a) serotonin
(b) GABA
(c) norepinephrine
(d) dopamine
C—norepinephrine The symptoms described are consistent with a “fight or flight” response. Norepinephrine is an excitatory neurotransmitter and also a stress hormone that helps maintain alertness and preparation to respond to external threats. Please refer to Chapter 34.
Inaccuracies in unilateral cerebellar coordination are referred to as ____.
(a) dysreflexia
(b) dystonia
(c) dysgraphestheia
(d) dysmetria
D—dysmetria Dysmetria refers to inaccurate unilateral fine motor coordination and is considered to be a sign of cerebellar dysfunction. The other three conditions are typically either cerebral or spinal in nature. Please refer to Chapter 6.
A 17-year-old male presents to the clinic due to depressed mood. His parents report he no longer hangs out with his friends and his grades are slipping. He reports to you that he sometimes hears his name being called but no one is there, and he has begun to ascribe significance to certain numbers that he feels have followed him around most of his life. Which stage is this presentation most consistent.
(a) premorbid
(b) prodromal
(c) acute
(d) paranoid
B—prodromal This patient’s profile is most consistent with the prodromal phase, which is marked by an increasing tendency toward social withdrawal, declines in role functioning, and brief, intermittent or subthreshold psychotic symptoms, including perceptual disturbances and odd, unusual, or suspicious thinking, that occurs with increasing frequency and conviction. Please refer to Chapter 35.
Which patient is most likely to demonstrate pronounced cognitive deficits after treatment for childhood acute lymphoblastic leukemia?
(a) male treated in adolescence with chemotherapy only
(b) male treated in middle childhood with radiation and chemotherapy
(c) female treated in early childhood with chemotherapy and radiation
(d) male treated in early childhood with chemotherapy only
C—female treated in early childhood with chemotherapy and radiation Younger age at treatment, female gender, and radiation therapy have been identified as factors associated with more severe neuropsychological impairment after treatment for childhood leukemia. Please refer to Chapter 25.
Among the following, which combination of preexisting issues would suggest a more significant risk for postoperative delirium?
(a) executive dysfunction and depression
(b) learning disability and anxiety
(c) low average IQ and depression
(d) dysnomia and anxiety
A—executive dysfunction and depression Although learning disability, low average IQ, and dysnomia might suggest reduced cognitive reserve, studies suggest that executive dysfunction poses a higher risk of postoperative delirium. Depression has been identified as an independent risk factor as well, but anxiety disorders have not been associated with substantially increased risk. Please refer to Chapter 27.
Lesions to the basal forebrain produce amnesia because ____.
(a) cholinergic inputs to the hippocampus and amygdala are disrupted
(b) pathways of the medial and lateral limbic circuits may be spared
(c) the basal forebrain contains dopaminergic neurons involved in memory retrieval
(d) the basal forebrain is a key site of memory storage
A—cholinergic inputs to the hippocampus and amygdala are disrupted The basal forebrain provides cholinergic innervations of the hippocampus and amygdala systems; thus, a lesion here can disrupt both circuits. Answer b cannot be correct, since large, structural lesions of the basal forebrain can involve connections of both the lateral and medial limbic circuits. Neither c nor d is correct because there is no evidence that the basal forebrain plays a specific role in retrieval or storage of memory representations. Please refer to Chapter 4.
Which of the following neurodevelopmental disorders is most associated with a high rate of comorbid developmental mathematics disability?
(a) Autism spectrum disorder
(b) Tourette syndrome
(c) spina bifida
(d) ADHD
C—spina bifida Mathematics disabilities are common among individuals with spina bifida and congenital hydrocephalus, and occur in more than half of the affected individuals. In contrast, math skills are often a relative strength in children with Autism spectrum disorders; children with Tourette syndrome typically do not manifest learning disabilities; and only approximately 40% of children with ADHD manifest learning disabilities. Please refer to Chapter 15.
Abrupt onset and step-wise progression of cognitive deficits ____.
(a) have not been consistently demonstrated in vascular dementia
(b) are more commonly associated with subcortical forms of vascular dementia
(c) correlate with progression of leukoaraiosis
(d) characterize vascular dementia of mixed pathology
A—have not been consistently demonstrated in vascular dementia Decades ago, it was thought that stepwise progression was a hallmark characteristic of vascular dementia. Research since then has demonstrated that this is not the case. The presence of stepwise progression has also not been linked conclusively to any particular type of pathology. Please refer to Chapter 31.
Which of the following is not true of anti-NMDA receptor encephalitis?
(a) Adult women are more likely to have an associated ovarian teratoma.
(b) Children may show hyperactivity, irritability, and temper tantrums early in disease course.
(c) Females are more affected by anti-NMDA receptor encephalitis.
(d) Low intellectual abilities are seen in children, but adult IQs fall in the average range.
