Exam #4 BOOK Flashcards
Accelerated cognitive decline in older adults with schizophrenia is ____.
(a) due to Parkinson’s disease
(b) a variant of Lewy body dementia
(c) present in a subgroup of patients, but no single cause has yet been identified
(d) probably early-onset Alzheimer’s disease
C—present in a subgroup of patients, but no single cause has yet been identified There have been suggestions that rapid cognitive decline in older adults with schizophrenia may be due to some unique pathological process but so far, the evidence is equivocal. It is clear that people with schizophrenia have many causes of increased morbidity and mortality, among which are multiple preventable medic
An example of equipotentiality might be ____.
(a) persons with Korsakoff amnesia retaining motor-skill learning
(b) patients with aphasia learning to speak again
(c) double dissociation of language and visual processing
(d) late onset of dementia in highly educated people
B—patients with aphasia learning to speak again Although still somewhat unclear, major theories of aphasia recovery suggest that (1) homologous brain regions from the contralateral hemisphere are thought to assume the functional duties of the damaged brain regions, and/or (2) that adjacent, undamaged cerebral regions are employed to assume functional duties . Please refer to Chapter 3.
You have been intimately involved with the healthcare of a child who experienced significant complications following the development of bacterial meningitis. Her family is extremely grateful for your care, and they bring you a $10 gift certificate to a local restaurant and a thank you card. What should you do?
(a) Accept the gift graciously.
(b) Refuse the gift even if they insist.
(c) Share the gift with the treatment team.
(d) Accept the gift but report it to the hospital.
A—Accept the gift graciously. Small gifts from patients of limited value are ethically acceptable. Refusing such gifts or signs of gratitude would be potentially harmful to the doctor-patient relationship. However, gifts should never be tied to specific expectations such as the completion of a favorable report or disability forms. There is no reporting or disclosure requirement for small gifts of nominal value. The psychologist would also need to be aware of their hospital’s policy regarding gifts as well since these can vary between institutions. Please refer to Chapter 7. General Principles and Ethical Standards: B, C, E; 6.04, 6.05
This type of multiple sclerosis profile involves a continual worsening of baseline functions from the onset, with minor fluctuations but no distinct relapses.
(a) relapsing-remitting
(b) secondary-progressive
(c) primary-progressive
(d) progressive-relapsing
C—primary-progressive The primary-progressive form of the disease is associated with a slow progressive decline in neurologic functioning with no clear relapses. Please refer to Chapter 24.
Which of the following neuropsychological domains has been proposed as an underlying deficit that may explain Autism spectrum disorder symptomatology?
(a) poor visual discrimination
(b) impaired sustained attention
(c) sensory hyper- and hypo-reactivity
(d) deficient executive functioning
D—deficient executive functioning The executive dysfunction theory proposes that deficits in social communication and restricted and repetitive behaviors observed in Autism spectrum disorder are evident because of deficits in cognitive flexibility, planning, self-monitoring, inhibition of ongoing behaviors, and initiation of new behavior. Please refer to Chapter 14.
Which of the following neuropsychological domains has been proposed as an underlying deficit that may explain Autism spectrum disorder symptomatology?
(a) poor visual discrimination
(b) impaired sustained attention
(c) sensory hyper- and hypo-reactivity
(d) deficient executive functioning
D—deficient executive functioning The executive dysfunction theory proposes that deficits in social communication and restricted and repetitive behaviors observed in Autism spectrum disorder are evident because of deficits in cognitive flexibility, planning, self-monitoring, inhibition of ongoing behaviors, and initiation of new behavior. Please refer to Chapter 14.
Two individuals are administered the same test, of which the data are normally distributed. Person 1 scores in the 48th percentile; Person 2 scores in the 93rd percentile. It is later found that there was an error in scoring of the test on these two administrations only, and 3 points are then added to each person’s score. Given this information, which of the following is true?
(a) Both percentile ranks will increase by the same amount.
(b) Person 1’s percentile rank will increase more than Person 2’s.
