Mock Exam - 3 - BRAIN Website

Question 1

Percentiles are __________ transformations of raw z-scores, t-scores, and IQ scores.

a) Non-linear
b) Linear
c) Absolute
d) Sampled

Answer 1

a) Non-linear

Percentiles are non-linear transformations unlike the other choices. That is, the amount of raw score difference between 55%-60% does not necessarily represent the same amount of raw score difference as between 94%-99%.

Question 2

In the Circle of Willis, the anterior communicating artery bridges:

a) The anterior cerebral artery to the middle cerebral artery
b) The left anterior cerebral artery to the right anterior cerebral artery
c) The basilar artery to the anterior cerebral artery
d) The carotid artery to the anterior cerebral artery

Answer 2

b) The left anterior cerebral artery to the right anterior cerebral artery

Question 3

In comparing Alzheimer’s Disease (AD) patients to Dementia with Lewy Bodies (DLB) patients during the mild dementia period, 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 3

d) depression and hallucinations are more common in DLB patients while delusions are more common in AD patients

One of the key early 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, but may develop hallucinations as the disease progresses.

Question 4

According to Posner & Peterson’s model of attention; the posterior attention system is responsible for _______________ whereas the anterior attention system is associated with ____________________:

a) Signal detection / orienting and awareness of environment
b) Disengagement of attention / shifting of attention
c) Orienting and awareness of environment / signal detection
d) Shifting of attention / disengagement of attention

Answer 4

c) Orienting and awareness of environment / signal detection

p. 858 – Blumenfeld

Question 5

The most common neurologic manifestation of HIV is:

a) multifocal leukoencephalopathy characterized by loss of strength in a limb
b) toxoplasmosis-related seizures, altered mentation and aseptic meningitis
c) emotional lability and delirium associated with HIV-associated dementia
d) all of the above

Answer 5

c) emotional lability and delirium associated with HIV-associated dementia

Question 6

A 32-year-old patient who does significantly worse on neuropsychological testing than he is capable of because he wants sympathy for his difficulties following a TBI is:

a) Showing a positive response bias
b) Malingering
c) Experiencing a Major Depressive Episode
d) Exhibiting a Factitious disorder

Answer 6

d) Exhibiting a Factitious disorder

This question concerns effort on testing. Malingering is intentional and motivated by an external reward. He is demonstrating a negative response bias but not a positive one. While he could be depressed, there is no evidence either way. Factitious disorder is behavior motivated by an intrinsic reward such as assuming the sick role.

Question 7

Which is false?

a) The Standard Error of Measurement is inversely related to the reliability of the test
b) There is a single Standard Error of Measurement for a test score, regardless of the level of performance.
c) The standard deviation of the sample must be known to calculate the Standard Error of Measurement
d) Confidence intervals based on the Standard Error of Measurement assume error distributions are normally distributed and homoscedastic.

Answer 7

b) There is a single Standard Error of Measurement for a test score, regardless of the level of performance.

Question 8

Which of the following is considered the classic indication of normal pressure hydrocephalus?

a) Headache worse in the evening
b) Cushing’s Triad (hypertension, bradycardia, irregular respirations)
c) Diplopia, attentional problems
d) Dementia/mental decline, gait difficulties, urinary incontinence

Answer 8

d) Dementia/mental decline, gait difficulties, urinary incontinence

While answer B is indicative of increased intracranial pressure, D is the classic signs of normal pressure hydrocephalus. Answer C could also be increased intracranial pressure but answer A would not indicate increased intracranial pressure, a headache in the morning would.

Question 9

The amygdale have been consistently identified as playing a crucial role in:

a) The perception of emotional cues
b) The production of emotional responses
c) Neither A nor B
d) A & B

Answer 9

d) A & B

Question 10

Which of the following differentiates diencephalic amnesia from bilateral temporal lobe amnesia?

a) Rate of forgetting
b) Pattern of retrograde amnesia
c) Autobiographic memory
d) Temporal ordering impairment

Answer 10

d) Temporal ordering impairment

Question 11

The striatum receives most of its blood supply from the?

a) Superior cerebellar artery
b) Middle cerebral artery
c) Lenticulostriate arteries
d) Both b and c

Answer 11

d) Both b and c

Question 12

Statistical significance is:

a) The likelihood that the dependent variable caused the effect in the independent variable due to non-chance differences
b) The practical value or importance of the effect or intervention
c) The extent to which an investigation can detect a difference when a difference exists
d) A direct function of sample size

Answer 12

d) A direct function of sample size

Answer B is the definition of clinical significance, answer C is the power, and answer A is incorrect as the independent variable exerts the effect on the dependent variable.

Question 13

The Geshwind-Galaburda Theory proposes that embryonic surges of testosterone delay the development of which hemisphere in males?

a) Left
b) Right
c) Both
d) Neither, only the diencephalon

Answer 13

a) Left

This theory regards the observed sex differences between males and females on neuropsychological testing: that males are better at spatial tasks and females are better at language related tasks.

