Book Exam 3

Question 1

In North America, abuse of a single drug is ____.

(a) common among women but not men
(b) uncommon
(c) not likely with comorbid depression
(d) characteristic of individuals with stimulant use

Answer 1

B—uncommon The large majority of individuals with substance abuse disorders misuse muliple

Question 2

You are seeing a former National Football League player who is seeking compensation for memory problems that he believes are related to playing professional football. Concerns about symptom feigning/exaggeration are apparent on multiple symptom validity tests. On the Test of Memory Malingering, he earns a 28 on Trial 1, a 46 on Trial 2, and a 45 on the retention trial. Performance on all other performance validity tests is unremarkable. According to the Slick criteria for malingered neurocognitive dysfunction (MND), the diagnosis of malingering is most likely to be ____.

(a) definite
(b) probable
(c) possible
(d) unlikely

Answer 2

C—possible

The score of 28 on Trial 1 is invalid per post-publication research on the TOMM, but the other scores (46, 45) fall just within the valid range, hence this is likely an indeterminate PVT finding. In the context of a clear external incentive to do poorly, indeterminate results on a single PVT along with multiple SVT abnormalities results in a diagnosis of “possible” MND according to the Slick criteria. Please refer to Chapter 12.

Question 3

On an inpatient rehabilitation unit, a 58-year-old woman has reportedly been walking into the wall on her left side during physical therapy, and the occupational therapist notices that the items placed on the left side of her lunch tray always remain untouched. Of the following, which is most consistent with this clinical presentation, and what would be the etiology?

(a) prosopagnosia; right occipital cerebrovascular accident (CVA)
(b) ideomotor apraxia; left parietal CVA
(c) right-left disorientation; left parietal CVA
(d) neglect; right parietal CVA

Answer 3

D—neglect; right parietal CVA

The behavior is indicative of a left neglect which is consistent with right CVA. Please refer to Chapter 5.

Question 4

The foremost risk factor for cerebral palsy is ____.

(a) low Apgar score
(b) birth asphyxia
(c) premature birth
(d) neonatal infection

Answer 4

C—premature birth

The other choices are actual risk factors but not as major. Please refer to Chapter 19.

Question 5

A 48-year-old man is status post-surgical resection of a large right frontal glioblastoma. During the course of your evaluation, significant visual scanning deficits, executive dysfunction, impulsivity, and impaired social skills become apparent. It is your opinion that he should not be driving and likely has a reduced capacity to make informed medical decisions. Midway through the examination, the patient becomes frustrated, refuses to continue, and storms out. Before he leaves the office, he instructs you to destroy his healthcare record and never share findings with anyone, especially his wife and the physician who referred him. What do you do first?

(a) Call later and inform the patient that you cannot destroy the record, but that you will respect his autonomy and not write a report.
(b) Call later and try to convince the patient that it is in his best interest to share the information with the referring provider and his wife.
(c) Anonymously report the patient to the department of motor vehicles indicating your concern about his ability to drive.
(d) Contact your state ethics committee and the referring provider to discuss the situation and review options.

Answer 5

D—Contact your state ethics committee and the referring provider to discuss the situation and review options.

In situations in which safety is of immediate concern, confidentiality can be breached in the interest of protecting the patient or others from imminent harm. In this vignette the patient has clear impairments which likely will place him and others at high risk. Although in some states it might be appropriate to contact the Department of Motor Vehicles (DMV), in other states psychologists are not allowed to do so. Thus, the most appropriate first step would be to collaborate with the referring provider and or an ethics committee to discuss options to address the situation. Although B is a reasonable option with some patients, in this case the patient has already left the building, and his presentation indicates that attempts to contact him are unlikely to be successful and will not adequately address the safety concern. Please refer to Chapter 7.

Question 6

High-functioning adolescents with Autism spectrum disorder tend to exhibit age-appropriate ____ but struggle with ____.

(a) spelling skills; multiplication and division
(b) decoding skills; reading comprehension
(c) sentence composition; letter formation
(d) math problem solving; written expression

Answer 6

B—decoding skills; reading comprehension

Academic abilities among middle to high school students with high-functioning autism are generally in the average range, but difficulties are most commonly observed on tasks that require inferential reasoning. Most commonly, students have difficulty with reading comprehension, written expression and mathematical problem solving. Please refer to Chapter 14.

Question 7

Of the medications listed, which carries the highest risk for the development of delirium following prolonged use at the prescribed dosage?

(a) beta blockers (b) serotonin reuptake inhibitors (c) corticosteroids (d) anticonvulsants

Answer 7

C —corticosteroids
Patients on beta blockers and or anticonvulsants often complain of sedation, difficulty concentrating, or memory problems, but these medications are not often associated with delirium. SSRI’s are quite safe relative to TCA’s and much less likely to result in confusion unless overused or multiple agents are prescribed (i.e., serotonin syndrome). The term steroid psychosis has been used to describe conditions in which patients develop delirium and or mania often following prolonged use of corticosteroids to treat chronic illness (e.g., lupus, rheumatoid arthritis, lympho

Question 8

Which imaging modality would be most useful in the diagnosis of Parkinson’s disease versus other Parkinson-plus disorders?

(a) cardiac MIBG scintigraphy
(b) structural MRI
(c) FDG PET
(d) resting state fMRI

Answer 8

A—cardiac MIBG scintigraphy

Cardiac uptake reduction precedes motor impairment and dopamine degeneration in Parkinson’s disease patients, and cardiac MIBG SPECT can accurately distinguish Parkinson’s disease from corticobasal syndrome, progressive supranuclear palsy, and multiple system atrophy. The heart to mediastinum ratio is decreased in Parkinson’s disease, irrespective of disease duration or severity. Please refer to Chapter 33.

Question 9

What sign is likely due to a disconnection rather than direct damage to a module?

(a) constructional dyspraxia
(b) any transcortical aphasia
(c) specific type of agnosia
(d) modality-specific anomia

Answer 9

D—modality-specific anomia

Any sensory specific cognitive deficit is likely a disconnection problem. In this case, unable to name visual objects, but can name with tactile presentation. Please refer to Chapter 3.

Question 10

According to most definitions, positive symptoms include ____.

(a) formal thought disorder and bizarre behavior
(b) delusions and hallucinations
(c) pseudobulbar affect and cognitive impairments
(d) attentional impairments and other

Answer 10

B—delusions and hallucinations

The term “positive symptoms” was originally intended to signify an excess of normal function, but has come to be understood more specifically to refer to delusions and hallucinations. This stands in contrast to the negative symptoms (that term originally used to describe the absence of affective expression, motivation, etc.) and disorganization symptoms (which include bizarre behavior, attentional impairment, alogia, and formal thought disorder). Please refer to Chapter 35.

Question 11

If you want to know the degree to which you can have confidence in a normal result on a psychometric test to rule out a specific condition, you should calculate this ratio:

(a) false negatives/(true negatives + false positives)
(b) true negatives/(false negatives + true positives)
(c) false negatives/(false negatives + true negatives)
(d) true negatives/(true negatives + false negatives)

Answer 11

D—true negatives/(true negatives + false negatives)

This refers to the negative predictive power of the test, or the degree to which a negative test result (i.e., indicative of normal performance) can be relied upon that a particular condition or illness is truly absent. Please refer to Chapter 8.

Question 12

You are reviewing medical records for a patient who has been in a car accident. During his neurological exam, it is noted that he presents with decreased shoulder shrug on the left and an inability to resist pressure from an examiner’s hand against the right jaw. These findings could suggest ____.

(a) left spinal accessory nerve XI dysfunction
(b) right spinal accessory nerve XI dysfunction
(c) bilateral spinal accessory nerve XI dysfunction
(d) feigned neurologic impairment

Answer 12

A—left spinal accessory nerve XI dysfunction Sternocleidomastoid strength and trapezius muscle lift are innervated by the ipsilateral cranial nerve XI. Please refer to Chapter 6.