(c) Person 2’s percentile rank will increase more than Person 1’s.
(d) Neither percentile rank will change.
B—Person 1’s percentile rank will increase more than Person 2’s. These two individuals’ scores will both change in reference to the normative group because of this addition. However, because of the assumption of a normal distribution, score differences in the middle of the distribution of percentiles are exaggerated compared to those at the extremes. Thus, changing a raw score by 3 points will have a larger influence on the percentile ranking close to the middle of the distribution. Please refer to Chapter 8.
Depression and anxiety in persons with epilepsy are ____.
(a) not consistently reported due to poor insight
(b) typically not severe enough to warrant treatment
(c) more common than in other chronic illnesses
(d) not as common as in other chronic illnesses
C—more common than in other chronic illnesses Higher rates of depression and anxiety are consistently reported among persons with epilepsy. When compared with other chronic illnesses, including those having a high incidence of childhood onset (e.g., diabetes), patients with epilepsy have a higher rate of depression. Severe depression, including suicidality, is not uncommon, and treatment of depression is a key component of maintaining quality of life. Please refer to Chapter 22.
Individuals using MDMA at raves or dance clubs are at high risk for ____.
(a) dehydration
(b) hypothermia
(c) hallucinations
(d) intention tremor
A—dehydration Dehydration often occurs with MDMA use at dance clubs or raves because users engage in long periods of dancing without adequate water intake. Please refer to Chapter 36.
Which of the following is most commonly comorbid with Tourette syndrome?
(a) ADHD
(b) Bipolar Disorder
(c) eating disorder
(d) Oppositional Defiant Disorder
A—ADHD ADHD, learning disabilities, obsessive-compulsive disorder, depression, generalized anxiety, panic attacks, sleep disorders, and migraines are comorbid conditions that can be seen in Tourette syndrome. While rage attacks can also be seen, and a diagnosis of intermittent explosive disorder is possible, this is different than an oppositional defiant disorder. Please refer to Chapter 33.
Patients with Alzheimer’s disease exhibit impairment most profoundly in this type of memory.
(a) source memory
(b) procedural memory
(c) long-term memory
(d) episodic memory
D—episodic memory Knowledge of temporal events and declarative memory is severely impaired in individuals with Alzheimer’s disease. Please refer to Chapter 5.
The pattern of stronger verbal than spatial skills in early hydrocephalus is ____.
(a) primarily apparent in spina bifida myelomeningocele and aqueductal stenosis
(b) an anomaly related to the motor demands of the Wechsler performance scales
(c) seen across all levels of economic disadvantage and ethnicity in spina bifida
(d) a correlate of very low birth weight and associated perinatal anoxia
A—primarily apparent in spina bifida myelomeningocele and aqueductal stenosis Fine motor impairment may contribute to the pattern but impairment is also noted on visuospatial tasks without significant motor demands or time bonuses. Please refer to Chapter 20.
The American Heart Association guidelines and current clinical practice for using tissue plasminogen activator (tPA) in adults after stroke include evidence of deficits, ____.
(a) brain hemorrhage on CT, and symptom duration of 3 to 4.5 hours or less
(b) no brain hemorrhage on CT, and symptom duration of 3 to 4.5 hours or less
(c) brain hemorrhage on CT, and symptom duration of 3 hours or less
(d) no brain hemorrhage on CT, and symptom duration of 3 hours or less
B—no brain hemorrhage on CT, and symptom duration of 3 to 4.5 hours or less Because TPA is a powerful thrombolysis agent American Heart Association guidelines require that all three criteria are met. Please refer to Chapter 26.
What can be said with regard to cognitive restitution/restorative training methods following traumatic brain injury?
(a) They outperform compensatory strategy training in all phases following injury.
(b) They have lasting benefits primarily in the recovery of simple attention skills.
(c) They have limited empirical support at any phase and typically do not generalize.
(d) They are typically only efficacious in addressing prospective memory skills.
C—They have limited empirical support at any phase and typically do not generalize. Cognitive restitution training methods have limited empirical support, especially as the time since injury increases. Please refer to Chapter 29.
