Mock Exam 1

Question 1

1. In general, which of the following treatments used for childhood brain tumors is associated with the poorest long-term neuro-cognitive outcomes?

Answer 1

Whole brain radiation

Question 2

2. Which of the following is false?
   a) Anterograde amnesia is associated with hippocampal damage
   b) Retrograde amnesia is associated with mammillary body or thalamic nuclei lesions
   c) Severe retrograde amnesia is almost always accompanied by anterograde amnesia
   d) The hippocampus is required for retrieval of remote memories

Answer 2

The hippocampus is required for retrieval of remote memories; the hippocampus is involved in the FORMATION of memories, not the retrieval

Question 3

3. Which of the following is not characteristic of Down’s Syndrome?
   a) Most prevalent type is trisomy 21
   b) Sleep apnea is common
   c) Females tend to have stronger cognitive profiles than males
   d) Language skills are acquired at a faster rate relative to other motor or cognitive skills in Down’s Syndrome

Answer 3

Language skills are acquired at a faster rate relative to other motor or cognitive skills in Down’s Syndrome. Actually, language skills are acquired at a slower rate.

Question 4

4. You are a neuropsychologist who has been asked to assess Mr. Jones’ decision-making capacity. What are your ethical obligations in this situation?
   a) You must obtain informed consent from Mr. Jones before proceeding with the assessment.
   b) You must provide Mr. Jones with an explanation of the assessment, consider his preferences and best interest, and obtain his assent.
   c) You do not require informed consent from Mr. Jones if he willingly complies with the assessment procedures, because consent is implied.
   d) You should only conduct the assessment if Mr. Jones demonstrates an understanding of the purpose of the assessment, foreseeable risks, discomforts and benefits, and the limits of confidentiality.

Answer 4

b. You must provide Mr. Jones with an explanation of the assessment, consider his preferences and best interest, and obtain his assent.

Question 5

5. A correlation coefficient of .80 means that the proportion of variance in Y that can be accounted for by knowing X is:
   a) 64%
   b) 80%
   c) 20%
   d) 36%

Answer 5

a. 64 %

Question 6

6. The vocal intonation that helps us understand the intended meaning of what people say is termed__________and is a __________ hemisphere specialization.
   a) Prosody, left
   b) Semantics, right
   c) Syntax, right
   d) Prosody, right

Answer 6

d. In normal language laterialization, prosody can be localized to the right hemisphere.

Question 7

7. As you lower the reliability of a test, the Standard Error of Measurement (SEM) ____.
   a) increases
   b) decreases
   c) remains the same
   d) can not be determined

Answer 7

a. increases

Question 8

8. “Does the test sample the domain that it is intended to measure?” refers to which type of validity?
   a) Construct validity
   b) Content validity
   c) Criterion validity
   d) Discriminant validity

Answer 8

b. Content validity

Content validity (also known as logical validity) refers to the extent to which a measure represents all facets of a given construct. For example, a depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.

Question 9

9. The hit rate of a test is best when ________
   a) the validity coefficient is low
   b) the selection ratio is high
   c) the base rate is moderate
   d) the reliability coefficient is low

Answer 9

c. the base rate is moderate

Question 10

10. Folate supplementation during pregnancy is recommended to prevent:
    a) Childhood Onset Epilepsy
    b) Neural Tube Defects
    c) Mitochondrial Disorders
    d) Down’s Syndrome

Answer 10

b. Neural tube defects

Question 11

11. Which statement is true about the diagnosis of ADHD?
    a) Stronger performance on digits backwards than digits forwards supports the diagnosis
    b) A continuous performance test is the most sensitive means of detecting ADHD
    c) ADHD is a clinically-based diagnosis
    d) Impairment on Trails B but not A is a sign that is specific to ADHD

Answer 11

c. ADHD is a clinically-based diagnosis

Question 12

12. Acalculia of the Spatial Type is often associated with right hemisphere dysfunction and may include all of the following features except:
    a) Misalignment of columns resulting in miscalculation
    b) Deficits in simple calculations presented auditorally (e.g., 2 + 2 = 5)
    c) Reversal errors (e.g., ’12’ for ’21’)
    d) Inversion errors (e.g., ‘6’ for ‘9’)

Answer 12

b. Deficits in simple calculations presented auditorally (e.g., 2+2=5)

Question 13

13. The Geschwind-Galaburda Theory:
    a) is based on the asymmetry of the planum temporale, which is particularly prominent in males
    b) is based on the asymmetry of the planum temporale, with the left hemisphere being smaller than the right for most right-handed people
    c) proposes that testosterone is implicated in greater development of the right hemisphere
    d) would explain males’ strengths in spatial tasks, but does not account for the increased rate of autoimmune disorders in males

Answer 13

c. Proposes that testosterone is implicated in greater development of the right hemisphere. Based on observation of the asymmetry of the planum temporale with the left hemisphere being larger than the right in most right-handed people. In males, however, there is less asymmetry- which is proposed to be an effect of testosterone in delaying the development of the left hemisphere, although greater development of the right. This theory provides rationale for the greater spatial skills in males, as well as the increased rate of autoimmune disorders in males.

Question 14

What is the planum temporale?

Answer 14

The planum temporale is the cortical area just posterior to the auditory cortex (Heschl’s gyrus) within the Sylvian fissure. It is a triangular region which forms the heart of Wernicke’s area, one of the most important functional areas for language. Original studies on this area found that the planum temporale was one of the most asymmetric regions in the brain, with this area being up to ten times larger in the left cerebral hemisphere than the right.

Question 15

14. A patient who can copy a cross, cube, and upside down tree but can not identify what these drawings are of has?
    a) Prosopagnosia
    b) Apperceptive agnosia
    c) Associative agnosia
    d) Optic aphasia

Answer 15

c. Associative agnosia involves a failure in object identification despite preserved ability to copy and even match stimuli. It often co-occurs with prosopagnosia.
- Apperceptive agnosia involves a failure in perceptual processing of the stimuli and therefore can not copy stimuli.
- Optic aphasia is impaired naming of visual objects with the patient still able to identify the object by other means and able to explain characteristics.

Question 16

15. A test was used as a screening measure for ADHD and 90% of the children with ADHD scored in the abnormal range. This is the test’s ___________. 80% of the children without ADHD obtained scores in the normal range. This is the test’s ______.
    a) sensitivity, specificity
    b) specificity, sensitivity
    c) positive predictive power, specificity
    d) sensitivity, negative predictive power

Answer 16

a. sensitivity, specificity

Question 17

16. Abnormalities in what areas of the brain have been proposed to correlate with impairment in autism?
    a) Cerebellum, brain stem, and temporal lobes
    b) Cerebellum, brain stem, and basal ganglia
    c) Temporal lobes and basal ganglia
    d) Basal ganglia and frontal lobes

Answer 17

a. Cerebellum, brain stem, and temporal lobes

Question 18

17. A 52 y.o. hypertensive, diabetic man awakens unable to speak coherently and has right arm and face weakness but the leg is not affected. Exam shows dysarthria, Broca aphasia, right hemiparesis (face and arm) and hemianesthesia. What is the most likely diagnosis?
    a) Left putaminal hemorrhage
    b) Left middle cerebral artery (MCA) occlusion
    c) Left carotid occlusion
    d) Left anterior cerebral artery occlusion
    e) Left posterior cerebral artery occlusion

Answer 18

b. Left middle cerebral artery ( MCA) occlusion

The distribution of weakness (face and arm, sparing the leg) and Broca’s aphasia suggests ischemia in MCA distribution. With carotid occlusion, the territory of MCA and ACA would be affected such that the face, arm and leg would be equally affected. Putaminal (subcortical) hemorrhage would not likely cause aphasia.