D—Low intellectual abilities are seen in children, but adult IQs fall in the average range. As a group, both children and adults with histories of anti-NMDA receptor encephalitis have average general intellectual abilities despite deficits seen in several domains including memory, attention, and aspects of executive functioning (i.e., organization, planning, and impulse control). Please refer to Chapter 23.
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
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.
A 65-year-old woman developed delirium secondary to sepsis and experienced an extremely complicated hospital course. Physicians have now deemed that she is medically stable and ready for transition to a subacute facility. However, when she is told about the plan for discharge and transition she becomes extremely belligerent, confused, combative, and insistent that she should be allowed to go home. This behavior results in a staff member getting hit by the patient and delay in her transfer. In an effort to curb this behavior and avoid safety issues for the patient and staff, the neuropsychologist advises the team not to provide information regarding the pending transfer. What can be said regarding deception in situations like this?
(a) It is unethical in most similar situations.
(b) It is ethically appropriate in some cases.
(c) It is only acceptable if approved by the ethics committee.
(d) It is often necessary with patients who are confused.
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
Which of the following transformations results in even intervals of the normative data?
(a) logarithmic
(b) z distribution
(c) percentile
(d) T distribution
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.
Brain injury during which of the following school years confers the most risk for a poor outcome?
(a) preschool
(b) elementary school
(c) middle school
(d) high school
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
A 28-year-old veteran presents with complaints of flashbacks, nightmares, and a heightened startle response. Which neuroanatomical area is likely to be directly involved in the maintenance of these symptoms?
(a) amygdala
(b) prefrontal cortex
(c) anterior cingulate
(d) basal ganglia
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.
You are evaluating a child with fetal alcohol spectrum disorder. When selecting your test battery, including behavioral questionnaires, which of the following DSM-5 diagnoses should be highest on your list of diagnostic considerations?
(a) Autism spectrum disorder
(b) ADHD
(c) Depressive Disorder, not otherwise specified
(d) Generalized Anxiety Disorder
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.
You have agreed to evaluate a 65-year-old woman who is also deaf. In order to ensure an accurate evaluation, you must ____.
(a) provide an American Sign Language interpreter
(b) use test materials with a reading level at or below the fourth grade
(c) determine the age at onset and severity of hearing loss
(d) make sure that you speak slowly and she can see your mouth
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.
Jane is an adult who recently earned a standard score of 70 on an individually administered intelligence test, a score that was consistent with previous measures of intellectual functioning as a child. Jane reported that she completed a local community college program as a certified nursing assistant and worked full time while living on her own. She stated that she completed all of her own activities of daily living such as driving, cooking, cleaning, caring for her hygiene, and managing her finances. She reported having a strong and supportive network of friends. Which statement best describes Jane’s level of functioning?
(a) She meets criteria for mild intellectual disability.
(b) She exhibits borderline intellectual functioning.
(c) Her intellectual functioning is likely in the low average range.
(d) No diagnosis can be determined because of the absence of an observer report.
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.
Which of the following cognitive domains may be more impaired early on in patients with Lewy body dementia versus Alzheimer’s disease?
(a) visuospatial
(b) memory
(c) language
(d) processing speed
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.
Which of the following disorders is associated with an increased risk of brain tumors?
(a) fragile X syndrome
(b) tuberous sclerosis
(c) Prader-Willi syndrome
(d) Sturge-Weber
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.
Wernicke’s encephalopathy is comprised by a triad of clinical symptoms including global confusion, abnormal eye movements, and ____.
(a) dysarthria
(b) vitamin D deficiency
(c) fatigue
(d) gait ataxia
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.
Family and twin studies of ADHD have been used to assess the degree to which variability in the disorder and its underlying latent traits are under genetic control. Which of the following statements is most true?
(a) The heritability of ADHD symptoms is approximately 25%.
(b) Shared environmental influence accounts for 25% of the variance.
(c) ADHD-I is more heritable than ADHD-H.
(d) A sibling of a child with ADHD has a 75% chance of having ADHD.
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.
A 74-year-old right-handed man with right leg weakness, grasp reflex, and executive function deficits should be further examined for possible ____.
(a) transcortical motor aphasia
(b) transcortical sensory aphasia
(c) fluent aphasia
(d) global aphasia
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.
A 41-year-old male with a history of multiple sclerosis has been referred to you for an evaluation. He reports that he is having problems keeping up with work demands in his job as an administrative assistant. Which of the following areas would be most important to assess based on the referral concern and what you know about outcomes associated with multiple sclerosis?
(a) processing speed, verbal IQ, inhibition
(b) working memory, fatigue, reading
(c) word generation, processing speed, depression
(d) processing speed, depression, fatigue
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.
When compared to normal controls, individuals with insomnia are 2 times more likely to have or develop ____, while they are ten times more likely to have or develop ____.
