Sample Test #1

Question 1

Pure word deafness results from _____.

A) destruction of primary auditory cortex
B) damage to auditory radiations within the acoustic nerve
C) bilateral disconnection of auditory receptive areas of Wernicke’s area
D) disconnection of Wernicke’s area from semantic regions of the anterior temporal lobe

Answer 1

C - bilateral disconnection of auditory receptive areas from Wernicke’s area

The lesion prevents the speech signal from undergoing phonological decoding in Wernicke’s area, but leaves intact sound decoding of nonspeech sounds

Question 2

Which route of administration causes most rapid central nervous system penetration by opioids or stimulants?

A) smoking
B) inhalation/nasal
C) injection
D) rectal

Answer 2

C - Injection

opiods and stimulants can cross the blood-brain barrier most readily when injected.

Question 3

An individual is given a battery of tests with at least three tests in each of five cognitive domains. He performs below the 10th percentile on one test in each of two separate cognitive domains. How do you interpret this pattern of performance?

A) The patient is clearly impaired in two important cognitive domains; I diagnose accordingly and provide treatment recommendations in my report.
B) The patient is essentially intact in almost all cognitive domains; I make no diagnosis and clarify in my report that no treatment is deemed necessary.
C) The patient may be impaired in one or more domain; I need more tests to be sure and will send a request for that in a report to the insurance company.
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.

Answer 3

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.

A finding of one or more low to very low scores in a relatively large battery is common in normative samples without neurological impairment. thus, unless findings fit a profile that is consistent with an impaired domain or expected impairment based on medical history/presumed etiology (i.e., variability across scores in ADHD), the findings should not be overinterpreted but considered in this light and discussed as possible normal variance in the interpretation section of the report.

Question 4

In contrast to women with multiple sclerosis, men with the disease may show ____.

A) greater cognitive impairment
B) more relapses
C) less neurologic deterioration
D) fewer lesions on MRI

Answer 4

A - greater cognitive impairment

Although men tend to get MS less frequently than women, they more frequently show progressive dz courses with more cog impairment

Question 5

A patient can both name and match-to-sample a visually presented object. She cannot remember where in a 3 x 3 spatial array the object was located. According to “top-bottom” theory, the lesion is likely somewhere in the _____.

A) forceps major
B) dorsal stream
C) ventral stream
D) forceps minor

Answer 5

B - dorsal stream

The impaired tasks requires remembering a spatial location, not identifying an object.

**The parietal lobes are part of the dorsal stream. **

Question 6

Which of the following would be expected to show the lowest vulnerability to the effects of hypoxia/anoxia?

A) areas supplied by the lenticulostriate arteries
B) watershed regions between the major arteries
C) regions with high metabolic demand
D) area of bifurcation of the major branches of the middle cerebral artery

Answer 6

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/hypoxia.

Question 7

Which statement best defines cerebral palsy?

A) It is a group of brain-based disorders characterized by motor impairments.
B) It is a disease process that results in abnormal motor control
C) It is a group of disorders that causes primary damage to the muscles
D) It is an umbrella term for disorders that result from perinatal asphyxia.

Answer 7

A - It is a group of brain-based disorders characterized by motor impairments.

CP is not considered a disease. It is caused by primary damage to the brain and most often results from prenatal causes.

Question 8

A 23-year-old patient with a known history of reading disorder (dyslexia) is referred for evaluation of possible major depression or other mood disorder. The neuropsychologist would like to administer the MMPI-2-RF to assist in diagnostic decision-making. There is no opportunity for professional audio presentation of the items via computer. Which of the following best describes how the neuropsychologist should proceed when electing to administer the MMPI-2-RF to this patient?

A) Administer a measure of reading achievement to ensure that the patient’s reading level is no less than a tenth-grade level of ability.
B) Read the test items aloud to the patient, repeating the items as necessary, to ensure adequate comprehension of item content.
C) Administer a reading achievement task to ensure no less than a fifth-grade reading level.
D) Administration of the MMPI-2-RF is no appropriate for use with this patient.

