Exam Questions Flashcards

Question

Jim is a 45-year-old diagnosed with HIV at age 30. He presented to Neurology recently with a chronic headache. Medical workup demonstrated elevated white blood count, and he was subsequently treated with intravenous amphortericin B, followed by oral fluconazole. Given this information, what is the most likely etiology of his presentation? a. Toxoplasmosis b. HIV-associated neurocognitive disorder c. Progressive multifocal leukoencephalopathy d. Cryptococcal meningitis

Answer 1

Cryptococcal meningitis key: Meds are to treat fungal infection

Answer 2

a. Dorsal, spatial relationships; Ventral, form

Answer 3

c. Simple migraine

Answer 4

d. Contralateral superior quadrantanopia; temporal

Answer 5

c. Optic neuritis due to multiple sclerosis

Answer 6

a. Crossed signs (e.g., weakness on one side of the face and contralateral body)

Answer 7

b. Ipsilateral; do not cross

Answer 8

c. Optic chiasm

Answer 9

c. Trochlear

Answer 10

d. Top-of-the-basilar syndrome

Answer 11

a. WAIS-IV digit span forward

Answer 12

d. Symptoms of intracranial hemorrhage can be delayed by hours after the event.

Answer 13

c. bilateral disconnection of auditory receptive areas from Wernicke's area. This lesion prevents the speech signal from undergoing phonologic decoding in Wernicke's area, but leaves intact sound decoding for nonspeech sounds. (Study CH 4)

Answer 14

C - injection. opioids and stimulants cross the BBB most readily when injected. (Study ch 36).

Answer 15

d. this may be due to normal variability. unless a disorder is otherwise indicated by history, I make no diagnosis but comment on the variability in my report. As stated in the section on interpretation of abnormal test results, a finding of one or more low to very low scores and a relatively large battery is common in normative samples without neurological impairment. Thus, unless the findings fit a profile that is consistent with an impaired domain or expected impairment based on medical history or presumed etiology (i.e. variability across scores inattention-deficit/hyperactivity disorder), The findings should not be over interpreted but considered in this light and discussed as possible normal variants in the interpretation section of the report (stucky chapter 8)

Answer 16

a. greater cognitive impairment (Stucky ch 24) Men tend to get MS less frequently than women, but more frequently show progressive disease courses with more cognitive impairment.

Answer 17

b. dorsal stream The impaired task requires remembering a spatial location, not identifying an object. The parietal lobes are part of the dorsal stream. see chapter 4

Answer 18

d. area of bifurcation of the major branches of the middle cerebral artery Areas of bifurcation of major cerebral arteries show higher risk for stroke, but are less vulnerable than the other regions listed to the effects of anoxia and hypoxia. See chapter 28

Answer 19

a. It is a group of brain-based disorders characterized by motor impairments Cerebral palsy is not considered a disease. It is caused by primary damage to the brain and most often results from prenatal causes. See chapter 19

Answer 20

c. administer a reading achievement task to ensure no less than a fifth grade reading level. It would be beneficial to administer a measure of reading achievement in this case as test items of the MMPI 2 RF require between a fifth and an eighth grade reading level. The clinician is also able to interpret VRIN-r and TRIN-r to establish whether the patients reading difficulties in any way resulted in non content responsivity that might invalidate the profile. See ch 10

Answer 21

c. Social cognition is affected in persons with both temporal lobe epilepsy and other epilepsy syndromes. Social cognition is disrupted by underlying neural networks supporting cognition, as well as cognitive and psychosocial factors. Problems with social cognition develop in childhood, and persist into adulthood due to a combination of factors beyond pathology including limited opportunity to engage with peers, learn, and practice social skills. See chapter 22.

Answer 22

d. hematopoietic stem cell transplant This is the only current treatment that extends life expectancy. Lorenzo oil normalizes plasma VL CFA but does not extend life. Pallidotomy and epilepsy surgery are not used as treatments for adrenoleukodystrophy. See chapter 18.

