Exam 2 Book

Question 1

A 67-year-old right-handed woman with no significant medical history was sitting and conversing with a friend at lunch when suddenly she began repeating what she heard and could not answer simple questions. At the hospital, her speech was fluent but echolalic. She was unable to follow commands, but repeated words and sentences with 100% accuracy. Naming was impaired. 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 1

C—transcortical sensory aphasia This aphasic syndrome resembles Wernicke’s aphasia, but because it involves the extrasylvian region, repetition is intact. Please refer to Chapter 5.

Question 2

You recently completed a neuropsychological evaluation with an elderly man and determined that he likely has middle stage dementia of the Alzheimer type. You have a release that allows you to speak with family members. You call the patient’s wife to arrange feedback. She agrees to come in for feedback but asks you not to tell her husband that he has dementia indicating that it will most certainly depress him further and that he might become suicidal. What should you do first?

(a) Thank her for the concern and call at another time to arrange feedback specifically with the patient.
(b) Tell the wife that you are obligated to provide the patient with all findings.
(c) Cancel the feedback session but provide a written report to the referring provider.
(d) Provide the patient with feedback unless you are convinced it will result in harm.

Answer 2

D—Provide the patient with feedback unless you are convinced it will result in harm. Patients, unless previously deemed legally incompetent, are entitled to be fully informed with regard to their healthcare. However, if the clinician determines that such information would be harmful, he or she can modify what is provided as long as there is reasonable justification for such action. The neuropsychologist could and likely should opt to provide the patient with these findings tactfully. However, it would be inappropriate to avoid providing the patient with any information after such an evaluation. Standard 2.09 requires psychologists to ensure that explanation of the results are provided using language that is reasonable and understandable to the patient or legally authorized persons who act on behalf of the patient. Please refer to Chapter 7.

Question 3

In children with Autism spectrum disorder, which of the following is most successful in treating irritability and hyperactivity?

(a) discrete trial instruction
(b) restricted diet
(c) deep-pressure/sensory stimulation
(d) psychotropic medications

Answer 3

D—psychotropic medications Medications have been shown to have success in decreasing irritability and hyperactivity in children and adolescents with ASDs. Please refer to Chapter 14.

Question 4

For a child with cerebral palsy, a favorable prognostic indicator is ____.

(a) hand preference by 15 months
(b) sitting by 24 months
(c) standing by 36 months
(d) pincer grasp by 11 months

Answer 4

B—sitting by 24 months Sitting by 24 months predicts future ambulation. Please refer to Chapter 19.

Question 5

Which of the following neurocognitive functions is generally best preserved among individuals with schizophrenia?

(a) visuospatial reasoning
(b) memory
(c) executive functioning
(d) attention

Answer 5

A—visuospatial reasoning Patients with schizophrenia show moderate to severe deficits across almost all neuropsychological functions; however, deficits in attention, memory, and executive functioning are among the most severe and reliably observed. Please refer to Chapter 35.

Question 6

A college-educated 50-year-old African American woman with memory complaints is referred for testing to rule out mild cognitive impairment from normal aging. Which set of normative data would be most appropriate for interpretation for a list-learning test?

(a) the norms included in the testing manual
(b) no normative data set is best, this case requires qualitative assessment
(c) norms that adjust for years of education
(d) a normative data set collected exclusively on African Americans

Answer 6

D —a normative data set collected exclusively on African Americans Since the referral question can be answered in the context of the examinee’s cultural group, the African American normative data is likely to provide the most accurate interpretive base. Please refer to Chapter 11.

Question 7

On what task can patients with substance-induced amnesia (formerly Korsakoff amnesia) demonstrate intact learning?

(a) spatial-location (b) facial recognition (c) pursuit-rotor (d) verbal list learning

Answer 7

C—pursuit-rotor Procedural memory is relatively intact, but any measure of episodic memory task (A, C, and D) will be failed. Please refer to Chapter 3.

Question 8

Which of the following conditions is an environmental cause of ADHD?

(a) exposure to tobacco smoke in utero (b) single uncomplicated mild traumatic brain injury (c) frequent otitis media (d) exposure to antiepileptic drugs in utero

Answer 8

A—exposure to tobacco smoke in utero Exposure to tobacco smoke in utero is considered to be a common potential environmental risk factor for developing ADHD symptoms. Please refer to Chapter 16.

Question 9

Patients in the early stages of Alzheimer’s disease will typically display all of the following memory characteristics except ____.

(a) little improvement with repeated learning trials (b) perseverative and echolalic behavior (c) errors during recall, such as intrusions (d) a heightened recency effect

Answer 9

B—perseverative and echolalic behavior Patients with early Alzheimer’s disease display a pattern of deficits characterized by reduced learning, rapid forgetting, increased recency recall, elevated intrusion errors, and poor recognition discriminability with increased false-positives. Perseverative behavior typically occurs later in the disease process. Please refer to Chapter 30.

Question 10

In the classic cortico-striatal-pallidal-thalamo-cortical loop, the “input” to the basal ganglia is to the ____ and the output is via the ____.

(a) globus pallidus; caudate nucleus (b) striatum; globus pallidus (c) globus pallidus; nucleus accumbens (d) striatum; nucleus accumbens

Answer 10

B—striatum; globus pallidus The striatum (caudate and putamen) receives cortical input and projects to the globus pallidus, which provides basal ganglia output to the thalamus. Each loop differs with respect to the specific striatal or pallidal region involved, but the basic architecture is the same in all loops. Please refer to Chapter 4.

Question 11

Which of the following is apt to be most sensitive to noncredible performance on a verbal list-learning memory test?

(a) total learning (b) short-delay free recall (c) long-delay free recall (d) recognition

Answer 11

D—recognition On verbal list-learning tests such as the CVLT, recognition measures have generally been found to be the most sensitive and specific to noncredible performance, in both adult and pediatric populations. Please refer to Chapter 12.

Question 12

The incidence of new onset epilepsy is greatest at the extreme age ranges, with higher rates in young children, decreasing rates through adolescence and adulthood, and rising incidence in the elderly. Which of the following is most likely to be a cause of new onset epilepsy in the elderly (>65) population?

(a) history of febrile seizures (b) cardiovascular disease (c) primary neurodegenerative disease (d) paraneoplastic limbic encephalitis

Answer 12

C—primary neurodegenerative disease While paraneoplastic limbic encephalitis is associated with new-onset epilepsy in adults, it is uncommon among elderly over age 65 years. Primary neurodegenerative disease (e.g., Alzheimers), traumatic brain injury, cerebrovascular disease, and primary CNS tumors are all common causes of new-onset epilepsy in the geriatric population. Please refer to Chapter 22.

Question 13

Which of the following is true of the behavioral variant of frontotemporal dementia?

(a) It is the most common of the three frontotemporal dementia variants. (b) It occurs more frequently in women than in men. (c) Frequent falls are typically the first sign of the disorder. (d) The average age of onset is older than for Alzheimer’s disease.

Answer 13

A—It is the most common of the three frontotemporal dementia variants Of the three FTD variants, bvFTD is the most common of the three FTD variants and occurs more frequently in men. The average age of onset is younger than for Alzheimer’s disease. Frequent falls as an early sign is more consistent with the motor variant. Please refer to Chapter 32.

Question 14

Significant psychiatric symptoms are common presenting symptoms in all of the following disorders, except ____.

(a) NMDA receptor encephalitis (b) HSV encephalitis (c) paraneoplastic limbi c encephalitis (d) bacterial meningitis

Answer 14

D—bacterial meningitis The most common presenting symptoms in bacterial meningitis include severe headaches, fever, and nuchal rigidity (i.e., neck stiffness). All of the other disorders often present with psychiatric symptoms, sometimes even in the absence of other neurological or physical symptoms. Please refer to Chapter 23.

Question 15

Autism is seen most commonly in which of the following disorders?

(a) neurofibromatosis type 1 (b) PKU (c) tuberous sclerosis (d) adrenoleukodystrophy

Answer 15

C—tuberous sclerosis Of the disorders listed, children with tuberous sclerosis are at greatest risk for Autism spectrum disorder (ASD), with 40–50% diagnosed with ASD. Please refer to Chapter 18.

Question 16

In multiple sclerosis, ____.

(a) African Americans are at higher risk than Caucasians (b) women are at higher risk than men (c) the elderly are at higher risk than young adults (d) the incidence is higher among urban dwellers relative to rural

Answer 16

B—women are at higher risk than men It is well established that multiple sclerosis is more common in women than in men. This pattern is also seen in teens with multiple sclerosis. Interestingly however, the gender ratio is about 1:1 in those with onset prior to puberty. Please refer to Chapter 24.

Question 17

Adults with congenital hydrocephalus ____.

(a) live independently because of their strong verbal skills (b) live for many years with difficulties related to their motoric difficulties (c) are underemployed relative to their IQ and literacy levels (d) develop neuropsychological deficits unlike those seen in childhood

Answer 17

C—are underemployed relative to their IQ and literacy levels Like many adults with disabilities, unemployment rates are high. Poor math and visuospatial skills have been implicated as a source of employment difficulties. Please refer to Chapter 20.

Question 18

Which of the following represents the most common physical complaints following moderate to severe traumatic brain injury in adults?

(a) dizziness and tinnitus (b) fatigue and sleep disturbances (c) headaches and back pain (d) visual disturbances

Answer 18

B—fatigue and sleep disturbances Fatigue and sleep disturbances are quite common following TBI at all levels of injury severity. Dizziness, tinnitus, headaches, pain, and visual disturbances also occur but with less frequency. Please refer to Chapter 29.