Answer 8

C - Administer a reading achievement task to ensure no less than a fifth-grade reading level.

Beneficial to administer reading measure b/c MMPI-2-RF requires btw 5yh and 8th grade.

Can also interpret VRIN-r and TRIN-r to establish whether the pt’s reading difficulties in any way resulted in non-content-responsivity that might invalidate the profile.

Question 9

Social cognition is a relatively new are of study in epilepsy, despite the high incidence of comorbidity between Autism spectrum disorder and epilepsy. Studies have shown that, even among person with epilepsy who do not have Autism spectrum disorder, that emotional recognition and theory of mind are affected. Which of the following is true about social cognition in persons with epilepsy?

A) Social cognition adversely affected in temporal lobe epilepsy, but no other epilepsy syndromes.
B) Social cognition is normal in persons with temporal lobe epilepsy, but affected in other epilepsy syndromes.
C) Social Cognition is affected in persons with both temporal lobe epilepsy and other epilepsy syndromes.
D) Social cognition is affected in children with epilepsy, but is age dependent and generally normal in adults.

Answer 9

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.

Question 10

Currently, the only treatment that extends the life expectancy for adrenoleukodystrophy is _____.

A) Lorenzo’s oil
B) epilepsy surgery
C) pallidotomy
D) hematopoietic stem cell transplant

Answer 10

D - hematopoietic stem cell transplant

HCST is the only current treatment that extends the life expectancy.

Lorenzo’s oil normalizes plasma VLCFA but does not extend life.

Pallidotomy and epilepsy surgery are not used as tx for adrenoleukodystrophy.

Question 11

A 47-year-old woman presents for testing. She was recently discharged after a 2-month hospitalization following a bout of depression, binge drinking, and anorexia. She denies any cognitive difficulties. Her sister, however, reported that the patient now has difficulties with orientation, concentration, memory, decision-making, and confabulation. The most likely diagnosis is ______.

A) Korsakoff’s dementia
B) ACoA aneurysm rupture
C) early-onset Alzheimer’s disease
D) psuedodementia

Answer 11

A - Korsakoff’s dementia

Given the confabulation in light of her recent drinking and vitamin deficiency, you would wan to consider KD

Question 12

A patient with a new onset stroke has become euphoric. Where in the brain is likely the location of the stroke?

A) bilateral prefrontal cortex
B) left hemisphere
C) right hemisphere
D) mammillary bodies

Answer 12

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 affect, i.e., “euphoria,” as the natural tendency toward negative valence is suppressed.

Question 13

Compared to typically developing peers, children with high-functioning Autism spectrum disorder are most likely to display the most severe deficit in which of the following executive functions?

A) organization and planning
B) planning and initiation
C) inhibition and flexibility
D) planning and inhibition

Answer 13

C - inhibition and flexibility

Children with high-functioning autism sometimes have typical organization ability, planning, and memory BUT might have difficulty with inhibition and flexibility, as observed in individuals who perseverate in their interests and have diminished behavioral control.

Question 14

Depression following moderate to severe traumatic brain injury in adults is not associated with _____.

A) increased cognitive impairment
B) poor functional outcome
C) alcohol use disorders
D) greater initial injury severity

Answer 14

D - greater initial injury severity

Depression is the most common psychological problem following TBI and occurs in 20-40% of individuals during the first year and up to 50% of individuals at some stage.

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 psychomotor speed, and less favorable outcomes.

Question 15

A 65-year-old patient with a 6-month history of lung cancer presents with recent onset of seizures, amnesia, and confusion. Of the following, the most probable etiology of cognitive dysfunction is _____.

A) paraneoplastic syndrome
B) malignant nerve sheath tumor
C) stroke or embolic shower
D) “chemobrain” from chemotherapy treatment

Answer 15

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 workign memory and attention and not with onset of seizures or amnesia.

Question 16

Nuchal rigidity is a hallmark feature of which disorder?