Patients with Alzheimer’s disease are more likely to produce what type of errors on confrontation naming?
(a) semantic
(b) echolalic
(c) phonemic
(d) perseverative
A—semantic In addition, patients with Alzheimer’s disease are less likely to benefit from semantic cues. Please refer to Chapter 30.
A 10-year-old girl is involved in a car accident in which her mother and brother are badly injured, but she is not. Shortly afterward on the scene she becomes tachycardic, short of breath, and can’t stop shaking. Which neurotransmitter is most likely involved?
(a) serotonin
(b) GABA
(c) norepinephrine
(d) dopamine
C—norepinephrine The symptoms described are consistent with a “fight or flight” response. Norepinephrine is an excitatory neurotransmitter and also a stress hormone that helps maintain alertness and preparation to respond to external threats. Please refer to Chapter 34.
Inaccuracies in unilateral cerebellar coordination are referred to as ____.
(a) dysreflexia
(b) dystonia
(c) dysgraphestheia
(d) dysmetria
D—dysmetria Dysmetria refers to inaccurate unilateral fine motor coordination and is considered to be a sign of cerebellar dysfunction. The other three conditions are typically either cerebral or spinal in nature. Please refer to Chapter 6.
A 17-year-old male presents to the clinic due to depressed mood. His parents report he no longer hangs out with his friends and his grades are slipping. He reports to you that he sometimes hears his name being called but no one is there, and he has begun to ascribe significance to certain numbers that he feels have followed him around most of his life. Which stage is this presentation most consistent.
(a) premorbid
(b) prodromal
(c) acute
(d) paranoid
B—prodromal This patient’s profile is most consistent with the prodromal phase, which is marked by an increasing tendency toward social withdrawal, declines in role functioning, and brief, intermittent or subthreshold psychotic symptoms, including perceptual disturbances and odd, unusual, or suspicious thinking, that occurs with increasing frequency and conviction. Please refer to Chapter 35.
Which patient is most likely to demonstrate pronounced cognitive deficits after treatment for childhood acute lymphoblastic leukemia?
(a) male treated in adolescence with chemotherapy only
(b) male treated in middle childhood with radiation and chemotherapy
(c) female treated in early childhood with chemotherapy and radiation
(d) male treated in early childhood with chemotherapy only
C—female treated in early childhood with chemotherapy and radiation Younger age at treatment, female gender, and radiation therapy have been identified as factors associated with more severe neuropsychological impairment after treatment for childhood leukemia. Please refer to Chapter 25.
Among the following, which combination of preexisting issues would suggest a more significant risk for postoperative delirium?
(a) executive dysfunction and depression
(b) learning disability and anxiety
(c) low average IQ and depression
(d) dysnomia and anxiety
A—executive dysfunction and depression Although learning disability, low average IQ, and dysnomia might suggest reduced cognitive reserve, studies suggest that executive dysfunction poses a higher risk of postoperative delirium. Depression has been identified as an independent risk factor as well, but anxiety disorders have not been associated with substantially increased risk. Please refer to Chapter 27.
Lesions to the basal forebrain produce amnesia because ____.
(a) cholinergic inputs to the hippocampus and amygdala are disrupted
(b) pathways of the medial and lateral limbic circuits may be spared
(c) the basal forebrain contains dopaminergic neurons involved in memory retrieval
(d) the basal forebrain is a key site of memory storage
A—cholinergic inputs to the hippocampus and amygdala are disrupted The basal forebrain provides cholinergic innervations of the hippocampus and amygdala systems; thus, a lesion here can disrupt both circuits. Answer b cannot be correct, since large, structural lesions of the basal forebrain can involve connections of both the lateral and medial limbic circuits. Neither c nor d is correct because there is no evidence that the basal forebrain plays a specific role in retrieval or storage of memory representations. Please refer to Chapter 4.
Which of the following neurodevelopmental disorders is most associated with a high rate of comorbid developmental mathematics disability?