Answer 23

a. Korsakoff's dementia given the confabulation in light of her recent drinking and vitamin deficiency, you would want to consider korsakoff’s syndrome. See chapter five.

Answer 24

c. right hemisphere The likely location of the stroke is in the right hemisphere, as the infarct has damaged cerebral structures that, by nature, are associated with negative valence on stimuli. The inhibitory effect of the damaged cerebral tissues results in positive effect, for example, euphoria, as the natural tendency toward negative valence (dysphoria) is suppressed. See ch 3.

Answer 25

c. inhibition and flexibility Children with high functioning autism sometimes have typical organization ability, planning, and rote memory. However, Corbetta and colleagues in 2009 demonstrated that they have difficulty with inhibition and flexibility, as is observed in individuals who perseverate in their interests and have diminished behavioral control. see chapter 14.

Answer 26

d. greater initial injury severity Depression is the most common psychological problem following TBI and occurs in 20 to 40% of individuals during the first year and up to 50% of individuals at some stage. Depression can occur at all levels of severity and the prevalence rate does not increase along with injury severity. Risk factors for post TBI depression include minority status, unemployment, low income, low education, and alcohol abuse. Post TBI depression has been linked to the development of increased cognitive impairments, reduced psycho motor speed, and less favorable functional outcomes. See chapter 29.

Answer 27

a. Paraneoplastic syndrome This constellation of symptoms suggests possible autoimmune reaction to cancer; cognitive dysfunction from chemotherapy treatment is typically associated with mild problems with working memory and attention and not with onset of seizures or amnesia. See chapter 25.

Answer 28

d. bacterial meningitis Nuchal (neck) rigidity is commonly cited as a common presenting symptom in bacterial meningitis. See chapter 23

Answer 29

d. impaired proprioception when vitamin B12 levels fall below healthy levels physical symptoms, psychological changes and cognitive impairments often develop. Symptoms may include anemia, weakness, fatigue, mood changes, memory loss, and disorientation. Patients may have impaired tactile recognition of pressure and vibration, difficulty walking, and peripheral tingling or numbness (parasthesias) due to damage to the dorsal sections and lateral pyramidal tracts in the spinal cord. Sustained deficiency typically leads to irreversible damage and may be marked by depression, irritability, impaired attention, hallucinations, and symptoms suggestive of dementia, but tremor, delusions, and apraxia are not associated with B12 deficiency. See chapter 27.

Answer 30

b. occur in a sizable minority of patients Hallucinations and delusions do not occur in the majority of patients with vascular dementia but they are not rare. Their presence does not signify anything about etiology. See chapter 31.

Answer 31

d. fragile X syndrome sex-linked genetic factors and male vulnerability to insult might account for some of the gender differences and ID. See chapter 13.

Answer 32

C. Test in both languages to obtain objective samples of language dominance and guide recommendations accordingly For a complete evaluation of the test taker's cognitive and linguistic status, evaluation should be in all of their languages. See Chapter 11.

Answer 33

C. Medication management and adherence Stabilization of symptoms with medication management and increased adherence would be indicated prior to assessment of functional capacity and to maximize benefit from any individualized vocational placement or social skills program. See chapter 35.

Answer 34

D. Transcortical motor aphasia In contrast to brokers aphasia, transcortical motor aphasia is characterized by relatively intact repetition

Answer 35

b. Visuospatial functioning Anoxic brain injury in children tend to result in significant impaired intellectual abilities, memory impairment, decreased attention span, and behavioral impairments whereas academic achievement, internalizing behavioral problems, and visuospatial deficits were generally less severe. See chapter 28.

Answer 36

d. impairment in social and occupational functioning The DSM 5 specifies that the symptoms and severity of the disorder must represent a change from previous functioning and calls clinically significant distress or impairment in social, occupational, or other important areas of functioning. As such, severity level is determined by the level of impairment on daily life functions. See chapter 34.