A) Creutzfeldt-Jakob disease
B) rabies encephalitis
C) West Nile Virus encephalitis
D) bacterial meningitis

Answer 16

D - bacterial meningitis

Nuchal (neck) rigidity is commonly cited as a common presenting problem in bacterial meningitis.

Question 17

Besides cognitive dysfunction, which of the following would you most expect to occur in chronic, untreated vitamin B12 deficiency?

A) delusions
B) ideomotor apraxia
C) resting tremor
D) impaired proprioception

Answer 17

D - impaired proprioception

low B12 levels are associated with physical, psychological, and cognitive symptoms.

Sxs may include: anemia, weakness, fatigue, mood changes, memory, loss, and disorientation.

Pts may have impaired tactile recognition of pressure and vibration, difficulty walking, and peripheral tingling or numbness due to damage to the dorsal sections and lateral pyramidal tracts in the spinal cord.

Sustained deficiency leads to irreversible damage and may be marked by depression, irritability, impaired attention, hallucinations, and symptom suggestive of dementia but tremor, delusions, and apraxia ARE NOT associated with b12 deficiency.

Question 18

In vascular dementia, delusions and visual hallucinations ____.

A) suggest a toxic or metabolic cause
B) occur in a sizable minority of patients
C) suggest mixed dementia
D) are considered quite rare

Answer 18

B - occur in a sizable minority of patients

delusions and visual hallucination do not occur in ALL vascular dementia patients but they are not rare.

Presence does not signify anything about their etiology.

Question 19

The 1.5:1 ratio of intellectual disability in males to females is in large part due to diagnoses such as ___.

A) Epilepsy
B) Down Syndrome
C) Traumatic Brain Injury
D) Fragile X syndrome

Answer 19

D - Fragile X syndrome

Sex-linked genetic factors and male vulnerability to insult might account for some of the gender differences.

Question 20

Your clinic evaluates a 10-year-old Spanish-dominant bilingual boy who is referred from school and is being considered for special academic services upon his return from a medical leave for treatment of a brain tumor. When considering which language to administer the tests in, you decide to _____.

A) test in Spanish since Spanish is his dominant language and these results will be most relevant in group functioning
B) test in English since that is the language of the setting of the school, where the results will be most relevant
C) test in both languages to obtain objective samples of language dominance and guide recommendations accordingly
D) forego testing due to the absence of adaptive normative data for bilingual children, and rely upon a functional assessment.

Answer 20

C - test in both languages to obtain objective samples of language dominance and guide recommendations accordingly

Question 21

A 21-year-old woman who has been diagnosed with schizophrenia reports that she believes her coworker is poisoning her food. She also reports daily auditory hallucinations. She states that she has stopped eating and attending work. Which of the following would be the most important initial treatment consideration for the neuropsychologist?

A) functional capacity assessment
B) supportive occupational placement program
C) medication management and adherence
D) social skills training program

Answer 21

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.

Question 22

A 68-year-old, right-handed man presents after a stroke with impaired verbal fluency and relatively intact auditory comprehension and repetition. What aphasia syndrome does he have?

A) Wernicke’s aphasia
B) conduction aphasia
C) Broca’s aphasia
D) transcortical motor aphasia

Answer 22

D - transcortical motor aphasia

In contrast to Broca’s aphasia, transcortical motor aphasia is characterized by relatively intact repetition.

Question 23

Which of the following domains is generally less affected in children following anoxic brain injury?

A) behavioral regulation
B) visuospatial functioning
C) attention span
D) verbal memory

Answer 23

B - visuospatial functioning

Anoxic brain injury in children tends to result in significantly impaired intellectual abilities, memory impairment, decreased attention span, and behavioral impairments whereas academic achievement, internalizing behavioral problems, and visuospatial deficits were generally less severe.

Question 24

A 44-year-old divorced woman presents with cognitive, emotional, and pain related complaints. She readily admits to a history of psychiatric treatment starting in her early 20s. Assuming a high likelihood of a mood or anxiety disorder which of the following would be the most important indicator of severity?