Question 14

If you placed a common object such as a key or pencil in the left hand of a typical commissurotomy patient, out of sight of the person, they:

a) Could find a similar object with their other hand
b) Could not feel the object
c) Could identify the object verbally
d) Could recognize the object, but not call out its name

Answer 14

d) Could recognize the object, but not call out its name

The hemispheres cannot communicate in these patients, making one hand unaware of what the other is doing. And only input to the left hemisphere (i.e. the right hand) would allow verbal naming.

Question 15

A patient presents with the chief complaint he is having trouble concentrating. He is not having any interpersonal difficulty with his co-workers or significant other. However, he displays irritable mood and distractibility, feels like his thoughts are racing, feels rested after only 3 hours of sleep, and talks non-stop. Drug testing is negative. The most likely diagnosis is:

a) Major Depressive Disorder
b) Bipolar II
c) Bipolar I
d) Primary Insomnia

Answer 15

b) Bipolar II

Racing thoughts and pressured speech make a depressive diagnosis and insomnia less likely choices. And the described symptoms are more consistent with hypomania than mania as he is not experiencing clinically significant distress or impairment in social or occupational settings.

Question 16

A patient with cortical blindness:

a) May be able to insert an envelope into a slot
b) Will always be aware of their deficit
c) Will report the world seems drained of color
d) Has intact portions of the retinotopic map in the primary visual cortex

Answer 16

a) May be able to insert an envelope into a slot

Patients with cortical blindness may have blindsight in which they still have some perception outside of conscious awareness. They can have anosognosia as in Anton’s syndrome and be unaware of their deficit. Answer C describes achromatposia and Answer D is incorrect as cortical blindness results from total destruction of the primary visual cortex.

Question 17

A patient who can not speak fluently but can comprehend and repeat phrases has:

a) Broca’s aphasia
b) Wernicke’s aphasia
c) Transcortical motor aphasia
d) Transcortical mixed aphasia

Answer 17

c) Transcortical motor aphasia

Question 18

Which of the following characteristics most reliably distinguishes vascular dementia from Alzheimer’s dementia?

a) Stepwise development
b) MRI that shows atrophy
c) Encoding rather than consolidation deficits on memory testing
d) Focal neurological findings and the presence of either diffuse or focal cognitive findings

Answer 18

d) Focal neurological findings and the presence of either diffuse or focal cognitive findings

While stepwise progression is associated with vascular or multi-infarct dementia, it is not a reliable distinction. MRI in vascular dementia may show infarcts but atrophy is not specific to this disease process. Consolidation deficits on memory testing are indicative of AD but encoding deficits are not considered indicative of vascular dementia. In fact, memory performance on testing is often better than seen in AD. (Lezak, Neuropsychological Assessment)

Question 19

Lesions causing achromatopsia often cause what other disorder?

a) Palinopsia
b) Alexia with agraphia
c) Prosopagnosia
d) Color anomia

Answer 19

c) Prosopagnosia

Both achromatopsia and prospognosia are caused by lesions on the fusiform gyrus of the occipitotemporal cortex.

Question 20

Which thalamic nuclei is part of the visual pathway?

a) Dorsomedial nuclei
b) Lateral geniculate nucleus
c) Medial geniculate nucleus
d) Lateral Posterior

Answer 20

b) Lateral geniculate nucleus

Question 21

Dr. X conducts neuropsychological screening assessments to ensure that elderly patients who are candidates for a particular treatment are not showing signs of dementia. In order to increase the _______ of her tests, Dr. X uses ethnically-adjusted cut-offs for patients from ethnic minority groups.

a) sensitivity
b) positive predictive value
c) specificity
d) reliability

Answer 21

c) specificity

Question 22

Difficulty recalling events following an injury is called ________________, while difficulty recalling previously learned information because learning new information interfered is called __________________.

a) Retrograde amnesia; retroactive interference
b) Retrograde amnesia; proactive interference
c) Anterograde amnesia; retroactive interference
d) Anterograde amnesia; proactive interference

Answer 22

c) Anterograde amnesia; retroactive interference

Question 23

Which diffuse modulatory system neurotransmitter to nuclei pairing is incorrect?

a) Basal Nucleus of Meynert and acetylcholine
b) Raphe Nuceli and serotonin
c) Locus Coeruleus and epinephrine
d) Ventral Tegmental Area and dopamine

Answer 23

c) Locus Coeruleus and epinephrine

The Locus Coeruleus cells release norepinephrine to virtually all parts of the brain. If you answered D, remember Dopamine is produced both in the substantia nigra and the ventral tegmental area.

Question 24

The ________ pathway is involved with the visual perception of where objects are and the ________ pathway is involved with the visual analysis of what objects are.

a) Ventral, dorsal
b) Dorsal, ventral
c) Rostral, caudal
d) Caudal, ventral

Answer 24

b) Dorsal, ventral

Question 25

All of the following are true about Locked-in Syndrome except:

a) It is typically a ventral pons lesion affecting bilateral corticospinal and corticobulbar tracts
b) Vertical eye movements and eye openings are spared
c) Spinal cord and cranial nerve receive no input from cortex
d) Pontine infarcts initially result in dysarthria and clumsy-hand syndrome

Answer 25

d) Pontine infarcts initially result in dysarthria and clumsy-hand syndrome

A paramedian pontine infarct can cause dysarthria and clumsy-hand syndrome that affects the contralateral arm. However, this is not part of Locked-In Syndrome. Locked-In Syndrome is a near coma state where communication is possible through eye blinks.