(a) Autism spectrum disorder
(b) Tourette syndrome
(c) spina bifida
(d) ADHD
C—spina bifida Mathematics disabilities are common among individuals with spina bifida and congenital hydrocephalus, and occur in more than half of the affected individuals. In contrast, math skills are often a relative strength in children with Autism spectrum disorders; children with Tourette syndrome typically do not manifest learning disabilities; and only approximately 40% of children with ADHD manifest learning disabilities. Please refer to Chapter 15.
Abrupt onset and step-wise progression of cognitive deficits ____.
(a) have not been consistently demonstrated in vascular dementia
(b) are more commonly associated with subcortical forms of vascular dementia
(c) correlate with progression of leukoaraiosis
(d) characterize vascular dementia of mixed pathology
A—have not been consistently demonstrated in vascular dementia Decades ago, it was thought that stepwise progression was a hallmark characteristic of vascular dementia. Research since then has demonstrated that this is not the case. The presence of stepwise progression has also not been linked conclusively to any particular type of pathology. Please refer to Chapter 31.
Which of the following is not true of anti-NMDA receptor encephalitis?
(a) Adult women are more likely to have an associated ovarian teratoma.
(b) Children may show hyperactivity, irritability, and temper tantrums early in disease course.
(c) Females are more affected by anti-NMDA receptor encephalitis.
(d) Low intellectual abilities are seen in children, but adult IQs fall in the average range.
D—Low intellectual abilities are seen in children, but adult IQs fall in the average range. As a group, both children and adults with histories of anti-NMDA receptor encephalitis have average general intellectual abilities despite deficits seen in several domains including memory, attention, and aspects of executive functioning (i.e., organization, planning, and impulse control). Please refer to Chapter 23.
In diagnosing vascular dementia, motor deficits secondary to cortical infarction ____.
(a) can explain the significant impairment in complex ADLs
(b) suggest silent infarction as an underlying pathophysiologic process
(c) suggest leukoaraiosis as an underlying pathophysiologic process
(d) are to be excluded when evaluating functional impairment in ADLs
D—are to be excluded when evaluating functional impairment in ADLs The NINDS-AIREN diagnostic criteria require that significant impairment in daily functioning be present, but that this impairment be secondary to deficits in memory and intellectual functions and not due to physical disability secondary to stroke. Please refer to Chapter 31.
A 65-year-old woman developed delirium secondary to sepsis and experienced an extremely complicated hospital course. Physicians have now deemed that she is medically stable and ready for transition to a subacute facility. However, when she is told about the plan for discharge and transition she becomes extremely belligerent, confused, combative, and insistent that she should be allowed to go home. This behavior results in a staff member getting hit by the patient and delay in her transfer. In an effort to curb this behavior and avoid safety issues for the patient and staff, the neuropsychologist advises the team not to provide information regarding the pending transfer. What can be said regarding deception in situations like this?
(a) It is unethical in most similar situations.
(b) It is ethically appropriate in some cases.
(c) It is only acceptable if approved by the ethics committee.
(d) It is often necessary with patients who are confused.
B—It is ethically appropriate in some cases. Although there might be more feasible options and the neuropsychologist’s recommendations may not always be appropriate, in this situation B is the best answer because deception can be ethically appropriate in some cases. Use of deception does not uniformly require approval from an ethics committee. Additionally, it is inaccurate to state that deception is “often” necessary with patients who are confused as there are other effective interventions. Notably, in neuropsychological assessment it could be argued that we often deceive patients in the context of performance validity testing when we inform or lead them to believe that a certain test measures a construct such as memory or is difficult, whereas it is in fact a very easy performance validity test that almost everyone should perform well on. However, this may not be considered deception if patients are informed at the outset, during the informed consent process, that such measures or indicators will be used during the evaluation, and they agree to the testing. Please refer to Chapter 7. General Principles and Ethical Standards: A, B, D, E; 3.04, 3.10
Which of the following transformations results in even intervals of the normative data?