A) scores on objective measures of mood/anxiety
B) number of symptoms and intensity
C) frequency of hospitalization
D) impairment in social and occupational functioning

Answer 24

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 cause 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.

Question 25

Which of the following evaluation findings is most likely to be seen in progressive supranuclear palsy versus other subcortical movement disorders

A) visuospatial deficits
B) pseudobulbar affect
C) slowed processing speed
D) marked encoding deficit

Answer 25

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.

Question 26

You are at a professional meeting for psychologists in your community. One of your colleagues indicates that she recently learned that a former patient of hers was referred to you for outpatient assessment and she wants to know how the patient performed. The clinician indicates that she developed a close relationship with the patient and his family and has been concerned about his recovery. You do not have a signed release of information. Which of the following is the most appropriate response?

A) Inform the colleague that it is unethical to request such information.
B) Remain collegial but state that you have never heard of the patient.
C) Request a release of information signed by the colleague.
D) Thank her for her interest but provide no more information.

Answer 26

D – Thank her for her interest but provide no more information.

You must receive direct permission from the patient to release confidential health information.

HIPAA allows providers to legally share PHI for treatment purposes without the patient’s consent. However, in this case, the information is not for treatment purposes, as it relates to a former patient.

Note: psychologists have a more restrictive ethical burden to protect PHI.

Question 27

In the behavioral variant of frontotemporal dementia, Pick cells and bodies are commonly found, among other places, in the pyramidal cells of the _____.

A) CA1 section and subiculum of the hippocampus
B) CA1 and CA2 sections of the hippocampus
C) CA2 and CA4 sections of the hippocampus
D) CA4 and subiculum sections fo the hippocampus

Answer 27

A – CA1 section and subiculum of the hippocampus

Pick bodies and Pick cells are commonly found in the amygdala, dentate gyrus, pyramidal cells fo 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.

Question 28

What happens to the mean, standard deviation, and the shape of the distribution when all scores are transformed into z scores?

A) The set of scores will have a mean of one, standard deviation of zero, and positively skewed.
B) The set of scores will have a mean of zero, standard deviation of one, and positively skewed distribution.
C) The set of scores will have a mean of zero, standard deviation of one, and unchanged distribution.
D) The set of scores will have a mean of one, standard deviation of one, and unchanged distribution.

Answer 28

C – The set of scores will have a mean of zero, standard deviation of one, and unchanged distribution.

Question 29

The risk of developing schizophrenia in females versus males is ___.

A) increased
B) decreased
C) about the same
D) unkonwn

Answer 29

B – decreased

Question 30

In most children with Autism spectrum disorders, communicative ability during the third through the fifth years of life ___.

A) improves with time, but contained abnormalities (e.g., echolalia, unusual prosody)
B) declines to mutism as in Rett’s disorder
C) declines but is marked by an increase in nonverbal communication ability
D) improves to the point of age-appropriate levels coupled with appropriate social gestures.

Answer 30

A – improves with time, but contained abnormalities (e.g., echolalia, unusual prosody)

Question 31

Pyramidal cerebral palsy is associated with ___.

A) dystonia
B) athetosis
C) spasticity
D) ataxia

Answer 31

C – spasticity

Question 32

You are seeing a child for an evaluation of dyslexia. The most important areas for assessment are phonological awareness, decoding, ____.

A) single-word reading, and spelling
B) visual scanning, and spelling
C) reading comprehension and spelling
D) reading letters in proper orientation and order

Answer 32

A) single-word reading, and spelling

Question 33

In Vietnamese culture, nodding is often a polite signal that the person is listening versus being agreeable. Given this tendency, and assuming that language is not an issue due to use of a competent interpreter, what would be the best approach to ensure understanding of test instructions when explaining a test to a first-generation Vietnamese examinee?

A) repeat the instructions more than once to ensure understanding
B) nothing as the neuropsychologist must follow a standardized protocol
C) ask the examinee if s/he understands the instructions
D) ask the examinee to explain the instructions in his/her own words

Answer 33

D) ask the examinee to explain the instructions in his/her own words

Question 34

In general, when compared to men with alcohol use disorder (AUD), the neuropsychological presentation of women with AUD shows ______.