Question 19

A psychiatrist refers a patient to a neuropsychologist for suspected organicity. This is an example of ____.

(a) domain-specific thinking (b) lateralization hypothesis testing (c) domain-general theory (d) localization theory

Answer 19

C—domain-general theory Organicity is an older term referring to the presence of brain damage, or abnormal cerebral function. It refers to a concept of whole-brain involvement, rather than specific, regional dysfunction of specific bran centers and corresponding discrete functional impairment (localization model). Please refer to Chapter 3.

Question 20

Among the sedative/hypnotics, abuse of barbiturates has largely been replaced by benzodiazepines in recent years because of which of the following?

(a) Benzodiazepines cost less. (b) Barbiturate intoxication carries more risk of accidental overdose. (c) Benzodiazepines have fewer long-term effects on neurocognition. (d) Withdrawal from benzodiazepines is safer.

Answer 20

B—Barbiturate intoxication carries more risk of accidental overdose. Respiratory depression is more common with acute effects of barbiturates which also increases the risk of accidental overdose. Benzodiazepines are not necessarily more costly than barbiturates, long-term neurocognitive effects, including memory problems, are more common with benzodiazepine use, and withdrawal from either type of drug requires inpatient hospitalization due to risk of seizures. Please refer to Chapter 36.

Question 21

Which of the following anatomic regions is most vulnerable to Wallerian degeneration following anoxic damage to the hippocampus?

(a) fornix (b) occipital lobe (c) internal capsule (d) hypothalamus

Answer 21

A—fornix The fornix is the primary output destination for the hippocampus. Degeneration of axons in the hippocampus may result in Wallerian degeneration and resultant atrophy in the fornix. Regions such as the internal capsule and occipital lobes are vulnerable to anoxia/hypoxia through different processes. Please refer to Chapter 28.

Question 22

A 3-year-old fair-skinned boy with blonde hair and light blue eyes presents for an evaluation of delayed speech and motor development. He is not speaking any words and has problems with balance. He is a happy boy who exhibits a broad social smile and flaps his hands repetitively. His parents describe severe problems with sleep and a recent onset of seizures. Evaluation findings are consistent with severe intellectual disability. Which of the following diagnoses best fits this descriptionb?

(a) fetal alcohol syndrome (b) Autism spectrum disorder (c) Angelman syndrome (d) Tay-Sachs disease

Answer 22

C—Angelman syndrome Fair hair, blue eyes, dysmorphic features (wide smiling mouth, thin upper lip, pointed chin), epilepsy, ataxia, microcephaly, happy disposition, hand flapping, intellectual disability, sleep disturbance, possible autistic features, and love of water and music characterize individuals with Angelman syndrome. Please refer to Chapter 13.

Question 23

A 33-year-old woman with a history of hypothyroidism presents with complaints of poor sleep quality, changes in appetite, reduced libido, and dysphoric mood. Of the following which neurotransmitter system is most likely involved?

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

Answer 23

D—serotonin— Serotonergic neurons are involved in a very broad range of physiological and behavioral processes including cardiovascular regulation, appetite, pain sensitivity, sexual behavior, mood, respiration, cognition, learning and memory, and other aspects of mood and behavior. This highlights the role of serotonin regulation in the management of mood disorders as well as behavioral impulse-control difficulties. Please refer to Chapter 34.

Question 24

The Babinski sign in an adult is usually associated with ____.

(a) upper motor neuron dysfunction (b) lower motor neuron dysfunction (c) cerebellar dysfunction (d) intact corticospinal functioning

Answer 24

A—upper motor neuron dysfunction The Babinski sign in adults is considered to be abnormal, and is elicited in the presence of upper motor neuron dysfunction. Please refer to Chapter 6.

Question 25

Overall, the most common medically unexplained symptom in children and teens is ____, with younger children more likely to report ____.

(a) headache, abdominal distress (b) diarrhea, dental pain (c) cognitive difficulties, constipation (d) nausea, mood symptoms

Answer 25

A—headache, abdominal distress There is considerable overlap between adult and pediatric somatoform presentations, although complaints in children are predictably a bit simpler. Please refer to Chapter 37.

Question 26

The medical history most typical of spastic diplegic cerebral palsy is ____.

(a) premature birth and greater upper than lower extremity involvement
(b) premature birth and neuroimaging findings of periventricular leukomalacia (
c) full-term birth and abnormalities involving the pyramidal system
(d) full-term birth and greater lower than upper extremity involvement

Answer 26

B—premature birth and neuroimaging findings of periventricular leukomalacia Greater lower than upper extremity involvement would be consistent with spastic diplegia. Please refer to Chapter 19.

Question 27

Which of the following is true about depression and suicide?

(a) More women attempt suicide, but more men are more likely to complete. (b) Men are more likely to attempt suicide, and are more likely to complete. (c) Elderly patients are more likely to attempt suicide than younger counterparts. (d) Adolescents are more likely to attempt suicide than adults.

Answer 27

A—More women attempt suicide, but more men are likely to complete. Depression is not a normal part of the aging process, as most elderly report being very satisfied with their lives, even in the context of medical illnesses or physical limitations. However, elderly patients with depression, particularly males, have the highest rate of successful suicide in the United States. Please refer to Chapter 34.

Question 28

Microscopic infarctions, white matter hyperintensities, silent brain infarcts and microhemorrhages secondary to cerebral amyloid angiopathy____.

(a) are clear evidence for cerebrovascular disease as a causal factor in vascular cognitive impairment
(b) provide no evidence for cerebrovascular disease as a causal factor in vascular cognitive impairment
c) are commonly observed in community-dwelling older adults, even in the absence of cognitive impairment
d) are unusual findings in otherwise cognitively healthy community-dwelling older adults

Answer 28

C—are commonly observed in community-dwelling older adults, even in the absence of cognitive impairment Because all of these phenomena occur in a significant proportion of nondemented community-dwelling older adults, their presence alone does not provide confirmation of cerebrovascular disease as a causative factor for cognitive impairment. Please refer to Chapter 31.

Question 29

A normative sample of a test where performance is measured in the number of errors made, and in which nearly all persons make no errors, would be called ____.

(a) positively skewed
(b) negatively skewed
(c) a bimodal distribution
(d) a random distribution

Answer 29

A—positively skewed Skewness refers to the degree of bias, either positively or negatively, in a distribution of scores in a population. Positive skewness occurs when a large percentage of the normal population performs well or nearly perfectly on a task or test. Skewness in a population is one way in which the assumption or normal distribution can be violated and thus invalidate the use of standard scores in evaluating some ones performance. Please refer to Chapter 9.

Question 30

Educational programming of a minimally verbal 8-year-old with Autism spectrum disorder should prioritize development in ____.

(a) eye contact, joint attention, play skills, and early academic skills
(b) joint attention, requesting gestures, play skills, and use of an augmentative or alternative communication device
(c) joint attention, play skills, self-care skills, and early academic skills
(d) self-care skills, early academic skills, and use of sign language

Answer 30

B—joint attention, requesting gestures, play skills, and use of an augmentative or alternative communication device Intervention for minimally verbal children with ASD should primarily focus on advancing functional communication. Research suggests that the introduction of augmentative or alternate communication devices (e.g., picture exchange communication systems or speech-generating devices) significantly increases initiation of communicative requests and communicative utterances. The addition of instruction in prelinguistic gestures (joint attention, requesting gestures) and play skills has been shown to increase engagement between child and adult. Please refer to Chapter 14.

Question 31

You have results from a comprehensive neuropsychological battery in an individual for whom the presumptive diagnosis is chronic schizophrenia. You expect the average deficit to be about how far below normative expectations?

(a) 0 to 0.5 standard deviations
(b) 0.5 to 1.0 standard deviations
(c) 1.0 to 1.5 standard deviations
(d) 1.5 to 2.0 standard deviations

Answer 31

C—1.0 to 1.5 standard deviations This is the typical deficit seen in a range of large-scale and meta-analytic studies. Chronic and “deficit” syndrome patients tend to have larger deficits, and “non-deficit” patients tend to have smaller deficits, but the clinician should not be surprised to see deficits in this range. Please refer to Chapter 35.

Question 32

A 50-year-old gentleman presents to a sleep clinic with excessive daytime fatigue and recurrent periods of lapsing into sleep that are precipitated by laughter or joking. Which of the following sleep disorders is most consistent with his clinical presentation?

(a) insomnia
(b) Type I narcolepsy
(c) Type II narcolepsy
(d) REM sleep behavior disorder

Answer 32

B—Type I narcolepsy Type I narcolepsy occurs with cataplexy, whereas type II narcolepsy occurs without it. Please refer to Chapter 37.

Question 33

The clinician evaluating the gentleman in question 32 could use the following test to confirm a diagnosis.

(a) multiple sleep latency test
(b) MMPI-2-RF
(c) self-report measures of mood
(d) magnetic resonance imaging

Guy with narcolepsy and laughing bouts.

Answer 33

A—multiple sleep latency test This procedure tests for excessive daytime sleepiness by recording the time it takes for an individual to fall asleep and enter REM. Please refer to Chapter 37.

Question 34

What combination of deficits and problems two years following severe traumatic brain injury would most likely predict the poorest community reentry outcome in an adult?

(a) visuospatial and moderate speed of information processing impairments
(b) personality changes and behavioral problems with mild memory impairments
(c) moderate attention, verbal memory, and speed of processing impairments
(d) moderate language and memory impairments, and moderate depression

Answer 34

B—personality changes and behavioral problems with mild memory impairments Although any of these impairments or problems could impact community reentry, emotional and behavioral issues following severe TBI tend to result in the poorest outcomes. These problems are often related to and or accompanied by impairments in executive function. Please refer to Chapter 29.