Question 13

A 35-year-old married male has been promoted regularly at work but is experiencing depressive signs and symptoms. During interview, he also reported experiencing intermittent episodes of high productivity and decreased need for sleep for a few days. He finds these episodes useful in terms of his work productivity, but they are followed by periods of increased depression. This presentation is suggestive of ____.

(a) Major Depressive Disorder
(b) Bipolar I Disorder
(c) Bipolar II Disorder
(d) Cyclothymic Disorder

Answer 13

C—Bipolar II Disorder As noted in DSM criteria, bipolar II disorder is unique in that hypomanic episodes are present but do not rise to a level of severity noted in bipolar I and cyclothymic disorders. Please refer to Chapter 34.

Question 14

A 7-year-old boy presents for evaluation of ADHD symptoms due to “daydreaming” during class and parent reports that he has to have simple instructions repeated over and over. These symptoms have been present since around 5 years of age and have gotten worse over the past few months. Other than concerns with attention, he does well in school and there is no history of learning disability. An EEG shows occasional generalized bursts of 3 hz spike and wave discharges. The most likely diagnosis is ____.

(a) temporal lobe epilepsy
(b) Landau-Kleffner syndrome
(c) self-limiting epilepsy with centrotemporal spikes
(d) childhood absence epilepsy

Answer 14

D—childhood absence epilepsy (CAE)

This type often presents as staring spells, and has a characteristic EEG pattern of 3 Hz spike and wave discharges. Seizures can be brief, and are self-limiting with 65–85% showing remission prior to or during adolescence. Please refer to Chapter 22.

Question 15

A clinical psychologist wants to use a brief instrument to screen for possible suicidal thoughts in adolescents. For this purpose, the instrument should have high ____.

(a) sensitivity (b) specificity (c) face validity (d) concurrent validity

Answer 15

A—sensitivity Because of the condition of interest, it is more important to avoid false positive than false negative errors. Please refer to Chapter 9.

Question 16

Which of the following is a typical side effect of psychostimulant medication?

(a) depression
(b) insomnia
(c) hallucinations
(d) lowered blood pressure

Answer 16

B—insomnia Common side effects of psychostimulant medication include decreased appetite, increased heart rate and blood pressure, and insomnia. Please refer to Chapter 16.

Question 17

A patient with amnesia has a large lesion affecting many brain structures. In each item below, a pair of structures is listed. Damage to which of these pairs is most likely to produce dense amnesia?

(a) mammillary bodies and dorsomedial thalamus
(b) amygdala and dorsomedial thalamus
(c) hippocampus and cingulate gyrus
(d) mammillothalamic tract and anterior thalamus

Answer 17

A—mammillary bodies and dorsomedial thalamus

The two-system theory of amnesia states that amnesia results from damage to some element of the medial and lateral limbic circuit. This alternative is the only one that contains an element from the medial system (mammillary bodies) together with an element from the lateral system (dorsomedial thalamus). Please refer to Chapter 4.

Question 18

What is the most important factor to consider when assessing prognosis for mortality after stroke?

(a) size of infarct
(b) location of infarct
(c) hemorrhagic etiology
(d) time since stroke

Answer 18

C—hemorrhagic etiology Hemorrhagic stroke has a much higher mortality rate in the first 6 months (about 50%) than ischemic stroke. Please refer to Chapter 26.

Question 19

In a neuropsychological evaluation of patients with functional somatic syndromes, what measure is most likely to show clinically relevant elevations?

(a) Beck Depression Inventory
(b) Patient Health Questionnaire-9
(c) MMPI-2 Restructured Clinical Scale 3
(d) MMPI-2 Restructured Clinical Scale 1

Answer 19

D—MMPI-2 Restructured Clinical Scale 1

Although many studies examining patients with FSS suggest specific deficits in attention, psychomotor speed, and working memory, these deficits attenuate or disappear when emotional stress factors are considered. Please refer to Chapter 37.

Question 20

A 7-year-old boy presents for evaluation. Upon meeting him, you note that he has elf-like features. Despite IQ in the range of moderate ID, he is very social. He is most likely to have which of the following?

(a) fragile X syndrome
(b) adrenoleukodystrophy
(c) Klinefelter syndrome
(d) Williams syndrome

Answer 20

D—Williams syndrome

Individuals with Klinefelter syndrome and adrenoleukodystrophy typically do not have IQ in the range of moderate intellectual disability. While fragile X syndrome is associated with moderate intellectual disability, elf-like features are only associated with Williams syndrome. Please refer to Chapter 18.

Question 21

A 25-year-old presents with aphasia 8 months after a severe traumatic brain injury. The most likely mechanism of injury was a ____.

(a) slip and fall
(b) bicycle crash
(c) gunshot wound
(d) sports collision

Answer 21

C—gunshot wound Language disorders can occur in the acute stage of recovery following TBI due to acceleration-deceleration type injury but they rarely continue long term. On the other hand, penetrating injuries often result in focal or more circumscribed impairments. Please refer to Chapter 29.

Question 22

Which of the following is least likely to be seen following hypoxic/ischemic damage?

(a) amnestic syndrome
(b) visuospatial deficits
(c) speed of processing impairment
(d) impaired attention/working memory

Answer 22

B—visuospatial deficits Impaired memory, processing speed, and attention are common cognitive problems following hypoxia/ischemia. Visuospatial deficits are less commonly seen. Please refer to Chapter 28.

Question 23

A brain MRI performed on a 5-year-old female with a history of preterm birth is abnormal. What are the most likely findings on imaging associated with this birth history?

(a) intraventricular hemorrhage and post-hemorrhagic hydrocephalus
(b) periventricular leukomalacia and focal neuronal injury
(c) periventricular hemorrhagic infarction and periventricular leukomalacia
(d) periventricular hemorrhagic infarction and cerebral ischemic lesions

Answer 23

C—periventricular hemorrhage infarction and periventricular leukomalacia

These injuries are the most common neurologic complications of premature birth and result from hypoxia-ischemia and intraventricular hemorrhage, and impaired cerebral blood flow. Please refer to Chapter 17.

Question 24

Which of these neurological conditions is relatively most frequently associated with frontotemporal dementia?

(a) amyotrophic lateral sclerosis
(b) multiple sclerosis
(c) multisystem atrophy
(d) primary lateral sclerosis

Answer 24

A—amyotrophic lateral sclerosis

FTD is known to occur in about 9% of patients with ALS and does not commonly co-occur with the other conditions listed. Please refer to Chapter 32.

Question 25

Which of the following helps to best account for the discrepancy between the less than 1% prevalence of intellectual disability (ID) and the bell curve model prediction that 2.5% of individuals have an IQ score of 70 or less?

(a) diagnostic variability across regions (especially for mild ID)
(b) referral biases associated with higher academic functioning
(c) the ratio of males to females in early childhood
(d) the association between life expectancy and severity of ID

Answer 25

D—the association between life expectancy and severity of ID

A recent meta-analysis of population-based studies estimated the prevalence of ID to be 10.37/1000 or about 1% of the population. Along with delayed diagnosis, the fact that life expectancy is shortened for individuals with more severe forms of ID accounts for the lowered prevalence relative to expectation based on the bell curve prediction (2.5%). Please refer to Chapter 13.

Question 25

Which of the following helps to best account for the discrepancy between the less than 1% prevalence of intellectual disability (ID) and the bell curve model prediction that 2.5% of individuals have an IQ score of 70 or less?

(a) diagnostic variability across regions (especially for mild ID)
(b) referral biases associated with higher academic functioning
(c) the ratio of males to females in early childhood
(d) the association between life expectancy and severity of ID

Answer 25

D—the association between life expectancy and severity of ID A recent meta-analysis of population-based studies estimated the prevalence of ID to be 10.37/1000 or about 1% of the population. Along with delayed diagnosis, the fact that life expectancy is shortened for individuals with more severe forms of ID accounts for the lowered prevalence relative to expectation based on the bell curve prediction (2.5%). Please refer to Chapter 13.