(a) Generalized Anxiety Disorder; Major Depressive Disorder
(b) a personality disorder; Major Depressive Disorder
(c) Major Depressive Disorder; schizophrenia
(d) a specific learning disorder; Generalized Anxiety Disorder
A—Generalized Anxiety Disorder/Major Depressive Disorder Anxiety and mood disorders are commonly reported by individuals with insomnia. Please refer to Chapter 37.
When conducting a neuropsychological evaluation on a 12-year-old child, the parent- and teacher-report measures from the BASC-3 can be used to examine the clinical probability indices for all of the following, except ____.
(a) ADHD
(b) Autism spectrum disorder
(c) specific learning disorder
(d) emotional behavior disorder
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.
Which of the following is an accurate statement regarding essential tremor?
(a) Essential tremor is an uncommon adult onset movement disorder.
(b) Essential tremor is secondary to reduced dopamine in the basal ganglia.
(c) There is no known genetic component to essential tremor.
(d) This type of tremor is typically postural and kinetic.
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.
Which of the following statements is most accurate regarding memory deficits in persons with epilepsy?
(a) Memory deficits in frontal and temporal lobe epilepsy (TLE) are the same.
(b) Memory deficits in TLE do not lateralize to the side of seizure onset.
(c) In TLE, verbal memory impairments are only present in left-side seizure onset.
(d) Verbal memory deficits in left TLE are more robust than visual memory deficits in right TLE.
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.
Chromosome 21 ____.
(a) has been marginally implicated in Alzheimer’s disease
(b) appears to be related to the development of amyloid plaques
(c) appears to be related to the development of neurofibrillary tangles
(d) has been ruled out as related to Alzheimer’s disease
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.
A 19-year-old man is in his second year of college when he becomes hyperverbal, can’t sleep, and reports boundless energy. On interview he reports “I’m at the top of my game” and is going to soon earn a large government grant based on his ideas regarding a ground-breaking new theory in physics. Assuming a likely psychiatric or neurologic illness whichconsidered in the treatment of these symptoms?
(a) benzodiazepines
(b) selective serotonin reuptake inhibitors
(c) monoamine oxidase inhibitors
(d) anticonvulsants
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.
You have been consulted to see an 82-year-old man on the intensive care unit due to persistent mixed level delirium with significant behavioral and personality changes. His wife asks, “My husband was perfectly healthy 2 weeks ago. Now the doctor says that he has a urinary tract infection that is making him crazy. I’ve had lots of UTIs and never acted like this. The infection is in his bladder not his brain. Does this make any sense to you?” How might you try to explain this?
(a) In older people the blood-brain barrier is more permeable and infections get in more easily thus resulting in delirium.
(b) While the UTI may not be the primary cause of the delirium, the antibiotics and catheter being used are probably affecting mental status.
(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.
(d) He probably had a dementia prior to developing the infection and this has now unmasked the underlying condition.
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.
On memory tests, children with congenital hydrocephalus typically perform ____.
(a) more poorly on tests of verbal than nonverbal learning and retrieval
(b) more poorly on tests of nonverbal than verbal learning and retrieval
(c) comparably poorly on tests of verbal and nonverbal learning and memory
(d) within normal limits on tests of verbal and nonverbal learning and retrieval
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.
A seizure is a discrete event that may or may not lead to diagnosis with epilepsy. According to the International League Against Epilepsy definition and classification system, which of the following would not lead to a diagnosis with epilepsy?
(a) two unprovoked seizures, at least 24 hours apart
(b) a single seizure when risk of a second is known to be elevated (>60%)
(c) diagnosis with an epilepsy syndrome
(d) spontaneous seizure with no known precipitating event or risk factor
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.
Frontotemporal dementia with motor neuron disease is characterized by ____.
(a) primarily ubiquitin-based pathology
(b) primarily tau pathology
(c) both tau pathology and ubiquitin-based pathology
(d) neither tau pathology nor ubiquitin-based pathology
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.
Which is the most common single gene disorder associated with Autism spectrum disorder?
(a) Prader-Willi syndrome
(b) fragile X syndrome
(c) Williams syndrome
(d) tuberous sclerosis
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.
A patient has a discrete, small lesion and develops full-blown amnesia. Which of the following lesions is most likely responsible?
(a) lesion of the anterior thalamus affecting the internal medullary lamina
(b) lesion of the anterior thalamic nucleus sparing the internal medullary lamina
(c) lesion affecting the left hippocampus
(d) lesion of the amygdala affecting the
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
What is the earliest age at which the diagnosis of Autism spectrum disorder tends to be reliable and stable across time?
(a) 48–60 months
(b) 0–6 months
(c) 36–48 months
(d) 18–24 months
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.
The risk for decline in previously mastered daily living skills 5 years post severe traumatic brain injury is greatest in which of the following groups?
(a) young children
(b) adolescents
(c) young adults
(d) middle-aged adults
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.
For individuals with schizophrenia the severity of cognitive impairments is estimated to range from ____ standard deviation units relative to demographically matched control groups.
