Chapter 5: Domains of Neuropsych Fx & Related Neurobehavioral DOs

Question 1

Which brain area plays a key role in motivating selective attention toward a salient stimulus?

A) inferior parietal
B) basal forebrain
C) dorsolateral frontal
D) anterior cingulate

Answer 1

D - anterior cingulate

Motivation and saliency involve executive systems such as the anterior cingulate (limbic)

Question 2

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 2

B - anterior communicating artery (ACoA) aneurysm

An aneurysm of the ACoA would be an example of a pathology producing diencephalic amnesia with resultant confabulation; the other three etiologies affect temporal areas.

Question 3

Posner and Peterson’s attentional model would predict difficulty with ____ as a result of damage to the ascending reticular activating system (ARAS).

A) alerting
B) detection
C) orienting
D) shifting

Answer 3

A - Alerting

Orienting and shifting, according to Posner and Petersen’s model, involves the posterior network; alerting and arousal involve the ARAS.

Question 4

Classification of aphasia is based primarily on which three parts of the language assessment?

A) fluency, repetition, prosody
B) fluency, comprehension, naming
C) fluency, comprehension, repetition
D) comprehension, naming, repetition

Answer 4

C - Fluency, comprehension, repetition

Fluent versus nonfluent speech localizes anterior from posterior aphasic syndromes; impairment in comprehension distinguishes Wernickes’ s from conduction aphasia, and the ability to repeat implies that perisylvian language areas are intact.

Question 5

A 63-year-old right-handed woman with hypertension was talking on the phone when suddenly she had difficulty getting words our and could not answer simple questions. She was taken to the hospital; on exam, she was able to follow three-step commands, and repeated words and sentences with 100% accuracy. Reading was not assessed. Writing was sparse and telegraphic. Naming was 1 of 6. What kind of aphasic syndrome is likely present in this patient?

A) Broca’s Aphasia
B) Wernicke’s Aphasia
C) Transcortical sensory Aphasia
D) Transcortical motor Aphasia

Answer 5

D - transcortical motor aphasia

This aphasic syndrome resembles Broca’s aphasia, but because it involves the extrasylvian region, repetition is intact.

Question 6

A 63-year-old right-handed woman with hypertension was talking on the phone when suddenly she had difficulty getting words our and could not answer simple questions. She was taken to the hospital; on exam, she was able to follow three-step commands, and repeated words and sentences with 100% accuracy. Reading was not assessed. Writing was sparse and telegraphic. Naming was 1 of 6.

Where is the patient’s lesion likely to have been?

A) extrasylvian area
B) Broca’s area
C) Wernicke’s area
D) arcuate fasciculus

Answer 6

A - extrasylvian area (anterior cerebral artery territory)

Question 7

Which of the following is NOT a symptom of Gerstmann Syndrome?

A) agraphia
B) acalculia
C) alexia
D) finger agnosia

Answer 7

C - alexia

The four components of Gerstmann syndrome are finger agnosia, acalculiac right-left disorientation, and agraphia

Question 8

A 16-year-old girl is evaluated in rehabilitation following a ruptured aneurysm. She is unable to follow commands, repeat, or name objects, but very matter-of-factly states, “I was ba frink clink in da damn.” The most likely diagnosis is ____.

A) Broca’s aphasia
B) conduction aphasia
C) anomic aphasia
D) Wernicke’s Aphasia

Answer 8

D - Wernicke’s aphasia

Although both Wernicke’s aphasia and conduction aphasia are characterized by fluent (albeit paraphasic) speech, only Wernicke’s aphasia also includes impaired comprehension.

Question 9

Intact spatial abilities but disturbed recognition of objects implies disruption in the ____ pathway.

A) dorsal
B) mesial
C) ventral
D) rostral

Answer 9

C - Ventral

Question 10

Which of the following is the loss of the ability to plan and execute complex gestures?

A) ideomotor apraxia
B) ideational apraxia
C) constructional apraxia
D) buccofacial apraxia

Answer 10

B - Ideational apraxia

Question 11

Which of the following might you see with damage to the dorsolateral frontal lobe?

A) emotional lability
B) Witzelsucht
C) abulia
D) lack of empathy

Answer 11

C - abulia

emotional lability, lack of empathy, and Witzelsucht would more likely be seen with orbitofrontal damage

Question 12

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

A) semantic
B) episodic
C) procedural
D) remote

Answer 12

B - episodic

Memory for temporal events

Question 13

A 5 year-old boy demonstrates delayed language, parallel play, and an obsession with electrical outlets, but can recite the day of the week of any date. He most likely demonstrates ____.

A) aphasia
B) obsessive comulsive disorder
C) savantism
D) schizophrenia

Answer 13

C - savantism

The patient described has autistic disorder, which has some association with savantism.

Question 14

You are called to evaluate an inpatient with a history of alcohol abuse who had tried to escape from his assisted living facility by climbing a tree 2 days ago. On admission, his toxicology screen was negative. Testing indicated poor orientation and attention, fair memory, and poor reasoning. Your tentative diagnosis is _____.

A) Korsakoff’s dementia
B) transient global amnesia
C) delirium
D) transient ischemic attack

Answer 14

C - delirium

The patient’s fair memory eliminates Korsakoff’s syndrome and TGA; their poor orientation and attention are consistent with delirium.

Question 15

The inability to recall events prior to an accident/illness or event is ___ amnesia.