Question 25

What neuropathological change correlates best with severity of cognitive impairment in patients with Alzheimer’s dementia?

(a) amyloid plaques
(b) neurofibrillary tangles
(c) synaptic density
(d) Lewy bodies

Answer 25

C—synaptic density

While amyloid plaques occur primarily before observed cognitive changes, neurofibrillary tangles, neuron loss and particularly synaptic loss parallel the severity of cognitive decline. Please refer to Chapter 30.

Question 25

Which of the following is not associated with decreased processing speed in patients with epilepsy?

(a) decreased white matter volume
(b) decreased memory and mesial temporal sclerosis
(c) suppression of neuronal excitability with antiepileptic drugs
(d) seizures involving frontal lobe networks

Answer 25

B—decreased memory and mesial temporal sclerosis

Side effects of treatment with antiepileptic drugs commonly include decreased processing speed. Studies have also shown that in persons with epilepsy there is a relation between decreased overall white matter volume and processing speed, as well as involvement of frontal lobe systems in seizure onset or propagation. Please refer to Chapter 22.

Question 25

You have been consulted to evaluate a 63-year-old man with a past medical history of diabetes, hypertension, and congestive heart failure. He underwent renal transplant 2 weeks ago. On examination, he is disoriented, highly distractible, and cannot accurately complete simple figure drawings. Physicians indicate that his mental status seemed fine prior to surgery. What diagnosis and etiology are most probable?

(a) vascular cognitive impairment and infection
(b) vascular cognitive impairment and hyponatremia
(c) delirium and drug reaction/interaction
(d) delirium and right hemisphere stroke

Answer 25

C—delirium and drug reaction/interaction

Post-transplant patients are at high risk for complications that cause delirium, such as infection, transplant rejection, or iatrogenic effects of drugs given to reduce risk of transplant rejection (e.g., calcineurin inhibitors (CNIs). CNIs can also cause posterior reversible encephalopathy syndrome (PRES), which is characterized by lethargy, headache, confusion, visual disturbance, seizures, and posterior changes on neuroimaging. Both symptoms and radiologic findings can resolve with prompt control of blood pressure and/or discontinuation of the CNI. Although the patient has risk factors for vascular cognitive impairment and stroke the clinical description is most consistent with delirium. P

Question 26

If a clinician only had time to administer three tests in the assessment of an individual with suspected dementia, he or she should include measures of____.

(a) figure learning, figure recall, and simple attention
(b) phonemic fluency, MMSE, and mental flexibility
(c) sensory motor tests, executive function, and drawing
(d) verbal episodic memory, category fluency, and naming

Answer 26

D—verbal episodic memory, category fluency, and naming

Episodic memory impairment is the hallmark neuropsychology feature of Alzheimer’s disease, with deficits in confrontation naming usually following. Category fluency is also often reduced in Alzheimer’s disease. Please refer to Chapter 30.

Question 27

In regards to memory, research suggests that individuals with substance use disorders (SUDs) commonly display cognitive deficits in ____.

(a) acquisition and encoding
(b) retention
(c) free recall
(d) recognition

Answer 27

A—acquisition and encoding

Individuals with SUDs typically display a pattern of performance in which there is difficulty with acquisition and encoding of information, but not with retention once adjustments are made for amount of information acquired. Please refer to Chapter 36.

Question 28

Each of the following are part of the extrapyramidal motor system, except ____.

(a) subthalamic nucleus
(b) globus pallidus
(c) cerebellum
(d) putamen

Answer 28

C—cerebellum

The extrapyramidal system is a set of subcortical circuits and pathways that includes the corpus striatum (caudate nucleus, putamen, and globus pallidus) together with the subthalamic nucleus, substantia nigra, red nucleus, and brain stem reticular formation. Some authorities include descending spinal cord tracts other than the corticospinal tracts (such as the vestibulospinal, rubrospinal, tectospinal, and reticulospinal tracts) in the extrapyramidal motor system. Please refer to Chapter 33.

Question 29

A 32-year-old man presents to your neuropsychology clinic with a history of herpes simplex virus encephalitis. He has cognitive complaints across multiple areas. What might you expect to find on imaging based on his history?

(a) inflammation of the cerebellum and temporal lobe
(b) temporal lobe pathology and hyperintensities in the orbitofrontal regions
(c) subcortical white matter lesions and atrophy
(d) lesions in the brain stem and basal ganglia

Answer 29

B—temporal lobe pathology and hyperintensities in the orbitofrontal regions

Multiple studies in individuals with herpes simplex virus have documented T2 hyperintensities in mesiotemporal and orbitofrontal lobes. Please refer to Chapter 23.

Question 30

A left-handed, 82-year-old man recently sustained a stroke and has fluent speech but impaired auditory comprehension and repetition. What is the most likely vascular distribution of the stroke?

(a) left hemisphere in the deep territory
(b) right inferior middle cerebral artery territory
(c) left inferior middle cerebral artery territory
(d) left superior middle cerebral artery territory

Answer 30

C—left inferior middle cerebral artery territory Fluent speech with auditory comprehension deficits and impaired repetition are the characteristics of Wernicke’s (fluent, sensory, receptive) aphasia, which is most commonly associated with damage to the left temporal and parietal regions and their interconnections (areas in the distribution of the left inferior middle cerebral artery). Please refer to Chapter 26.

Question 31

Time from diagnosis to death is longest in which of the following disorders?

(a) Parkinson’s disease
(b) progressive supranuclear palsy
(c) Lewy body dementia
(d) corticobasal syndrome

Answer 31

A—Parkinson’s disease

Life expectancy in treated Parkinson’s disease is almost the same as age-matched controls, while mean survival is less than 10 years from time of diagnosis to death for patients with progressive supranuclear palsy, Lewy body dementia, and corticobasal syndrome. Please refer to Chapter 33.

Question 32

Which of the following has been found to be a risk factor for cognitive impairment in patients with breast cancer following treatment?

(a) neo-adjuvant therapy
(b) concurrent radiation treatment
(c) older age
(d) estrogen receptor positive cancer

Answer 32

C—older age

Older age and lower cognitive reserve were related to post-treatment decline in processing speed in a prospective study with patients with breast cancer (without chemo; with chemo) and a group of normal controls. Chemotherapy and disease factors are believed to affect a range of physiological mechanisms and cognitive impairments result from a combination of age, comorbidities, treatment. Radiation therapy is less likely to affect cognitive function directly, but may affect lung and heart function, which can contribute to comorbidities and frailty. Please refer to Chapter 25.

Question 33

Diagnostic criteria for social (pragmatic) communication disorder overlaps considerably with Autism spectrum disorder symptomatology. To help differentiate between these disorders, clinicians could look for a history of which of the following?

(a) limited nonverbal communication
(b) difficulty with turn taking in conversation
(c) difficulty inferring meaning from speech
(d) presence of stereotyped language

Answer 33

D—presence of stereotyped language

Social (pragmatic) communication disorder (SPCD) was added to the DSM-5 in part because of changes in Autism spectrum disorder (ASD) criteria. The diagnosis was developed to capture individuals who present with deficits in social communication, but have no history of restricted and repetitive behaviors (who may have previously qualified for the diagnosis of pervasive developmental disorder-not otherwise specified; PDD-NOS). Diagnostic criteria for SPCD outlines similar social communication deficits seen in ASD (including deficits in nonverbal communication, difficulty with turn taking, and limited inferential reasoning), but notes that individuals with SPCD cannot evidence restricted and repetitive behaviors (including stereotyped language). Please refer to Chapter 14.

Question 34

“Working memory” is an example of ____.

(a) a whole-brain phenomenon
(b) domain-specific theory
(c) dysexecutive syndrome
(d) domain-general theory

Answer 34

B—domain-specific theory

One or more central processors are thought to control specific functions. Working memory operates as a set of sub-systems, controlled by a limited-capacity executive system. Please refer to Chapter 3.