Question 19

18. The use of deception in research
    a) Should never be done
    b) Can be done and is shared with participants only after the study
    c) Can be done in all situations, provided that there is scientific value
    d) Can be done provided that alternative procedures are not feasible

Answer 19

d. Can be done provided that alternative procedures are not feasible.

Question 20

19. In determining suspicious effort, which should be ruled out?
    a) Factitious Disorder
    b) Somatoform Disorder
    c) Psychotic Disorder
    d) All of the above

Answer 20

d. All of the above

Question 21

20. What is the most reliable indicator of a developmental reading disorder?
    a) Poor contextual reading
    b) Difficulty acquiring rapid, context-free word-reading skill
    c) Poor verbal working memory
    d) VIQ – Achievement score discrepancy

Answer 21

b. Difficulty acquiring rapid, context-free word-reading skill

Question 22

21. All of the following have been reported as being associated with reading disorders except:
    a) Reduced volumes in dominant hemisphere perisylvian areas
    b) Symmetrical planum temporale
    c) Cortical malformations in the frontal and temporal areas
    d) Reduced insular and frontal lobe volumes

Answer 22

a. Reduced volumes in dominant hemisphere perisylvian areas

Question 23

22. What feature of ADHD is typically not seen in NVLD?
    a) Inattention
    b) Hyperactivity
    c) Impulsivity
    d) Executive Dysfunction

Answer 23

b. Hyperactivity

Question 24

23. A 25 year-old woman is referred for neuropsychological assessment by her general practitioner because of memory complaints. Information obtained during the clinical interview indicates that she has no memory of a 6-month period of time in 2001, after witnessing the assault of a close friend. Memory for recent events is intact. Based on this information alone, which of the following is highest on the list of differential diagnoses:
    a) adjustment disorder
    b) retrograde amnesia
    c) conversion disorder
    d) psychogenic amnesia

Answer 24

d. Psychogenic amnesia

Question 25

24. Test-retest reliability is most suitable for evaluating
    a) Unstable traits such as speed of performance
    b) Stable traits, such as aptitude
    c) Subjective traits such as creativity
    d) Can be used for all of the above

Answer 25

b. Stable traits, such as aptitude

Question 26

25. You are informed by the test manual that the test you are using has a reliability coefficient of .81. Therefore, _____% is due to measurement error
    a) 9
    b) Square root of 19
    c) 10
    d) 19

Answer 26

d. 19

Question 27

26. The Striatum is part of the Basal Ganglia and includes which structures?
    a) Caudate and Putamen
    b) Caudate and Globus Pallidus
    c) Globus Pallidus and Substantia Nigra
    d) The Striatum includes all of these structures

Answer 27

d. All of the above

Question 28

27. Of the WAIS factor scores, _____ is least sensitive to neuropsychiatric disorders:
    a) POI
    b) VCI
    c) WMI
    d) PSI

Answer 28

b. VCI

Question 29

28. In comparing Alzheimer’s Disease (AD) patients to Dementia with Lewy Bodies (DLB) patients, typically:
    a) AD patients do better on confrontation naming tests
    b) AD patients have day-to-day fluctuations in cognition but DLB patients do not
    c) AD patients exhibit parkinsonism while DLB patients do not
    d) depression and hallucinations are more common in DLB patients while delusions are more common in AD patients

Answer 29

D. One of the key features distinguishing Lewy Body dementia from AD is the visual hallucinations seen in DLB. AD patients typically have delusions rather than actual hallucinations.

Question 30

29. Gender effects have been shown to be least evident on which of the following tests:
    a) Test of Memory Malingering (TOMM)
    b) smell identification test
    c) finger tapping
    d) MMPI-2

Answer 30

a. Test of Memory Maligering (TOMM)

Question 31

30. With respect to the WAIS-III factor scores, practice effects are:
    a) Largest for Processing Speed and Smallest for Verbal Comprehension
    b) Largest for Working Memory and smallest for perceptual Organization
    c) Largest for Verbal Comprehension and smallest for Processing Speed
    d) Largest for Perceptual Organization and smallest for Working Memory

Answer 31

D. Largest for POI and smallest for WMI

Question 32

31. In which conditions are confabulations not found?
    a) Anton’s syndrome
    b) Gerstmann’s syndrome
    c) Anosognosia
    d) Wernicke-Korsakoff syndrome

Answer 32

B. Gerstmann’s syndrome: it is a controversial entity that consists of right-left confusion, dyslexia, dyscalculia, and finger agnosia.
- Anton’s syndrome, or denial of blindness, blind patients typically confabulate or fantasize about the appearance of objects presented to them. It occurs most often in elderly patients who undergo opthalmogic surgical procedures and cannot see out of their eyes temporarily.
Anosognosia ( failure to acknowledge a deficit, usually a left side hemiparesis) is often accompanied by confabulation, denial, and “other defense mechanisms”

According to Kaufmann, the confabulations in Wernicke-Korsakoff are an uncommon symptom, unless the patients also have marked memory impairments

Question 33

32. Which of one of the following statements regarding Heschl’s gyrus is false:
    a) Heschl’s gyrus is bilateral and located adjacent to the planum temporale.
    b) In almost all individuals, the left-sided Heschl’s gyrus, like the left-sided planum temporale, has greater surface area than its right-sided counterpart.
    c) Each Heschl’s gyrus reflects auditory stimulation predominantly from the contralateral ear.
    d) Heschl’s gyrus appears to sort auditory stimulation for direction, pitch, loudness, and other acoustic properties rather than words for their linguistic properties.

Answer 33

b. The dominant hemisphere planum temporale, which is integral to language function, has greater surface area than its counterpart. Heschl’s gyrus, which processes the auditory qualities of sound, is bilaterally symmetric.

Question 34

33. In non-fluent aphasia, why is the arm typically more paretic than the leg?
    a) The motor cortex for the arm is supplied by the middle cerebral artery (MCA), which is usually occluded. The motor cortex for the leg is supplied by the anterior cerebral artery (ACA), which is usually spared.
    b) The arm has larger cortical representation
    c) The infarct occurs in the internal capsule
    d) The motor cortex for the arm is supplied by the ACA, which is usually occluded.
    e) The motor cortex for the leg is supplied by the MCA, which is usually spared.

Answer 34

a. The motor cortex for the arm is supplied by the middle cerebral artery (MCA), which is usually occluded. The motor cortex for the leg is supplied by the anterior cerebral artery (ACA), which is usually spared.

Question 35

34. In which disorder(s) is echolalia a symptom?
    a) Autism
    b) Isolation aphasia
    c) Tourette’s syndrome
    d) All of the above

Answer 35

d. All of the above; echolalia, an involuntary repetition of another’s words, is a manifestation of diverse neurologic conditions. It also occurs within the context of dementia

Question 36

35. Which of the following is NOT a feature of Asperger’s Disorder:
    a) Impaired social interactions
    b) Delayed language development
    c) Restricted, repetitive and stereotyped patterns of behavior, interests and activities.
    d) Normal development of age-appropriate self-help and adaptive behavior

Answer 36

b. Delayed language development

Question 37

36. You are a neuropsychologist who is hired by an attorney (Ms. Smith) to perform a neuropsychological assessment of Mr. Patient to document cognitive deficits related to a brain injury following a motor vehicle accident. The attorney hired by the defendant’s insurance company (Ms. Jones) contacts you to demand that she be present during the evaluation. In this situation, which of the following statements is correct?
    a) It is acceptable to allow Ms. Smith to observe the evaluation because Mr. Patient is his client, but not Ms. Jones
    b) It is acceptable to allow Ms. Jones to observe the assessment, but only if Mr. Patient provides his consent.
    c) It is not acceptable to allow Ms. Jones to observe the assessment due to issues of test security and threats to the validity of the examination.
    d) It is acceptable to allow Ms. Jones to observe the assessment, but not the clinical interview.