Question 26

A lesion in the cerebellum will cause ________ upper extremity tremor.

a) Ipsilateral
b) Contralateral
c) Bilateral
d) No

Answer 26

a) Ipsilateral

Cerebellar circuits decussate twice before reaching the lower motor neurons. Therefore, each side of the cerebellum controls the same side of the body, not the opposite side. Answer D, incidentally, is caused by a lesion of the posterior column and involves loss of joint position sense, which cerebellar lesions do not.

Question 27

Which of the following statements is true regarding the longitudinal course of neurocognitive impairments in individuals with schizophrenia?

a) Cognitive functioning, particularly verbal skills, declines following the first psychotic break.
b) Measureable cognitive deficits, most often in attention, are seen prior to the first psychotic break.
c) Cognitive functioning, particularly executive functions, improves following initiation of anti-psychotic medication.
d) Neurocognitive functioning progressively declines throughout the adult years and is correlated with positive psychotic symptoms.

Answer 27

b) Measureable cognitive deficits, most often in attention, are seen prior to the first psychotic break.

Question 28

All aphasias involve which of the following?

a) Conduit’ d’ approche
b) Ideomotor apraxia
c) Anomia
d) Contralateral hemiparesis

Answer 28

c) Anomia

Conduit’ d’ approche is increasingly closer phonological approximations of a word. The correct answer, anomia, is present to some degree in every aphasia.

Question 29

Which of the following is not a correctly defined subtype of Math Disorder:

a) Difficulty performing operations is anarithmetria
b) A deficit in knowledge of concepts is acalculia with verbal deficits
c) Difficulty organizing and manipulating numbers spatially is spatial dyscalculia
d) A deficit in attention causing numbers to be copied down incorrectly or neglect of operational signs (e.g. + or -) is sensory neglect.

Answer 29

d) A deficit in attention causing numbers to be copied down incorrectly or neglect of operational signs (e.g. + or -) is sensory neglect.

While inattention may be a cause of math disorder as defined in the DSM-IV, sensory neglect typically refers to a right parietal lesion symptom in which material in one visual field, usually the left, is ignored unless attention is drawn to it.

Question 30

Atrophy associated with normal aging generally reflects a loss of:

a. Myelin
b. Grey matter in the striatum and thalamus
c. Neurons in the primary visual cortex
d. Neurons in the frontal lobes

Answer 30

a. Myelin

Question 31

Recognizing a friend is a kind of __________ memory.

a) Implicit
b) Semantic
c) Autobiographical
d) Episodic

Answer 31

b) Semantic

Recognizing a friend is best thought of as a type of semantic memory, which is knowledge acquired during one’s lifetime (Kolb and Wishaw, 2003). Tulving considered all knowledge which was not autobiographical to be semantic knowledge. Episodic memory is singular events a person recalls and is the other type of explicit memory besides semantic. Implicit memory unconscious and nonintentional.

Question 32

A 70 year old man who has normal physical function and is still successfully running a small business, believes that the President of the United States’ wife (whom he has never met) is in love with him. He has been questioned by the Secret Service following repeated attempts to contact the First Lady. His most likely diagnosis would be:

a) Folie a Deux (Shared Psychotic Disorder)
b) Schizophrenia, Continuous
c) Delusional Disorder, Erotomanic Type
d) Dementia of the Alzheimer’s Type

Answer 32

c) Delusional Disorder, Erotomanic Type

While both Schizophrenia and dementia are a possibility, the fact he is still managing a small business suggests he does not have the other impairments that accompany those illnesses. When behavior is not markedly odd or impaired outside of nonbizarre delusions, delusional disorder is the appropriate choice. The First Lady would have to be psychotic and delusional, as well, for a diagnosis of Shared Psychotic Disorder.

Question 33

The Papez circuit refers to:

a) Neuroanatomical structures involved in aggression, including the septum, diagonal band of Broca, and insula.
b) The Long Term Potentiation pathway in the Hippocampus, including CA1 through CA3
c) Neuroanatomical structures involved in olfaction, including the olfactory bulb, olfactory tract, uncus and amygdala.
d) Neuroanatomical structures involved in emotion and memory, including hippocampus, cingulate, mamillary bodies, fimbria, and insula.

Answer 33

d) Neuroanatomical structures involved in emotion and memory, including hippocampus, cingulate, mamillary bodies, fimbria, and insula.

Question 34

In reviewing a patient’s medical records prior to an assessment you notice that the patient is reported to have a deficit of the first cranial nerve (CN I). You expect the patient to:

a) Perform poorly on tests requiring visual scanning and also have difficulty in recognizing friends’ voices
b) Perform poorly on the Smell Identification Test, and also have difficulty with impulse control
c) Perform poorly on tests involving auditorily-presented information and also have difficulty in recognizing friends’ voices
d) Perform poorly on the Smell Identification Test, and also have agraphesthesia

Answer 34

b) Perform poorly on the Smell Identification Test, and also have difficulty with impulse control

Question 35

Which of the following is not a benefit of computerized neuropsychological testing:

a) Increased consistency of administration procedures
b) Greater precision in measuring reaction times
c) Decreased need for clinical interpretation
d) Automated data collection and storage

Answer 35

c) Decreased need for clinical interpretation

Question 36

You are designing a longitudinal study of neuropsychological outcomes in normal adults utilizing the same test battery for 4 assessments over a 4 year span. Which of the following statements is most true regarding practice effects:

a) An equal improvement in the test scores across the four assessments is expected, due to practice effects.
b) The greatest improvement in test scores due to practice effects will be evident between the first and second assessments.
c) The greatest improvement in test scores due to practice effects will be evident between the third and fourth assessments.
d) Practice effects are unlikely if the assessments are at least one year apart.