(a) 0.0 to 0.5
(b) 0.5 to 1.0
(c) 1.0 to 1.5
(d) 1.5 to 2.0
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.
A mother and father present to your office for an intake appointment regarding their teenage son who has a history of premature birth. Which of the following factors are most essential when evaluating the potential impact of the birth history on functional outcome?
(a) gestational age, availability of NICU care, birth weight, and presence of neurological/medical complications
(b) prenatal steroid administration, birth weight, grades III or IV intraventricular hemorrhage, and inpatient developmental assessment results (e.g., Bayley or Mullen scores)
(c) gestational age, length of NICU stay, maternal age, and presence of neurological/medical complications
(d) gestational age, birth weight, inpatient ultrasound results, and postnatal steroid administration
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.
During the clinical interview, your new patient who recovered from bacterial meningitis describes undergoing a procedure where she was in a seated position while the doctors inserted a needle below her spinal cord to remove fluid. You suspect that the patient underwent a/an ____ during her hospitalization, and plan to request the records associated with this procedure.
(a) evoked potential (EP)
(b) electromyogram (EMG)
(c) lumbar puncture
(d) central line insertion
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.
Which of the following is true about diagnostic findings typically seen in young adult females recently diagnosed with anti-NMDA receptor encephalitis?
(a) the brain MRI is abnormal in most cases
(b) EEGs are normal in nearly all cases
(c) a teratoma in the ovaries is identified in a majority of cases
(d) NMDA receptor antibodies are found in the CSF or blood
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.
Obsessive-compulsive disorder symptoms have been associated with all of the following except ____.
(a) Tourette syndrome
(b) hypomanic states
(c) ADHD
(d) PANDAS
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.
In creating PVTs and SVTs, both simulation and criterion groups designs utilize a comparison group with bona fide neurologic problems. This is because developers are focused on controlling for ____ error.
(a) true positive
(b) true negative
(c) false positive
(d) false negative
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.
The association of IQ and seizure outcome following epilepsy surgery is believed to be attributable to ____.
(a) low IQ as a proxy for widespread neuropathology
(b) low IQ leading to poor treatment compliance
(c) VIQ-PIQ discrepancy lateralizing to side of surgery
(d) low IQ associated with antiepileptic drug side effects
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.
Presence of orthostatic hypotension in addition to gait ataxia as presenting symptoms would be most consistent with ____.
(a) corticobasal syndrome
(b) progressive supranuclear palsy
(c) multiple system atrophy
(d) Parkinson’s disease
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.
Individuals 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
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.
After a stroke, a patient presents with a global aphasia, with severe deficits in both expressive and receptive language functions, but does not have a motor deficit. The lesion is ____.
(a) not the typical middle cerebral artery pattern
(b) not the typical posterior cerebral artery pattern
(c) the typical middle cerebral artery pattern
(d) the typical anterior cerebral artery pattern
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.
The post-test odds of a diagnostic test is the ____.
(a) proportion of individuals at risk for the disease in the population sample at a certain time
(b) proportion of individuals the test identifies as having the disease at a certain time
(c) proportion of individuals the test identifies as having the disease who truly have the disease factored by the likelihood ratio of those who do not have the disease
(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
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.
Many believe that ____, Alzheimer’s disease can be clinically differentiated from Lewy body dementia.
(a) in the early stages
(b) in all stages
(c) in the middle to late stages
(d) in the late stages
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.
You are conducting a neuropsychological evaluation with a teenager who has a history of executive deficits and behavioral dysregulation. During your clinical interview, the mother shares that she drank red wine twice per week throughout the pregnancy because she read online that red wine was good for heart and brain health. Based on the literature and current standards, how would you conceptualize the risk associated with this specific amount of alcohol use during pregnancy?
(a) One to two drinks per week at any point during pregnancy is considered safe.
(b) One to two drinks during the third trimester only is considered safe.
(c) No amount of alcohol use during pregnancy is considered safe.
(d) Red wine specifically is considered safe to drink during pregnancy.
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.
In vascular dementia, donepezil and galantamine ____.
(a) are ineffective as a treatment modality
(b) may delay cognitive decline
(c) are most effective when memory deficits are present
(d) significantly increase risk of major stroke
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.
Parametric statistics rely on the assumed validity of the central limit theorem, which states that the attribute being assessed is normally distributed in the population and/or normative sample such that the distribution approximates a normal curve. Which type of data violates this assumption?
(a) continuous variables
(b) interval data
(c) ratio data
(d) ordinal data
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.
Which of the following is a frequent co-occurring condition in children with math learning disabilities?
(a) intellectual disability
(b) dyslexia
(c) language difficulties
(d) Autism spectrum disorder
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.
You evaluate a 33-year-old woman who sustained a concussion 6 months ago. She complains of persistent impairments in memory and concentration. She also meets diagnostic criteria for Major Depressive Disorder. Which of the following would you most likely recommend?