Question 35

You diagnosed an 80-year-old man with mild cognitive impairment 1 year ago. He returns for repeated evaluation, and his wife describes stable activities of daily living during most of the day but some new episodes of increased confusion, wandering behavior, and suspiciousness during evening hours. The diagnosis of most concern would be ____.

(a) sundowning
(b) encephalopathy
(c) dementia with delirium
(d) dementia with delusions

Answer 35

C—dementia with delirium The symptoms in this case are commonly referred to as sundowning, which is not a formal diagnosis but rather a description of symptoms. Thus, c is the best answer listed because it is a formal diagnosis. Please refer to Chapter 27.

Question 36

A patient walks into your office and announces that this is not your office. Rather, your real office is somewhere else and this is a lookalike. Which symptom is this patient displaying?

(a) utilization behavior
(b) Fregoli’s syndrome
(c) Capgras syndrome
(d) reduplicative paramnesia

Answer 36

D—reduplicative paramnesia The feeling that a place has been duplicated. Capgras syndrome and Fregoli’s syndrome are imposter syndromes (person). Please refer to Chapter 5.

Question 37

In functional neuroimaging studies, the “neural signature” of dyslexia includes overactivation of ____.

(a) Wernicke’s area
(b) striate cortex
(c) inferior frontal gyrus
(d) angular gyrus

Answer 37

C—inferior frontal gyrus The neural signature of dyslexia includes underactivation of Wernicke’s area, the striate cortex, and the angular gyrus, but overactivation of the inferior frontal gyrus. Please refer to Chapter 15.

Question 38

Your patient is participating in a specialized physical therapy program for individuals who have difficulties with balance. While reviewing her records, you notice that during her most recent session, her therapist performed the Dix-Hallpike maneuver. During this procedure, elicitation of vertigo and nystagmus suggest ____ dysfunction that is ____ to the side of the downward ear.

(a) oculomotor; ipsilateral
(b) vestibular; contralateral
(c) vestibular; ipsilateral
(d) oculomotor; contralateral

Answer 38

C—vestibular; ipsilateral Although nystagmus presents as eye movement, it is a vestibular function mediated by dysfunction involving the vestibular branch of cranial nerve VIII, and effects are observed ipsilaterally. Please refer to Chapter 6.

Question 39

Individuals with substance use disorders (SUDs) frequently show neuropsychological impairments on measures of executive functioning, sustained attention/concentration, and ____.

(a) manual dexterity
(b) processing speed
(c) word-list generation
(d) reading comprehension

Answer 39

B—processing speed Deficits in processing speed are common in people with SUDs. Please refer to Chapter 36.

Question 40

A 14-year-old adolescent with a history of ischemic stroke at age 7 is referred for a neuropsychological evaluation. What is the most likely cause of his stroke?

(a) congenital heart disease
(b) bacterial meningitis
(c) arteriovenous malformation
(d) cerebral arteriopathy

Answer 40

D—cerebral arteriopathy Arteriopathy accounts for more than 50% of the cases of childhood stroke. Common arteriopathies include Moya-Moya syndrome, transient cerebral arteriopathy (vasculitis), and arterial dissection. Congenital heart disease is a common cause of childhood stroke, but not as common as arteriopathy. Bacterial meningitis is more often a cause of cerebral sinovenous thrombosis. Arteriovenous malformation is a common cause of hemorrhagic stroke. Please refer to Chapter 26.

Question 41

In addition to attention and concentration, direct retraining techniques will most likely generalize to real-world tasks in which of the following domains?

(a) verbal memory
(b) nonverbal memory
(c) visual scanning
(d) language processing

Answer 41

C—visual scanning Many direct retraining techniques do not have sufficient evidence to support real-world generalization. Possible exceptions include process-specific approaches that address cognitive functions such as attention and concentration (in the acute phase of recovery), visual scanning, and spatial organization. The true effects of cognitive rehabilitation are sometimes uncertain when factoring in natural recovery. Please refer to Chapter 29.

Question 42

A neuropsychologist has developed a busy private practice over the years and no longer needs to solicit or advertise for new patients. He does not want to expand his hours and decides to limit his practice. He instructs his office staff to begin refusing to accept patients with certain types of insurance. Which of the following most appropriately describes these actions?

(a) It is illegal and unethical
(b) It is legal and ethical
(c) It is legally acceptable but unethical
(d) It is ethical but may not be legal

Answer 42

B—It is legal and ethical. There is no legal or ethical mandate to care for any patient who wants to see you. A doctor–patient relationship must be entered into voluntarily by both parties. If a psychologist decides to focus on one specific patient population, they can. However, it would be unethical if the psychologist were to accept or reject certain patients based on arbitrary personal preferences. Yet, psychologists should not take on a patient if they have any biases that could affect objectivity, competence, or effectiveness (ES 3.06). At the same time, psychologists do not engage in unfair discrimination (ES 3.01). In this vignette, for patients he does not accept, the psychologist should provide appropriate alternatives if they are available. Also, the clinician could and certainly should refer patients elsewhere if or when the patient is requesting services the clinician is not competent or able to provide. However, if there is no doctor–patient relationship, there is no obligation to arrange for care from another psychologist. This is entirely different than situations in which the patient is already under the psychologist’s care. Once having accepted responsibility for a patient, there is far less freedom on the part of the psychologist to break that relationship. Abruptly discontinuing care of a patient in need without appropriate transfer is typically inconsistent with ethical practice and potentially akin to patient abandonment. Please refer to Chapter 7. General Principles and Ethical Standards: B, C; 3.01, 3.06, 3.11

Question 43

Early-onset dementia is typically associated with ____.

(a) a prolonged course
(b ) more rapid decline
(c) hallucinations
(d) tremor

Answer 43

B—more rapid decline Patients with early-onset Alzheimer’s disease often demonstrate a faster decline on neuropsychological tests administered over the course of a year, suggesting a more aggres

Question 44

Of the four major dopamine pathways, the one most prominently associated with motor regulation is the ____ pathway.

(a) tubero-infundibular
(b) mesolimbic
(c) mesostriatal
(d) mesocortical

Answer 44

C—mesostriatal This pathway primarily innervates the basal ganglia which is critical for motor regulation and aspects of cognitive function. Please refer to Chapter 4.

Question 45

Damage to which cranial nerve is MOST likely to lead to dysarthria?

(a) glossopharyngeal nerve
(b) vagus nerve
(c) spinal accessory nerve
(d) hypoglossal nerve

Answer 45

D—hypoglossal nerve Of the cranial nerves listed, the hypoglossal nerve has specific innervation to the tongue. Please refer to Chapter 6.

Question 46

The frequency of various etiologies for epilepsy varies by age. Which of the following is considered a major factor in the development of neonatal seizures and neonatal epilepsy?

(a) nonaccidental trauma
(b) febrile illness
(c) hippocampal sclerosis
(d) hypoxic-ischemic injury

Answer 46

D—hypoxic-ischemic injury Nonaccidental trauma is a leading cause of infant and toddler injury and death in the United States, and injuries in survivors may lead to later development of epilepsy, but is not a cause of neonatal seizures. Febrile illness leading to seizures typically occurs in childhood, not in the neonatal period. Leading causes of neonatal seizures include hypoxic-ischemic injury (20–30%), Infarction/hemorrhage (20–30%), brain malformations (5–10%), Infections (5–10%), metabolic (7–20%) genetic (6–10%) and unknown/other (10%). Please refer to Chapter 22.

Question 47

A 10-year-old child presents with generally intact language skills after a history of stroke. What is the most likely type of stroke associated with this outcome?

(a) perinatal ischemic stroke
(b) perinatal hemorrhagic stroke
(c) childhood ischemic stroke
(d) childhood hemorrhagic stroke

Answer 47

A—perinatal ischemic stroke Studies have consistently reported an overall delay in the onset of language after perinatal ischemic stroke, but a normal trajectory of language development afterward in the majority of cases. Strokes later in childhood result in language deficits when lesions involve the left hemisphere. The outcomes of hemorrhagic stroke are not well studied. Please refer to Chapter 26.

Question 48

A 35-year old woman presents upon referral from her primary care physician due to memory problems over the past 6 months. Upon interview and review of systems, she also reports menstrual cycle irregularities (which she attributed to stress associated with caring for young children and working full-time) and is also reporting increasing headaches and visual changes (which she attributed to an exacerbation of migraines). There is no history of cancer. What should be high on your differential diagnosis list?

(a) meningioma
(b) pituitary tumor
(c) cerebellar tumor
(d) paraneoplastic syndrome

Answer 48

B—pituitary tumor Tumors in the sella area can present with hormonal dysregulation and vision issues (due to compression of the optic chiasm). While cerebellar tumors might present with vision changes, hormonal changes are rare. Meningiomas are tumors in the meninges, and may present with headaches but not changes in endocrine functioning or vision. Meningiomas are sometimes found incidentally. Please refer to Chapter 25.

Question 49

You are interested in detecting the presence or absence of adequate engagement in cognitive testing with a test that has been normed across clinical populations. You want to be sure to minimize false positive errors (i.e., identifying someone as giving suboptimal effort when their performance reflects true impairment). In order to do this, you will want to set your cut-off for the test on the basis of what?

(a) multitrait multimethod matrix
(b) receiver operating curve analysis for the clinical group of interest
(c) area under the receiver operator characteristic curve
d) consideration of the standard error of measurement

Answer 49

B—receiver operating curve analysis for the clinical group of interest The ROC curve allows us to visualize the performance of a test by creating a plot of sensitivity and 1-specificity based on various cut-off values determining a positive test within a specific normative group. If the goal is to maximize specificity (i.e., minimizing false-positive errors), the cut point will be selected on that basis. The clinician should be aware in the context of their overall interpretation that an emphasis on specificity will result in decreased sensitivity to suboptimal engagement. Please refer to Chapter 8.