A) deficits develop after shorter drinking histories
B) reduced verbal abilities
C) better performance on visuoperceptual/visuospatial tasks
D) better performance on time tasks

Answer 34

A) deficits develop after shorter drinking histories

Question 35

When giving a personality inventory to a patient who is 18 years old, one should _____.

A) always administer the adult version of the inventory, in the instance that the patient may need to take the inventory again in the future
B) always administer the adolescent version as the norms for the adult version tend to overpathologize someone of this age
C) consult specific personality inventory manuals to guide-decision making
D) give both the adolescent and adult version and compare them

Answer 35

C) consult specific personality inventory manuals to guide-decision making

Question 36

An upper left or upper right visual field quadrant loss would suggest the involvement of the optic radiations passing through the ____ lobe of the cerebral hemisphere ____ to the field defect.

A) parietal; ipsilateral
B) frontal; contralateral
C) temporal; bilateral
D) temporal; contralateral

Answer 36

D) temporal; contralateral

Question 37

Jessica has been concerned about multiple sclerosis (MS) for many years. She does has not had symptoms in the past. Nevertheless, she routinely sees her doctor to rule out the diagnosis. What is the most likely DSM-5 diagnosis?

A) somatic symptom disorder
B) psychological factors affecting other medical disorders
C) hypochondriasis
D) illness anxiety disorder

Answer 37

D) illness anxiety disorder

Question 38

Studies have shown the children with epilepsy have nearly three times the incidence of ADHD compared to children without epilepsy. Treatment of ADHD symptoms with stimulants in children with epilepsy is _____.

A) safe, and as effective as in children with ADHD alone
B) safe, but not effective compared with ADHD alone
C) effective, but carries increased risk of seizure exacerbation in some children
D) neither safe nor effective

Answer 38

C) effective, but carries increased risk of seizure exacerbation in some children

Question 39

A 9-year-old girl referred for an evaluation for academic difficulties. She presents with short stature and a webbed neck. Her neuropsychological evaluation reveals dyscalculia and deficits in visuospatial skills. She most likely has which disorder?

A) Turner syndrome
B) Williams syndrome
C) Angelman syndrome
D) tuberous sclerosis

Answer 39

A) Turner syndrome

Question 40

August is a 17-year-old referred to you after a recent diagnosis of multiple sclerosis. You are reviewing WAIS-IV scores from the first part of your evaluation and have noticed a pattern of performance suggestive of slowed processing speed. Based on this finding and your review of the literature of pediatric multiple sclerosis, what else are you likely to assess to confirm or disconfirm impairment in processing speed?

A) word list generation, visual-motor integration, attention
B) depression, visual-motor integration, fatigue
C) attention, visual perception, receptive language
D) visual-motor integration, sleep hygiene, word list generation

Answer 40

B) depression, visual-motor integration, fatigue

Question 41

A neuropsychologist in pediatric epilepsy surgery program plans to do both pre- and post-operative evaluations with the same memory test. the best way to determine whether any change in performance is clinically meaningful would be to _____.

A) just use equally reliable alternate forms of the same test
B) subtract the standard error of measurement from the second score
C) calculate the reliable change index, with a 90% confidence interval
D) add the standard error of the estimate to the second score

Answer 41

C) calculate the reliable change index, with a 90% confidence interval

Question 42

In the US, in utero exposure to lead is most likely to occur through exposure from ____.

A) maternal occupation
B) imported toys
C) gasoline
D) cosmetics

Answer 42

A) maternal occupation

Question 43

Adrenergic neurons originate in ____.

A) the basal forebrain
B) the raphe nuclei
C) the locus coeruleus and lateral tegmental area
D) the substantial nigra pars compacta

Answer 43

C) the locus coeruleus and lateral tegmental area

Question 44

The most persistent cognitive deficit in patients with limbic encephalitis is ______.