Answer 37

c. It is not acceptable to allow Ms. Jones to observe the assessment due to issues of test security and threats to the validity of the examination.

Question 38

37. If forced to take only one test to your new position on a desert island with a need for neuropsychological assessment, one would be best served to take a test with high _____ in determining who should be flown to the mainland for more extensive neuropsychological evaluations in moderate base rate conditions.
    a) face validity
    b) construct validity
    c) negative predictive power
    d) specificity
    e) positive predictive power

Answer 38

c. Negative predictive power

Negative predictive value (NPV) represents the probability that a person does not have a disease or condition, given a negative test result. … Sensitivity refers to the true positive rate for people with a disease or condition having a positive test result.

Question 39

38. Conditions that may lead to worsening neurological deficit in acute stroke patients include:
    a) Hypoxia
    b) Hyperglycemia
    c) Atrial fibrillation (AF)
    d) All of the above

Answer 39

d. All of the above; AF may cause stroke recurrence. The occurrence of other factors should be avoided in stroke patients as they worsen neurological deficit. If infection complicates stroke, e.g., pneumonia, urinary tract infection, neurological deficits can worsen.

Question 40

39. Clinical features of left posterior cerebral artery (PCA) occlusion include:
    a) Right homonymous hemianopsia and hemianesthesia
    b) Right hemiballismus
    c) Vertigo and ataxia
    d) Right hemiparesis
    e) Alexia and agraphia

Answer 40

a. Right homonymous hemianopsia and hemianeshesia; this is the answer for most patients; however, PCA may supply the thalamus and also result in hemianesthesia. Alexia without agraphia may result.

Question 41

40. A 50 y.o. normotensive man has an episode of sudden loss of vision in the right eye. This persists for 15 minutes ad then rapidly resolves. He has normal neurological and opthalmological examination. The mechanism of this episode is most likely:
    a) Demyelination of optic nerve
    b) Artery-to-artery embolism involving carotid and ophthalmic arteries
    c) Thrombosis in situ in carotid artery
    d) Optic nerve compression
    e) None of the above

Answer 41

b. Artery-to-artery embolism involving carotid and opthalmic arteries; this TIA is known as amaurosis fugax due to carotid atherosclerotic disease. This can cause transient blindness.
-Optic nerve demyelination may cause sudden visual loss but would not resolve so quickly.
Compression of the optic nerve would cause gradual visual loss and reduced papillary light response.

Question 42

41. A 50 y.o. man with atrial fibrillation suddenly becomes “confused.” He is alert and attentive. His speech is fluent but he has difficulty following commands. The following other neurological abnormalities might include:
    a) Hemiparesis
    b) Acalculia
    c) Left lower quadrantanopia
    d) Agraphia
    e) No focal findings since patient has encephalopathy

Answer 42

b. Alcalculia: Sudden onset indicates vascular etiology!! Because the patient appears confused and cannot comprehend normally, this indicates Wernicke’s aphasia. This involves the posterior temporal lobe of the dominant hemisphere, and acalculia may also be present. The visual field fibers pass through this region and ischemia may cause right homonymous hemianopsia. Therefore, patients with Wernicke’s aphasia may also have accompanying right homonymous hemianopsia but no hemiparesis or hemianesthesia.

Question 43

42. Which of the following is not a symptom of carotid artery TIA?
    a) Paresthesias
    b) Anterograde amnesia
    c) Hemisensory loss
    d) Hemianopsia
    e) Transient aphasia

Answer 43

b. Anterograde amensia; carotid artery TIA, caused by emboli at common carotid bifurcation, leads to hemispheral TIAs with symptoms of contralateral hemiparesis, hemisensory loss, paresthesias, hemianopsia, transient aphasia, and hemi-inattention.

Question 44

43. Which of the following does not occur in MCA strokes?
    a) Upper extremity hemiparesis
    b) Aphasia
    c) Hemineglect
    d) Lower extremity hemiparesis

Answer 44

d. Lower extremity hemiparesis. The homonculus shows that the motor strip for the lower extremity is perfused by the Anterior Cerebral Artery ( ACA) in the medial aspect of the hemisphere.

Question 45

44. Trazodone is a __________ and may affect neuropsychological test results because it can make your patient ___________ .
    a) Mood stabilizer, restless
    b) Anxiolytic, drowsy
    c) Antipsychotic, experience psychomotor slowing
    d) Antidepressant, drowsy

Answer 45

d. antidepressant; drowsy. Trazodone is actually often used as a hypnotic to help patients sleep.

Question 46

45. A stroke in which vascular supply would cause dysfluent speech, anomia, intact comprehension and reading?
    a) Left Internal Carotid Artery
    b) Right Middle Cerebral Artery
    c) Left Anterior Cerebral Artery
    d) Left Middle Cerebral Artery

Answer 46

d. Left MCA infarcts cause Broca’s aphasia characterized by dysfluent speech, poor repetition, anomia, and intact comprehension and reading.

Question 47

46. A lesion in the lower left optic radiation causes:
    a) Right homonymous hemioanopsia with sparing of macular vision
    b) Bitemporal hemianopsia
    c) Right upper homonymous quadrantanopsia
    d) Left lower homonymous quadrantanopsia

Answer 47

c. Right upper homonymous quadrantanopsia- post optic chiasm, lower optic radiations affect the upper contralateral visual quadrant field, upper optic radiations affect the lower contralateral visual quadrant field.

Question 48

47. If you were a patient demonstrating a general lack of concern about your cognitive deficits, were over the age of 60, and had a clean neurological work-up other than borderline MMSE, the most likely diagnosis to rule out would be _________________, with a likelihood of around ___________.
    a) Alzheimer’s disease, 80%
    b) unable to determine with data presented
    c) Pick’s dementia, 20%
    d) Alzheimer’s disease, 60%
    e) Cerebrovascular accident, 15%.

Answer 48

a. Alzheimer’s disease; 80 %

Question 49

48. The parvocellular and magnocellular layers of the dorsal lateral geniculate nucleus
    a) may represent different visual systems.
    b) analyze the same kind of information from the visual field.
    c) are connected to the nasal and temporal halves of the retina, respectively.
    d) receive input from the contralateral and ipsilateral halves of the visual field, respectively.

Answer 49

a. may represent different visual systems.

Question 50

49. Damage limited to the fusiform region of the right hemisphere would be expected to impair the recognition of ___________ .
    a) movement of objects through space.
    b) fruits and vegetables.
    c) faces.
    d) object location.

Answer 50

c. Faces; damage limited to the fusiform region of the right hemisphere would be expected to impair the recognition of faces.

Question 51

50. A difficulty in scanning the visual scene is ___________ .
    a) ocular apraxia.
    b) prosopagnosia.
    c) visual agnosia.
    d) optic ataxia.

Answer 51

a. Ocular apraxia: Cogan type ocular motor apraxia is a rare congenital disorder characterized by a defect in side-to-side (horizontal) eye movements. The eyes do not move properly in response to stimuli or voluntarily. When affected infants are asked to fixate on an object to the side, their eyes will lag and then move in the opposite direction. In order to compensate for this, the infants will sharply jerk their heads past the desired object in an effort to bring the eyes to a position where they can view the object. When the eyes fixate on the object, the head will return to its normal position. These jerking head movements are the most noticeable sign of Cogan type ocular motor apraxia and are usually recognized three to four months after birth. Before these head jerkings occur, an infant’s inability to fixate on an object may sometimes be mistaken for blindness.

Infants with Cogan type ocular motor apraxia will also be unable to follow rapid movements across their fields of vision, such as focusing on a moving train (opticokinetic nystagmus). The disorder can also be associated with mild developmental delay and speech difficulties.