Question 50

Your 23-year-old patient was diagnosed with anti-NMDA receptor encephalitis 2 months prior to your evaluation. Which of the following would you expect her to describe regarding her initial symptom presentation?

(a) flu-like symptoms for 1 week, followed by hallucinations, delusions, and emotional instability, a period of unresponsiveness, then decreased breathing rate and low blood pressure
(b) abnormal motor movements, primarily of upper extremities, followed by symptoms of mania then respiratory distress
(c) acute seizure onset followed by inability to speak nor demonstrate comprehension of language then a 1-week period of persistent headache and fatigue
(d) gradual onset of neck rigidity and confusion, followed by psychotic symptoms and excessive talkativeness, then posturing

Answer 50

A—flu-like symptoms for 1 week, followed by hallucinations, delusions, and emotional instability, a period of unresponsiveness, then decreased breathing rate and low blood pressure This progression of symptoms is the most common in anti-NMDA receptor encephalitis (seen in about 70% of adult patients). Please refer to Chapter 23.

Question 51

A 49-year-old woman is referred by her attorney in relation to a personal injury claim of disabling mild traumatic brain injury. The validity scale profile of the Personality Assessment Inventory (PAI) was as follows: Inconsistency (ICN) T = 52; Infrequency (INF) T = 40; Negative Impression Management (NIM) T = 65; and Positive Impression Management (PIM) T = 31. Based on these results, the profile is probably ____.

(a) invalid due to symptom over-report and should not be interpreted
(b) best interpreted using non-gender-based norms
(c) an accurate reflection of current psychological and emotional functioning
(d) difficult to interpret without knowing which normative comparison group was used

Answer 51

C—accurate reflection of current psychological and emotional functioning The validity scale findings are well within an interpretative range according to conventional cut-scores listed in the PAI manual. Please refer to Chapter 10.

Question 52

Cerebral palsy can be challenging to define because ____.

(a) its symptoms vary based on whether it originates in the brain or spinal cord
(b) the diagnosis does not describe a specific neurological disorder
(c) its only pathognomonic feature changes as the motor system matures (
d) the non-progressive and progressive subtypes differ in their

Answer 52

B—the diagnosis does not describe a specific neurological disorder Cerebral palsy originates in the brain. There is not a single hallmark feature to aid in diagnosis. It is not progressive. Please refer to Chapter 19.

Question 53

Your 42-year-old patient indicates that she was prescribed Zoloft for depression 4 days ago but it doesn’t seem to help. She is thinking about stopping the medication. In addition to encouraging her to talk with the prescribing physician you explain that if taken appropriately, antidepressant medications typically are fully effective in ____ from the first dose.

(a) 7 to 10 days
(b) 10 to 21 days
(c) 2 to 3 weeks
(d) 4 to 6 weeks

Answer 53

D—4 to 6 weeks Initial effectiveness of antidepressant medications typically occurs at approximately 1 to 2 weeks, but the medications are not fully effective for another 2 to 4 weeks. Please refer to Chapter 34.

Question 54

You are performing a neuropsychological evaluation on a 12-year-old boy. Results from your evaluation reveal significant attention difficulties in both home and school settings, increased variability in response latencies on a visual CPT, slowed rapid automatized naming, poor phonological awareness, and decreased processing speed, all in the context of average intelligence. Based on this information, which diagnostic formulation would be most probable?

(a) ADHD and dyslexia
(b) ADHD without a comorbid condition
(c) dyslexia without a comorbid condition
(d) mixed receptive-expressive language disorder

Answer 54

A—ADHD and dyslexia These findings are most likely evidence of both ADHD (e.g., inattention and executive dysfunction) and dyslexia (e.g., poor phonological awareness). Decreased rapid automatized naming is seen in both disorders. This combination of diagnoses is quite typical. Please refer to Chapter 16.

Question 55

Neuropsychological profiles of persons with progressive supranuclear palsy are characterized by impairment primarily in ____.

(a) confrontation naming
(b) intellectual functions
(c) visuospatial construction
(d) executive functions

Answer 55

D—executive functions This is believed to be due to subcortical/frontal connections being affected by the disease. Please refer to Chapter 32.

Question 56

Which of the following best characterizes the current state of knowledge regarding individuals with intellectual disability (ID)?

(a) Specific cognitive and behavioral profiles have been identified for a variety of syndromes of ID.
(b) Individuals with ID show a general pattern of global impairment across measures.
(c) Variability occurs in individuals with ID such that no particular patterns in cognitive and behavioral profiles have been identified.
(d) A discrepancy between IQ and adaptive living skills (IQ>ADLs) has been identified for most but not all syndromes.

Answer 56

A—Specific cognitive and behavioral profiles have been identified for a variety of syndromes of ID. Research has identified specific profiles for a variety of syndromes such as Down syndrome, fragile X syndrome, and Williams syndrome. Please refer to Chapter 13.

Question 57

Preferred surgical treatment in advanced Parkinson’s disease with maximum medication response is ____.

(a) bilateral pallidotomy
(b) subthalamic nucleus deep brain stimulation
(c) vagal nerve stimulation
(d) stem cell transplant

Answer 57

B—subthalamic nucleus deep brain stimulation DBS of either the STN or GPi has a broader influence on all Parkinsonian symptoms and are the surgical targets of choice in most Parkinson’s disease patients. Please refer to Chapter 33.

Question 58

Addie was diagnosed with multiple sclerosis at age 12 and has been adherent to treatment recommendations. She has also undergone serial evaluations. She presents for a neuropsychological re-evaluation at age 17. What might you expect to find on testing across time?

(a) improved cognition given her adherence to medication
(b) worsened cognition across time
(c) cognition that is unchanged
(d) no clear expected longitudinal pattern

Answer 58

D—no clear expected longitudinal pattern Findings regarding longitudinal neuropsychological outcomes in pediatric multiple sclerosis have been mixed. Patterns of cognitive functioning described over time have included improvement, stability, or decline. Please refer to Chapter 24.

Question 59

In terms of the relationship between false positive rate and positive predictive power, which of the following statements is true?

(a) Positive predictive power increases with increases in the false positive rate.
(b) Positive predictive power decreases with decreases in the false positive rate.
(c) Positive predictive power and false positive rates are unrelated.
(d) Positive predictive power increases with decreases in the false positive rate.

Answer 59

D—Positive predictive power increases with decreases in the false positive rate. Positive predictive power = true positives/(true positives + false positives). By decreasing false positive rate, one increases positive predictive power. For instance, if false positive rate is zero (positive predictive power = true positives/(true positives + 0 false positives) = 1.00), then you have 100% positive predictive power. Please refer to Chapter 8.

Question 60

You are evaluating a 9-year-old child who has been struggling in his math class. In addition to math calculation and math problem solving, it will be important to assess math fluency, ____.

(a) working memory, executive functions, and math-specific anxiety
(b) working memory, executive functions, and depression
(c) verbal memory, executive functions, and math-specific anxiety
(d) working memory, executive functions, and decoding

Answer 60

A—working memory, executive functions, and math-specific-anxiety When assessing difficulties in mathematics, the neuropsychologist should evaluate math calculation, math problem solving, and math fluency. Executive functions have also been demonstrated to be important predictors of math performance, particularly working memory. Lastly, math-specific anxiety has been found to be negatively correlated with mathematical performance. Please refer to Chapter 15.

Question 61

A 30-year-old single man presents with a 12-year history of unstable relationships and emotional volatility. He endorses resentment about perceived abandonment by others but denies delusions of reference or dissociative features. This pattern most likely meets criteria for ____.

(a) Passive-Aggressive Personality Disorder
(b) Schizophreniform Disorder (
c) Cyclothymic Disorder
(d) Borderline Personality Disorder

Answer 61

D—Borderline Personality Disorder A cardinal feature of Borderline Personality Disorder is a pattern of unstable relationships without the presence of hallucinations, delusions, and other forms of thought disorder. Please refer to Chapter 34.

Question 62

The “what-where” cognitive system represents ____.

(a) the differential processing of the prefrontal cortex
(b) differential dorsal-ventral information processing
(c) the work of Roger Sperry and Michael Gazzaniga
(d) domain-general theory of double dissociation

Answer 62

B—differential dorsal-ventral information processing The dorsal stream represents the “where” system, while the ventral stream, the “what” system. This is relatively predictive inasmuch as parietal systems (dorsal) in the right hemisphere are associated with visuospatial processing, while temporal systems (left hemisphere) are associated with object identification/naming. Please refer to Chapter 3.

Question 63

All of the conventional or first-generation and most of the atypical or second-generation antipsychotic drugs share which putative pharmacological property?

(a) glutamatergic antagonism
(b) norepinephrine reuptake inhibition
(c) D1-type dopamine receptor antagonism
(d) D2-type dopamine receptor antagonism

Answer 63

D—D2-type dopamine receptor antagonism

Both first- and second-generation antipsychotic medications are thought to have their antipsychotic efficacy mediated by action at D2-type dopamine receptors, although second-generation medications may have additional actions in the context of a more complex pharmacologic profile. The efficacy of the second-generation agents is only marginally superior on selected outcomes, and it is not clear that these agents offer significant advantages on cognitive endpoints. Please refer to Chapter 35.

Question 64

White matter hyperintensities in vascular dementia have been shown to correlate positively with ____.