Answer 37

B. Pseudobulbar affect uncontrollable crying or laughing is most likely to be seen in progressive supranuclear palsy, and in fact, there are a number of affective and behavioral symptoms that can be seen in PSP. See chapter 33

Answer 38

D. Thank her for her interest but provide no more information Investors Steve direct permission from the patient to release confidential health information. You're must respect this right even if the person asking is a trusted colleague or superior. You have no idea regarding how the information might be used or if your patient would want the information released to that particular individual. Third party is also do not have an automatic right to the patients P hi even if they were previously involved in the patient care. The HIPAA privacy rule allows providers to legally share vhi for treatment purposes without the patients consent. However, in this case, the information is not for treatment purposes, as it relates to a former patient. Moreover, even if the information was legally allowed according to HIPAA, psychologists have a more restrictive ethical burden to protect confidentiality before communicating with non authorized individuals. Answer B is inappropriate as psychologists are not advised or required to be deceptive when protecting patient confidentiality. Finally, the patient, not the person requesting the information, must sign the consent form for release of information, which is why answer C is incorrect. See chapter seven.

Answer 39

a. CA1 Section and subiculum of the hippocampus Pick bodies and pick cells are commonly found in the amygdala, dentate gyrus, pyramidal cells of the CA1 section and subiculum of the hippocampus, hypothalamic lateral tuberal nucleus, dorsomedial region of the putamen, globus pallidus, locus ceruleus, mossy fibers and monodendritic brush cells in the granule cell layer of the cerebellum, and frontal and temporal neocortex. See chapter 32

Answer 40

c. The set of scores will have a mean of 0, standard deviation of 1, and unchanged distribution When an entire distribution of scores is transformed into Z scores, the resulting distribution will have a mean of 0, a standard deviation of 1, and the same shape as the original distribution. It is possible to take distributions of data points and depart from true normality in some way and transform them so as to be fit to a normal curve. This may be necessary to solve any one of many problems of distributional shape, And numerous types of transformations may be appropriate depending on the shape of the data (e.g. reciprocals or log transformations for extreme positive skew). every decision to utilize a transformation must be related to an essential measurement concern that can be identified and expressed, and consideration should be made that at times, transformations are inappropriate or misleading. It is essential that the clinician understand the underlying distribution and its impact on the meaning of the selected representation of the performance. See chapter 8

Answer 41

b. Decreased | See chapter 35

Answer 42

a. Improves with time, but contains abnormalities (e.g., echolalia, unusual prosody) language generally improves between the 3rd and 5th year, but is often marked with abnormalities such as echolalia, unusual prosody, and other language abnormalities associated with ASD's. See chapter 14

Answer 43

c. spasticity the other choices are associated with extrapyramidal CP. See chapter 19.

Answer 44

a. Single word reading, and spelling Dyslexia is a specific reading disorder characterized by deficits in phonological awareness, fluent decoding and word reading, and spelling. It has nothing to do with visual processing or letter writing. Reading comprehension is affected, but the noted core deficits are key to assessment. See chapter 15.

Answer 45

d. ask the examinee to explain the instructions in his or her own words Repeating instructions would not necessarily result in understanding, while asking the examinee if he or she understands may result in a polite nod. Following standard protocol would not address understanding and may invalidate the test results or place the examinee at a disadvantage. Asking the examinee to explain his or her understanding will allow the NP to assess the examinees appreciation of the instructions. See Chapter 11.

Answer 46

a. Deficits develop after shorter drinking histories Although most research on AUD has been conducted with men, research with women has shown comparable neuropsychological deficits. However, these deficits tend to manifest after shorter drinking history as compared to men. See chapter 36

Answer 47

c. consult specific personality inventory manuals to guide decision making adolescents who are 18 years old may be given the MMPI 2 RF or the MMPI a RF because normative and clinical samples for both the RF and the a RF instruments include 18 year olds. The clinician should make a case by case judgment about which assessment to use with 18 year olds. A suggested guideline would be to use the a RF instrument with 18 year olds who are still in high school and the two RF instrument with 18 year olds who are in college, working, or living and otherwise independent adult life. See chapter 10.