Question 35

A neuropsychologist is evaluating a child whose mother acknowledged smoking marijuana during pregnancy. In considering the potential effects of this exposure on the child’s neuropsychological performance, which of the following factors should the neuropsychologist consider as a likely confound of the relation between marijuana exposure and neuropsychological outcome?

(a) tobacco use
(b) maternal obesity
(c) timing of exposure
(d) alcohol use

Answer 35

D—alcohol use

Women who consume marijuana frequently drink alcohol during pregnancy, making it difficult to parse out the impact of prenatal exposure to marijuana. Please refer to Chapter 21.

Question 36

Which of the following is not hypothesized to be involved in the neuropathology of schizophrenia?

(a) excessive synaptic pruning
(b) abnormal embryogenesis
(c) amyloid deposition
(d) disrupted white matter integrity

Answer 36

C—amyloid deposition

The neuropathology of schizophrenia is thought to involve abnormal embryogenesis, excessive synaptic pruning, and disruptions of white matter integrity, not amyloid deposition. Please refer to Chapter 35.

Question 37

The post-test probability of a test is ____.

(a) the probability of the individual having the disease when the test result is positive
(b) the probability the individual has the disease within the population
(c) equal to the positive predictive power or the ability of the test to identify the disease
(d) the increase in odds a positive test result adds to the pre-test probability

Answer 37

A—the probability of the individual having the disease when the test result is positive

The post-test probability is the probability the individual has a disease with a positive test result and is based on the post-test odds, which is the increase in the odds of a person having the disease with a positive test result from the pre-test odds. Please refer to Chapter 9.

Question 38

A patient presents with a diagnosis of cerebral palsy (CP) related to a history of prematurity and intraventricular hemorrhage. Which is the most likely type of CP given this history?

(a) extrapyramidal
(b) dyskinetic
(c) ataxic
(d) spastic diplegia

Answer 38

D—spastic diplegia

Due to the proximity of the corticospinal tracts with the periventricular area. Please refer to Chapter 17.

Question 39

A patient with multiple sclerosis has distinct episodes of acute worsening of neurologic symptoms followed by variable recovery of function, with periods of stability between attacks. This would best be characterized as ____ multiple sclerosis.

(a) relapsing-remitting
(b) secondary-progressive
(c) primary-progressive
(d) progressive-relapsing

Answer 39

A—relapsing-remitting Relapsing-remitting multiple sclerosis is the most common disease course and is characterized by acute attacks with recovery between events. Please refer to Chapter 24.

Question 40

Deficits in which of the following would be least likely in early vascular dementia?

(a) speed of processing
(b) word generation to semantic or letter cues
(c) word-finding and language comprehension
(d) planning, organizing, and flexibility in problem-solving

Answer 40

C—word-finding and language comprehension See Chui and Ramirez-Gomez (2018) or Cullum et al. (2018) for reviews of neuropsychological findings in vascular cognitive impairment and vascular dementia. Please refer to Chapter 31.

Question 41

Extrapyramidal cerebral palsy is typically associated with ____.

(a) severe cognitive impairments
(b) abnormal involuntary movements
(c) more involvement of the legs than arms
(d) significantly shortened life expectancy

Answer 41

B—abnormal involuntary movements

The upper extremities tend to be more impaired. Choices a and c are more consistent with severe spastic quadriplegia. Please refer to Chapter 19.

Question 42

Which of the following is an uncommon emotional-behavioral complication following moderate to severe traumatic brain injury in children?

(a) depression
(b) ADHD
(c) mania
(d) anxiety

Answer 42

C—mania Mania and psychosis are fairly uncommon complications following TBI. Please refer to Chapter 29.

Question 43

The statistical probability of an observed difference between test scores, either within scales of a test or across different tests, is determined by relative rarity of a difference in scores based on the central limit theorem and is related to the test(s) reliability and standard error of measurement. This statistical difference is based on the assumption of ____.

(a) heterogeneity of variance between the tests
(b) homogeneity of variance between tests
(c) a minimal correlation between the scales or tests
(d) the ability to reject the null hypothesis

Answer 43

B—homogeneity of variance between tests

Variability in test performance refers to the reasons (or variables) that test performance is similar or different among individuals. For example, people with TBI often share a common source of variance in measured abilities, such as processing speed. The concept of homogeneity of variance states that these “variances in common” among similar groups should vary predictably based on their cause and are thus termed homogeneous. Please refer to Chapter 9.

Question 44

As children with congenital hydrocephalus move into adolescence, they are at high risk for _____.

(a) dementia and early onset of aging
(b) conduct disorder
(c) new onset of medical problems unrelated to shunting
(d) anxiety and depression

Answer 44

D—anxiety and depression

Psychosocial problems, including anxiety and depression, often emerge in adolescents and adults because of social isolation, teasing and lack of acceptance by peers, avoidance by peers because of their disability, and the increased stress on the family. Please refer to Chapter 20.

Question 45

The assessment of general intelligence would be most impacted by which of the following?

(a) nonfluent aphasia
(b) fluent aphasia
(c) alexia without agraphia
(d) anosognosia

Answer 45

B—fluent aphasia

Fluent aphasia affecting lexical access to the meaning of words will directly impact measures of intelligence dependent on verbal ability and many nonverbal tests because comprehension of instructions may be impaired. Please refer to Chapter 5.

Question 46

Which condition is considered by some to be a variant of frontotemporal dementia yet by others is considered a form of Alzheimer’s disease?

(a) semantic variant
(b) progressive non-fluent aphasia variant
(c) logopenic variant
(d) behavioral variant

Answer 46

C—logopenic variant The logopenic variant of FTD is considered by some to actually be a variant of Alzheimer’s disease because the majority of logopenic variant cases have Alzheimer’s disease pathology. Please refer to Chapter 32.

Question 47

Numerosity is understanding and recogniz ing the concept of quantity. It most often includes which of the following abilities?

(a) symbolic comparison
(b) procedural counting
(c) conceptual counting
(d) rapid digit naming

Answer 47

A—symbolic comparison

Comparison (symbolic or non-symbolic) and number line estimation skills are collectively referred to as numerosity. While procedural and conceptual counting are important in the development of math skills, they are not considered numerosity. Please refer to Chapter 15.

Question 48

A 71-year-old woman presents to your office, accompanied by her son. The son is concerned that his mother may be developing depression as she has been reticent to attend family events, preferring to watch television or sit in her bedroom. She has also become less competent with select hobbies, such as card playing and knitting. She has forgotten conversations she has had with him but has not forgotten her appointments and needs only occasional reminders to take her medications. The son denies that his mother has experienced any significant recent medical or life events and indicated that she has no history of depression. Based on this information, what is the woman’s most likely diagnosis?

(a) Major Depressive Disorder
b) Mild Neurocognitive Disorder
(c) Alzheimer’s disease
(d) vascular cognitive impairment

Answer 48

B—Mild Neurocognitive Disorder

While at first glance it would appear that your patient has symptoms of depression, the nature of her emotional changes in the absence of a precipitating event, psychiatric history, or medical change is concerning. Rather, her symptoms are commonly seen in patients with mild cognitive impairment/mild neurocognitive disorder, which, in addition to forgetfulness, can include a decrease in initiative and increase in apathy, the latter which can result in increased isolation. Please refer to Chapter 30.

Question 49

In individuals with Sturge-Weber, seizures are typically seen on ____.

(a) the side of the body contralateral to the port-wine birthmark
(b) the side of the body ipsilateral to the port-wine birthmark
(c) either side of the body, regardless of the port-wine birthmark
(d) both sides of the body in a generalized pattern

Answer 49

A—the side of the body contralateral to the port-wine birthmark

Seizures are seen on the side of the body opposite to the port-wine birthmark. Please refer to Chapter 18.

Question 49

What can be said regarding the autonomous decision-making of children under the age of 12 referred for neuropsychological evaluation?