(a) language and visuospatial deficits
(b) personality and behavioral deficits
(c) speed of processing and executive function deficits
(d) constructional and working memory deficits

Answer 64

C—speed of processing and executive function deficits Chui and Ramirez-Gomez (2018) discuss the presumed relationship between the cognitive deficits of vascular cognitive impairment, including vascular dementia, and the underlying neurocircuitry that is disrupted to produce these findings. Haaland and Swanda (2008) present a discussion of these issue

Question 65

Which of the following comorbidity is about 50% in Autism spectrum disorder?

(a) tics
(b) seizures
(c) anxiety
(d) schizophrenia

Answer 65

C—anxiety A variety of studies have documented a high frequency of anxiety disorders in Autism spectrum disorder. Please refer to Chapter 14.

Question 66

The pattern of anoxic/hypoxic brain injury in neonates found to be most strongly associated with poor long-term outcome is injury to which areas?

(a) basal ganglia and thalamus
(b) deep brainstem nuclei
(c) watershed regions
(d) dorsolateral prefrontal cortex

Answer 66

A—basal ganglia and thalamus

The predominant pattern of brain injury in neonates found to be most strongly associated with poor long-term outcome, more so than the severity of injury in any given region, is injury to the basal ganglia and thalamus. Please refer to Chapter 28.

Question 67

In children born very preterm, poorer long-term outcome in academic and social-emotional domains is associated with ____.

(a) lower general cognitive ability and persistent executive dysfunction
(b) length of NICU stay and presence of chronic respiratory problems
(c) visual-motor integration problems and slowed speed of processing
(d) periventricular leukomalacia and post-hemorrhagic hydrocephalus

Answer 67

A—lower general cognitive ability and persistent executive dysfunction

While increased incidence and severity of neurological complications, as well as specific neuropsychological weaknesses are risk factors for long-term outcome, lower IQ and problems in executive functioning have been shown to predict academic and social-emotional functioning. Please refer to Chapter 17.

Question 68

Minimum test requirements for psychological and neuropsychological tests require sufficient reliability and validity. Although many types of reliability and validity have been described to evaluate the performance of a test, a basic understanding regarding the relationship between the concepts of reliability and validity is characterized as ____.

(a) reliability is more important than validity
(b) a test with good validity can have poor reliability
(c) a test must have reliability to have validity
(d) validity is more important than reliability

Answer 68

C—a test must have reliability to have validity

Reliability is critical for test validity, and a test cannot demonstrate validity without prerequisite reliability. Please refer to Chapter 9.

Question 69

You are asked to evaluate an adolescent with learning problems. During your clinical interview, the mother reports that she has epilepsy. Which of the following variables would suggest that the mother’s medical history is contributory to the adolescent’s current cognitive problems?

(a) inconsistent use of anti-seizure medications during the pregnancy
(b) use of valproate during the pregnancy to manage her seizures
(c) grand mal seizures monthly during the pregnancy
(d) use of Keppra during the pregnancy to manage her seizures

Answer 69

B—use of valproate during the pregnancy to manage her seizures

In-utero exposure to valproate has been consistently linked to cognitive and behavioral deficits. Please refer to Chapter 21.

Question 70

Which of the following statements regarding dopamine is true?

(a) The nigrostriatal dopamine system is dysfunctional in Parkinson’s disease.
(b) Most drugs designed to treat schizophrenia are designed to increase dopamine.
(c) The mesolimbic dopamine system is dysfunctional in Parkinson’s disease.
(d) The mesocortical system is specifically implicated in addictive behavior.

Answer 70

A—The nigrostriatal dopamine system is dysfunctional in Parkinson’s disease. Dopamine arising from the substantia nigra is the primary site of dysfunction in Parkinson’s disease. The other alternatives are incorrect. Regarding alternative b, since schizophrenia is most directly associated with a hyperdopaminergic state, most drugs designed to treat it are designed to decrease, not increase, dopamine signal. Not directly involved in Parkinson’s disease (alternative c), the mesolimbic circuit is most directly associated with addictive behavior, not the mesocortical system (alternative d). Please refer to Chapter 4.

Question 71

The psychotherapy approach with the best evidence base in treating patients with somatoform symptoms has traditionally been ____.

(a) cognitive behavioral therapy
(b) motivational interviewing
(c) dialectical behavior therapy
(d) cognitive processing therapy

Answer 71

A—cognitive behavioral therapy

Early controlled trials examining FSS used CBT-oriented interventions, although more recent studies have extended the range of interventions employed. Please refer to Chapter 37.

Question 72

In early stage Alzheimer’s disease, the greatest neuronal loss occurs in the ____.

(a) frontal and temporal lobes
(b) temporal lobes and upper brainstem nuclei
(c) frontal and parietal lobes
(d) frontal lobe and hippocampus

Answer 72

B—temporal lobes and upper brainstem nuclei

In early stages of Alzheimer’s disease the basal nucleus and locus ceruleus are significantly affected. There is also subcortical neuron loss in the nucleus basalis of Meynert (substantia innominata). Neuron loss in the locus ceruleus leads to decreased levels of cholinergic and noradrenergic markers. Please refer to Chapter 30.

Question 73

A recently detoxified patient with alcohol use disorder demonstrates neuropsychological impairment 1 week post abstinence. To assess the persistent neurotoxic effects of alcohol, one should retest the patient at least ____.

(a) 6 months post treatment
(b) 1 month post treatment
(c) 1 year post treatment
(d) 2 weeks post treatment

Answer 73

A—6 months post treatment

The recovery process from the neurotoxic effects of alcohol can be divided into acute (1–2 weeks), subacute (3 weeks to 2 months), and intermediate (2–6 months) phases. Therefore, a clinician should wait at least 6 months to ensure that an individual has moved through the recovery phases (and thus has had sufficient time to gain back any lost function) before drawing conclusions about enduring neurotoxic effects of alcoholism. Any assessments performed earlier than the 6-month period may not be as informative because neuropsychological deficits found will likely improve with time. Please refer to Chapter 36.

Question 74

Worldwide estimates of ADHD are typically lower than those found in the United States (~5% vs. ~10%). Which one of the following statements is most likely to explain this difference in base rates?

(a) expectations within academic settings
(b) exposure to environmental toxins
(c) access to specialized healthcare clinics
(d) ethnic and/or racial differences

Answer 74

C—Access to specialized healthcare clinics.

Although worldwide estimates of ADHD are lower, they likely differ as a function of varying diagnostic methods, practice guidelines, and access to specialized clinics. There is no significant difference between various racial groups. Please refer to Chapter 16.

Question 75

Your 85-year-old patient experienced delirium during a recent ICU admission and he is now in an extended care facility. Which of the following is most predictive of persistent cognitive impairment and future complications requiring hospital readmission?

(a) infectious cause
(b) length of delirium
(c) stroke history
(d) psychosis during delirium

Answer 75

B—length of delirium

Individuals with persistent delirium are about three times more likely to die within 1 year of hospitalization. Every additional 48 hours of delirium increases mortality risk by about 11%. Please refer to Chapter 27.

Question 76

Which of the following would you be least likely to see in a patient with left hemisphere or frontal damage?

(a) confabulation
(b) alexithymia
(c) circumlocution
(d) anosognosia

Answer 76

B—alexithymia

Inability to understand, process, or describe emotions. This symptom is typically seen more often with right-hemisphere dysfunction. Circumlocution (a language symptom) can occur with left-hemisphere damage (e.g., anomia and conduction aphasia); confabulation can be seen with Wernicke’s aphasia and transcortical sensory aphasia, as well as more diencephalic-mediated amnesias; anosognosia, while seen with right-hemisphere damage, can also result from frontal dysfunction and is sometimes seen with Wernicke’s aphasia. Please refer to Chapter 5.

Question 77

Although the BDI-II and BAI have a long tradition of assessing symptoms of depression and anxiety in adults, clinicians might consider administration of the full-length Geriatric Depression Scale (GDS) in geriatric samples because the ____.

(a) GDS includes well-established T scores that are more appropriately normed in aging samples
(b) GDS includes far fewer test items and is likely to be less burdensome
(c) GDS includes fewer items that are specific to the physical manifestations of emotional difficulty
(d) BDI-II and BAI include norms that only extend to age 60

Answer 77

C—GDS includes fewer items that are specific to the physical manifestations of emotional difficulty

Physical complaints tend to increase with age, and some of the content included on the BDI-II and BAI may be falsely attributed to emotional distress as opposed to common age-related ailments. Please refer to Chapter 10.

Question 78

Processing speed in people with acquired or congenital hydrocephalus ____.

(a) is best assessed with paper-and-pencil tests
(b) must take into account the motor requirements of the task
(c) is inconsistently impaired depending on the severity of hydrocephalus
(d) is impaired in congenital, but not acquired hydrocephalus

Answer 78

B—must take into account the motor requirements of the task

On paper and pencil tasks of processing speed, children with spina bifida are slower, but the differences are not apparent if motor speed is taken into account. Please refer to Chapter 20.

Question 79

Which of the following is considered to be a common risk associated with temporal lobectomy?

(a) intellectual disability
(b) Gerstmann syndrome
(c) hemiparesis
(d) superior quadrantanopsia

Answer 79

D—superior quadrantanopsia

Gerstmann syndrome is associated with lesions in the angular-supramarginal gyrus and would not be expected as a consequence of temporal lobectomy. Intellectual disability may be associated with some epilepsy syndromes, but is not caused by temporal lobectomy. However, it is not uncommon for temporal lobectomy to be associated with visual field defects (superior quadrant) due to the anatomy of the optic radiations near the posterior temporal lobe. Please refer to Chapter 22.