(a) SSRI or SNRI medications
(b) psychotherapy
(c) stimulant medications
(d) combination therapy
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.
The Preschool ADHD Treatment Study (PATS) was a large multi-site, double-blind, crossover, placebo-controlled clinical trial, evaluating the effect of methylphenidate in preschoolers with ADHD. Which of the following statements best describes the results from this study?
(a) Medication led to improvement in symptoms but with effect sizes smaller than those observed in the MTA studies.
(b) Medication side effects were less common than those observed in the MTA studies.
(c) Early medication treatment led to a significant decline in symptoms later in childhood.
(d) Behavioral therapy was less effective in children in this age range than the older children in the MTA studies.
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.
According to meta-analyses, there is an increased risk of ____ in children with neonatal hypoxia.
(a) motor dysfunction
(b) dyslexia
(c) constructional apraxia
(d) intellectual disabilities
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.
Individuals with mild intellectual disability are likely to accomplish all but which of the following?
(a) driving independently
(b) reading at a ninth-grade level
(c) making small purchases
(d) holding a job
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.
Cognitive reserve refers to ____.
(a) some individuals being less vulnerable to brain insult
(b) late-onset dementia without family history of it
(c) early onset dementia without family history of it
(d) full scale IQ in the high-average range
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.
Twelve-month outpatient treatment follow-up studies reveal the substance abuse relapse rate to be about ______.
(a) 85% (b) 70% (c) 50% (d) 30%
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.
Treatment of patients with medically unexplained symptoms with antidepressants has shown ____.
(a) tricyclic antidepressants to be the most effective
(b) serotonin selective reuptake inhibitors to be the most effective
(c) monoamine oxidase inhibitors to be the most effective
(d) no clear evidence of effectiveness for any one class of drugs
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.
A 29-year-old woman presents in your office. You note that she has short stature. During the interview, she reports that she struggled in school and particularly had difficulty with math classes. She further reports significant stress and anxiety related to fertility problems she is currently experiencing. You suspect she may have which disorder?
(a) Turner syndrome
(b) Klinefelter syndrome
(c) neurofibromatosis type 1
(d) Williams syndrome
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.
Which may be apparent as a late effect status-post treatment of breast cancer with chemotherapy?
(a) hypothyroidism
(b) headaches
(c) visuospatial impairments
(d) memory problems
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.
A 10-year-old patient with a diagnosis of cerebral palsy is referred for testing. Given what is known about risk factors associated with cerebral palsy, which of the following is most likely true regarding the patient?
(a) The patient is female, African American, and presents with intellectual disability.
(b) The patient is male, African American, and was born very low birth weight.
(c) The patient is female, Latin/x, and presents with spastic diplegia.
(d) The patient is male, and presents with ataxic cerebral palsy and intellectual disability.
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.
A patient presents with left sided weakness and an inability to deploy attention to the left side of space. The patient likely has a lesion of the ____.
(a) left frontal lobe
(b) left parietal lobe
(c) right frontal lobe
(d) right temporal lobe
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.
Following acceleration-deceleration traumatic brain injury, neuroimaging is most likely to reveal lesions in ____.
(a) temporal and parietal areas
(b) frontal and subcortical areas
(c) temporal and subcortical areas
(d) frontal and temporal areas
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.
A neuropsychologist, who agrees to evaluate a 25-year-old, Caucasian woman, administers the MMPI-2-RF as a component of the evaluation. The patient completed the MMPI-2-RF in the context of a psychological assessment approximately 3 weeks before. The clinician interprets the second MMPI-2-RF profile with the knowledge that, relative to most other scales, test-retest reliabilities are generally lower for the ____.
(a) higher-order (H-O) scales
(b) restructured clinical (RC) scales
(c) VRIN-r and TRIN-r scales
(d) Personality Psychopathology Five (PSY-5) scales
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.
Rupture of bridging veins between sulci on the upper surface of the brain causes ____.
(a) subarachnoid hemorrhage
(b) intracerebral hemorrhage
(c) epidural hematoma
(d) subdural hematoma
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.
In adults with multiple sclerosis, deficits are most commonly seen in the area of ____.
(a) memory
(b) processing speed
(c) attention
(d) executive function
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.
Which type of restricted and repetitive behavior (RRB) is least prevalent among individuals with Autism spectrum disorder (ASD) at all ages?
(a) stereotyped motor movements
(b) compulsive behavior
(c) repetitive self-injurious behavior
(d) restricted interests
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
Individuals with latent herpes simplex virus (HSV) infection are at increased risk for ____ later in life.
(a) Alzheimer’s disease (b) stroke (c) Lewy body disease (d) frontotemporal dementia
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.
Alexia without agraphia is associated with damage to the ____.