A) organization and planning
B) language and word retrieval
C) memory and new learning
D) auditory and visual attention

Answer 44

C) memory and new learning

Question 45

Which regions of the brain show the most atrophy in Alzheimer’s disease?

A) temporoparietal
B) orbitofrontal and primary motor
C) occipitoparietal
D) thalamus and basal ganglia

Answer 45

A) temporoparietal

Question 46

The multimodal treatment study of children with ADHD (1999, 2004) is the largest, best-controlled study to date assessing the efficacy of medication and behavioral therapy for children. Which of the following statements best characterizes the findings with regard to ADHD symptoms?

A) Behavioral intervention alone was slightly superior to medication intervention alone, particularly in younger children.
B) There was a large effect seen for medication treatment, for which the addition of behavioral therapy produced no significant added benefit.
C) Medication and behavioral therapy combined performed significantly better than mediation alone or behavioral therapy alone.
D) There were no significant differences between medication alone, behavioral therapy alone, and combination of medication and behavioral therapy.

Answer 46

B) There was a large effect seen for medication treatment, for which the addition of behavioral therapy produced no significant added benefit.

Question 47

A 65-year-old, right-handed man is referred following an ischemic stroke in the inferior division of the right MCA. what cognitive problem(s) are most likely to be present?

A) parts of the Gerstmann syndrome
B) left hemispatial inattention and constructional apraxia
C) right-left confusion and constructional apraxia
D) amnesia for nonverbal information

Answer 47

B) left hemispatial inattention and constructional apraxia

Question 48

A patient sustains a severe traumatic brain injury in a high-speed motor vehicle collision. At the scene she is unable to open her eyes, is completely flaccid, and displays no vocalization. The most likely Glasgow Coma Scale score is ____.

A) 0
B) 1
C) 3
D) 5

Answer 48

C) 3

Question 49

A 9-year-old girl presents to your office with her mother. The girl is nonverbal but attempts to engage you socially by making eye contact, laughing, and smiling. In discussion with her mother, you learn that the girl started exhibiting developmental delays in infancy and then developed seizures at 2 years of age. The girl most likely has which disorder?

A) Prader-Willi syndrome
B) Angelman syndrome
C) Turner syndrome
D) PKU

Answer 49

B) Angelman syndrome

Individuals with Angelman syndrome exhibit significant cognitive deficits and are typically nonverbal, but demonstrate social interest

Question 50

Adult survivors of childhood brain tumors are at increased risk for ____.

A) kidney and liver disease
B) secondary tumors and encephalitis
C) secondary tumors, late-onset seizures, and stroke
D) late-onset seizures and heart disease

Answer 50

C) secondary tumors, late-onset seizures, and stroke

Question 51

The orbitofrontal cortex is relevant to which attentional function?

A) selective attention
B) initiation of response
C) inhibition of response
D) alternating attention

Answer 51

C) inhibition of response

Other types of attention are subsumed by anterior cingulate (selective), dorsolateral frontal (initiation), and prefrontal areas (alternating), respectively

Question 52

Which of the following statements is true regarding presence of psychiatric symptoms in movement disorders?

A) depression can occur years prior to motor symptoms in Huntington’s disease
B) Hallucination are a rare side effect of medications used to treat Parkinson’s disease.
C) Mania can be seen in patients with progressive supranuclear palsy
D) Visual hallucination typically occur late in the course of Lewy body dementia.

Answer 52

A – Depression can occur years prior to motor symptoms in Huntington’s disease.

Depression, as well as other psychiatric symptoms (e.g., anxiety, psychosis, obsessive-compulsiveness) can precede motor symptoms formal diagnosis of Huntington’s disease. With respect to the other disorders listed, well-informed, EARLY NOT LATE visual hallucinations are a core diagnostic feature of Lewy body dementia. Emotional lability can be seen in progressive supranuclear palsy, but mania PER SE is not typical. Visual hallucinations are a common side effect of Parkinson’s disease medications.