(a) logarithmic
(b) z distribution
(c) percentile
(d) T distribution
C—percentile Expression of scores in percentiles forces the data into a rectangular distribution, forcing artificially even intervals regardless of the underlying values. Use of such transformations are optimal to minimize misinterpretations of tests with non-normal distributions, but the underlying distribution of the data needs to be considered in the context of clinical interpretation (i.e., small changes in raw scores in the middle of the distribution will result in a magnified influence on the percentile ranking). Please refer to Chapter 8.
Brain injury during which of the following school years confers the most risk for a poor outcome?
(a) preschool
(b) elementary school
(c) middle school
(d) high school
A—preschool Children who sustain traumatic brain injury during infancy and early childhood have worse neuropsychological and functional outcomes than those injured in later childhood or the teenage years. Please refer to Chapter 29
A 28-year-old veteran presents with complaints of flashbacks, nightmares, and a heightened startle response. Which neuroanatomical area is likely to be directly involved in the maintenance of these symptoms?
(a) amygdala
(b) prefrontal cortex
(c) anterior cingulate
(d) basal ganglia
A—amygdala The central nucleus of the amygdala senses and identifies fear and anxiety-laden stimuli and initiates the emotional response. It has been shown to be strongly involved in the formation of emotional memories, especially fear-related memories. The amygdalocentric model of Posttraumatic stress disorder proposes that it is associated with hyperarousal of the amygdala and insufficient top-down control by the medial prefrontal cortex and the hippocampus, particularly during extinction, which reflects a primary association with anxiety rather than depression. Please refer to Chapter 34.
You are evaluating a child with fetal alcohol spectrum disorder. When selecting your test battery, including behavioral questionnaires, which of the following DSM-5 diagnoses should be highest on your list of diagnostic considerations?
(a) Autism spectrum disorder
(b) ADHD
(c) Depressive Disorder, not otherwise specified
(d) Generalized Anxiety Disorder
B—ADHD 60–95% of children with FASD qualify for a diagnosis of ADHD. Externalizing disorders are particularly common in this population. Please refer to Chapter 21.
You have agreed to evaluate a 65-year-old woman who is also deaf. In order to ensure an accurate evaluation, you must ____.
(a) provide an American Sign Language interpreter
(b) use test materials with a reading level at or below the fourth grade
(c) determine the age at onset and severity of hearing loss
(d) make sure that you speak slowly and she can see your mouth
C—determine the age at onset and severity of hearing loss A deaf older adult may be experiencing late onset hearing loss or may be congenitally deaf. They may use speech and residual hearing or communicate primarily through signs or writing. The approach to assessment will depend on this information. Please refer to Chapter 11.
Jane is an adult who recently earned a standard score of 70 on an individually administered intelligence test, a score that was consistent with previous measures of intellectual functioning as a child. Jane reported that she completed a local community college program as a certified nursing assistant and worked full time while living on her own. She stated that she completed all of her own activities of daily living such as driving, cooking, cleaning, caring for her hygiene, and managing her finances. She reported having a strong and supportive network of friends. Which statement best describes Jane’s level of functioning?
(a) She meets criteria for mild intellectual disability.
(b) She exhibits borderline intellectual functioning.
(c) Her intellectual functioning is likely in the low average range.
(d) No diagnosis can be determined because of the absence of an observer report.
B—She exhibits borderline intellectual functioning In order to meet diagnostic criteria for intellectual disability, individuals must have an IQ score of 70 or below and exhibit deficits in adaptive functioning. Based on her report of adaptive functioning, Jane best fits in the category of borderline intellectual functioning. Please refer to Chapter 13.
Which of the following cognitive domains may be more impaired early on in patients with Lewy body dementia versus Alzheimer’s disease?
(a) visuospatial
(b) memory
(c) language
(d) processing speed
A—visuospatial Neuropsychologically, greater deficits in visuospatial functioning than in other domains may help differentiate Lewy body dementia from Alzheimer’s disease. Please refer to Chapter 33.
Which of the following disorders is associated with an increased risk of brain tumors?