Answer 36

b) The greatest improvement in test scores due to practice effects will be evident between the first and second assessments.

Question 37

A child is tested in 2003 with the WISC-3, yielding a Full Scale IQ of 97. A year later, he receives the WISC-4, yielding a full scale IQ of 93. Which of the following best explains the difference in scores?

a) Practice effect
b) Flynn effect
c) Standard error of measurement
d) Statistical regression to the mean

Answer 37

b) Flynn effect

Question 38

Deficits in which of the following cognitive domains is most commonly seen in early deterioration of children with x-linked adrenoleukodystrophy:

a) Memory encoding and retention
b) Language articulation
c) Visual-perception
d) Phonetic decoding

Answer 38

c) Visual-perception

This is a neurodegenerative condition seen in children that typically involves cerebral demyelination. Cognitive dysfunction is generally correlated with the extent of white matter changes on MRI. Hematopoetic stem cell transplant is the most effective treatment. Visual-spatial functioning is an excellent predictor of neurocognitive function after stem cell transplant for cerebral X-ALD. See work of Elsa Shapiro; Cox et al (2006), Archives of Neurology, 63; 69-73.

Question 39

You receive a referral to assess a 73 year old widowed man with symptoms of emotional changes and significant lability, worsening memory, and difficulty completing the tasks of everyday living without assistance from his 43 year old daughter who does not live in the home. The daughter is aware of this referral. The best way to proceed in completing this assessment would be:

a) Assess this man alone, as he is above the age of consent and currently living independently
b) Ask his daughter to attend the assessment, to provide consent for assessment if decisional capacity is in question
c) Ask his daughter to attend the assessment to ensure this man keeps his appointment
d) Assess this man alone as there is no indication that his capacity is impaired

Answer 39

b) Ask his daughter to attend the assessment, to provide consent for assessment if decisional capacity is in question

Question 40

The concept of cognitive reserve has been used to explain the fact that across individuals, there is not a direct relationship between brain pathology or damage and the degree of disruption in performance. Which of the following variables should not be used as a proxy for cognitive reserve:

a) Education level
b) Scores on the NART word reading test
c) Scores on a Digit-Symbol coding test
d) WAIS Vocabulary subtest

Answer 40

c) Scores on a Digit-Symbol coding test

Question 41

Cognitive functioning in multiple sclerosis (MS) is characterized by:

a) Subcortical and frontal dysfunction
b) Preserved executive functioning
c) Strengths in processing speed and working memory
d) Impaired immediate auditory attention span

Answer 41

a) Subcortical and frontal dysfunction

Question 42

The limbic system is important for _ _ , which involves this key structure ___:

a) Homeostasis; hypothalamus
b) Olfaction; orbital frontal cortex
c) Memory; cingulate gyrus
d) Emotions and drives; hippocampal formation

Answer 42

a) Homeostasis; hypothalamus

Question 43

Procedural memory is often associated with the

a) Basal ganglia
b) Cerebellum
c) Motor cortex
d) All of the above

Answer 43

d) All of the above

Question 44

In patients in the early stages of Alzheimer’s disease, WAIS profiles usually show:

a) Block Design is higher than Vocabulary
b) High scores are obtained on Information, Vocabulary, and Comprehension
c) High scores are obtained on digit symbol and digits backward
d) Low scores are obtained on similarities and digits forward

Answer 44

b) High scores are obtained on Information, Vocabulary, and Comprehension

Question 45

Compared to patients with depression, those with dementia of the Alzheimer’s subtype typically

a) Suffer vegetative symptoms such as loss of appetite, disturbed sleep and constipation
b) Display intact structure and content of speech
c) Have signs of aphasia, ataxia, or agnosia
d) May display careless drawings and construction, but improve given extra time and encouragement

Answer 45

c) Have signs of aphasia, ataxia, or agnosia

Question 46

In Lewy Body Dementia, all of the following are true except

a) Level of arousal fluctuates throughout the day
b) Visual hallucinations are common
c) Parkinsonian type symptoms are noted, but are not often responsive to l-dopa
d) Lewy bodies are found in the basal ganglia

Answer 46

d) Lewy bodies are found in the basal ganglia

Question 47

This disorder is characterized by parkinsonian symptoms, psychosis, and hepatic
dysfunction:

a) Progressive supranuclear palsy (PSP)
b) Wilson’s disease
c) Shy Drager syndrome
d) Olivopontocerebellary atrophy