(a) They can’t provide informed consent unless emancipated.
(b) They can’t provide informed consent but can give informed assent.
(c) Their capacity for assent or consent cannot be determined.
(d) Their consent is irrelevant as consent must come from a parent or guardian.

Answer 49

B—They can’t provide informed consent but can give informed assent. Currently there are no validated procedures to determine the level of capacity required for informed assent in this population. Although, with few exceptions, informed consent and permission is required from the parent or guardian, patients should be involved in assent for such procedures at a developmentally appropriate level. Children and adolescents are by definition vulnerable, and care should be taken to ensure that they are involved in their own care appropriately. Answer A is wrong because adolescents can be emancipated but young children cannot. Please refer to Chapter 7. General Principles and Ethical Standards: A, B, E; 3.10, 4.02, 4.05

Question 49

A neurologist suspects that her patient is experiencing cerebellar dysfunction and would like to evaluate further. The two most relevant tests she might select are ____.

(a) the finger-to-nose test and the Rinne test
(b) the heel-shin test and the Romberg test
(c) switching hands palm up and palm down and visual field testing
(d) examination of tongue protrusion and visual field testing

Answer 49

B—the heel-shin test and the Romberg test Cerebellar functions in the lower extremities are examined by the heel-shin-test, in which the patient lies on his back, lifts the heel of his foot, and moves it in a straight line along his opposite shin up to the knee. In the Romberg test, patients are asked to stand with their feet together and close their eyes. The “Romberg sign” is when unsteadiness occurs within several seconds of closing the eyes. The Rinne test assesses auditory function via the vestibulocochlear nerve (CN VIII). During this test, a vibrating tuning fork is placed just outside each ear to assess air conduction and on the forehead or mastoid to assess bone conduction. Tongue protrusion can be used to assess hypoglossal nerve (CN XII) function, and visual field testing is not routinely conducted to assess cerebellar dysfunction. Please refer to Chapter 6.

Question 50

A 58-year-old, recently widowed man presents with symptoms consistent with Major Depressive Disorder. Combination therapy is recommended. With regard to pharmacologic intervention, which neurotransmitter system would not be a primary target?

(a) serotonin
(b) norepinephrine
(c) GABA
(d) dopamine

Answer 50

C—GABA Gamma-aminobutyric acid is a major inhibitory neurotransmitter in the CNS, playing a role in helping to induce relaxation and sleep and in preventing overexcitation. Depletion is associated with a heightening of the anxious response. Dopamine, serotonin, and norepinephrine have all been found to be involved in depressive disorders. Please refer to Chapter 34.

Question 51

In typical development, restricted and repetitive behaviors are ____.

(a) common in the first 2 years of life, and may continue to be observed during the preschool years
(b) common in the first year of life and then decline afterward
(c) common in the first 2 years of life and then decline afterward
(d) uncommon across the first years of life, and through the preschool years

Answer 51

A—common in the first 2 years of life, and may continue to be observed during the preschool years

Typically developing infants often engage in repetitive, rhythmic behaviors and these behaviors may take up more than one third of waking hours around 24 months of age. While repetitive motor movements peak at approximately 24 months of age, inflexibility, ritualistic behaviors, and restricted interests are often observed during the preschool years in normative development. Please refer to Chapter 14.

Question 52

The most common underlying pathology in adult epilepsy is ____.

(a) low-grade glioma
(b) malformation of cortical development
(c) hippocampal sclerosis
(d) traumatic brain injury

Answer 52

C—hippocampal sclerosis Although all of the listed pathologies are associated with adult epilepsy, the most common pathology is mesial temporal sclerosis, accounting for up to two thirds of cases. Please refer to Chapter 22.

Question 53

The average age of onset for Alzheimer’s disease is approximately ____ years old.

(a) 60
(b) 65
(c) 70
(d) 75

Answer 53

D—75

Most patients are diagnosed between the ages of 70 and 79, with 74.7 years as the mean based on National Institutes of Health figures. Please refer to Chapter 30.

Question 54

A 10-year-old child is referred for assessment. He was born full-term, weighing 4 pounds, 6 ounces. What might be a typical profile for this child?

(a) lower IQ, executive functioning weaknesses, and academic problems
(b) motor deficits, executive functioning weaknesses, and visuospatial processing problems
(c) lower IQ, academic problems, and motor deficits
(d) performance within normal limits

Answer 54

A—lower IQ, executive functioning weaknesses, and academic problems

The child likely meets criteria for intrauterine growth restriction. Independent of prematurity and neonatal complications, specific neuropsychological impairments can be observed as the function and structure of the CNS is impacted by growth restriction in utero. Motor deficits and difficulties with visuospatial processing are more commonly associated with preterm birth. Please refer to Chapter 17.

Question 55

An adolescent undergoing cranial radiation for treatment of leukemia suddenly develops excessive sleepiness within 2 months of initiating therapy. This symptom is most likely related to ____.

(a) emotional adjustment problems
(b) relapse of leukemia
(c) sleep apnea
(d) acute radiation toxicity

Answer 55

D—acute radiation toxicity

Radiation toxicity can develop early on after treatment and can include somnolence, presumably related to transient demyelination and neuroinflammation. Please refer to Chapter 25.

Question 56

An 83-year-old woman is referred by her psychiatrist for neuropsychological evaluation to assess her capacity to raise her grandson. Aside from one very low score on a test of attention, cognitive performances were consistently within a normal range relative to normative comparison groups, without evidence of objective impairment. MMPI-2 validity scales included the following: Variable Response Inconsistency (VRIN) T = 39; True Response Inconsistency (TRIN) T = 41; Infrequency (F) scale T = 80; Infrequency Psychopathology (Fp) T = 41. Which of the following factors is most likely to account for these findings?

(a) limited attention to item content
(b) a continuing history of significant psychopathology
(c) denial of any current emotional difficulties
(d) advanced age

Answer 56

B—a continuing history of significant psychopathology

F-scale elevations may arise from three underlying sources, including inconsistent or variable response style, genuine (usually severe) psychopathology, and symptom exaggeration. Seeing as there is not evidence of content non-responsivity on VRIN or TRIN, and no evidence of symptom exaggeration on Fp, an F-scale elevation of this magnitude most likely reflects genuine psychopathology. Please refer to Chapter 10.

Question 57

Which method has resulted in increased likelihood of securing competitive employment for people with schizophrenia?

(a) targeted strategy-based interventions
(b) vocational rehabilitation
(c) individual placement with support
(d) on-the-job training

Answer 57

C—individual placement with support

As compared to traditional vocational rehabilitation services, individually based supportive interventions have shown greater effects for obtaining and maintaining stable employment in people with schizophrenia. Please refer to Chapter 35.

Question 58

A 13-year-old child who sustained a stroke in the superior left middle cerebral artery distribution at age 2 months presents with intact language functioning. What other neuropsychological findings are most likely?

(a) deficits in visuospatial skills and right-sided motor deficits
(b) deficits in visuospatial skills and left-sided motor deficits
(c) intact visuospatial skills and left-sided motor deficits
(d) deficits in verbal memory and right-sided motor deficits

Answer 58

A—deficits in visuospatial skills and right-sided motor deficits

Poor visuospatial functioning after an early left hemisphere stroke may reflect the phenomenon of crowding, and can occur even with left-hemisphere damage, while language functioning may remain intact. Motor functioning does not tend to reorganize as much as cognitive functions, so left-sided motor deficits are unlikely after a left hemisphere stroke. Please refer to Chapter 26.

Question 59

Which statement is true of severe cerebral palsy (CP)?

(a) Gross motor problems tend to decrease after puberty.
(b) When present, chronic pain often decreases in adulthood.
(c) Problems related to premature aging are common.
(d) Life expectancy is similar to the general CP population.

Answer 59

C—Problems related to premature aging are common. Gross motor problems and pain are not expected to decrease. Life expectancy can be shortened. Please refer to Chapter 19.