Question 80

Individuals with this disorder typically have below average cognitive functioning and demonstrate hypersociability and an affinity for music.

(a) Turner syndrome
(b) Williams syndrome
(c) 22q11.2 deletion syndrome
(d) Sturge-Weber syndrome

Answer 80

B—Williams syndrome

Hypersociability and an affinity for music are associated only with Williams syndrome. While individuals with 22q11.2 deletion syndrome may have below average intellectual functioning, they do not have the other characteristics. Individuals with Turner syndrome and Sturge-Weber syndrome typically do not have below average cognitive functioning. Please refer to Chapter 18.

Question 81

While playing football without a helmet, a 17-year-old is hit on the side of the head. He experiences a brief loss of consciousness but recovers in minutes with no residual symptoms. Approximately 30 minutes later, he becomes increasingly confused and lethargic. He is taken to the emergency room. Upon examination, he presents with mild left-sided weakness, and a slightly larger, nonresponsive right pupil. What is the likely cause of his symptoms?

(a) hemorrhagic contusion
(b) epidural hematoma
(c) diffuse axonal injury
(d) evolving ischemic infarct

Answer 81

B—epidural hematoma

A right sided epidural hematoma is most likely developing resulting in lethargy, confusion, and compression of the third cranial nerve which would cause an enlarged pupil on the ipsilateral side. Please refer to Chapter 29.

Question 82

You are assessing a 12-year-old patient due to concerns about attention problems and difficulties learning. During the chart review, you learn that the medical team recently identified conductive hearing loss. Assuming a neurologic cause which of the following diagnoses is most likely?

(a) bacterial meningitis
(b) viral meningitis
(c) HIV encephalitis acquired perinatally
(d) enteroviral encephalitis

Answer 82

C—HIV encephalitis acquired perinatally

While hearing loss is commonly associated with bacterial meningitis (about 11%), it is sensorineural hearing loss. Conductive hearing loss is prevalent (20–38%) in children who contract HIV perinatally. Please refer to Chapter 23.

Question 83

It is not uncommon for the behavioral variant of frontotemporal dementia to be misdiagnosed as ____.

(a) schizophrenia
(b) Posttraumatic stress disorder
(c) Autism spectrum disorder
(d) selective mutism

Answer 83

A—schizophrenia

Behavioral variant frontotemporal dementia is frequently misdiagnosed as schizophrenia (late onset) due to positive and negative psychotic symptoms of psychosis. Please refer to Chapter 32.

Question 84

Oliver, a 52-year-old factory worker, has been referred to you secondary to a disability claim. He was diagnosed with primary progressive multiple sclerosis 10 years prior and had continued to work despite worsening physical symptoms. However, he can no longer maintain the same level of productivity and is at risk of losing his job. Which symptom is the best predictor of having to reduce work hours or cease working completely?

(a) cognitive decline
(b) spasticity
(c) vision changes
(d) fatigue

Answer 84

D—fatigue

The fatigue associated with multiple sclerosis can be quite debilitating, occurs most days, presents suddenly, tends to worsen as the day progresses, and is more severe than normal fatigue and likely to interfere with quality of life and daily activities. Over the course of the disease, at least 75% of patients with multiple sclerosis report fatigue. It is considered to be one of the most common and most disabling symptoms and is one of the primary reasons for limiting or leaving employment. Further, the primary progressive form of multiple sclerosis, which shows less treatment efficacy, typically leads to earlier disability . Please refer to Chapter 24.

Question 85

What cognitive syndrome can be seen after left-hemisphere posterior cerebral artery stroke?

(a) alexia without agraphia
(b) agraphia without alexia
(c) agraphia and alexia
(d) alexia and anosognosia

Answer 85

A—alexia without agraphia

This syndrome relies on damage to the left visual cortex and splenium of the corpus callosum, which produces a right homonymous hemianopia and disconnects visual input processed in the right occipital cortex from the intact left-hemisphere regions necessary for reading and writing. Writing is not impaired because left parietal regions necessary for processing writing are intact, and writing is not fully dependent on visual input (i.e., such patients are able to write but can’t read what they have written). Please refer to Chapter 26.

Question 86

A 13-year-old treated for a medulloblastoma with surgery, craniospinal radiation, and chemotherapy at age 6 demonstrates a substantial decline in IQ scores compared to prior evaluation at age 9. These findings suggest ____.

(a) relapse of brain tumor
(b) loss of previously acquired skills (regression)
(c) late effect of radiation therapy on brain development
(d) significant emotional adjustment difficulties interfering with learning

Answer 86

C—late effect of radiation therapy on brain development

Studies of children treated for medulloblastoma with surgery, craniospinal radiation, and chemotherapy demonstrate decline in IQ that has been related to disruption in white matter development. Please refer to Chapter 25.

Question 87

A patient presents with asymmetric motor dysfunction and does not respond to a medication trial of levodopa. What is the most likely diagnosis?

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

Answer 87

A—corticobasal syndrome

Motor symptoms are generally greater on one side for both Parkinson’s disease and corticobasal syndrome; however, patients with corticobasal syndrome do not have a strong immediate response to levodopa. Please refer to Chapter 33.

Question 88

An 11-year-old child with a history of preterm birth at 26 weeks is referred for assessment due to concerns for social-emotional and adaptive functioning. Given his birth history, the child is at increased risk for ____.

(a) autism, epilepsy, intellectual disability
(b) ADHD, bipolar disorder, aphasia
(c) anxiety, muscular dystrophies, ataxia
(d) spastic hemiplegia, intellectual disability, ADHD

Answer 88

A—autism, epilepsy, intellectual disability

While not an exhaustive list, children born extremely preterm are at increased risk for autism, epilepsy, and intellectual disability. Muscular dystrophy is a genetic disorder. Maternal bipolar disorder increases the risk for preterm birth. However, there is no current evidence of an increased risk for bipolar disorder in children born preterm. Spastic diplegia is more commonly associated with preterm birth than spastic hemiplegia. Please refer to Chapter 17.

Question 89

Which of the following is not associated with a pseudodementia, or dementia syndrome of depression?

(a) presence of psychomotor retardation
(b) depressed mood or agitation
(c) progressive/degenerative course
(d) impaired immediate memory and learning abilities

Answer 89

C—progressive/degenerative course

There is a high degree of overlap between symptoms of depression and dementia, but one important distinction is that pseudodementia does not typically present with an insidious progression. Cognitive declines associated with depression typically clear, or at least improve, if the depression is treated. Please refer to Chapter 34.

Question 90

You work in a small integrated primary care clinic in a rural setting and primarily evaluate pediatric patients. There are no other pediatric neuropsychologists within 200 miles of your location. The bilingual physician (English and Spanish) wants you to evaluate a 5-year-old Spanish-speaking child he saw yesterday. You do not speak Spanish. The physician explains that he has noticed a definite regression in the child’s language skills over the past 6 months and is concerned about possible seizures. He realizes that your exam may be limited but asks you to help in any way you can, explaining that the family does not have the means to travel and that the waiting list at the closest children’s hospital is over 6 months. The clinic administrator also asks you to do whatever you can to help. What should you do?

(a) See the patient and conduct the best exam possible.
(b) Refuse; you are not competent to perform this assessment.
(c) Assist the physician in finding a center with bilingual clinicians.
(d) See the patient but only give visuospatial and nonverbal tasks.

Answer 90

A—See the patient and conduct the best exam possible. In situations like this the most desirable action is to refer the child to qualified colleagues who can conduct an evaluation in the patient’s native language. While this is preferred, it is not always practical or possible. Another alternative is to simply refuse the referral if you are unable to proceed with a valid and reliable evaluation. However, in this scenario the child may have a serious neurologic problem, and the potential benefits of assisting the physician in some fashion are likely to outweigh the risks. Use of an interpreter would be necessary in such situations, but the impact or potential limitations that such practice places on the assessment should always be noted in the report. Without a professional interpreter, the neuropsychologist in this situation would be hard pressed to complete a competent assessment without baseline data or familiarity with the language. In some cases a clinician could consider administering only nonverbal tasks and outline the limitations of the assessment, conclusions, and recommendations in the report. However, in this vignette the concern is regarding language abilities, and a visually based evaluation would not sufficiently address the referral question. Finally the neuropsychologist performing this evaluation should seek supervision or professional consultation from an expert in this particular area to enhance the likelihood of conducting an informed and conscientious examination despite the above listed limitations. Please refer to Chapter 7.

Question 91

Typically, about ____ of patients with mild neurocognitive disorder develop dementia each year?

(a) 20% (b) 10% (c) 80% (d) 50%

Answer 91

B—10%

Between 8% and 15% of patients with mild cognitive impairment (MCI) progress to dementia each year following diagnosis, with amnestic MCI being the most likely to lead to Alzheimer’s disease. Please refer to Chapter 30.

Question 92

The chronic effects of opiates include all of the following except____.

(a) processing speed
(b) working memory
(c) decision-making
(d) executive function

Answer 92

A—processing speed

The chronic cognitive effects are limited to executive function, working memory, and decision making (i.e., impulsivity). Please refer to Chapter 36.

Question 93

Leukoaraiosis refers to the ____.

(a) primary pathology underlying all variants of multi-infarct dementia
(b) scattered lacunar infarctions in the periventricular white matter
(c) nonspecific loss of density of subcortical white matter
(d) primary pathology underlying cerebral amyloid angiopathy

Answer 93

C—nonspecific loss of density of subcortical white matter

Periventricular white matter loss with scattered lacunar infarctions characterizes Binswanger’s disease. The primary pathology underlying multi-infarct dementia is multiple areas of cerebral infarction in both cortical and subcortical cerebral tissue. Please refer to Chapter 31.