In other rare cases of Cogan type ocular motor apraxia, individuals exhibit an inability to fixate on objects to one particular side of the body (unilateral ocular motor apraxia). In some of these cases, individuals may demonstrate improper eye movements and/or an inability to track an object with the other eye.

Cogan type ocular motor apraxia is not progressive and many affected individuals eventually learn to compensate for the disorder by overshooting the eyes instead of jerking the head. The number and severity of symptoms varies widely among affected individuals.

Some individuals with Cogan type ocular motor apraxia have a brain abnormality such as underdevelopment (hypoplasia) of the corpus callosum, hypoplasia of the cerebellum, or an abnormality in the grey matter. (For more information on agenesis of corpus callosum, see the Related Disorders section of this report.)

Question 52

51. A difficulty in using visual guidance to reach for an object is ___________ .
    a) ocular apraxia.
    b) prosopagnosia.
    c) visual agnosia.
    d) optic ataxia.

Answer 52

d. optic ataxia Optic ataxia is a high order deficit in reaching to visual goals that occurs with posterior parietal cortex (PPC) lesions. It is a component of Balint’s syndrome that also includes attentional and gaze disorders.

Question 53

What is Balint’s Syndrome?

Answer 53

Bálint’s syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object by using vision (optic ataxia).

Question 54

52. Imaging studies of individuals with autism have shown all of the following except:
    a) delayed maturation of the frontal lobes
    b) reduced activation of the amygdala during processing of facial emotion
    c) enlargement of the lateral ventricles
    d) overall reduced brain size

Answer 54

d. Overall reduced brain size

Question 55

53. The inability to perceive more than one object in a visual scene is called ________ .
    a) ocular apraxia.
    b) prosopagnosia.
    c) visual agnosia.
    d) simultanagnosia.

Answer 55

d. simultanagnosia

Question 56

54. In Alzheimer’s disease, which of the following receptors is most severely depleted?
    a) Muscarinic acetylcholine
    b) Nicotinic acetylcholine
    c) Frontal dopamine
    d) Nigrostriatal dopamine

Answer 56

a. Muscarinic acetylcholine; in AD, muscarinic acetylcholine receptors are depleted, especially in the limbic system and association areas. Although they are found in the brain, nicotinic acetylcholine receptors are found predominantly in the spinal cord and neuromuscular junction.

Question 57

55. Which of the dopamine tracks is associated with the positive symptoms of Schizophrenia?
    a) Nigrostriatal
    b) Mesolimbic
    c) Tubero-innfundibular
    d) Mesocortical

Answer 57

b. Mesolimbic

Question 58

56. Which of the dopamine tracks is associated with extrapyramidal motor disorders?
    a) Nigrostriatal
    b) Mesolimbic
    c) Tubero-innfundibular
    d) Mesocortical

Answer 58

a. Nigrostriatal

Question 59

57. The primary treatment for a communicating hydrocephalus, or normal pressure hydrocephalus is ____________, which results in decreased _________________ in the ventricles. One way to distinguish NPH from a subcortical dementia is ________________.
    a) Burr-hole suction, CSF, finger oscillation speed
    b) Burr-hole suction with steroid treatment, choroid plexus production of CSF, falling
    c) Shunting, blood, aphasia
    d) shunting, CSF, incontinence

Answer 59

d. Shunting, CSF, incontinence:

” The primary treatment for a communicating hydrocephalus, or NPH, is shunting, which results in decreased CSF in the ventricle. One way to distinguish NPH from a subcortical dementia is incontinence.

Question 60

58. Treatments that use ABA designs to determine their efficacy are most vulnerable to the effects of __________ .
    a) Learning
    b) History
    c) Measurement error
    d) Abulia

Answer 60

a. Learning; treatments that use ABA designs to determine their efficacy are most vulnerable to the effects of learning.

Question 61

59. The most common sites of brain contusion in TBI, due to jagged bony prominences abutting brain tissue in the cranial vaults, are:
    a) Calcarine fissure and orbitofrontal regions
    b) Inferiolateral temporal regions
    c) Parietoccipital cortex and dorsolateral frontal regions
    d) Anterior temporal lobes and orbitofrontal regions

Answer 61

d. Anterior temporal lobes and orbitofrontal regions

While the occipital lobe ( and therefor Calcarine fissure) and orbitofrontal areas are both injured in the classic contracoup injury, the occiptal lobe does not have a jagged bony prominence to contend with. The rostral or anterior edge of the temporal lobe and the orbitofrontal area of the frontal lobe abut jagged bony prominence.

Question 62

60. Of the following, which one is not a sign of cerebellar damage?
    a) intention tremor
    b) dysdiadochokinesia
    c) truncal ataxia
    d) Hoover’s sign

Answer 62

d. Hoover’s sign: Hoover’s sign is NOT a sign of cerebellar damage. Hoover’s sign is a common psychogenic symptom. The other 3, eg, intention tremor, dysdiadochokinesia, truncal ataxia, are signs of cerebella lesions.

Hoover’s sign of leg paresis is one of two signs named for Charles Franklin Hoover.[1]

It is a maneuver aimed to separate organic from non-organic paresis of the leg.[2] The sign relies on the principle of synergistic contraction.

Involuntary extension of the “normal” leg occurs when flexing the contralateral leg against resistance. To perform the test, the examiner should hold one hand under the heel of the “normal” limb and ask the patient to flex the contralateral hip against resistance (while the patient is supine), asking the patient to keep the weak leg straight while raising it. If the patient is making an honest effort, the examiner should feel the “normal” limb’s heel extending (pushing down) against his or her hand as the patient tries to flex (raise) the “weak” leg’s hip. Feeling this would indicate an organic cause of the paresis. If the examiner does not feel the “normal” leg’s heel pushing down as the patient flexes the hip of the “weak” limb, then this suggests functional weakness (sometimes called “conversion disorder”), i.e. that effort is not being transmitted to either leg.

Alternatively, if a patient reports weakness of hip extension (rare in itself, even in the case of hemiparesis, in which hip extension is relatively preserved) and appears to have weakness upon direct testing of hip extension, Hoover’s test can also be applied. If an examiner places one hand behind the heel of the patient’s weak leg and asks her or him to push against it, no movement will be felt. If the patient is asked to raise the other leg (i.e. flexion at the contra-lateral hip), the examiner will feel pressure on his or her hand as the patient involuntarily extends the weak hip. This can be pointed out to the patient in a non-confrontational manner, to help persuade the patient of the functional nature of the weakness.[3] In the context of a positive Hoover’s sign, functional weakness (or “conversion disorder”) is much more likely than malingering or factitious disorder.[3]

Strong hip muscles can make the test difficult to interpret.[4]

Efforts have been made to use the theory behind the sign to report a quantitative result.[5]

Question 63

61. When speaking of Tourette’s syndrome, which statement would not be completely accurate?
    a) It is four times more common in boys
    b) Abnormal MRI and EEG findings correlate highly w/ diagnosis
    c) There is autosomal dominant inheritance w/ incomplete penetrance.
    d) There is increased incidence of ADHD and OCD

Answer 63

b. Abnormal MRI and EEG findings correlate highly with diagnosis. MRI and other tests are generall unrevealing, so diagnosis is based on clinical presentation. The other statements are complete accurate.

• It is 4 times more common in boys
• There is autosomal dominant inheritance with incomplete penetrance
• There is increased incidence of ADHD and OCD

Question 64

62. Dementia in Parkinson’s Disease is least associated with:
    a) Akinesia
    b) Rapid progression of the illness
    c) Being older
    d) tremor

Answer 64

D. Dementia is LEAST closely associated with tremor. According to Kaufman, if dementia occurs at the onset of an illness with parkinsonism, consider diffuse Lewy Body disease in people older than 50. In young adults, consider Wilson’s disease, juvenile Huntingtons, and drug abuse.