(a) right visual cortex and splenium of the corpus callosum (
b) left visual cortex and splenium of the corpus callosum
(c) left parietal region and body of the corpus callosum (
d) right parietal region and body of the corpus callosum
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.
A 63-year-old right-handed woman with hypertension was talking on the phone when suddenly she had difficulty getting words out and could not answer simple questions. She was taken to the hospital, and on exam was alert and oriented to person and time, but not place. Speech was sparse, halting, and labored. She was able to follow 3-step commands, and repeated words and sentences with 100% accuracy. Reading was not assessed. Writing was sparse and telegraphic. Naming was 1 of 6. What kind of aphasic syndrome is likely present in this patient?
(a) Broca’s aphasia
(b) Wernicke’s aphasia
(c) transcortical sensory aphasia
(d) transcortical motor aphasia
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.
On the rehabilitation unit your patient was recently started on Elavil to improve sleep and address nighttime headaches. Over the next 3 days, he develops increasing confusion, nighttime visual hallucinations, and gastrointestinal symptoms. Assuming that this is related to the recent change in medication, what might you expect the medical work up to show?
(a) high serum dopaminergic activity
(b) low serum dopaminergic activity
(c) low serum anticholinergic activity
(d) high serum anticholinergic activity
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.
Martin is a 6-year-old child with Down syndrome. He is social and has friends his age. He earned a standard score of 68 on a measure of one word receptive language skills and an overall score of 65 on an intelligence test. He can say the alphabet and count to 10. His parents provide him with more supervision than is typical for others his age. He participates in regular education programming with a paraprofessional aid. He is most likely to be diagnosed with intellectual disability that is ____ in severity.
(a) mild
(b) moderate
(c) severe
(d) profound
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.
You will be conducting a neuropsychological assessment on a patient with Parkinson’s disease, and receive medical records from the patient’s referring physician. The physician administered the Folstein Mini Mental Status Examination (MMSE) as part of his examination with this patient. Which of the following is critical in interpreting the results of the MMSE for this patient?
(a) The MMSE should not have been selected over other screens such as the Montreal Cognitive Assessment (MoCA).
(b) The MMSE de-emphasizes working memory and executive functions and may lack sensitivity to subcortical-frontal dysfunction.
(c) Mental status screens may disproportionately emphasize language function, and therefore exaggerate pathology in Parkinson’s disease.
(d) The cut scores used on mental status screens such as the MMSE are precise and typically reflect true neurocognitive status for most disorders.
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.
Which of the following is less commonly seen in young children with depression?
(a) frequent crying spells and despondency
(b) nightmares related to separation from loved ones
(c) somatic complaints such as nausea, vomiting, or headaches
(d) worry that a parent or family member may die
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.
A pediatric neuropsychologist is concerned that a particular test for ADHD may be missing too many children with the condition when the conventional cut-off point is used. The neuropsychologist therefore changes the cut-off from 1.5 standard deviations below the mean to 1 standard deviation below the mean. What will happen as a result?
(a) Sensitivity will be increased and specificity will be increased. (b) Sensitivity will be decreased and specificity will be increased. (c) Sensitivity will be increased and specificity will be decreased. (d) Sensitivity will be decreased and specificity will be decreased
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.
.
You are conducting an evaluation of an 11-year-old to help determine eligibility for Social Security disability benefits. The child earns a full scale IQ of 82. The child earns below chance scores on multiple performance validity tests. Which of the following is apt to be the most appropriate diagnosis?
(a) malingering by proxy
(b) Munchausen by proxy
(c) pediatric condition falsification
(d) factitious disorder
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.
An 18-month-old boy with a normal birth history has been newly diagnosed with hemiplegic cerebral palsy (CP). Which prognostic statement is true?
(a) Although most children with hemiplegic CP learn to walk, this milestone is usually achieved after age 2.
(b) Some children with hemiplegic CP develop functional language but they are in the minority.
(c) There is a higher rate of epilepsy in children with CP overall, and this includes the hemiplegic subtype.
(d) Although there is a higher rate of learning disabilities in children with CP overall, this is not true of the hemiplegic subtype.
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.
In the case described in Question 93, what is an MRI most likely to show?
(a) hypoxic-ischemic injury
(b) focal internal capsule lesion
(c) periventricular leukomalacia
(d) middle cerebral artery stroke
An 18-month-old boy with a normal birth history has been newly diagnosed with hemiplegic cerebral palsy (CP). Which prognostic statement is true?
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.
A neuropsychological assessment administered when the child described in Question 93 enters elementary school is most likely to yield which set of findings?
(a) average IQ with dysarthria but otherwise normal language; weaknesses in attention and visuospatial skills
(b) average IQ with dysarthria and impaired receptive and expressive language; normal attention and visuospatial skills
(c) borderline IQ with mildly impaired receptive and expressive language, attention, and visuospatial skills
(d) borderline IQ with mildly impaired expressive language and normal attention and visuospatial skills
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.