Answer 47

b) Wilson’s disease

Question 48

Supplementary motor area partial seizures often include:

a) Vertigo, contralateral numbness, tingling, burning, sensation of movement,
aphasia/hemineglect, eyes/head deviate
b) Fencing posture with extension of contralateral upper extremity, tonic posturing, speech arrest and unusual sounds
c) Elaborate motor automatism, making unusual sounds,autonomic changes, olfactory hallucinations, and incontinence
d) Visual hallucinations, or seeing flashes/lights, scotoma/hemianopia in contralateral visual field, nystagmoid/oculogyric jerks, eye blinking

Answer 48

b) Fencing posture with extension of contralateral upper extremity, tonic posturing, speech arrest and unusual sounds

Question 49

When asked to demonstrate how to use scissors, a patient with this type of apraxia may open and close their index and middle fingers to represent the scissors:

a) Ideomotor
b) Ideational
c) Limb-kinetic
d) Constructional

Answer 49

a) Ideomotor

Question 50

The dorsolateral frontal cortex is important for:

a) Arousal and activation
b) Spatial selective attention
c) Response initiation, inhibition
d) Sequencing, persistence, switching

Answer 50

d) Sequencing, persistence, switching

Question 51

Which of the following statements is true regarding the use of deep brain stimulation for Parkinson’s Disease:

a) It is highly effective in treating rigidity, but can negatively impact processing speed and executive functioning
b) It is highly effective in improving apathy associated with Parkinson’s Disease
c) It is highly effective in improving executive functioning
d) It is not effective in reducing tremor

Answer 51

a) It is highly effective in treating rigidity, but can negatively impact processing speed and executive functioning

Question 52

You work in a hospital setting with a medical population. Which of the following statements about the use of symptom validity testing is true?

a) Patients should be told the names of the symptom validity tests that were used during the assessment.
b) Based on failure of one or more symptom validity tests, you can safely conclude that your client is malingering.
c) Alerting your client that symptom validity testing will be used in the assessment has been shown to routinely improve effort on testing.
d) It is appropriate to warn clients that methods for detecting exaggeration and poor effort are part of the assessment process.

Answer 52

d) It is appropriate to warn clients that methods for detecting exaggeration and poor effort are part of the assessment process.

Question 53

The most consistent neuropsychological deficit seen in Childhood Absence Epilepsy is:

a) Verbal Memory Deficits
b) Visual Memory Deficits
c) Language Deficits
d) Global Cognitive Delays (i.e., mental retardation)

Answer 53

b) Visual Memory Deficits

Question 54

The initial symptom seen in children with Landau-Kleffner Syndrome is typically:

a) Loss of social contact
b) Intention Tremor
c) Auditory Agnosia
d) Constructional Apraxia

Answer 54

c) Auditory Agnosia

Question 55

The most frequently reported symptom in individuals with Multiple Sclerosis is:

a) Memory Impairment
b) Attention/processing speed deficits
c) Headache
d) Fatigue

Answer 55

d) Fatigue

Question 56

Which Multiple Sclerosis Subtype is typically associated with the LEAST cognitive impairment?

a) Relapsing Remitting
b) Secondary Progressive
c) Primary Progressive
d) None of the above have associated cognitive deficits

Answer 56

a) Relapsing Remitting

Question 57

Which neurocutaneous syndrome is associated with reduced intelligence, optic pathway gliomas, and an overall decrease of high signal intensity lesions on T2 weighted MRI with increasing age:

a) Neurofibromatosis – Type 1
b) Sturge-Weber syndrome
c) Neurofibromatosis – Type 2
d) Tuberous Sclerosis

Answer 57

a) Neurofibromatosis – Type 1

Question 58

Which class of medications boasts the best support for treatment of executive dysfunction and problems with sustained attention?

a) Benzodiazepines, such as Klonopin
b) Selective Serotonin Reuptake Inhibitors (SSRI’s), such as Prozac
c) alpha-2a adrenergic agonists, such as guanfacine
d) Stimulants, such as methylphenidate

Answer 58

d) Stimulants, such as methylphenidate

Question 59

What is a potential problem in attempting to use the Glasgow Coma Scale (GCS) in the diagnosis of mild Traumatic Brain Injury?

a) A ceiling effect
b) A floor effect
c) An age effect
d) A practice effect

Answer 59

a) A ceiling effect

Question 60

Which of the following is NOT a feature of somatization disorder?

a) Symptoms involve multiple organ systems
b) Early onset and chronic course of physical symptoms, regardless of mood state
c) Symptoms are not intentionally produced or feigned.
d) Preoccupation with fears of having a specific disease

Answer 60

d) Preoccupation with fears of having a specific disease

Question 61

A 25 year old, right handed female patient is referred to you for a baseline neuropsychological assessment with concerns because her 56 year old father was recently diagnosed with Huntington’s disease. She discusses genetic testing with you, specifically for the IT -15 gene. You should counsel the following in her consideration whether or not to participate in genetic counseling.

a) Every biological son or daughter born to a parent with HD has a 50 percent chance of inheriting the disease
b) Paternal transmission increases the risk of inheritance for females to approximately 60 percent.
c) She should request a different test because the IT-15 gene is not associated with HD
d) She should not worry as HD is inherited through maternal transmission only.