Wilson’s disease is a genetic disorder in which copper builds up in the body. Symptoms are typically related to the brain and liver. Liver related symptoms include vomiting, weakness, fluid build up in the abdomen, swelling of the legs, yellowish skin, and itchiness. Brain related symptoms include tremors, muscle stiffness, trouble speaking, personality changes, anxiety, and seeing or hearing things that others do not.[1]

About half the people with Wilson’s disease have neurological or psychiatric symptoms. Most initially have mild cognitive deterioration and clumsiness, as well as changes in behavior. Specific neurological symptoms usually then follow, often in the form of parkinsonism (cogwheel rigidity, bradykinesia or slowed movements and a lack of balance are the most common parkinsonian features[7]) with or without a typical hand tremor, masked facial expressions, slurred speech, ataxia (lack of coordination) or dystonia (twisting and repetitive movements of part of the body). Seizures and migraine appear to be more common in Wilson’s disease.[5] A characteristic tremor described as “wing-beating tremor” is encountered in many people with Wilson’s; this is absent at rest but can be provoked by extending the arms.[8]

Cognition can also be affected in Wilson’s disease. This comes in two, not mutually exclusive, categories: frontal lobe disorder (may present as impulsivity, impaired judgement, promiscuity, apathy and executive dysfunction with poor planning and decision making) and subcortical dementia (may present as slow thinking, memory loss and executive dysfunction, without signs of aphasia, apraxia or agnosia). It is suggested that these cognitive involvements are related and closely linked to psychiatric manifestations of the disease.[7]

Psychiatric problems due to Wilson’s disease may include behavioral changes, depression, anxiety disorders, and psychosis.[5] Psychiatric symptoms are commonly seen in conjunction with neurological symptoms and are rarely manifested on their own. These symptoms are often poorly defined and can sometimes be attributed to other causes. Because of this, diagnosis of Wilson’s disease is rarely made when only psychiatric symptoms are present.[7]

Question 65

63. Which of the symptoms does not typically characterize Dementia with Lewy Bodies?
    a) Extrapyramidal signs
    b) Visual hallucinations and delusions
    c) Pseudobulbar palsy
    d) Memory and attentional deficits

Answer 65

c. Pseudobalbar Palsy- it is typical of progressive supranuclear palsy, a subcortical dementia.
- DLB is considered a mixed dementia, as it is difficult to classify as either cortical or subcortical. The other 3 choices are all classic features of DLB: extrapyramidal signs, visual hallucinations/delusions, and memory and attentional deficits

Question 66

64. Which of the following two vascular structures are the only two UNPAIRED vessels near or a part of the Circle of Willis?
    a) posterior cerebellar artery and posterior communicating artery
    b) anterior communicating artery and posterior communicating artery
    c) basilar artery and anterior communicating artery
    d) basilar artery and posterior communicating artery

Answer 66

c. Basilar artery and anterior communicating artery; these two do NOT have a match on the other side to make it a pair. The PCOMM does, as do all the others mentioned. These 2 are important with regards to Top of the Basilar vascular diseases and Anterior Comm being the site for many berry aneurysms.

Berry aneurysm: A small aneurysm that looks like a berry and classically occurs at the point at which a cerebral artery departs from the circular artery (the circle of Willis) at the base of the brain. Berry aneurysms frequently rupture and bleed.

Question 67

65. With an understanding that dementia can happen late in the course of MS or possibly not at all, which MS features are often associated with cognitive impairment?
    a) Physical impairments
    b) Atrophy
    c) Total lesion volume
    d) All of the above

Answer 67

d. All of the above; physical impairments, atrophy, and total lesion volume are often associated with cognitive impairment.
- Along with A-C, duration of the illness, enlarged cerebral ventricles, corpus callosum atrophy, and cerebral hypometabolism are also associated with MS related cognitive impairment.

Question 68

66. Symptoms of vertigo, vomiting, transient global amnesia, and nystagmus are indicative of:
    a) Carotid Artery TIA’s
    b) Basilar Artery TIA’s
    c) CVA of the MCA
    d) Lenticulostriate TIA’s

Answer 68

b. Basilar artery TIA’S; vertebrobasilar artery TIAs symptoms include those mentioned, PLUS tinnitus, circumoral paresthesias or numbness, dysarthria, dysphagia, drop attacks, ataxia, and cranial nerve abnormalities.

Question 69

67. Abnormalities with saccades are a hallmark feature of which disease?
    a) Parkinson’s Disease
    b) Huntington’s Disease
    c) Epilepsy
    d) Dandy-Walker Syndrome

Answer 69

b. Huntington’s Disease: it’s a hallmark symptom that usually comes on very early in the course of HD.

Saccade: a rapid movement of the eye between fixation points.

Question 70

68. Wernicke’s encephalopathy is caused by thiamine deficiency usually associated with an alcoholic population. What is the classic triad of symptoms?
    a) ataxia, confusional state, eye movement abnormalities
    b) vertigo, retrograde amnesia, nystagmus
    c) confabulation, retrograde amnesia, conduction aphasia
    d) ataxia, vertigo, transient global amnesia

Answer 70

a. ataxia, confusional, eye movement abnormalities: ACE

Confabulation and retrograde amnesia are also associated with this disorder, Wernicke’s Encephalopathy, but more so with the more chronic form of the disorder called Wernicke-Korsakoff Syndrome, or Korsakoff’s.

Question 71

69. Which tremor is associated with parkinsonism?
    a) postural
    b) intention
    c) resting
    d) action
    e) benign

Answer 71

c. Resting tremor is most closely associated with Parkinsonism

Question 72

70. Which seizure type typically is characterized by lip smacking, chewing or other automatic stereotyped movements, emotional changes (e.g., fear, sadness, or déjà vu feelings), as well as hallucinations of auditory, tactile, visual, or olfactory sensory experiences?
    a) primary generalized seizure
    b) secondary generalized seizure
    c) typical simple absence seizures
    d) partial (simple or complex) seizure

Answer 72

d. Partial ( simple or complex) seizures are typically characterized by lip smacking, chewing, or other automatic stereotyped movements, emotional changes (e.g., fear, sadness, or deja vu feelings), as well as hallucinations of auditory, tactile, visual, or olfactory sensory experiences.

Partial seizures begin in one part of the brain and may or may not spread to other regions. They usually consist of specific motor, sensory, or psychic alterations, that are often accompanied by stereotyped automatic movements. These seizures often stem from temporal lobe ( although about 10 % are frontal) and accompanied by emotional changes ( fear, sadness, pleasure, deja vu). Hallucinations or misperceptions are also common ictal phenomena of simple and complex partial seizures. Simple partial seizures have no alteration in consciousness as a result of seizure discharge. In COMPLEX partial seizures, there’s always alteration of consciousness.

Question 73

71. A researcher hypothesizes that students who perform a Milky Way hip flip the night before their Board Written Exam score higher on the exam than students who don’t. She obtains a sample of 40 students and assigns 20 to the “Milky Way hip flip ” group and 20 to the “no Milky Way hip flip” group. She concludes, on the basis of a statistical test, that her hypothesis was correct. In the population, however, there is no difference on the Board Written Exam between students who do and do not perform a Milky Way hip flip the night before they take the exam. What type of error has been made?
    a) Type I Error
    b) Type II Error
    c) Sampling error
    d) Standard error

Answer 73

a. Type I error: this type of error occurs when the null hypothesis is rejected when it is true; in other words, when one concludes that a difference exists when it really does not. It’s “ thinking you have something when you really don’t. EG, a false positive. A Type I error is detecting an effect when there really is none.