Question 53

Which of the following is the most important factor in determining the severity of cognitive impairment in persons with epilepsy?p

A) Seizure frequency
B) history of febrile seizure
C) type of medication
D) abnormal MRI finding

Answer 53

A- Seizure frequency

While age at seizure onset is typically considered the most important factor in determining the severity of cognitive function, amount the options listed seizure frequency/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)

Question 54

An 8-year-old child presents for neuropsychological assessment with a history of prematurity and a diagnosis of periventricular leukomalacia (PVL). What is a typical pattern of weakness in a child with this history?

A) spatial memory, attention, vocabulary
B) visuospatial processing, processing speed, working memory
C) visuospatial processing, vocabulary, working memory
D) word reading, verbal fluency, and fine motor

Answer 54

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, are hypothesized to be the source of visuospatial processing problems. The frequency of white matter pathology in preterm infants is thought to explain the common deficits in processing speed and the increased rates of abnormalities in frontal and subcortical functional systems can result in working memory deficits. Problems with attention, word list generation, and fine motor dexterity can also be seen. Weak word reading and vocabulary skills are typically not associated with preterm birth.

Question 55

Studies conducted with the MMPI-2 and MMPI-2-RF in litigating mild traumatic brain injury samples reveal a greater tendency to ____.

A) adopt a defensive response style marked by underreporting of symptoms
B) endorse paranoia and “psychotic” symptoms as opposed to somatic complaints and other “neurotic” symptoms
C) endorse somatic complaints and other “neurotic” symptoms as opposed to paranoia and “psychotic” symptoms
D) respond randomly or inconsistently to test items about cognitive and somatic symptoms.

Answer 55

C – endorse somatic complaints and other “neurotic” symptoms as opposed to paranoia and “psychotic” symptoms.

Various neuropsychology researchers have demonstrated that scales such as FBS, Hs, Hy, and RC1 are more likely to be elevated than other validity and clinical scales sensitive to psychotic thinking.

Question 56

Under anoxic/hypoxic conditions, when neurons can no longer replenish adenosine triphosphate (ATP), the following response occurs.

A) Neurons begin to self-hibernate so as to minimize metabolic processes.
B) The brain diverts stored ATP from other brain regions to the hypoxic area.
C) A series of neurtoxic processes are initiated that lead to neuronal death.
D) Axons rapidly rupture and disintegrate.

Answer 56

C – A series of neurotoxic processes are initiated that lead to neuronal death.

Neurons store virtually no energy, and thus loss of oxygen and glucose results in rapid ATP depletion. If not rapidly reversed, neuronal death ensues. A series of secondary toxic processes is also triggered. the sodium and calcium pumps fail, resulting in depolarization of the neuronal membrane and the release of excessive levels of glutamate. Glutamate is the most common excitatory neurotransmitter, but at excessive levels, it becomes excitotoxic to neurons. A further series of toxic effects are triggered that involve lactic acidosis from anaerobic metabolism, cytotoxic edema, free radical production, and others.

Question 57

The most effective intervention for improving reading fluency is ____.

A) structured questioning
B) repeated reading
C) visual training
D) phonics instruction

Answer 57

B – Repeated Reading

Repeated reading is the most effective intervention for improving reading fluency for students with learning disabilities. Structured questioning and phonics instruction are interventions typically used for reading comprehension and reading decoding, respectively. Visual training is not supported by the literature.

Question 58

When seeing a patient you notice detailed descriptions of intense fear and anxiety responses relative to prior stressful experiences. Which structure is thought to sense and identify fear and anxiety-laden stimuli and initiate this type of emotional response?

A) caudate nucleus
B) prefrontal cortex
C) insula
D) amygdala

Answer 58

D – 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 PTSD 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, but this reflects a primary association with anxiety rather than depression.

Question 59

When performance on a test is not normally distributed but there is some variance, what is the best way to interpret the test result using normative data?