Answer 61

a) Every biological son or daughter born to a parent with HD has a 50 percent chance of inheriting the disease

Question 62

Which of the following neurodevelopmental disorders is characterized by short stature, webbed neck, ptosis, hypertelorism, low set ears, high arched palate, low set ears, generally lowered IQ but relatively preserved verbal skills, and is found among girls and boys?

a) Noonan syndrome
b) Turner syndrome
c) Williams syndrome
d) Marfan’s syndrome

Answer 62

a) Noonan syndrome

Question 63

In your clinical practice, you receive a referral for neuropsychological assessment of a 20 year old female with Systemic Lupus Erythematosus (SLE) who is complaining of memory and attention difficulties that are affecting her performance at work. The patient smokes marijuana daily and has done so for 3-4 years. Which is the best course of action in this situation:

a) Conduct the neuropsychological assessment as you normally would. There are no cognitive effects associated with marijuana use.
b) Conduct a neuropsychological assessment but be sure to include effort tests in your test battery.
c) Conduct the neuropsychological assessment to address the referral question, requesting that the patient not use marijuana on the day of the assessment.
d) Conduct the neuropsychological assessment to address the referral question, only if the patient is able to abstain from marijuana use for 30 days prior to testing.

Answer 63

d) Conduct the neuropsychological assessment to address the referral question, only if the patient is able to abstain from marijuana use for 30 days prior to testing.

Question 64

What distinguishes PD from atypical parkinsonism?

a) Atypical parkinsonism is not associated with bradykinesia
b) Symptoms are bilateral and symmetrical in PD but asymmetrical in atypical parkinsonism
c) Atypical parkinsonism is associated with both resting and postural tremor
d) PD responds to levodopa whereas atypical parkinsonism does not.

Answer 64

d) PD responds to levodopa whereas atypical parkinsonism does not.

Question 65

Symptoms of hydrocephalus include all but which of the following:

a) Headache, nausea, vomiting
b) Cognitive impairment
c) Papilledema, decreased vision
d) 10th nerve palsies

Answer 65

d) 10th nerve palsies

Question 66

The following statements about Alzheimer’s disease and Pick’s disease are true, except:

a) Both are characterized by amyloid plaques and neurofibrillary tangles
b) Both involve cortical atrophy
c) Both are associated with aphasic deficits
d) Medial temporal regions are more extensively affected in Alzheimer’s than Pick’s

Answer 66

a) Both are characterized by amyloid plaques and neurofibrillary tangles

Question 67

Which of the following is typically preserved in early Alzheimer’s disease?

a) Word finding
b) Visual-spatial and constructional abilities
c) Recognition memory
d) Behaviour regulation

Answer 67

d) Behaviour regulation

Question 68

The most important factor to consider when interpreting discrepancies between tests scores in children is:

a) the base rate of the discrepancy
b) the magnitude of the discrepancy
c) the statistical significance of the discrepancy
d) the child’s age

Answer 68

a) the base rate of the discrepancy

Question 69

Which of the following anti-epileptic medications is often associated with memory and verbal fluency difficulties at higher doses or when dosage is rapidly increased?

a) topirimate (Topamax)
b) gabapentin (Neurontin)
c) lamotrigine (Lamictal)
d) levetiracetam (Keppra)

Answer 69

a) topirimate (Topamax)

Question 70

Neglect is considered to be a failure to respond/report or orient to novel stimuli…

a) As a result of a circumscribed lesion to primary motor/sensory areas
b) Due to deficits in the individual’s ability to adequately perceive and interpret his/her environment
c) Resulting from lesions that are ipsilateral to perceived neglect
d) Focal and possibly generalized lesions involving right parietal/frontal lesions

Answer 70

d) Focal and possibly generalized lesions involving right parietal/frontal lesions

Question 71

A 17-year old adolescent comes to you after sustaining an mTBI in a fender bender. There was a brief loss of consciousness at the scene (i.e., <30 seconds), Glasgow Coma Scale was 15 in the upon arrival of EMTs 15 minutes post accident, and CT scan unremarkable in the ER 3 hours post-accident. Your best course of action in assessing this individual would be to:

a) Obtain educational records from grade school to help rule out pre-existing cognitive difficulties.
b) Utilize several ‘effort tests’ in your battery to rule out malingering or factitious disorder.
c) Wait at least 10 days to evaluate this individual, as the effects of a concussion would not be expected to persist for much more than a week
d) All of the above

Answer 71

d) All of the above

Question 72

The standard deviation of a test is equal to:

a) 2 times the variance
b) ½ the variance
c) Variance, squared
d) The square root of the variance

Answer 72

d) The square root of the variance

Question 73

Which of the following is not true about the association between Parkinson’s Disease and depression?

a) Depression is unrelated to severity of motor symptoms
b) Depression is distinguishable for its greater anxiety component
c) Depression in PD has a high remittance rate and is amenable to treatment
d) Depression does not improve significantly when treatment with L-Dopa reduces disability

Answer 73

c) Depression in PD has a high remittance rate and is amenable to treatment

Question 74

A lawyer representing a patient’s family requests to observe all testing conducted with the 7 year old patient and to have the child’s parents sit with the child during testing. Your best course of action in ensuring valid assessment results is to:

a) Allow both the lawyer and the parents to observe testing, to ensure that there is transparency in your assessment.
b) Allow the parents, but not the lawyer, to sit in on the evaluation to ensure the child is comfortable in the testing situation
c) Allow neither the parents nor the lawyer to sit in on the evaluation
d) Allow a medical resident, but neither the parents nor lawyer, to sit in on the evaluation