Answer 48

d. Temporal; Contralateral Quadrantanopsia requires a fairly specific lesion and mostly occurs with direct involvement of Myers loop in the contralateral temporal lobe. See chapter six.

Answer 49

d. Illness anxiety disorder Illness anxiety disorder was previously known as hypochondriasis. It does not involve the actual experience of symptoms, despite great concerns about contracting illnesses. See chapter 37.

Answer 50

c. effective, but carries increased risk of seizure exacerbation in some children While the effect size for treatment efficacy in children with epilepsy may be slightly smaller than compared with children with ADHD alone, there is evidence that treatment with stimulants is effective for managing ADHD symptoms in children with epilepsy. Regarding safety and risk of increased seizures, there is very little data to address the question. However there are a few studies that have shown that a small number of patients do have increased seizures with stimulant treatment. Patients with higher seizure frequency at the time of treatment initiation may have increased risk of seizure exacerbation. See chapter 22.

Answer 51

a. Turner syndrome Short stature and webbed neck are physical characteristics associated with Turner syndrome but not the other disorders listed individuals with Williams syndrome also tend to have greater visual spatial deficits but tend to have lower overall cognitive ability. Individuals with tuberous sclerosis and Angelman syndrome have broader cognitive deficits, with significant cognitive deficits seen in Angelman syndrome. See chapter 18.

Answer 52

b. depression, visual motor integration, fatigue Given the graph oh motor component of the Wechsler processing speed tasks, as well as documented deficits seen in visual motor integration for individuals with multiple sclerosis, examining this area would be an important step in the assessment. Likewise, depression and fatigue are considered to be commonly associated with MS and may be associated with reduced speed of performance. See chapter 24.

Answer 53

c. calculate the reliable change index, with a 90% confidence interval The reliable change index will indicate whether the difference between the two scores is larger than can reasonably be expected on the basis of practice effects or measurement error alone. See chapter nine.

Answer 54

a. Maternal occupation In utero exposure to lead at the current time is most likely to occur when the mother is exposed to lead at her occupation, such as in factories that use lead in manufacturing products. See chapter 21.

Answer 55

c. the locus coeruleus and lateral tegmental area The locus coeruleus and lateral tegmental area are the primary sources of adrenergic input to the brain. The other alternatives in this item refer to structures that are associated with neurotransmitters other than norepinephrine. See chapter 4

Answer 56

c. memory and new learning Limbic encephalitis commonly involves bilateral temporal pathology, causing persistent deficits in memory and new learning. See chapter 23

Answer 57

a. Temporoparietal Alzheimer's pathology usually begins in temporal lobe structures and spreads to parietal regions before affecting the frontal lobes. The spread of pathology parallels the pattern of neuropsychological dysfunction. See chapter 30.

Answer 58

b. There was a large effect seen for medication treatment, for which the addition of behavioral therapy produced no significant added benefit. There was no significant benefit from the behavioral therapy added to the stimulant medication with regard to ADHD symptom reduction. However, with regard to non-symptom areas (e.g., social skills), there was added benefit noted with the behavioral therapy interventions. See chapter 16

Answer 59

b. left hemispatial inattention and constructional apraxia These are most often associated with right parietal, especially inferior parietal, damage. In contrast, parts of the gerstmann syndrome are seen after left inferior parietal damage; Right left confusion (part of Gerstmann syndrome) can also be seen after left inferior parietal damage, and nonverbal memory deficits are associated with damage to the right medial temporal lobe or the diencephalic system (e.g., Korsakoff’s). see chapter 26

Answer 60

c. 3 GCS is a system for determining the degree of impairment in patients through the assessment of eye opening, verbal response, and motor response. In this example, the patient would receive a score of one in each domain resulting in a GCS of three, which is the lowest score possible. See chapter 29.

Answer 61

b. Angelman syndrome Individuals with Angel men syndrome exhibit significant cognitive deficits and are typically nonverbal, but demonstrate social interest and others. See chapter 18.