(a) fragile X syndrome
(b) tuberous sclerosis
(c) Prader-Willi syndrome
(d) Sturge-Weber
B—tuberous sclerosis Tuberous sclerosis complex (TSC) is one of the hereditary genetic syndromes associated with a predisposition for brain tumors. Central nervous system manifestations of TSC include subependymal giant cell astrocytomas. These are considered benign tumors and are commonly treated via surgical resection. Neurologic complications can occur due to intraventricular location. Please refer to Chapter 25.
Wernicke’s encephalopathy is comprised by a triad of clinical symptoms including global confusion, abnormal eye movements, and ____.
(a) dysarthria
(b) vitamin D deficiency
(c) fatigue
(d) gait ataxia
D—gait ataxia Wernicke’s encephalopathy is an acute neuropsychiatric reaction to thiamine deficiency and is characterized by confusion, ataxia, nystagmus, and ophthalmoplegia. Please refer to Chapter 36.
Family and twin studies of ADHD have been used to assess the degree to which variability in the disorder and its underlying latent traits are under genetic control. Which of the following statements is most true?
(a) The heritability of ADHD symptoms is approximately 25%.
(b) Shared environmental influence accounts for 25% of the variance.
(c) ADHD-I is more heritable than ADHD-H.
(d) A sibling of a child with ADHD has a 75% chance of having ADHD.
C—ADHD-I is more heritable than ADHD-H. Although both symptom dimensions are significantly heritable, ADHD-H is less heritable than ADHD-I. The heritability of ADHD is approximately 75%; nonshared environment (as opposed to shared environment) and measurement error accounts for the rest of the variance. First-degree relatives have a 30–35% chance of having ADHD. Please refer to Chapter 16.
A 74-year-old right-handed man with right leg weakness, grasp reflex, and executive function deficits should be further examined for possible ____.
(a) transcortical motor aphasia
(b) transcortical sensory aphasia
(c) fluent aphasia
(d) global aphasia
A—transcortical motor aphasia Right leg weakness, grasp reflex and executive function deficits are characteristics of damage in the distribution of the left anterior cerebral artery, which can be associated with transcortical motor aphasia. Please refer to Chapter 26.
A 41-year-old male with a history of multiple sclerosis has been referred to you for an evaluation. He reports that he is having problems keeping up with work demands in his job as an administrative assistant. Which of the following areas would be most important to assess based on the referral concern and what you know about outcomes associated with multiple sclerosis?
(a) processing speed, verbal IQ, inhibition
(b) working memory, fatigue, reading
(c) word generation, processing speed, depression
(d) processing speed, depression, fatigue
D—processing speed, depression, fatigue Individuals with multiple sclerosis experience a host of symptoms that may adversely impact daily functioning. The patient referred to you complains of problems keeping up with work. Reduced processing speed is the most common cognitive problem in multiple sclerosis while language-based skills tend to be preserved in adults with multiple sclerosis. Likewise, depression is commonly associated with multiple sclerosis and literature suggests a relation between depression and cognitive functioning including speed of performance. Fatigue is one of the most common symptoms reported in individuals with multiple sclerosis. Research has shown reduced performance over time with sustained mental effort suggesting that fatigue may play a role. Please refer to Chapter 24.
When compared to normal controls, individuals with insomnia are 2 times more likely to have or develop ____, while they are ten times more likely to have or develop ____.
(a) Generalized Anxiety Disorder; Major Depressive Disorder
(b) a personality disorder; Major Depressive Disorder
(c) Major Depressive Disorder; schizophrenia
(d) a specific learning disorder; Generalized Anxiety Disorder
A—Generalized Anxiety Disorder/Major Depressive Disorder Anxiety and mood disorders are commonly reported by individuals with insomnia. Please refer to Chapter 37.
When conducting a neuropsychological evaluation on a 12-year-old child, the parent- and teacher-report measures from the BASC-3 can be used to examine the clinical probability indices for all of the following, except ____.