Question 60

Damage to the medial frontal cortex is primarily associated with ____.

(a) intentional disorders
(b) disinhibition of emotion and personality
(c) executive dysfunction
(d) ADHD

Answer 60

A—intentional disorders

Damage to the medial frontal cortex results in syndromes such as akinesia, bradykinesia, apathy, and, in most severe form, akinetic mutism. Please refer to Chapter 4.

Question 61

In the context of Alzheimer’s disease, neurofibrillary tangles are ____.

(a) primarily found in the temporal lobe
(b) primarily found in the frontal and parietal lobes
(c) found in clusters throughout multiple brain areas
(d) limited to subcortical as opposed to cortical areas

Answer 61

C—found in clusters throughout multiple brain areas Neurofibrillary tangles are often found in hippocampal and amygdaloid areas, and in specific brainstem nuclei—nucleus basalis of Meynert in the forebrain, nucleus raphe nucleus in the midbrain, and the locus ceruleus at the anterior pontine level. Please refer to Chapter 30.

Question 62

On the Wechsler intelligence tests the index score that is most likely to show decline following traumatic brain injury is ____.

(a) verbal comprehension
(b) perceptual reasoning
(c) working memory
(d) processing speed

Answer 62

D—processing speed

Tests that tap processing speed tend to be among the most sensitive to changes following TBI. Although verbal comprehension and perceptual reasoning scores might decline due to focal injuries causing aphasia or visuospatial impairment it is much more common to observe declines in processing speed and executive aspects of attention due to the diffuse impact of TBI. Please refer to Chapter 29.

Question 63

Which of the following occurs frequently among young children with Autism spectrum disorder?

(a) obesity
(b) nearsightedness
(c) enlarged head circumference
(d) close set eyes

Answer 63

C—enlarged head circumference Enlarged head size is one of the few consistently replicated findings among individuals with Autism spectrum disorder. Please refer to Chapter 14.

Question 64

The neuropsychological profile in mixed Alzheimer’s disease (AD) and subcortical vascular disease is ____.

(a) typical of that commonly seen in AD, with memory impairment greater than executive dysfunction
(b) typical of that commonly seen in pure vascular dementia, with executive dysfunction greater than memory impairment
(c) characterized by grossly equivalent severity of memory and executive dysfunction
(d) characterized by pronounced visuospatial impairments and equivalent severity in executive dysfunction

Answer 64

A—typical of that commonly seen in AD, with memory impairment greater than executive dysfunction

Chui and Ramirez-Gomez (2015) review the literature to date and find that, although the pattern of neuropsychological impairment in vascular cognitive impairment (VCI) is highly variable, when VCI and AD co-occur the neuropsychological profile is dominated by AD. Please refer to Chapter 31.

Question 65

Early initiation of immunotherapy is associated with positive outcomes in which of the following diagnoses?

(a) anti-NMDA receptor encephalitis
(b) HSV encephalitis
(c) bacterial meningitis
(d) HIV encephalitis

Answer 65

A—anti-NMDA receptor encephalitis

The most consistent predictor of positive outcome in patients with anti-NMDA receptor encephalitis is early and effective immunotherapy. In patients with tumors (commonly ovarian teratomas), tumor removal is also correlated with positive outcome. Please refer to Chapter 23.

Question 66

Prenatal exposure to nicotine is most consistently linked to problems in which of the following?

(a) language functions
(b) externalizing disorders
(c) memory functions
(d) internalizing disorders

Answer 66

B—externalizing disorders

Prenatal nicotine exposure is consistently linked to externalizing disorders, namely ADHD and Oppositional Defiant Disorder. Neurocognitive findings are equivocal. Please refer to Chapter 21.

Question 67

The behavioral variant of frontotemporal dementia begins with changes in personality, interpersonal conduct, and which of the following?

(a) emotional regulation
(b) telegraphic speech
(c) dyspraxia
(d) dysgraphia

Answer 67

A—emotional regulation

The behavioral variant of frontotemporal dementia begins with changes in personality, interpersonal conduct, and emotional regulation, reflecting progressive disintegration of the underlying neural circuits. Please refer to Chapter 32.

Question 68

Children with spina bifida myelomeningocele and children with Dandy-Walker syndrome ____.

(a) are often intellectually deficient
(b) are most often nonambulatory
(c) show similar performance on neuropsychological tests
(d) show impairment on measures of fine motor skills

Answer 68

D—show impairment on measures of fine motor skills The motor impairment similarity is due to cerebellar compromise. Please refer to Chapter 20.

Question 69

The etiology of amnesia most likely to result in confabulation is a(n) ____.

(a) anoxic encephalopathy
(b) anterior communicating artery (ACoA) aneurysm
(c) surgical ablation of the medial temporal lobe
(d) herpes encephalopathy

Answer 69

B—anterior communicating artery (ACoA) aneurysm An aneurysm of the ACoA would be an example of a pathology producing diencephalic amnesia with resultant confabulation typically involves frontal systems; the other three etiologies typically affect medial temporal areas. Please refer to Chapter 5.

Question 70

What are the three elements in any Bayesian model?

(a) prior probability distribution, posterior probability distribution, and likelihood function
(b) posterior probability distribution, likelihood function, and new data
(c) prior probability distribution, likelihood function, and new data
(d) prior probability distribution, posterior probability distribution, and new data

Answer 70

C—prior probability distribution, likelihood function, and new data

In frequentist analysis (as opposed to Bayesian models), one chooses a model (likelihood function) for the available data and then calculates either a p value or confidence interval. Alternatively, Bayesian models can be calculated to provide direct probability statements about parameters of interest, but one must first summarize prior information about the parameters of interest. The three elements of any Bayesian model are the prior probability distribution, likelihood function, and new data. When these three elements are put together, the posterior probability distribution can be generated. Please refer to Chapter 8.

Question 70

A 9-year-old child presents for clinical evaluation with the following symptoms: poor working memory, fatigue, excessive sleepiness, distractibility, slow responsiveness, and daydreaming. Which of the following diagnoses is most likely given the presented information?

(a) ADHD- combined type
(b) ADHD- inattentive type with sluggish cognitive tempo
(c) ADHD- combined type and learning disorder with specific impairment in reading
(d) ADHD-inattentive type and Major Depressive Disorder

Answer 70

B—ADHD-inattentive type with sluggish cognitive tempo Recent factor analytic studies have consistently shown that many symptoms of sluggish cognitive tempo (SCT) covary with the inattentive ADHD symptoms; however, there is consistent evidence that there are unique components of SCT (lethargy, underactivity, and slowness) that appear to be distinct from the inattention associated with ADHD. Please refer to Chapter 16.

Question 70

Among the most vulnerable brain regions to thiamine deficiency in patients with Wernicke-Korsakoff syndrome is which structure?

Answer 70

B—mammillary bodies Neuronal loss in the mammillary bodies, thalamus, and cerebellum, along with hemorrhagic lesions in the paraventricular and periaqueductal grey matter are the most vulnerable to WKS. Please refer to Chapter 36.

Question 71

Cerebellar mutism or posterior fossa syndrome is ____.

(a) more common in adults than children after brain tumor surgery
(b) a type of aphasia that occurs after cerebellar stroke (c) a transient complication of surgery that resolves completely
(d) characterized in part by loss of speech and cranial nerve deficits

Answer 71

D—characterized in part by loss of speech and cranial nerve deficits Cerebellar mutism is a complication of posterior fossa surgery and seen more commonly in children than adults. Symptoms gradually resolve over time, but motor coordination and cognitive/psychological issues may persist . Please refer to Chapter 25.

Question 72

Among the most vulnerable brain regions to thiamine deficiency in patients with Wernicke-Korsakoff syndrome is which structure?

(a) basal ganglia (b) mammillary bodies (c) hypothalamus (d) prefrontal cortex

Answer 72

B

Question 73

Cerebellar mutism or posterior fossa syndrome is ____.

