Mock Exam - 2 - BRAIN Website Flashcards
In general, which of the following treatments used for childhood brain tumors is associated with the poorest long-term neuro-cognitive outcomes?
a) corticosteroids
b) chemotherapies
c) whole brain radiation
d) posterior fossa surgical resection
c) whole brain radiation
Whole brain radiation has been shown to have a significant adverse effect on overall IQ, processing speed and attention, due to white matter changes. These long-term cognitive effects are more pronounced in girls and are related to the radiation dose, total area of the brain radiated, and age at treatment.
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
d) The hippocampus is required for retrieval of remote memories
The hippocampus is involved in the formation of memories, not the retrieval.
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
d) Language skills are acquired at a faster rate relative to other motor or cognitive skills in Down’s Syndrome
See Handbook of Neurodevelopmental and Genetic Disorders in Children (Chapter on Downs Syndrome, Actually language skills are acquired at a slower rate)
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.
b) You must provide Mr. Jones with an explanation of the assessment, consider his preferences and best interest, and obtain his assent.
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%
a) 64%
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
d) Prosody, right
In normal language lateralization, prosody can be localized to the right hemisphere.
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
a) increases
“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
b) Content validity
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
c) the base rate is moderate
Folate supplementation during pregnancy is recommended to prevent:
a) Childhood Onset Epilepsy
b) Neural Tube Defects
c) Mitochondrial Disorders
d) Down’s Syndrome
b) Neural Tube Defects
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
c) ADHD is a clinically-based diagnosis
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’)
b) Deficits in simple calculations presented auditorally (e.g., 2 + 2 = 5)
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
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. Kolb and Whishaw, Fundamentals of Human Neuropsychology – Fifth Edition, 2003, page 663).
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
c) Associative agnosia
- Apperceptive agnosia involves a failure in perceptual processing of the stimuli, and therefore can not copy stimuli.
- Associative agnosia involves a failure in object identification despite preserved ability to copy and even match stimuli. It often co-occurs with prosopagnosia.
- 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.
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
a) sensitivity, specificity
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
a) Cerebellum, brain stem, and temporal lobes
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
b) Left middle cerebral artery (MCA) occlusion
The distribution of weakness (face and arm, sparing the leg) and Broca 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.
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
d) Can be done provided that alternative procedures are not feasible
In determining suspicious effort, which should be ruled out?
a) Factitious Disorder
b) Somatoform Disorder
c) Psychotic Disorder
d) All of the above
d) All of the above
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
b) Difficulty acquiring rapid, context-free word-reading skill
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
a) Reduced volumes in dominant hemisphere perisylvian areas
What feature of ADHD is typically not seen in NVLD?
a) Inattention
b) Hyperactivity
c) Impulsivity
d) Executive Dysfunction
b) Hyperactivity
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
d) psychogenic amnesia
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
b) Stable traits, such as aptitude
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
d) 19
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
a) Caudate and Putamen
Of the WAIS factor scores, _____ is least sensitive to neuropsychiatric disorders:
a) POI
b) VCI
c) WMI
d) PSI
b) VCI
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
d) depression and hallucinations are more common in DLB patients while delusions are more common in AD patients
One of the key features distinguishing Dementia with Lewy Bodies (DLB) from Parkinson’s Dementia is the visual hallucinations seen in DLB. Alzheimer’s patients typically have delusions rather than actual hallucinations.
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
a) Test of Memory
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
d) Largest for Perceptual Organization and smallest for Working Memory
In which conditions are confabulations not found?
a) Anton’s syndrome
b) Gerstmann’s syndrome
c) Anosognosia
d) Wernicke-Korsakoff syndrome
b) Gerstmann’s syndrome
- Gerstman’s syndrome is a controversial entity that consists of right-left confusion, dyslexia, dyscalculia, and finger agnosia. It is usually attributed to lesions in the dominant angular gyrus.
- In Anton’s syndrome (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.
- Anosognoia (failure to acknowledge a deficit, usually left side hemiparesis) is often accompanied by confabulation, denial, and “other defense mechanisms” (clearly written by a psychiatrist).
- According to Kaufmann, the confabulations in Wernicke-Korsakoff are an uncommon symptom, unless the patients also have marked memory impairments.
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.
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.
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.
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.
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.
In which disorder(s) is echolalia a symptom?
a) Autism
b) Isolation aphasia
c) Tourette’s syndrome
d) All of the above
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.
Note: Mixed transcortical aphasia is the least common of the three transcortical aphasias (behind transcortical motor aphasia and transcortical sensory aphasia, respectively). This type of aphasia can also be referred to as “Isolation Aphasia”. This type of aphasia is a result of damage that isolates the language areas (Broca’s, Wernicke’s, and the arcuate fasciculus) from other brain regions. Broca’s, Wernicke’s, and the arcuate fasiculus are left intact; however, they are isolated from other brain regions.
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
b) Delayed language development
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.
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.
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
c) negative predictive power
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
d) All of the above
A& F 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.
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
a) Right homonymous hemianopsia and hemianesthesia
The answer is a) for most patients; however, PCA may supply the thalamus and also result in hemianesthesia. Alexia without agraphia may result
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
b) Artery-to-artery embolism involving carotid and ophthalmic arteries
This TIA is known as “amaurosis fugax” due to carotid atherosclerotic disease. This causes 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.