(a) ADHD
(b) Autism spectrum disorder
(c) specific learning disorder
(d) emotional behavior disorder
C—specific learning disorder The BASC-3 provides clinical probability indices for ADHD, autism, and emotional behavior disorder, which can be used to inform diagnostic impressions and behavior intervention recommendations. Please refer to Chapter 10.
Which of the following is an accurate statement regarding essential tremor?
(a) Essential tremor is an uncommon adult onset movement disorder.
(b) Essential tremor is secondary to reduced dopamine in the basal ganglia.
(c) There is no known genetic component to essential tremor.
(d) This type of tremor is typically postural and kinetic.
B—Essential tremor is secondary to reduced dopamine in the basal ganglia. The pathogenesis of essential tremor is mostly unexplained. There appears to be a strong genetic component, at least for familial cases. Some reports suggest that the neuropathology of essential tremor is localized in the brainstem (locus ceruleus) and cerebellum, but the presence of cerebellar pathology is controversial. Please refer to Chapter 33.
Which of the following statements is most accurate regarding memory deficits in persons with epilepsy?
(a) Memory deficits in frontal and temporal lobe epilepsy (TLE) are the same.
(b) Memory deficits in TLE do not lateralize to the side of seizure onset.
(c) In TLE, verbal memory impairments are only present in left-side seizure onset.
(d) Verbal memory deficits in left TLE are more robust than visual memory deficits in right TLE.
D—Verbal memory deficits in left TLE are more robust than visual memory deficits in right TLE. The extensive body of literature regarding memory deficits in TLE indicates that verbal memory deficits in left TLE are consistently identified using a variety of methods/verbal memory tests. Exacerbation of deficits following dominant temporal lobectomy is predictable based on presurgical memory ability. However, the presence of nonverbal memory deficits in right TLE is not as consistently observed, and, in many cases of right TLE, there are no memory deficits. This may be due to a combination of factors, including methodological differences and a lack of coherence between models of nonverbal memory and tests that are used to assess the construct. Please refer to Chapter 22.
Chromosome 21 ____.
(a) has been marginally implicated in Alzheimer’s disease
(b) appears to be related to the development of amyloid plaques
(c) appears to be related to the development of neurofibrillary tangles
(d) has been ruled out as related to Alzheimer’s disease
B—appears to be related to the development of amyloid plaques Chromosome 21 is also involved in Down syndrome, and older individuals with Down syndrome typically develop plaques consistent with Alzheimer’s disease. Please refer to Chapter 30.
A 19-year-old man is in his second year of college when he becomes hyperverbal, can’t sleep, and reports boundless energy. On interview he reports “I’m at the top of my game” and is going to soon earn a large government grant based on his ideas regarding a ground-breaking new theory in physics. Assuming a likely psychiatric or neurologic illness whichconsidered in the treatment of these symptoms?
(a) benzodiazepines
(b) selective serotonin reuptake inhibitors
(c) monoamine oxidase inhibitors
(d) anticonvulsants
D—anticonvulsants The symptoms described are highly suggestive of bipolar disorder. Anticonvulsant medications are typically used to manage bipolar disorder. High-potency benzodiazepines are effective for the management of anxiety with few side effects aside from drowsiness. Selective serotonin reuptake inhibitors are the most commonly prescribed antidepressants in anxiety disorder. Tricyclics are used occasionally, and monoamine oxidase inhibitors may be used with close monitoring. Please refer to Chapter 34.
You have been consulted to see an 82-year-old man on the intensive care unit due to persistent mixed level delirium with significant behavioral and personality changes. His wife asks, “My husband was perfectly healthy 2 weeks ago. Now the doctor says that he has a urinary tract infection that is making him crazy. I’ve had lots of UTIs and never acted like this. The infection is in his bladder not his brain. Does this make any sense to you?” How might you try to explain this?
(a) In older people the blood-brain barrier is more permeable and infections get in more easily thus resulting in delirium.
(b) While the UTI may not be the primary cause of the delirium, the antibiotics and catheter being used are probably affecting mental status.