(a) more common in adults than children after brain tumor surgery
(b) a type of aphasia that occurs after cerebellar stroke
(c) a transient complication of surgery that resolves completely
(d) characterized in part by loss of speech and cranial nerve deficits

Answer 73

D—characterized in part by loss of speech and cranial nerve deficits Cerebellar mutism is a complication of posterior fossa surgery and seen more commonly in children than adults. Symptoms gradually resolve over time, but motor coordination and cognitive/psychological issues may persist . Please refer to Chapter 25.

Question 74

You are seeing a college student who is having difficulty with pre-calculus. This is the first time that he has struggled in math. He has never been diagnosed with a mathematics disability and earned As and Bs in math through high school. The most important question to answer when taking a history is whether ____.

(a) he has had proper instruction in math and has built a foundation for his current college class
(b) the new demands of the math class are causing undue anxiety
(c) he might need to drop out and take a prerequisite for this class
(d) he is experiencing another source of stress in his life that could be causing difficulty in this class

Answer 74

A—he has had proper instruction in math and has built a foundation for his current college class

This student is unlikely to have a learning disability, if he made it to college with As and Bs in math. Although the other areas should certainly be addressed, the answer most relevant to a specific problem in math is A. Please refer to Chapter 15.

Question 75

Following moderate to severe traumatic brain injury, the release of which of the following would be considered excitotoxic?

(a) glutamate (b) GABA (c) dopamine (d) cortisol

Answer 75

A—glutamate Glutamate is the only potential TBI related excitotoxic agent listed. Please refer to Chapter 29.

Question 76

A 22-year-old man presents with complaints of frequent panic attacks, generalized anxiety, and difficulty leaving the house. In addition to cognitive behavioral therapy what type of medication might be important in the initial stages of treatment?

(a) selective serotonin reuptake inhibitors
(b) serotonin and norepinephrine reuptake inhibitors
(c) benzodiazepines
(d) NMDA receptor antagonists

Answer 76

C—benzodiazepines This patient clearly has an anxiety disorder that is impacting his ability to function. Although occasionally used in patients with an agitated depression, benzodiazepines are more often used to treat anxiety-based disorders. Furthermore, benzodiazepines are sedating and classified as depressants. Thus, while they can help alleviate anxiety they can exacerbate or worsen depressive symptoms. Please refer to Chapter 34.

Question 77

The MMPI-2 Restructured Form validity index most sensitive to somatic malingering is ____.

(a)F-r (b) Fs (c) Fp-r (d) FBS-r

Answer 77

B—Fs

Fs and Fp-r are both good at differentiating simulators from patients with somatoform disorders and medical patients. Fs was more sensitive, while Fp-r was more specific. Please refer to Chapter 37.

Question 78

You are consulted to evaluate a 62-year-old woman on the geropsychiatry unit. The patient has been extremely anxious and paranoid for the past 3 weeks with no sign of improvement. She refuses most tests and interventions. The psychiatrist is concerned about a progressive dementia but has not been able to complete an adequate examination. However, when her son comes to visit, she calms considerably and agrees to participate in your assessment, but only if her son stays in the room with her. What do you do?

(a) The risks to test security are too high; don’t conduct the assessment.
(b) Wait until the patient’s anxiety and paranoia improve and then test.
(c) Conduct the assessment with the son present but tell him he cannot assist.
(d) Have the patient’s son sign a nondisclosure agreement before proceeding.

Answer 78

C—Conduct the assessment with the son present but tell him he cannot assist. The ethical conflict here is between test security and ensuring that the patient receives appropriate care (i.e., beneficence). The psychologist must also consider the well-established impact of a third party on test performance. In this vignette the evaluation will likely assist with differential diagnosis and treatment planning even if it is brief in nature. Her symptoms have not improved in 3 weeks, and waiting would delay care unnecessarily, possibly leading to delayed clinical diagnosis and or poor overall outcome. Although there is some risk to test security, it is not sufficient to deny the patient access to the service. In cases where two ethical standards are in conflict, the neuropsychologist must decide which takes precedence in that specific circumstance or situation. A nondisclosure agreement is excessive and unnecessary as the odds of the son memorizing and sharing specific test questions with third parties are unlikely. Please refer to Chapter 7. General Principles and Ethical Standards: A, B, E; 3.04, 4.06, 9.02, 9.11

Question 79

A 14-year-old girl was hospitalized after being found wandering downtown and “talking crazy.” You are seeing her on the day of admission. On examination she reports that ants are crawling up and down her legs and that she can’t scratch them off. She is experiencing ____ and the likely etiology is ____?

(a) release hallucinations; drug intoxication
(b) visceral hallucinations; drug withdrawal
(c) hypnogogic hallucinations; drug withdrawal
(d) formication hallucinations; drug intoxication

Answer 79

D—formication hallucinations/drug intoxication Release hallucinations typically occur following acute loss of sensory input (e.g., blindness). Visceral hallucinations are experienced as odd or unlikely internal sensations as opposed to external ones. Hypnogogic hallucinations may occur normally when someone is in the process of falling asleep. Formication hallucinations can occur with drug intoxication and or during drug withdrawal. The history indicates that the patient was likely recently exposed to an illicit substance that is causing the hallucinations. Please refer to Chapter 27.

Question 80

All but which of the following tend to change with normal aging?

(a) gist recall
(b) psychomotor speed
(c) ep isodic memory
(d) processing speed

Answer 80

A—gist recall

Normal aging is associated with declines in multiple cognitive domains and specific functions, although the ability to recall the gist of stories is relatively less affected by aging than recall of details. Please refer to Chapter 30.

Question 81

Studies of depression in epilepsy have found that ____.

(a) patients with left temporal lobe epilepsy (TLE) are more depressed than patients with right TLE
(b) patients with right TLE are more depressed than patients with left TLE
(c) neither patients with right TLE nor left TLE show depression
(d) both patients with right TLE and left TLE show depression

Answer 81

D—both patients with right TLE and left TLE show depression

Although some studies have suggested a lateralized mood effect, the majority of studies show higher incidence of depression and anxiety in persons with epilepsy, regardless of laterality of seizure onset. More important factors are severity of epilepsy and seizure frequency. Please refer to Chapter 22.

Question 82

Which of the following conditions co-occur in as many as 40–70% of cases with Autism spectrum disorder?

(a) attentional problems (b) depression (c) oppositionality (d) phobias

Answer 82

A—attentional problems

Numerous studies suggest that attentional difficulties are the most common comorbidity in children with Autism spectrum disorder (ASD). Studies have shown that the among children with ASD, comorbidity rate of ADHD is in the 40–70% range. Please refer to Chapter 14.

Question 83

Which of the following is commonly seen in vascular dementia?

(a) dissociation between Trails A and B performance
(b) early impairment in personality and behavior
(c) deficits in letter fluency and set-shifting tasks
(d) marked dysnomia and micrographia

Answer 83

C—deficits in letter fluency and set-shifting tasks

Neither a dissociation between Trails A and B nor micrographia are characteristic of VaD. Early changes in personality and behavior are characteristic of frontal lobe dementia and are far less common in VaD. Measures of executive function and impaired letter fluency are commonly reported cognitive changes in VaD. Please refer to Chapter 31.

Question 84

You see a 10-year-old boy with a history of HIV encephalitis due to contracting the virus perinatally. He shows low average intellectual abilities and impairments in working memory, visuospatial reasoning, and processing speed. He struggles with self-confidence in school due to poor grades and asks why he is having these difficulties. Based on the World Health Organization guidelines, what would you recommend to his mother?

(a) Tell him he was sick as a baby, but doctors do not really know why.
(b) Inform him of his HIV disease status in an age-appropriate way.
(c) Discuss HIV in detail, including his family members’ contraction of the virus.
(d) Wait until he is 14 to disclose his status given his low average intelligence.