Answer 62

c. Secondary tumors, late onset seizures, and stroke Adult survivors of childhood medulloblastoma are at increased risk for strokes and seizures; at 30 years post diagnosis, cumulative incidence of seizures is 34% and of strokes, 15%. Cumulative incidence of seizures and survivors of all types of brain tumors is 40%, 30 years post diagnosis. Subsequent malignant neoplasms and meningiomas had a cumulative incidence of 6%. See chapter 25.

Answer 63

b. initiation of response Other types of attention are subsumed by anterior cingulate, dorsolateral frontal, and prefrontal areas, respectively. See chapter five.

Answer 64

a. Depression can occur years prior to motor symptoms in Huntington's disease. Depression , as well as other psychiatric symptoms (e.g., anxiety, psychosis, OCD) can proceed motor symptoms and formal diagnosis of Huntington's disease. With respect to the other disorders listed, well formed, early not late visual hallucinations are a core diagnostic feature of lewy body dementia. Emotional ability can be seen in PSP, that mania Purcell is not typical. Visual hallucinations are a common side effect of Parkinson's disease medications. See chapter 33.

Answer 65

a. Seizure frequency Well age at seizure onset is typically considered the most important factor in determining severity of cognitive function, among the options listed seizure frequency or severity is the most important. The nature and extent of abnormal MRI findings may be a factor in seizure severity, however the presence of MRI abnormality alone provides little information about the severity of cognitive impairment in many cases (e.g., tumor-related epilepsy). history of febrile seizures is common, even among persons who never develop epilepsy and is not usually associated with cognitive impairment alone. Medications may be a proxy for seizure severity, but many persons with epilepsy tolerate medications well, without cognitive side effects. See chapter 22.

Answer 66

b. visuospatial processing, processing speed, working memory The proximity of the vulnerable periventricular region to the optic radiations, as well as dorsal stream dysfunction involved in the integration of visual information, or hypothesized to be the source of visuospatial processing problems. The frequency of white matter pathology and preterm infants is thought to explain the common deficits in processing speed and the increased rate of abnormalities in frontal and subcortical functional systems can result in working memory deficits. Problems with attention, wordlist generation, and fine motor dexterity can also be seen. Weak word reading and vocabulary skills are typically not associated with preterm birth. See chapter 27

Answer 67

c. Fluent, echolalic

Answer 68

d. Repetition

Answer 69

d. Mixed transcortical aphasia

Answer 70

b. Wernicke-Korsakoff's syndrome

Answer 71

b. Transcortical motor aphasia

Answer 72

a. Anterior; impaired comprehension of phonological (syntactic) information used to construct word names; posterior; impaired comprehension of the sequencing of meaningful word sounds to convey meaning (lexical/semantic)

Answer 73

a. The right hemisphere is responsible for producing negative valence, and the left hemisphere for positive valence

Answer 74

d. Schemas

Answer 75

c. Impaired repetition

Answer 76

c. Left MCA

Answer 77

c. Poor comprehension of spoken words

Answer 78

b. MCA-PCA watershed infarcts

Answer 79

c. Aphemia

Answer 80

c. Verbal addition

Answer 81

a. Phrases <5 words long, more content than function words

Answer 82

b. Dominant inferior parietal lobule

Answer 83

a. Sisters of Notre Dame prospective dementia study

Answer 84

a. Length of Post-Traumatic Amnesia

Answer 85

b. Transient Global Amnesia

Answer 86

a. Milner’s research on removal of frontal lobe tissue on executive function

Answer 87

b. Basal ganglia

Answer 88

b. Difficulty reaching for objects directly

Answer 89

c. Narrative with delusions

Answer 90

d. Transcortical Motor

Answer 91

a. Transcortical Mixed

Answer 92

c. Intact remote memory

Answer 93

c. Centered at the workspace and that test objects are centered in front of the patient and immobile if possible