Answer 74

c) Allow neither the parents nor the lawyer to sit in on the evaluation

Question 75

Neurons in the _____ are the principal source of serotonin production in the CNS.

a) Caudate
b) Globus pallidus
c) Substantia nigra
d) Rostral and caudal Raphe

Answer 75

d) Rostral and caudal Raphe

Question 76

The finding of periventricular white matter hyperintensities on MRI has a:

a) High specificity for post-infectious encephalitis
b) High specificity for cranial radiation injury
c) High sensitivity for multiple sclerosis but poor specificity
d) Neither high sensitivity or specificity for adrenoleukodystrophy

Answer 76

c) High sensitivity for multiple sclerosis but poor specificity

Question 77

Wilson’s disease, an autosomal recessive disease of copper metabolism, has an early affinity for degeneration of the ____, resulting in _____.

a) Prefrontal cortex, disinhibited behavior
b) Cerebellum, tremor
c) Striatum, tremor
d) Hippocampus, psychosis

Answer 77

c) Striatum, tremor

Question 78

Dr. X is using a screening measure to identify patients with a rare condition and later compares the proportion of those who test positive on the screening measure with a “gold standard” measure of the rare condition. Dr. X is testing the screening measure’s:

a) sensitivity
b) positive predictive power
c) negative predictive power
d) specificity

Answer 78

b) positive predictive power

Question 79

Kluver-Bucy syndrome is associated with

a) Aggressive behavior, hyper-orality, and hyper-sexuality
b) Nonaggressive behavior, hyper-orality and hyper-sexuality
c) Aggressive behavior, hyper-orality and hypo-sexuality
d) Nonaggressive behavior, hypo-orality, and hypo-sexuality

Answer 79

b) Nonaggressive behavior, hyper-orality and hyper-sexuality

Question 80

You are testing a 35-year female patient, with 14 years of education. She was diagnosed with Bipolar II disorder 13 years ago and is currently asymptomatic. You would expect her FSIQ to be:

a) Within normal limits
b) Invalid due to attention and motivation difficulties
c) One SD below the mean
d) One SD above the mean

Answer 80

a) Within normal limits

Question 81

A lesion in the right lateral geniculate nucleus (LGN) of the thalamus, may cause:

a) Monocular visual field defects
b) Right homonymous visual field defects
c) Left homonymous visual field defects
d) Bitemporal visual field defects

Answer 81

c) Left homonymous visual field defects

Question 82

The following are true of motor neglect except for:

a) Is characterized by better movement in the ipsilesional rather than contralateral space
b) Includes reluctance to move limbs on the left (limb akinesia or intentional neglect)
c) Includes a delay in initiating movement (hypokinesia)
d) Occurs because of damage to the corticospinal system

Answer 82

d) Occurs because of damage to the corticospinal system

Question 83

Which of the following scores is likely to be a relative strength for a child with autism with fluent speech who is assessed at age 6:

a) Executive functions as measured on the Rey Complex Figure Task
b) Verbal Comprehension index on the WISC-IV
c) Theory of Mind as measured on the NEPSY-II
d) Word Reading as measured on the WIAT-III

Answer 83

d) Word Reading as measured on the WIAT-III

Question 84

Which can be used to indirectly measure regional brain activity during seizures and help localize their region of onset

a. Perfusion MRI
b. BOLD fMRI
c. Diffusion MRI
d. Magnetic Resonance Spectroscopy

Answer 84

d. Magnetic Resonance Spectroscopy

Question 85

Your patient demonstrates poor letter formation, the inability to write on a line, and writes over the model of a sentence he is supposed to be copying. His letters are not slanted, his spacing is even, he can spell irregular words, and he writes without paraphasic errors. You conclude he has:

a. Lexical agraphia
b. Pure agraphia
c. Spatial agraphia
d. Fluent agraphia

Answer 85

b. Pure agraphia

Question 86

Mood and motivational states can affect immune status and appetite through connections with the:

a) Thalamus
b) Frontal lobe
c) Hypothalamus
d) Brainstem centers

Answer 86

c) Hypothalamus

Question 87

In which of the following situations should you be most likely to chose population-based rather than demographically-adjusted norms?

a) Making a diagnosis of mental retardation
b) Making a diagnosis of dementia
c) Assessing cognitive strengths and weakness in a patient with multiple sclerosis
d) Assessing the cognitive implications of a traumatic brain injury

Answer 87

a) Making a diagnosis of mental retardation

Question 88

Which of the following statements best reflects the most current research on radiation-related cognitive effects in children treated for central nervous system tumors?

a) Neglect and visual-spatial difficulties are the most common cognitive impairments.
b) Cognitive deficits are related to the dose and total area of the brain irradiated.
c) The cognitive effects of radiation are minimized when children are also treated with chemotherapies.
d) Cognitive deficits post-radiation treatment typically resolve within 12-24 months.

Answer 88

b) Cognitive deficits are related to the dose and total area of the brain irradiated.