Type II error: A Type II error is incorrectly retaining a false null hypothesis ( false negative), or the failure to detect an effect when there actually is one.

Question 74

72. A study is conducted to assess the effectiveness of a new anti-anxiety medication. The Beck Anxiety Inventory (BAI) is used to measure anxiety levels. If the mean score of subjects who take the drug is compared to the population mean for anxious subjects on the BAI, the statistical test that would be used would be:
    a) t-test for independent samples
    b) t-test for correlated samples
    c) t-test for single sample
    d) one-way ANOVA

Answer 74

c. T-test for single samples

The one sample t-test is appropriate when a study involves only one sample. It is designed to compare the mean of a single sample to a known population mean. It is a seldom used test as we don’t often have a known population mean ( ex: of population mean= if we knew from a government survey the national average income for psychologists, then we could take a sample of female psychologists and compare to the known population mean)

Question 75

73. An experimenter is testing the hypothesis that there is no difference between treatment modalities in regards to the scores obtained by patients on a depression measure. His design calls for two groups— psychodynamic treatment versus a CBT treatment. He uses a t-test to analyze the data at time two as there were no differences between the groups at time 1. The results are: Group 1 BDI mean = 12; Group 2 mean = 8. The t-value exceeds the tabled critical value at the .01 level for a 2-tailed test. He should:
    a) Accept the null and conclude the alternative hypothesis is false.
    b) Reject the null and conclude the alternative hypothesis is supported.
    c) Retain the null and conclude that the alternative hypothesis is supported.
    d) Not make an interpretation, as the researcher should have used a one-tailed test.

Answer 75

b. Reject the null and conclude the alternative hypothesis is supported.

If the results are significant at the .01 level, then you REJECT the null hypothesis and conclude that the alternative hypothesis is true (i.e., that the means are significantly different).

Question 76

74. In a study in which a one-way ANOVA is used, the null hypothesis would be that
    a) Sample variances are equal.
    b) Population variances are equal.
    c) Sample means are equal.
    d) Population means are equal.

Answer 76

d. Population means are equal. An ANOVA is designed to test the hypothesis that group means were drawn from the same population; i.e., that means are equal in the population.

Question 77

75. A drawback of norm-referenced interpretation is that:
    a) A person’s performance is compared to the performance of other examinees.
    b) It does not permit comparisons of individual examinee’s scores on different tests.
    c) It does not indicate where the examinee stands in relation to others of the same population.
    d) It does not provide absolute standards of performance.

Answer 77

d. Norm-referenced interpretation involves comparing an examinee’s score to the scores of others who have taken the same test. A drawback of this type of interpretation is that it does not provide absolute standards of “ good” or “bad” performance- the examinee’s score must be interpreted in light of the performance of the norm group as a whole.

Norm-referenced tests report whether test takers performed better or worse than a hypothetical average student, which is determined by comparing scores against the performance results of a statistically selected group of test takers, typically of the same age or grade level, who have already taken the exam.

Question 78

76. What is the location of pathology that contributes to the classic triad of Wernicke’s encephalopathy?
    a) basal forebrain and septal nuclei
    b) ventral striatum and ventral pallidum
    c) cingulate gyrus and temporal pole
    d) mammilary bodies and medial diencephalic structures

Answer 78

d. Mammilary bodies and medial diencephalic structures

According to Blumenfeld, “pathologically, these patients have bilateral necrosis of the mammilary bodies and a variety of medial diencephalic and other periventricular nuclei.” He associates the anterograde and retrograde amnesia with bilateral diencephalic lesions, as well as impairments in judgment, initiative, impulse control, and sequencing tasks to frontal lobe dysfunction.

Question 79

77. The most likely primary progressive dementia to consider when a patient presents with primary symptoms of changes in comportment and language is
    a) Parkinson’s
    b) Huntington’s
    c) Alzheimer’s
    d) Fronto-Temporal Dementia
    e) Primary Progressive Aphasia

Answer 79

d. FTD; comportment means behavior

Question 80

78. When evaluating a child with a Nonverbal Learning Disability (NVLD), you would be most concerned that the child might also have a ____________ Disorder.
    a) Reading
    b) Mathematics
    c) Disorder of Written Expression
    d) Expressive Language

Answer 80

b. Mathematics

Question 81

79. Sex-dependent penetrance (complete in males; incomplete in females); lack of asymmetry in the planum temporale; smaller neurons in the left medial geniculate nucleus (MGN) compared to the right MGN; and possible involvement of chromosome 6 and 15 are findings associated with what developmental disorder:
    a) Asperger’s Disorder
    b) Dyslexia or Reading Disorder
    c) ADHD
    d) Rett’s Disorder

Answer 81

b. Dyslexia or reading disorder

Question 82

80. Item difficulty index (p) is calculated by dividing the number who answered correctly by total number of sample. Items with moderate difficulty level are typically retained. What is the moderate difficulty value of p and why is this value preferred?
    a) p=0.5 which helps maximize differentiation of subjects
    b) p=0.35 which produces a more face valid test
    c) p=0.75 which helps maximize differentiation of subjects
    d) p=1.0 which produces normal distribution of scores

Answer 82

a. p=.05 which helps maximize differentiation of subjects

Question 83

81. Which of the following intervention methods for severe memory disorders involves the prevention of errors during acquisition of information.
    a) Self-Instruction Training
    b) Massed practice
    c) Metacognition Training
    d) Errorless Learning

Answer 83

d. Errorless learning

Question 84

82. Risk factors associated with premature birth include all of the following except:
    a) Hypoxic ischemic encephalopathy (HIE)
    b) Intraventricular hemorrhage (IVH)
    c) Multifocal Leukoencephalopathy
    d) Periventricular Leukomalacia (PVL)

Answer 84

c. Multifocal leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is a rare and usually fatal viral disease characterized by progressive damage (-pathy) or inflammation of the white matter (leuko-) of the brain (-encephalo-) at multiple locations (multifocal). It is caused by the JC virus, which is normally present and kept under control by the immune system. JC virus is harmless except in cases of weakened immune systems. In general, PML has a mortality rate of 30–50 percent in the first few months and those who survive can be left with varying degrees of neurological disabilities.

PML occurs almost exclusively in patients with severe immune deficiency, most commonly among patients with acquired immune deficiency syndrome (AIDS), but people on chronic immunosuppressive medications including chemotherapy are also at increased risk of PML, such as patients with transplants, Hodgkin’s Lymphoma, multiple sclerosis, psoriasis and other autoimmune diseases.

Question 85

83. Optic neuritis is epidemiologically and pathophysiologically related to
    a) AIDS
    b) Multiple Sclerosis
    c) Myasthenia gravis
    d) Meniere’s disease

Answer 85

b. Multiple Sclerosis

Optic neuritis: is an inflammation of the optic nerve.
Optic neuritis is often associated with multiple sclerosis, and can be an early sign of the disease.
Pain and temporary vision loss are common symptoms.
Optic neuritis usually gets better on its own. In some cases, steroid medications are used to reduce inflammation.

Question 86

84. Which of the following behavioral symptoms is not characteristic of diffuse axonal injury?
    a) decreased mental efficiency
    b) decreased complex reasoning ability
    c) decreased receptive vocabulary
    d) decreased ability to perform mental arithmetic

Answer 86

c. decreased receptive vocabulary is not characteristic of diffuse axonal injury.

Diffuse axonal injury is widespread damage to the white matter of the brain that usually results from acceleration/deceleration types of injury. Ischemic brain injury resulting from an insufficient blood supply to the brain, is one of the leading causes of secondary brain damage after head trauma.