Answer 94

a. Depression-like symptoms

Answer 95

b. Stroking his hand to see if he exhibited a grasp reflex

Answer 96

d. Cortical-basal degeneration

Answer 97

a. Olfactory nerve

Answer 98

b. Cerebellum

Answer 99

d. Identify severity of white matter changes

Answer 100

d. MRI, DWI

Answer 101

a. Susceptibility-weighted imaging

Answer 102

d. dark on CT and bright on T2 FLAIR

Answer 103

a. Right hemiparesis

Answer 104

a. Aphasia

Answer 105

d. Herpes simplex encephalitis

Answer 106

c. Perseveration

Answer 107

d. Hyperreflexia

Answer 108

a. Lenticulostriate

Answer 109

c. R motor deficit

Answer 110

a. ~25%, posterior

Answer 111

b. PCA infarct

Answer 112

b. Syncope

Answer 113

d. Describe what questions were asked and how the patient answered

Answer 114

b. Awkwardly move their hand toward their face

Answer 115

b. CN III, IV, & VI

Answer 116

a. Truncal

Answer 117

b. Extensor (decerebrate)

Answer 118

c. Subarachnoid hemorrhage

Answer 119

a. Patent foramen ovale (PFO)

Answer 120

d. Presurgical brain mapping

Answer 121

a. Bacterial meningitis

Answer 122

b. Extinction on double simultaneous stimulation

Answer 123

a. Visual deficits in one eye

Answer 124

c. Basal ganglia

Answer 125

d. Left ACA

Answer 126

a. Left MCA inferior division

Answer 127

b. Strokes in the watershed zones

Answer 128

d. Headache

Answer 129

b. Medulla

Answer 130

c. UMN problems

Answer 131

c. Bilaterally reduced regional glucose metabolism in the posterior tempoparietal cortices in addition to anterior and mesial temporal lobes

Answer 132

B selective attention

Answer 133

A anomic aphasia A Extrasylvian area

Answer 134

D. spontaneous recovery has been documented in some cases

Answer 135

C. not express emotions

Answer 136

C. ideational apraxia

Answer 137

D. motor or sensory deficits

Answer 138

D. anterior cingulate

Answer 139

A. alerting

Answer 140

c. fluency, comprehension, repetition

Answer 141

C. ventral

Answer 142

c. savantism

Answer 143

c. delirium

Answer 144

D. Spilling dimethylmercury on your latex gloves while conducting an experiment

Answer 145

D. there is no reliable way to determine maternal alcohol consumption

Answer 146

B. mercury

Answer 147

a. Dopamine

Answer 148

B. Clinical interview with parents

Answer 149

C. fetal alcohol spectrum disorder

Answer 150

a. Neuronal migration and proliferation

Answer 151

b. use of other substances

Answer 152

d. attention

Answer 153

a brain tumor. a growth of abnormal cells inside the skull cavity. They often disseminate and seed along the CSF pathways, but they rarely spread outside the CNS. Tumors can be either benign (noncancerous) or malignant (cancerous). Most common symptoms in adults and children is persistent headache. but most first present to doctors due to seizures.

Answer 154

glia. provide a number of metabolic, electrical, and mechanical support functions to neurons. 99% of CNS tumors originate from glial cells (e.g., astrocytes, oligodendrocytes, microglia, and ependymal cells)

Answer 155

metastatic tumors originate from other places in the body and spread to the brain via blood cells and lymph channels. most originate in the lungs (50%), followed by breast cancer (15-20%), and melanomas (10%). Around 24-40% of adult patients with non-CNS tumors will eventually develop metastatic brain cancer. Prognosis is related to the cancer's primary site. For example, the prognosis for brain metastases from breast cancer is more favorable than metastases from colon cancer. Most primary brain tumors in adults develop above the tentorium in the hemispheres. Of the primary brain tumors, Astrocytoma is the most common. Metastatic cancers are twice as common in adults, whereas primary brain tumors are twice as common in children.

Answer 156

Most primary brain tumors in children are found in the posterior fossa. Medulloblastoma is the most common primary brain tumor in children.