Answer 84

B—Inform him of his HIV disease status in an age-appropriate way. Regardless of low average intellectual abilities and or cognitive impairments patients are entitled to be informed of their condition and treatment options in an age-appropriate way. Minors and patients with a guardian may not be able to provide informed consent but they can assent to evaluation and or treatment. Please refer to Chapter 23.

Question 85

Memory of who you stayed with at a conference last month would be an example of ____ memory.

(a) semantic (b) episodic (c) procedural (d) remote

Answer 85

B—episodic Memory for temporal events. Please refer to Chapter 5.

Question 86

In general, the effects of hypoxic/ischemic injury are most detrimental in ____.

(a) infants and toddlers but not in senior adults
(b) senior adults but not in infants and toddlers
(c) persons at both extremes of the age spectrum
(d) late adolescence and early to mid adulthood

Answer 86

C—persons at both extremes of the age spectrum

Seniors often have reduced cognitive and cerebral reserve, thus making them more vulnerable to the short and long term consequences of hypoxic/ischemic injury. Children, especially those under the age of 4, are in a critical period of neurodevelopment and anoxic/hypoxic injury can disrupt/interrupt this process contributing to increased risk for long-term cognitive and neuropsychiatric complication. Please refer to Chapter 28.

Question 87

Jane is a 21-year-old woman diagnosed with multiple sclerosis who is currently attending college. Based on what is known about neuropsychological outcomes associated with multiple sclerosis, which of the following accommodation is most likely to be appropriate in Jane’s case?

(a) extended time for tests
(b) oral reading of exam questions by a proctor
(c) unlimited excused absences for medical appointments
(d) shortened assignments

Answer 87

A—extended time for tests

Given reduced processing speed, which is the most common cognitive problem in multiple sclerosis, affected individuals are likely to benefit from extended time for tests. In higher education settings, students with disabilities must meet the same standards (attendance, coursework) as unaffected peers and therefore, shortened assignments or unlimited excused absences are unlikely to be approved as an accommodation in college. Current research does not show a clear pattern of reading problems; however, individual assessment would inform this need depending on factors unique to the patient. Please refer to Chapter 24.

Question 88

Which of the following findings can be seen early in both Parkinson’s disease and corticobasal syndrome?

(a) asymmetric motor dysfunction
(b) personality change
(c) alien hand syndrome
(d) resting tremor

Answer 88

A—asymmetric motor dysfunction Motor symptoms are generally greater on one side for both Parkinson’s disease and corticobasal syndrome. Please refer to Chapter 33.

Question 89

Most of the time, this genetic disorder is caused when abnormal cell division results in an extra full or partial copy of chromosome 21. The extra genetic material causes the developmental changes and clinical features of this disorder.

(a) Prader-Willi syndrome
(b) Down syndrome
(c) Williams syndrome
(d) fragile X syndrome

Answer 89

B—Down syndrome Down syndrome is the most common chromosomal abnormality or genetic cause of intellectual disability and occurs in 1.2 in 1,000 live births. Please refer to Chapter 13.

Question 90

When cognitive variables such as working memory, inhibition, and processing speed are used to predict attention, what percentage of the total variance in attention is typically explained?

(a) less than 40% (b) 40–50% (c) 50–60% (d) 60–70%

Answer 90

A—less than 40% The amount of variance that is often explained in reading and math skills when doing cognitive modeling ranges between 75–85%. In contrast, only about 25–30% of variance in attention is accounted for by cognitive predictors such as inhibition, processing speed, and working memory. Please refer to Chapter 16.

Question 91

For whom would the MMPI-2, MMPI-2-RF, and PAI most likely be contraindicated?

(a) an 84-year-old, African American, retired attorney with multiple sclerosis
(b) an 18-year-old, Hispanic candidate for gastric bypass surgery
(c) a 28-year-old, Asian American gentleman with a sixth-grade reading level
(d) a 17-year-old, Caucasian woman with disabling deafness

Answer 91

D—a 17-year-old, Caucasian woman with disabling deafness The standardization samples that accompany each of these inventories were aged 18 years or older. Please refer to Chapter 10.

Question 92

There is anatomic evidence of separate visual channels for ____.

(a) form, shapes, and objects
(b) form, color, and motion
(c) faces, objects, and animals
(d) familiar and unfamiliar objects

Answer 92

B—form, color, and motion

These three channels of information have different origins in retina, different thalamic and cortical targets, and different projections to association cortex. Other alternatives within this item are all variations on the “form,” for which some cortical specialization exists but no evidence of distinct channel separation. Please refer to Chapter 4.

Question 93

You are examining a 58-year-old African American right-handed man from South Carolina with 9 years of education. He acknowledges visual and auditory hallucinations, including seeing and hearing “ghosts,” ever since his brother passed away 6 months ago. He is obese and has diabetes that is not well controlled. Which of the following reflects the most likely diagnosis given the information you have?

(a) Given both auditory and visual hallucinations, a psychotic disorder due to a medical condition(s) should be investigated.
(b) Given the combination of psychotic symptoms and the temporal proximity to the death of a close relative, the diagnosis of depressive disorder with psychotic features should be investigated.
(c) Given cultural and educational background, more detailed queries should be made before concluding that his visual and auditory perceptions reflect a psychotic disorder.
(d) Given the risk factors for cerebrovascular disease, workup for ischemic disease and vascular cognitive impairment should be prioritized.

Answer 93

C—Given cultural and educational background, more detailed queries should be made before concluding that his visual and auditory perceptions reflect a psychotic disorder.

Certain religious beliefs and sensory experiences may be common in some cultures, while considered unusual in others. Additional factors including cerebrovascular disease may pose vulnerability for symptoms of all kinds, and the additional information that he has visual hallucinations (not just auditory hallucinations) might further lead you to suspect other causes of symptoms that are not on the schizophrenia spectrum. But before concluding that these reflect pathological symptoms at all, you need to take the cultural, educational and socioeconomic factors into account. Please refer to Chapter 35.

Question 94

What type of aphasia most commonly results from an infarct of the left inferior middle cerebral artery distribution in an adult?

(a) Broca’s aphasia
(b) transcortical motor aphasia
(c) global aphasia
(d) Wernicke’s aphasia

Answer 94

D—Wernicke’s aphasia

Left inferior middle cerebral artery infarct can result in damage to the superior temporal cortex, which is associated with Wernicke’s aphasia. Please refer to Chapter 26.

Question 95

Which of the following drugs is most likely to cause persisting changes on MRI?

(a) hallucinogens
(b) Ecstasy
(c) methamphetamine
(d) benzodiazepines

Answer 95

C—methamphetamine

Abnormal neuroimaging findings are more frequent and severe with methamphetamine rather than those of cocaine or prescription stimulants and can persist for several years following cessation of use. Please refer to Chapter 36.

Question 95

Which of the following drugs is most likely to cause persisting changes on MRI?

(a) hallucinogens
(b) Ecstasy
(c) methamphetamine
(d) benzodiazepines

Answer 95

C—methamphetamine Abnormal neuroimaging findings are more frequent and severe with methamphetamine rather than those of cocaine or prescription stimulants and can persist for several years following cessation of use. Please refer to Chapter 36.

Question 95

Which of the following drugs is most likely to cause persisting changes on MRI?

(a) hallucinogens
(b) Ecstasy
(c) methamphetamine
(d) benzodiazepines

Answer 95

C—methamphetamine Abnormal neuroimaging findings are more frequent and severe with methamphetamine rather than those of cocaine or prescription stimulants and can persist for several years following cessation of use. Please refer to Chapter 36.

Question 96

Which of the following drugs is most likely to cause persisting changes on MRI?

(a) hallucinogens
(b) Ecstasy
(c) methamphetamine
(d) benzodiazepines

Answer 96

C—methamphetamine Abnormal neuroimaging findings are more frequent and severe with methamphetamine rather than those of cocaine or prescription stimulants and can persist for several years following cessation of use. Please refer to Chapter 36.