Question 87

85. Nuchal rigidity is most likely a sign of which of the following
    a) Subarachnoid hemorrhage
    b) Transtentorial herniation
    c) Communicating hydrocephalus
    d) Epidural hematoma

Answer 87

a. subarachnoid hemorrhage

nuchal rigidity. Definition: impaired neck flexion resulting from muscle spasm (not actual rigidity) of the extensor muscles of the neck; usually attributed to meningeal irritation.

Classic presentation

The central feature of classic SAH is sudden onset of severe headache (thunderclap headache), often described as the “worst headache of my life.” Less severe hemorrhages may cause headache of moderate intensity, neck pain, and nonspecific symptoms. Absence of headache in the setting of a ruptured intracranial aneurysm is rare and probably represents amnesia for the event.
The headache may be accompanied by nausea and/or vomiting from increased ICP and meningeal irritation. Symptoms of meningeal irritation, including nuchal rigidity and pain, back pain, and bilateral leg pain, occur in as many as 80% of patients with SAH but may take several hours to manifest. Photophobia and visual changes are common. Focal neurologic deficits may also occur.
Sudden loss of consciousness (LOC) occurs at the ictus in as many as 45% of patients as intracranial pressure (ICP) exceeds cerebral perfusion pressure. LOC often is transient; however, approximately 10% of patients remain comatose for several days, depending on the location of the aneurysm and the amount of bleeding.
Seizures during the acute phase of SAH occur in 10-25% of patients. Seizures result from the sudden rise in ICP or direct cortical irritation by blood. No correlation exists between the seizure focus and the anatomic site of aneurysm rupture.
A proposed decision rule for diagnosis of SAH focuses on the following 7 characteristics, which are strongly associated with SAH:
Aged 40 years or older
Witnessed loss of consciousness
Complaint of neck pain or stiffness
Onset of manifestations with exertion
Arrival by ambulance
Vomiting
Diastolic blood pressure ≥100 mm Hg or systolic blood pressure ≥160 mm Hg
Should one or more of these be present in a patient with an acute nontraumatic headache reaching maximum intensity within 1 hour, the possibility of SAH hemorrhage should be investigated. [12] On the other hand, it may be possible to consider foregoing investigation in patients with none of these characteristics. [12] This decision rule has not yet been validated. Further study is needed before this approach can be recommended.
Approximately 30-40% of patients are at rest at the time of SAH. Physical or emotional strain, defecation, coitus, and head trauma contribute to varying degrees in the remaining 60-70% of cases.

Question 88

76. What is the location of pathology that contributes to the classic triad of Wernicke’s encephalopathy?
    a) basal forebrain and septal nuclei
    b) ventral striatum and ventral pallidum
    c) cingulate gyrus and temporal pole
    d) mammilary bodies and medial diencephalic structures

Answer 88

d. Mammilary bodies and medial diencephalic structures

According to Blumenfeld, “pathologically, these patients have bilateral necrosis of the mammilary bodies and a variety of medial diencephalic and other periventricular nuclei.” He associates the anterograde and retrograde amnesia with bilateral diencephalic lesions, as well as impairments in judgment, initiative, impulse control, and sequencing tasks to frontal lobe dysfunction.

Question 89

77. The most likely primary progressive dementia to consider when a patient presents with primary symptoms of changes in comportment and language is
    a) Parkinson’s
    b) Huntington’s
    c) Alzheimer’s
    d) Fronto-Temporal Dementia
    e) Primary Progressive Aphasia

Answer 89

d. FTD; comportment means behavior

Question 90

78. When evaluating a child with a Nonverbal Learning Disability (NVLD), you would be most concerned that the child might also have a ____________ Disorder.
    a) Reading
    b) Mathematics
    c) Disorder of Written Expression
    d) Expressive Language

Answer 90

b. Mathematics

Question 91

79. Sex-dependent penetrance (complete in males; incomplete in females); lack of asymmetry in the planum temporale; smaller neurons in the left medial geniculate nucleus (MGN) compared to the right MGN; and possible involvement of chromosome 6 and 15 are findings associated with what developmental disorder:
    a) Asperger’s Disorder
    b) Dyslexia or Reading Disorder
    c) ADHD
    d) Rett’s Disorder

Answer 91

b. Dyslexia or reading disorder

Question 92

80. Item difficulty index (p) is calculated by dividing the number who answered correctly by total number of sample. Items with moderate difficulty level are typically retained. What is the moderate difficulty value of p and why is this value preferred?
    a) p=0.5 which helps maximize differentiation of subjects
    b) p=0.35 which produces a more face valid test
    c) p=0.75 which helps maximize differentiation of subjects
    d) p=1.0 which produces normal distribution of scores

Answer 92

a. p=.05 which helps maximize differentiation of subjects

Question 93

81. Which of the following intervention methods for severe memory disorders involves the prevention of errors during acquisition of information.
    a) Self-Instruction Training
    b) Massed practice
    c) Metacognition Training
    d) Errorless Learning

Answer 93

d. Errorless learning

Question 94

92. Which statistical test is used in experimental designs that are most likely to assess causation?
    a) Chi square
    b) Pearson r
    c) ANCOVA
    d) Discriminate Function Analysis

Answer 94

c. ANCOVA: Analysis of covariance (ANCOVA) is a general linear model which blends ANOVA and regression. ANCOVA evaluates whether population means of a dependent variable (DV) are equal across levels of a categorical independent variable (IV) often called a treatment, while statistically controlling for the effects of other continuous variables that are not of primary interest, known as covariates (CV) or nuisance variables. Mathematically, ANCOVA decomposes the variance in the DV into variance explained by the CV(s), variance explained by the categorical IV, and residual variance. Intuitively, ANCOVA can be thought of as ‘adjusting’ the DV by the group means of the CV(s)

Question 95

83. Optic neuritis is epidemiologically and pathophysiologically related to
    a) AIDS
    b) Multiple Sclerosis
    c) Myasthenia gravis
    d) Meniere’s disease

Answer 95

b. Multiple Sclerosis

Optic neuritis: is an inflammation of the optic nerve.
Optic neuritis is often associated with multiple sclerosis, and can be an early sign of the disease.
Pain and temporary vision loss are common symptoms.
Optic neuritis usually gets better on its own. In some cases, steroid medications are used to reduce inflammation.

Question 96

84. Which of the following behavioral symptoms is not characteristic of diffuse axonal injury?
    a) decreased mental efficiency
    b) decreased complex reasoning ability
    c) decreased receptive vocabulary
    d) decreased ability to perform mental arithmetic

Answer 96

c. decreased receptive vocabulary is not characteristic of diffuse axonal injury.

Diffuse axonal injury is widespread damage to the white matter of the brain that usually results from acceleration/deceleration types of injury. Ischemic brain injury resulting from an insufficient blood supply to the brain, is one of the leading causes of secondary brain damage after head trauma.

Question 97

85. Nuchal rigidity is most likely a sign of which of the following
    a) Subarachnoid hemorrhage
    b) Transtentorial herniation
    c) Communicating hydrocephalus
    d) Epidural hematoma

Answer 97

a. subarachnoid hemorrhage

nuchal rigidity. Definition: impaired neck flexion resulting from muscle spasm (not actual rigidity) of the extensor muscles of the neck; usually attributed to meningeal irritation.