Question 94

One reason the diagnostic process for cerebral palsy (CP) can result in a false positive error is ____.

(a) an infant with a normal neurological exam can show signs of CP at follow-up
(b) there can be a latency between a perinatal brain insult and its manifestations
(c) an infant can present with an unremarkable birth history and no risk factors
(d) neurological and motor abnormalities in an infant can be transient

Answer 94

D—neurological and motor abnormalities in an infant can be transient The other choices would result in false negative errors. Please refer to Chapter 19.

Question 95

A 65-year-old physician is referred for evaluation due to concerns regarding declines in work performance. In a detailed test battery he earns multiple scores at the 2nd to 5th percentile. These scores should be labeled as ____.

(a) abnormal
(b) deficient
(c) impaired
(d) low

Answer 95

D—low

According to the AACN consensus conference scores, no matter how low, should not be labeled as abnormal, deficient, or impaired because this implies an interpretive judgment. Scores can be low for a variety of reasons one of which is the presence of genuine cognitive impairment. Please refer to Chapter 9.

Question 96

Within the language domain, what type of difficulty would be most likely found in a 12-year-old with average IQ and Autism spectrum disorder?

(a) simplified grammar
(b) impaired pragmatics
(c) inattention to vocabulary
(d) oral apraxia

Answer 96

B—impaired pragmatics

Studies of language deficits in ASD suggest that for most high functioning children and adolescents with ASD, basic grammar, articulation, phonology, and one-word expressive and receptive vocabulary are intact. Conversely, pragmatic language is commonly found to be an area of weakness. Please refer to Chapter 14.

Question 97

Schizophrenia is most common in which of the following disorders?

(a) 22q11.2 deletion syndrome
(b) neurofibromatosis type 1
(c) fragile X syndrome
(d) PKU

Answer 97

A—22q11.2 deletion syndrome

25–30% of individuals with 22q11.2 deletion syndrome are diagnosed with a psychotic disorder. The other disorders are not associated with increased risk of psychosis. Please refer to Chapter 18.

Question 98

A 48-year-old male attorney presents for evaluation of possible transient ischemic attacks in the absence of any other cerebrovascular indicators. During interview, he reported that these “events” are characterized by an inability to speak when he attends church with his wife, despite being able to speak in high-level work and other social activities. This may be a sign of ____.

(a) selective mutism
(b) Social Anxiety Disorder
(c) specific phobia
(d) Panic Disorder

Answer 98

A—selective mutism

This description reflects the characteristics of selective mutism. Social anxiety is characterized by persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others, but does not include an inability to speak. Similarly, specific phobias and panic disorder also do not result in an inability to speak within specific settings. Please refer to Chapter 34.

Question 99

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 99

B—ideational apraxia

Ideational apraxia is the loss of the ability to plan and execute complex gestures because the individual has lost the understanding of the object’s purpose. It differs from ideomotor apraxia in that the individual may understand the purpose of the object but he or she cannot generate the specific movements needed to imitate or demonstrate their use. Please refer to Chapter 5.

Question 100

You are evaluating a 20-year-old college student who is currently on academic probation at his university, due to consistently poor grades. He complains of having multiple ADHD symptoms and is requesting accommodations and modifications. During your clinical interview, you find that there is no history of previous ADHD diagnosis or academic difficulties in high school. Which of the following statements would be most important to consider in your neuropsychological evaluation?

(a) According to the DSM-5 diagnostic criteria, you cannot diagnosis ADHD in an adult if symptoms were not present prior to the age of 12 years.
(b) This college student likely has both a learning disability and ADHD, and therefore your evaluation should include a focus on reading and writing skills.
(c) Utilization of both SVTs and PVTs would be important given the concerns for secondary gain and lack of typical ADHD developmental history.
(d) Substance abuse would be the first differential diagnosis to consider.

Answer 100

C—Utilization of both SVTs and PVTs would be important given the concerns for secondary gain and lack of typical

ADHD developmental history. When there is a lack of developmental history and the presence of secondary gain (e.g., extended time for exams), it is extremely important to objectively measure response bias and symptom exaggeration. Please refer to Chapter 16.

Question 101

Extensive white matter hyperintensity volume is associated with ____.

(a) a more than doubling of the risk of vascular cognitive impairment in aged adults
(b) depression and agitation in vascular dementia
(c) pure vascular dementia but not mixed dementia
(d) lacunar states unrelated to dementia of any type

Answer 101

A—a more than doubling of the risk of vascular cognitive impairment in aged adults

Adults ≥ age 60 with white matter hyperintensity volumes > 1 SD above the mean for their 5-year age group have a greater than doubling of their risk of mild vascular neurocognitive disorder, vascular dementia and stroke. Please refer to Chapter 31.

Question 102

Which type of multiple sclerosis is generally associated with the worst cognitive functioning?

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

Answer 102

B—secondary-progressive The progressive forms of the disease are generally associated with more cognitive impairment, typically both in frequency and severity of symptoms, than what is seen in the relapsing-remitting form of the disease.

The progressive forms of MS generally have more cognitive impairment but those with secondary-progressive generally have more cognitive impairment due to disease duration. By definition, these individuals have already had MS (relapsing-remitting) for about 10 years on average. Consequently, by the time they move into the progressive phase, they have been living with the condition longer and are generally more cognitively impaired. Please refer to Chapter 24.

Question 103

A 74-year-old male patient is referred for neuropsychological evaluation by his primary care physician. He has been complaining of memory problems and word-finding difficulties, but no other cognitive changes. If a blood work-up is performed, which apolipoprotein E pattern would be most suggestive of Alzheimer’s disease?

(a) ε2/ε3 (b) ε3/ε3 (c) ε3/ε4 (d) ε4/ε4

Answer 103

D—ε4/ε4

While having apolipoprotein E ε2 and ε3 alleles may have a protective effect, apolipoprotein E ε4 increases the risk for developing Alzheimer’s disease. Having one copy of the ε4 allele increases one’s risk through an increase in protein clumps, or amyloid plaques. Having two copies of the ε4 allele increases one’s risk further. Please refer to Chapter 30.

Question 104

Hydrocephalus ____.

(a) primarily affects the white matter of the brain
(b) primarily affects the brain’s ventricular system
(c) causes permanent brain injury
(d) has widespread effects on the brain

Answer 104

D—has widespread effects on the brain

Hydrocephalus has widespread effects on the brain, including stretching of white matter axons and compressive effects on cortical structures. Please refer to Chapter 20.

Question 105

A neuropsychologist has been referred a patient who reportedly sustained a traumatic brain injury 12 months ago. Which combination of information would be most helpful in determining the injury severity?

(a) Glasgow Coma Score (GCS), length of post-traumatic amnesia (PTA), time to follow commands (TFC)
(b) loss of consciousness, length of PTA, brain CT
(c) GCS, length of PTA, first hospital MMSE score
(d) brain MRI, length of PTA, extended mental status exam 1-month post injury

Answer 105

A—Glasgow Coma Score (GCS), length of post-traumatic amnesia (PTA), time to follow commands (TFC)

Injury severity is best determined by GCS, PTA, and TFC not necessarily the initial CT scan or mental status examination because CT can be negative in moderate to severe TBI and acute mental status can be affected by multiple non-brain injury related issues. Additionally, cognitive and functional outcome from moderate to severe TBI is variable and can be influenced by multiple factors. Thus, test scores do not always directly correlate with the severity of injury. It should also be noted that GCS and TFC can be negatively affected by a variety of non-TBI related factors and thus length of PTA tends to be a better overall indicator with regard to injury severity. Radiologic studies are central in differentiating between uncomplicated and complicated mild TBI. Please refer to Chapter 29.

Question 106

In reviewing the medical record for a pediatric patient with a history of preterm birth, retinopathy of prematurity (ROP) is documented. In considering the neurologic history of the child and course of disease, you know that the probable cause and prognosis of ROP are ____.

(a) a hypoxic or ischemic event with variable course over time
(b) a hypoxic or ischemic event that remains static over time
(c) oxygen toxicity or hypoxia that remains static over time
(d) oxygen toxicity or hypoxia that can worsen over time

Answer 106

D—oxygen toxicity or hypoxia that can worsen over time

ROP can result from oxygen toxicity related to the excessive use of oxygen after birth or hypoxia. In some preterm babies, ROP worsens over time. Please refer to Chapter 17.

Question 107

Mixed dementia most commonly occurs as ____.

(a) cerebrovascular disease and Alzheimer’s disease
(b) Alzheimer’s disease and Lewy body disease
(c) cerebrovascular disease and Lewy body disease
(d) cerebrovascular disease and frontotemporal dementia

Answer 107

A—cerebrovascular disease and Alzheimer’s disease (AD)

The base rates of these differing dementing disorders are such that AD is the most common co-occurring pathology with cerebrovascular disease. Furthermore, there are data strongly suggesting that cerebrovascular disease hastens amyloid deposition significantly, but no such data regarding alpha-synuclein or the tauopathies that characterize the Lewy body diseases and the frontotemporal dementias . Please refer to Chapter 31.

Question 108

The two-system theory of amnesia suggests that ____.

(a) damage to either the hippocampus or amygdala produces amnesia
(b) there are two different forms of amnesia
(c) amnesia results from damage to the hippocampus or diencephalon
(d) both medial and lateral limbic circuits must be damaged to cause amnesia

Answer 108

D—both medial and lateral limbic circuits must be damaged to cause amnesia

This conclusion was first reached by Mishkin in 1978, when he examined effects of combined hippocampal and amygdala lesions on memory, and has subsequently been refined in many investigations. Please refer to Chapter 4.