(c) Older bodies are less tolerant of changes and although the brain is not directly infected his overall reaction to the infection can cause delirium.
(d) He probably had a dementia prior to developing the infection and this has now unmasked the underlying condition.
C—Older bodies are less tolerant of changes and although the brain is not directly infected his overall reaction to the infection can cause delirium. With perhaps the exception of urosepsis, delirium in older patients with delirium related to UTI is more likely due to the physiologic effects and response to infection as opposed to the infection directly affecting the brain. The patient may have had underlying cognitive problems prior but this is an assumptive leap and the information provided does not support this conclusion. While certain medications and catheters can increase the risk for delirium it is unlikely that those are the primary cause of delirium in this individual who has already developed an infection. Please refer to Chapter 27.
On memory tests, children with congenital hydrocephalus typically perform ____.
(a) more poorly on tests of verbal than nonverbal learning and retrieval
(b) more poorly on tests of nonverbal than verbal learning and retrieval
(c) comparably poorly on tests of verbal and nonverbal learning and memory
(d) within normal limits on tests of verbal and nonverbal learning and retrieval
C—comparably poorly on tests of verbal and nonverbal learning and memory Although discrepancies showing better verbal than nonverbal performance is apparent on some tasks, this pattern is not apparent on learning and memory tasks, possibly because of compression of the hippocampus from hydrocephalus. Please refer to Chapter 20.
A seizure is a discrete event that may or may not lead to diagnosis with epilepsy. According to the International League Against Epilepsy definition and classification system, which of the following would not lead to a diagnosis with epilepsy?
(a) two unprovoked seizures, at least 24 hours apart
(b) a single seizure when risk of a second is known to be elevated (>60%)
(c) diagnosis with an epilepsy syndrome
(d) spontaneous seizure with no known precipitating event or risk factor
D—spontaneous seizure with no known precipitating event or risk factor Epilepsy was previously diagnosed when there were at least two unprovoked seizures. However, the current definition indicates diagnosis with epilepsy can be made after a single seizure, if the risk of recurrence is high based on other medical factors. Spontaneous seizure with no known precipitating event is not sufficient for diagnosis with epilepsy, and may often be found to be related to transient factors (e.g., systemic medical illness, ETOH or substance use). Please refer to Chapter 22.
Frontotemporal dementia with motor neuron disease is characterized by ____.
(a) primarily ubiquitin-based pathology
(b) primarily tau pathology
(c) both tau pathology and ubiquitin-based pathology
(d) neither tau pathology nor ubiquitin-based pathology
A—primarily ubiquitin-based pathology Frontotemporal dementia with motor neuron disease is characterized by ubiquitin-based pathology rather than tau pathology, involving the frontal and temporal lobes. Please refer to Chapter 32.
Which is the most common single gene disorder associated with Autism spectrum disorder?
(a) Prader-Willi syndrome
(b) fragile X syndrome
(c) Williams syndrome
(d) tuberous sclerosis
B—fragile X syndrome Fragile X syndrome is the most common single gene disorder associated with autism. It is also the leading cause of inherited intellectual disability. Please refer to Chapter 18.
A patient has a discrete, small lesion and develops full-blown amnesia. Which of the following lesions is most likely responsible?
(a) lesion of the anterior thalamus affecting the internal medullary lamina
(b) lesion of the anterior thalamic nucleus sparing the internal medullary lamina
(c) lesion affecting the left hippocampus
(d) lesion of the amygdala affecting the
A—lesion of the anterior thalamus affecting the internal medullary lamina A is the only alternative that involves damage to both limbic circuits or reference to the preponderance of anterior thalamic lesions as necessary for the production of
What is the earliest age at which the diagnosis of Autism spectrum disorder tends to be reliable and stable across time?
(a) 48–60 months
(b) 0–6 months
(c) 36–48 months
(d) 18–24 months
D—18–24 months This is currently the most reliable time at which an Autism spectrum disorder can be diagnosed and remain stable across time. Please refer to Chapter 14.