Classic presentation

The central feature of classic SAH is sudden onset of severe headache (thunderclap headache), often described as the “worst headache of my life.” Less severe hemorrhages may cause headache of moderate intensity, neck pain, and nonspecific symptoms. Absence of headache in the setting of a ruptured intracranial aneurysm is rare and probably represents amnesia for the event.
The headache may be accompanied by nausea and/or vomiting from increased ICP and meningeal irritation. Symptoms of meningeal irritation, including nuchal rigidity and pain, back pain, and bilateral leg pain, occur in as many as 80% of patients with SAH but may take several hours to manifest. Photophobia and visual changes are common. Focal neurologic deficits may also occur.
Sudden loss of consciousness (LOC) occurs at the ictus in as many as 45% of patients as intracranial pressure (ICP) exceeds cerebral perfusion pressure. LOC often is transient; however, approximately 10% of patients remain comatose for several days, depending on the location of the aneurysm and the amount of bleeding.
Seizures during the acute phase of SAH occur in 10-25% of patients. Seizures result from the sudden rise in ICP or direct cortical irritation by blood. No correlation exists between the seizure focus and the anatomic site of aneurysm rupture.
A proposed decision rule for diagnosis of SAH focuses on the following 7 characteristics, which are strongly associated with SAH:
Aged 40 years or older
Witnessed loss of consciousness
Complaint of neck pain or stiffness
Onset of manifestations with exertion
Arrival by ambulance
Vomiting
Diastolic blood pressure ≥100 mm Hg or systolic blood pressure ≥160 mm Hg
Should one or more of these be present in a patient with an acute nontraumatic headache reaching maximum intensity within 1 hour, the possibility of SAH hemorrhage should be investigated. [12] On the other hand, it may be possible to consider foregoing investigation in patients with none of these characteristics. [12] This decision rule has not yet been validated. Further study is needed before this approach can be recommended.
Approximately 30-40% of patients are at rest at the time of SAH. Physical or emotional strain, defecation, coitus, and head trauma contribute to varying degrees in the remaining 60-70% of cases.

Question 98

86. All the following are true except:
    a) All valid tests are reliable.
    b) The area under the curve (AUC) of an ROC curve reveals the overall accuracy of a test.
    c) All reliable tests are valid.
    d) The positive likelihood ratio reveals the likelihood a test-positive patient actually has the condition.

Answer 98

c. All reliable tests are valid; this is NOT true!

Question 99

87. The cognitive profile of depressed patients is characterized by:
    a) Slowed mental processing and mild attentional problems
    b) Visual-spatial deficits
    c) Mild word-finding difficulties and poor memory recognition
    d) Lack of awareness of their cognitive difficulties

Answer 99

a. Slowed mental processing and mild attentional problems

Question 100

98. What is ventriculomegaly?
    a) Atypically developed ventricles associated with migrational disorders
    b) Attenuation of cerebral white matter surrounding the ventricles
    c) Compressed ventricles associated with mass lesions in the cranium
    d) Ventricular enlargement with or without hydrocephalus

Answer 100

d. Ventricular enlarement with or without hydrocephalus

Question 101

89. Which of the following statements is false regarding Transient Global Amnesia (TGA)?
    a) It involves an acute onset of retrograde and anterograde amnesia with no obvious cause
    b) It is commonly accompanied by right hemiplegia
    c) Following one episode of TGA, there is a low likelihood of subsequent episodes
    d) During an episode of TGA, an individual typically asks the same question over and over.

Answer 101

b. It is commonly accompanied by right hemiplegia.

Question 102

90. Tourette’s Syndrome is most commonly associated with deficits in _________ .
    a) olfaction
    b) auditory memory
    c) language
    d) attention

Answer 102

d. Attention

Question 103

91. The telencephalon includes:
    a) The prosencephalon and the diencephalon
    b) The thalamus and cerebral cortex
    c) The entire forebrain
    d) The cerebral cortex, subcortical white matter, and basal ganglia

Answer 103

d. Telencephalon: The cerebral cortex, subcortical white matter, and basal ganglia

Question 104

92. Which statistical test is used in experimental designs that are most likely to assess causation?
    a) Chi square
    b) Pearson r
    c) ANCOVA
    d) Discriminate Function Analysis

Answer 104

c. ANCOVA:

Question 105

93. Alexia without agraphia can be associated with a __________, if ___________ is also affected
    a) Right PCA infarct, angular gyrus
    b) Left PCA infarct, splenium of corpus callosum
    c) Left MCA infarct, angular gyrus
    d) Left ACA infarct, splenium of corpus callosum

Answer 105

B. Left PCA infarct, splenium of corpus callosum

Question 106

94. Which of the following statements about febrile seizures is false?
    a) Febrile seizures occur in about 3-4% of children
    b) One simple febrile seizure is not associated with increased risk for epilepsy
    c) If one has a single febrile seizure, a second febrile seizure is likely to occur within one year.
    d) Complex febrile seizures last longer than 15 minutes and may have focal features.

Answer 106

c. If one has a single febrile seizure, a second febrile seizure is likely to occur within one year.

Children aged 3 months to 5 or 6 years may have tonic-clonic seizures when they have a high fever. These are called febrile seizures (pronounced FEB-rile) and occur in 2% to 5% of all children. There is a slight tendency for them to run in families. If a child’s parents, brothers or sisters, or other close relatives have had febrile seizures, the child is a bit more likely to have them.
Sometimes the seizure comes “out of the blue.” A fever may begin silently in a previously healthy child and a seizure can be the first sign that alerts the family that the child is ill.

Question 107

95. When both amygdale have been ablated, the result is usually
    a) Emotional hyperactivity
    b) Decreased oral tendencies
    c) Loss of normal fear
    d) Hyposexualism

Answer 107

c. Loss of normal fear

Question 108

96. Which of the following statements is false regarding delirium?
    a) Delirium refers to a disturbance of consciousness that is accompanied by a change in cognition
    b) Disorientation to time and place are not commonly associated with delirium.
    c) Delirium is most common in children and the elderly.
    d) Symptoms of delirium typically develop very rapidly and fluctuate throughout the day.

Answer 108

b. Disorientation to time and place are not commonly associated with delirium.

Question 109

97. Papez’s circuit is a heuristic device to describe:
    a) Disorders of speech
    b) Disorders of emotion
    c) Disorders of reading
    d) Disorders of vision

Answer 109

b. Disorders of emotion

Papez’s circuit: The Papez circuit (or medial limbic circuit) (pronounced /peɪpz/.[1][2][3]), is a neural circuit for the control of emotional expression. In 1937, James Papez proposed that the circuit connecting the hypothalamus to the limbic lobe was the basis for emotional experiences. Paul D. MacLean reconceptualized Papez’s proposal and coined the term limbic system. MacLean redefined the circuit as the “visceral brain” which consisted of the limbic lobe and its major connections in the forebrain – hypothalamus, amygdala, and septum. Over time, the concept of a forebrain circuit for the control of emotional expression has been modified to include the prefrontal cortex.

Recent studies show that it has a more significant role in memory functions than in emotions. Some of the structures that Papez originally described such as the hippocampus now appear to have little to do with emotional behavior.

Question 110

99. One of the reasons Parkinson’s disease patients do not show symptoms of the disease until they have lost most of their dopamine-containing axons from the substantia nigra is that:
    a) the remaining cells gradually begin to produce serotonin instead, which is much more potent than dopamine
    b) all of the cell loss occurs in a very brief (less than one week) period of time
    c) the receptors on the relevant postsynaptic membranes develop denervation supersensitivity.
    d) the caudate nucleus gradually takes over the functions of the substantia nigra.

Answer 110

c. The receptors on the relevant postsynaptic membranes develop denervation supersensitivity.

Question 111

100. People born without a corpus callosum (i.e., agenesis of the corpus callosum)
     a) cannot verbally describe an object in their left hand if they cannot see it
     b) are exceptionally skilled at motor tasks involving their hands.
     c) show a general impairment in language abilities.
     d) are (in terms of behavior) virtually indistinguishable from people born with a corpus callosum.

Answer 111

d. Are (in terms of behavior) virtually indistinguishable from people born with a corpus callosum.