Question 109

Which one of the following is not an appropriate use of personality testing?

(a) identifying psychological factors affecting a known medical condition
(b) evaluation of psychological status with regard to disability or return to work
(c) evaluation of psychological readiness for surgical or other medical intervention
(d) ruling out a medical condition in a patient whose medical evaluations have been equivocal

Answer 109

D—ruling out a medical condition in a patient whose medical evaluations have been equivocal

The clinical interview, review of available records pertaining to an individual’s medical and psychiatric history, and specific diagnostic criteria are absolutely essential in arriving at a formal psychological diagnosis. Please refer to Chapter 10.

Question 110

A child with neurofibromatosis type 1 is most at risk for ____.

(a) schizophrenia
(b) intellectual disability
(c) ADHD
(d) Autism spectrum disorder

Answer 110

C—ADHD

30–50% of children with neurofibromatosis type 1 are diagnosed with ADHD; 4–8% are diagnosed with intellectual disability. Children with neurofibromatosis type 1 are not at greater risk for schizophrenia or Autism spectrum disorders. Schizophrenia is associated with 22q11.2 deletion syndrome, while intellectual disability is associated with tuberous sclerosis, Sturge-Weber syndrome, William syndrome, fragile X syndrome, Prader Willi syndrome, and Angelman syndrome. Please refer to Chapter 18.

Question 111

A woman with schizophrenia has a monozygotic twin. The likelihood that her twin sister will also develop schizophrenia is about ____.

(a) 2% (b) 10% (c) 30% (d) 80%

Answer 111

C—30%

Since monozygotic (identical) twins have largely the same genes, they have the highest concordance rate for schizophrenia. The risk for schizophrenia decreases from these levels depending on the degree of the genetic relationship. First-degree relatives have closer to a 10% risk, and second-degree relatives have closer to a 2% risk. The 80–85% statistic is the often-cited overall heritability for schizophrenia. Note that if schizophrenia had heritability of 100% (e.g., if it were due to a single gene with 100% penetrance, like a simple Mendelian genetic trait), then the monozygotic twin of someone with schizophrenia would have a 50% risk. Please refer to Chapter 35.

Question 112

A patient presents with axial rigidity, falls, and memory loss. The spouse does not report REM sleep behavior disorder. Which of the following diagnosis is most likely?

(a) progressive supranuclear palsy
(b) Parkinson’s disease
(c) multiple system atrophy
(d) Huntington’s disease

Answer 112

A—progressive supranuclear palsy

Axial rigidity and falls are common early symptoms of progressive supranuclear palsy. REM behavioral symptoms may or may not be present in progressive supranuclear palsy and it is not part of the diagnostic criteria. Please refer to Chapter 33.

Question 113

Evidence-based intervention for learning disabilities is best established for ____.

(a) written language disabilities
(b) nonverbal learning disabilities
(c) mathematics disabilities
(d) reading disabilities

Answer 113

D—reading disabilities Substantial research demonstrates the effectiveness of intervention to improve reading in children (and adults) with reading disabilities. There is far less research on interventions to improve written expression and math skills. Please refer to Chapter 15.

Question 114

Support for the brain reserve hypothesis can be found within which clinical trend?

(a) Serotonin syndrome is more likely in patients on two SSRIs.
(b) Vitamin B12 deficiencies often result in diffuse cognitive impairments.
(c) Higher incidence of delirium follows urinary tract infection in the elderly.
(d) Stroke is more common in patients with a history of vascular disease.

Answer 114

C—Higher incidence of delirium follows urinary tract infection in the elderly

All of the statements are true but C is the best answer as it is most supportive of the brain reserve hypothesis (see also Chapter 3, Important Theories in Neuropsychology: A Historical Perspective). Please refer to Chapter 27.

Question 115

Which of the following is NOT true with regard to frontal lobe damage and emotion/behavior?

(a) orbitofrontal damage has been associated with disinhibition
(b) orbitofrontal damage has been associated with impulsivity
(c) right frontal damage has been associated with depression
(d) medial frontal damage has been associated with lack of initiation (abulia)

Answer 115

C—right frontal damage has been associated with depression Actually, left frontal damage is typically associated with depression; the rest are true. Please refer to Chapter 5.

Question 116

A patient presents with a constellation of symptoms typical of an upper motor neuron (UMN) lesion. Which would he LEAST likely demonstrate?

(a) weakness
(b) hyporeflexia
(c) hyperreflexia
(d) increased tone

Answer 116

B—hyporeflexia

UMN lesions are often characterized by weakness, hyperreflexia, and increased tone. Weakness, atrophy, fasciculations, and hyporeflexia can be indicative of lower motor neuron lesions, making this the incorrect option. Please refer to Chapter 6.

Question 117

The same patient with the UMN described above is also demonstrating abnormal reflexes. Upon assessment, his neurologist might expect to see ____.

(a) absent reflexes
(b) decreased reflexes and the Babinski sign
(c) decreased reflexes and the Wartenberg’s sign
(d) the Babinski and the Wartenberg’s signs

Answer 117

D—the Babinski and the Wartenberg’s signs

Individuals with UMN demonstrate increased reflexes (hyperreflexia). In particular, adults will show the Babinski sign (fanning of the toes and upward flexion of the big toe) and Wartenberg’s sign (involuntary abduction). Please refer to Chapter 6.

Question 118

A neuropsychologist is asked to evaluate a 9-year-old child with documented blood lead levels of 25 μg/dL. In which of the following domains should the neuropsychologist expect to find the most deficits?

(a) executive functions
(b) language skills
(c) memory functions
(d) math abilities

Answer 118

A—executive functions

In utero and childhood exposure to lead has been linked most consistently to deficits in attention/executive functions and visuospatial skills. Please refer to Chapter 21.

Question 119

Which of the following epilepsy syndromes is most likely to show spontaneous remission?

(a) temporal lobe epilepsy
(b) childhood absence epilepsy
(c) Lennox-Gastaut
(d) frontal lobe epilepsy

Answer 119

B—childhood absence epilepsy

The natural history of epilepsy syndromes is quite variable, but, of the syndromes listed, childhood absence epilepsy is the most likely to remit during early adolescence. However, up to 15% of children with childhood absence epilepsy will go on to develop juvenile myoclonic epilepsy. Please refer to Chapter 22.

Question 120

On Test 1, an individual obtains a T score of 65. On Test 2, she obtains a scaled score of 115. On Test 3, she scores in the 60th percentile. On Test 4, her score is equivalent to a z score of 0.5. Which of the following is the correct ordering of these scores, from lowest to highest?

(a) Test 4, Test 3, Test 2, Test 1
(b) Test 3, Test 4, Test 2, Test 1
(c) Test 4, Test 2, Test 3, Test 1
(d) Test 3, Test 2, Test 4, Test 1

Answer 120

B—Test 3, Test 4, Test 2, Test 1

Converting each to score to one common metric will allow for their comparisons. Using percentiles, Test 1 = 93, Test 2 = 84, Test 3 = 60, Test 4 = 69. Please refer to Chapter 8.

Question 121

Alcohol and marijuana exposure in utero are both associated with ____.

(a) prematurity
(b) tremors
(c) growth reduction
(d) endocrine disruption

Answer 121

C—growth reduction

Prenatal exposure to marijuana is associated with fetal growth reduction and reduced gestational duration, whereas children exposed to alcohol in utero are often small for gestational age and may continue to show growth deficiency as adolescents and adults. Please refer to Chapter 21.

Question 122

A 65-year-old, right-handed man is evaluated after a left hemisphere ischemic stroke. You diagnose him with a conduction aphasia because he demonstrates ____.

(a) intact fluency, intact comprehension, impaired repetition
(b) impaired fluency, intact comprehension, impaired repetition
(c) intact fluency, impaired comprehension, impaired repetition
(d) impaired fluency, impaired comprehension, intact repetition

Answer 122

A—intact fluency, intact comprehension, impaired repetition

The cardinal symptom of conduction aphasia is impaired repetition without significant impairment in fluency and comprehension. Impaired fluency, intact comprehension, and impaired repetition is characteristic of Broca’s aphasia. Fluent speech, impaired comprehension, and impaired repetition is characteristic of Wernicke’s aphasia. Impaired fluency, impaired comprehension, and intact repetition is characteristic of mixed transcortical aphasia. Please refer to Chapter 26.

Question 123

The most frequently reported problem in the cerebral palsy population that has a negative impact on quality of life is ____.

(a) motor impairment
(b) fatigue
(c) social isolation
(d) pain

Answer 123

D—pain

Motor impairment, fatigue and social isolation negatively impact quality of life but pain is the more common complaint. Please refer to Chapter 19.

Question 124

A side effect of intrathecal chemotherapy with methotrexate is ____.

(a) leukoencephalopathy
(b) peripheral nerve deficits
(c) ataxia
(d) hemiparesis

Answer 124

A—leukoencephalopathy

Leukoencephalopathy is related to cerebral white matter damage. It is one of the known neurotoxic side effects of methotrexate therapy. The frequency and severity is related to the dose, cumulative exposure, and other factors. It is noted as white matter hyperintensities on T2-weighted MR imaging, which may be transient or persistent. Please refer to Chapter 25.

Question 125

A complete loss of oxygen in the arterial blood or tissues is referred to as ____.

(a) hyponatremia (b) anoxia (c) hypoxemia (d) apoptosis

Answer 125

B—anoxia

Anoxia involves a total loss of oxygen in the arterial blood and tissues. Anoxia usually results from sudden and severe medical events such as cardiac arrest. Whereas anoxia and ischemia are viewed as separate processes, in severe cases they usually coexist. Please refer to Chapter 28.