The ApoE ε4 allele is carried on chromosome ____.
(a) 21
(b) 20
(c) 19
(d) 18
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.
According to most estimates, schizophrenia is approximately ____ heritable.
(a) 50%
(b) 80–85%
(c) 0.5–2%
(d) 30%
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.
In recent cognitive modeling of the association between reading and attention skills, which of the following cognitive predictors accounts for the overlap between the two phenotypic domains?
(a) inhibition
(b) working memory
(c) processing speed
(d) vocabulary
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.
In comparison to patients in the United States with frontotemporal dementia, patients in Greece and Turkey are diagnosed with FTD _____.
(a) at an earlier age because the symptoms occur earlier and are more severe
(b) at an earlier age because the symptoms occur earlier despite presenting with less impairment
(c) at a later age because the symptoms are not reported until later and the level of impairment is less
(d) at a later age because the symptoms are not reported until later despite presenting with more impairment
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.
In comparison to patients in the United States with frontotemporal dementia, patients in Greece and Turkey are diagnosed with FTD _____.
(a) at an earlier age because the symptoms occur earlier and are more severe
(b) at an earlier age because the symptoms occur earlier despite presenting with less impairment
(c) at a later age because the symptoms are not reported until later and the level of impairment is less
(d) at a later age because the symptoms are not reported until later despite presenting with more impairment
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.
Benzodiazepines can affect memory and psychomotor speed by ____.
(a) potentiating GABA-ergic transmission
(b) their strong anticholinergic, sedating effect
(c) potentiating a strong β-adrenergic blockade
(d) stimulating a glutamatergic cascade resulting in cell death
A—potentiating GABA-ergic transmission Benzodiazepines exert their sedative and antianxiety properties by enhancing GABA receptor binding. Please refer to Chapter 4.
Attention problems in people with congenital hydrocephalus ____.
(a) reflect problems with cognitive control and self-regulation
(b) should be identified because of the robust response to stimulant medication
(c) occur with a higher frequency than in typically developing children
(d) are best diagnosed with cognitive tests without heavy motor demands
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.
Which of the following is more commonly seen early in progressive supranuclear palsy than in Parkinson’s disease?
(a) bilateral rest tremor
(b) limb rigidity
(c) autonomic dysfunction
(d) postural instability
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.
New, minimally invasive surgery techniques for temporal lobe epilepsy include laser thermal ablation. Early studies show better language and memory outcome with this procedure compared with other temporal lobe surgical techniques. Which of the following is most likely associated with improved outcome following selective laser amygdala-hippocampal ablation?
(a) better seizure control with laser ablation compared with standard surgery
(b) hippocampus is not an essential component of the system for naming
(c) presence of hippocampal sclerosis prior to surgery
(d) good baseline performance on measures of naming and recognition
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.
The inability to recall events prior to an accident, illness or event is ____ amnesia.
(a) global
(b) psychogenic
(c) anterograde
(d) retrograde
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.
Boys with fragile X syndrome demonstrate ____.
(a) fewer cognitive impairments than girls
(b) greater cognitive impairments than girls
(c) regression in skills over time
(d) improvement in skills over time
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.
Boys with fragile X syndrome demonstrate ____.
(a) fewer cognitive impairments than girls
(b) greater cognitive impairments than girls
(c) regression in skills over time
(d) improvement in skills over time
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.
Which of the following has not been associated with vascular cognitive impairment (VCI)?
(a) vitamin B12 deficiency
(b) hepatic dysfunction
(c) diabetes mellitus
(d) ApoE ε4 genotype
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.
You have evaluated an 18-year-old college freshman who has never been diagnosed with a learning disability and has never had formal academic support. However, review of her history, academic records, and standardized test scores is consistent with a reading disability. Which of the following would be the most appropriate recommendations for this student?
(a) work with a reading specialist and 50% additional time on tests
(b) vision therapy and the opportunity to take exams orally
(c) 50% additional time on tests and additional breaks during the test
(d) Irlen lenses to use when reading her textbooks and 100% extended time on tests
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.
Among the most commonly reported cognitive difficulties in functional somatic syndromes are ____.
(a) speech/language skills
(b) visuospatial/perceptual skills
(c) attention/concentration skills
(d) general intellectual functioning
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.
During a sustained period of alcohol withdrawal a 27-year-old woman complains that bugs are crawling up and down her arms and into her ears. She is experiencing ____.
(a) hypnagogic hallucinations
(b) formication hallucinations
(c) release hallucinations
(d) metamorphosia hallucinations
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.
A 13-year-old boy is accidentally hit on the head with a baseball bat. He is knocked unconscious and taken to the emergency room. CT scan of the head reveals a concave hyperdensity in the left frontal epidural space, with mild mass effect evidenced. Which of the following likely occurred?
(a) tearing of the left uncinate fasciculus
(b) rotational acceleration and deceleration injuries
(c) impact of the brain over bony skull prominences
(d) laceration of the middle meningeal artery
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.