A) anterograde
B) retrograde
C) global
D) psychogenic

Answer 15

B - Retrograde

Question 16

Anosodiaphoria

Answer 16

Disorder wherein patients are aware they have impairments (e.g., paralysis), yet show no emotional concern or distress about it; neglect also often present

Brain system damage –> Right parietal or frontal systems

Question 17

Alexithymia

Answer 17

An inability to understand, process, or describe emotions

Brain system damage–> Right hemisphere

Question 18

Emotional lability

Answer 18

Fluctuations of emotion and/or increased emotional reactivity

Brain system damage–> Orbitofrontal area limbic system

Question 19

Pseudobulbar affect

Answer 19

Type of emotional lability; extreme involuntary emotional responses (i.e., tearful crying, excessive laughing) to mild stimulation

Brain system damage –> due to pseudobulbar palsy, or damage to the upper motor neuron corticobulbar tract.

Question 20

Abulia

Answer 20

passive behavior wherein one exhibits little spontaneous activity and markedly delayed responses and tends to speak briefly or softly. In the extreme, the patient may be immobile, akinetic and mute, but will continue to appear awake, sitting with his or her eyes open.

Question 21

Circumlocution

Answer 21

The purposeful substitution of usually many words for a word or other words a pt is unable to find that manifests as talking around word-finding difficulties rather than using specific words. These are not considered paraphasic errors, and circumlocution is not the equivalent of tangentiality.

Question 22

Crystallized intelligence (Gc)

Answer 22

This refers to the breadth and depth of knowledge and understanding that is acquired through learning, education, experience, and acculturation; it is often resistant to the effects of aging and neurologic injury or illness.

Question 23

Dysarthria

Answer 23

A speech disorder involving difficulty in articulation.

NOT an aphasia or language disorder, although sometimes confused with them.

Patients with dysarthria are typically able to read and write normally, which readily differentiates them from patients with expressive aphasia.

Question 24

Dysphonia

Answer 24

A speech disorder involving difficulty in vocalization

Question 25

Fluid intelligence (Gf)

Answer 25

This intelligence refers to the ability to reason, adapt, solve problems, form concepts, and understand relationships in unfamiliar or novel circumstances. Unlike, Gc, it is susceptible to the effects of aging.

Question 26

Literal (or phonemic) paraphasias

Answer 26

The substitution or rearrangement of sounds or syllables in otherwise correct words.

Question 27

Pragmatics

Answer 27

The context in which the words are used

Question 28

Prosody

Answer 28

An element of speech that contributes to the conveyance of meaning through rhythm, stress, pitch, loudness, tempo, and intonation. It can indicate the basic structure of a sentence, the emotional content, or the main point in an utterance.

Question 29

Semantics

Answer 29

The meanings of words and the rules governing the use of words. It is the sequencing of meaningful words and sounds to convey meaning

Question 30

Semantic paraphasias

Answer 30

The substitution of a correct word or phrase for another semantically related word/phrase.

Note: Semantic paraphasias in the form of multiword paraphasic errors or “paragrammatism” is one feature that differentiates the syndrome of Wernicke’s aphasia from other fluent aphasic syndromes.

Question 31

Syntax

Answer 31

The rules governing the structure of phrases and sentences

Question 32

Verbal paraphasias

Answer 32

The substitution of one correct word for another. Some substitutions may have no obvious semantic relationship with the correct word, whereas others involve substitution of a correct word or phrase for another semantically related word or phrase.

Question 33

ATTENTION:

What are some associated disorders with notable impairment in attention?

Answer 33

Delirium

Attention-Deficit/Hyperactivity Disorder (ADHD)

Hemispatial Inattention (A.K.A. Neglect)

Traumatic Brain Injury (TBI)

Others: depression, anxiety, fatigue, lack of sleep, environmental factors (i.e., noise), and medications

Question 34

ATTENTION: What does the following relevant brain structure do with regard to attention?

Ascending Reticular Activating System (ARAS)

Answer 34

Arousal and attention

Question 35

ATTENTION: What does the following relevant brain structure do with regard to attention?

Anterior Cingulate (and Limbic System)

Answer 35

Determines saliency of stimuli and associated emotion/motivation

Question 36

ATTENTION: What does the following relevant brain structure do with regard to attention?

Prefrontal

Answer 36

Response selection, control, sustained attention, focus, switching, searching, and alternating attention

Question 37

ATTENTION: What does the following relevant brain structure do with regard to attention?

Orbitofrontal

Answer 37

inhibition of responses

Question 38

ATTENTION: What does the following relevant brain structure do with regard to attention?

Dorsolateral Frontal

Answer 38

Initiation of responses

Question 39

ATTENTION: What does the following relevant brain structure do with regard to attention?

Superior Colliculus

Answer 39

Shifting attention; eye movements

Question 40

ATTENTION: What does the following relevant brain structure do with regard to attention?

Lateral Pulvinar

Answer 40

Extracting information from the target location and filtering distractions

Question 41

ATTENTION: What does the following relevant brain structure do with regard to attention?

Inferior and Posterior Parietal

Answer 41

underlies disengagement from a stimulus and the representation of space; its damage is associated with hemispatial inattention/neglect

Question 42

ATTENTION: What does the following relevant brain structure do with regard to attention?

Right Hemisphere

Answer 42

Spatial attention; associated with hemispatial inattention/neglect