Question 89

Dr. X is a neuropsychologist in a large urban centre and has received a referral for a 38 year-old male following a work-related head injury. The patient is a new immigrant from Ghana whose first language is Twi but is described as having “conversational” English skills. Dr. X does not speak Twi herself, nor does she know of any neuropsychologists in the area who speak Twi. What is Dr. X’s best course of action in this situation?

a) Request that the patient bring a family member to the assessment who speaks both Twi and English and proceed with the assessment using the family member as an interpreter.
b) Begin the assessment with the patient, using only non-verbal tests and a verbal list-learning measure with the word list translated into Twi using an on-line language translation program.
c) Conduct the neuropsychological assessment in English, but note in the report that the interpretation of results should be viewed with caution because of cultural and language issues.
d) Consider whether she can accept the referral and conduct the evaluation within the boundaries of her competence and if not, decline the referral.

Answer 89

d) Consider whether she can accept the referral and conduct the evaluation within the boundaries of her competence and if not, decline the referral.

Question 90

__________Syndrome is characterized by face, arm and leg weakness, aphasia and neglect.

a) Anterior communicating artery
b) Middle cerebral artery
c) Posterior communicating artery
d) Posterior cerebral artery

Answer 90

b) Middle cerebral artery

Question 91

Which of the following statements is not true about Tourette’s Syndrome (TS)?

a) Diagnosis is based on the presence of either motor tics or vocal tics that begin before age 18 years.
b) TS often occurs comorbidly with obsessive-compulsive disorder.
c) TS is associated with deficits in attention and executive functioning.
d) Pharmaceutical treatments for TS act on the dopamine system.

Answer 91

a) Diagnosis is based on the presence of either motor tics or vocal tics that begin before age 18 years.

Question 92

Which of the following tumors would be most likely to cause bitemporal hemianopia?

a. Meningioma
b. Medulloblastoma
c. Pituitary adenoma
d. Pineoblastoma

Answer 92

c. Pituitary adenoma

Question 93

Which of the following statements is true regarding the relationship between subjective memory complaints and objective memory performance in neurological populations?

a) Correlations between subjective memory complaints and objective memory performance are high.
b) Correlations between subjective memory complaints and objective memory performance are moderate.
c) Correlations between subjective memory complaints and objective memory performance are low and are generally mediated by the patient’s age.
d) Correlations between subjective memory complaints and objective memory performance are low and are generally mediated by the patient’s mood and anxiety symptoms.

Answer 93

d) Correlations between subjective memory complaints and objective memory performance are low and are generally mediated by the patient’s mood and anxiety symptoms.

Question 94

Receiver operating characteristic (ROC) curves are used to:

a) Determine the diagnostic accuracy of a given test or helping to determine which of two tests is more accurate for diagnosing a certain condition.
b) Determine the effects of practice on an individual’s test-retest scores
c) Transform non-normally distributed score distributions
d) Determine effect sizes.

Answer 94

a) Determine the diagnostic accuracy of a given test or helping to determine which of two tests is more accurate for diagnosing a certain condition.

Question 95

Disorders of neuronal cell migration, such as lissencephaly and polymicrogyria are often associated with:

a) Cerebral palsy
b) Facial dysmorphology and attention problems
c) Mental retardation and seizures
d) Agenesis of the corpus callosum

Answer 95

c) Mental retardation and seizures

Question 96

Which of the following statements is false regarding the apolipoprotein E-4 (ApoE-4) gene:

a) It increases susceptibility to Alzheimer’s Disease.
b) It is related to earlier onset of Alzheimer’s Disease.
c) It increases susceptibility to Lewy Body Dementia.
d) It reduces the efficacy of acetylcholinesterase inhibitor therapy in patients with Alzheimer’s Disease.

Answer 96

d) It reduces the efficacy of acetylcholinesterase inhibitor therapy in patients with Alzheimer’s Disease.

Question 97

Mutism, ataxia and emotional lability are features of:

a) Marfan’s Syndrome
b) Posterior fossa syndrome following resection of a cerebellar tumor in childhood
c) Dandy-Walker syndrome
d) Lead exposure in childhood

Answer 97

b) Posterior fossa syndrome following resection of a cerebellar tumor in childhood

Question 98

Which of the following statements is correct regarding third party observers of neuropsychological assessments:

a) Informed consent provided by the patient is sufficient to allow a third party to observe.
b) The presence of third party observers may violate standardized test administration procedures and limit interpretation of the results.
c) Third party observers are permissible as long as the observer does not take notes or use any recording devices.
d) Third party observers of assessments are not permissible in any circumstances.

Answer 98

b) The presence of third party observers may violate standardized test administration procedures and limit interpretation of the results.

Question 99

Which of the following features of depression is not commonly seen in individuals with Parkinson’s Disease?

a) Anhedonia
b) Apathy
c) Suicide attempts
d) Sleep disturbance

Answer 99

c) Suicide attempts

Question 100

Relative to the childhood symptoms of attention-deficit/hyperactivity disorder (ADHD) the presentation of ADHD in adults is:

a) Less likely to include executive dysfunction
b) Less likely to include hyperactivity
c) Less likely to include inattention
d) More likely to include features of Oppositional Defiant Disorder.

Answer 100

b) Less likely to include hyperactivity