Preterm birth and low birth weight is defined as less than ____.
(a) 35 weeks gestation and birth weight below 7 pounds, 6 ounces
(b) 36 weeks gestation and birth weight below 6 pounds, 6 ounces
(c) 37 weeks gestation and birth weight below 5 pounds, 8 ounces
(d) 34 weeks gestation and birth weight below 5 pounds, 1 ounce
C—37 weeks gestation and birth weight below 5 pounds, 8 ounces Please refer to Chapter 17.
Which of the following domains are most consistently reported to be impacted in children and adults with a history of encephalitis?
(a) executive functions (b) visuospatial functions (c) receptive language (d) fluid intelligence
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.
Which of the following statements about ApoE is true?
(a) ApoE ε2 is most strongly linked with Alzheimer’s disease pathology
(b) ApoE ε2 virtually rules out Alzheimer’s disease
(c) The presence of ApoE ε4 is diagnostic for Alzheimer’s disease
(d) ApoE ε4 is a known risk for Alzheimer’s disease
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.
You are asked to evaluate a child with a history of significant alcohol exposure in utero. During your medical record review, you find a report from a structural brain MRI. Which of the following MRI findings is most likely?
(a) greater gray matter than white matter hypoplasia
(b) greater white matter than gray matter hypoplasia
(c) a reduction in the size of the cerebellar vermis
(d) a reduction in the size of the frontal lobes
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.
Which of the following is considered a symptom of the disorganized syndrome?
(a) anhedonia
(b) poverty of speech
(c) flat affect
(d) loose associations
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.
In children, the most common form of stroke is ____.
(a) traumatic hemorrhagic
(b) sinovenous thrombosis
(c) arterial ischemic
(d) non-traumatic hemorrhagic
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.
In Alzheimer’s disease, the progression of atrophy affects the following systems in which order?
(a) hippocampus and entorhinal cortex in the late stages, preceded by changes in the frontal, temporal, and parietal association areas
(b) basal ganglia in the middle stages, and temporal, frontal, and parietal association areas as the disease progresses
(c) hippocampus and entorhinal cortex in the earliest stages, and temporal, frontal, and parietal association areas as the disease progresses
(d) hippocampus and entorhinal cortex in the earliest stages, followed by basal ganglia involvement
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.
Increased risk of intellectual decline in children treated for medulloblastoma is associated with ____.
(a) total resection
(b) higher dose radiation and neurologic complications
(c) treatment in adolescence
(d) endocrine dysfunction
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.
Of the following areas of functioning, which neuropsychological domain tends to be most resilient to anoxic/hypoxic injury?
(a) contextual verbal memory
(b) visuospatial memory
(c) intellectual functioning
(d) processing speed
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.
In idiopathic normal pressure hydrocephalus, the general neuropsychological profile ____.
(a) shows a consistent pattern of strengths and weaknesses
(b) shows a pattern associated with subcortical pathology
(c) is identical to patterns associated with secondary normal pressure hydrocephalus
(d) often shows marked improvement with treatment
D—often shows marked improvement with treatment Please refer to Chapter 16.
A test that has a very high mean relative to the possible points and a small standard deviation would be best evaluated/interpreted using ____.
(a) a ratio scale and describing test performance as normal or impaired
(b) an ordinal scale and describing test performance categorically
(c) parametric statistics and converting performance to a percentile
(d) parametric statistics and converting performance to a standard score
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.
Which one of the following statements is true regarding the assessment and diagnosis of childhood ADHD?
(a) Neuropsychological tests have adequate sensitivity and specificity for diagnosing ADHD.
(b) ADHD is most often diagnosed by a mental health professional.
(c) ADHD occurs more often with comorbid conditions than without.
(d) Feigning of ADHD symptoms is a rare phenomenon in clinical practice.
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.
Patients with which of the following would be least likely to develop depression?
(a) anosodiaphoria
(b) Broca’s aphasia
(c) multiple sclerosis
(d) Huntington’s disease
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.
A brain tumor is suspected in a patient who is pregnant. Given the risk of ionizing radiation exposure with certain types of imaging studies, which of the following would be the least contraindicated for use?
(a) computed tomography
(b) magnetic resonance imaging
(c) single photon emission tomography
(d) positron emission tomography
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.
A 70-year-old woman is referred for assessment 2 months following a fall down her basement steps. Injury parameters indicate mild injury (GCS = 15, LOC = less than 1 minute, PTA = 1 hour). Neuropsychological assessment reveals moderate visuospatial impairments and evidence of mild left hemispatial inattention. Based on these findings, what type of pathology should be ruled out?
(a) slowly developing subdural hematoma
(b) focal seizure activity in the right hemisphere
(c) lacunar infarction in the right hemisphere
(d) ocular disturbances impacting visual acuity
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.