A) z score
B) T score
C) percentile
D) cut-off

Answer 59

C – percentile

As discussed in the chapter section on normalization and transformation, use of standardized scores that assume a normal distribution are not appropriate when there is not a normal distribution in the noramative data, as occurs when most ppl in the normative sample do relatively well on the test. Thus, interpretation of either a Z or T score would be inappropriate. Although a cut score could be used, dichotomizing the sample results in loss of some of the critical measurement measurement meaning of the score, especially when scores fall very close to the cut-off . thus, use of a percentile distribution is most appropriate because this at least tells the clinician the proportion of the sample that did as well as or worse than the patient of interest.

Question 60

Which of the following is false?

A) Vascular dementia is uncommon in pathophysiological pure form.
B) Vascular dementia often co-occurs with the pathophysiology of Alzheimer’s disease.
C) Vascular dementia can present with symptoms suggestive of normal pressure hydrocephalus
D) Vascular dementia has a relatively invariant

Answer 60

D – Vascular dementia has a relatively invariant pathophysiological presentation.

Question 61

An individual with cerebellar mutism syndrome is most likely to have a history of ____.

A) epilepsy
B) TBI
C) brain tumor
D) stroke

Answer 61

C – Brain Tumor

Cerebellar mutism or posterior fossa syndrome is a complication of surgery to the cerebellum, more commonly seen in children than adults.

Question 62

Estimating premorbid functioning based on educational level and current word reading performance is an example of ____.

(a) combined current performance and demographic method of estimating premorbid functioning
(b) combined current performance and actuarial estimation of premorbid functioning
(c) best performance method of estimating premorbid functioning
(d) combined demographic and actuarial method of estimating premorbid functioning

Answer 62

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Question 63

Persons with progressive supranuclear palsy often initially present with ____.

(a) dysdiadochokinesia
(b) impaired vertical gaze
(c) right side hemiplegia
(d) impaired horizontal gaze

Answer 63

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Question 64

You are a new attending neuropsychologist at a prestigious university hospital. Your former supervisor is in her late 60s and seems to be having significant and increasing memory difficulty. While she is seeing patients on the unit, you have found her twice in the hallway having forgotten where she was going. Staff tells you privately that they don’t rely on her because she seems confused a lot and cannot keep information straight. The chief of the neuropsychology service knows, but keeps her on patient care rotations. He is interviewing potential faculty to replace the clinician, and he asks you to be patient during the process. Which of the following is most appropriate ethically?

(a) Wait for now, the chief of service is aware and responsible.
(b) Observe your former supervisor and assess for impairment.
(c) Report the neuropsychology chief to the state ethics committee.
(d) Discuss your concern with the unit director or chief of staff.

Answer 64

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Question 65

Repetitive behaviors are defined as repetitive, nonfunctional activities or interests that occur regularly and interfere with daily functioning. The following four repetitive behaviors can all be seen in Autism spectrum disorder; which is selectively associated with low IQ?

(a) narrow interests in maps and timetables
(b) repetitive watching of television commercials
(c) engaging in actions that cause injury to self
(d) needing routes to stay the same all the time

Answer 65

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Question 66

In patients with Alzheimer’s disease, cholinesterase inhibitors given in the early stages of illness ____.

(a) may delay nursing home placement
(b) may delay onset of incontinence
(c) may delay onset of motor or sensory impairments
(d) rarely delay functional or cognitive changes

Answer 66

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Question 67

Paul Broca is credited with which of the following?

(a) The law of mass action
(b) Identifying the brain region subserving verbal comprehension
(c) Discovery of conduction aphasia
(d) Identifying the brain region subserving expressive speech

Answer 67

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Question 68

A 19-year-old man presents to the clinic with his parents. They are concerned because he has stopped hanging out with his friends, spends most of his time alone in his room, and rarely bothers to shower or change clothes. He dropped out of the local community college he was attending. In addition, he is sometimes seen muttering to himself, and has a hard time expressing himself. He becomes easily upset with his parents, often accusing them of spying on him and trying to ruin his life. This all started about 5 months ago, though his parents say they may have seen subtle signs as early as 1 year ago. During your interview with him, the man refuses to answer most of your questions and avoids eye contact. Which of the following would be his most likely diagnosis?

(a) schizophreniform disorder
(b) schizophrenia
(c) schizoaffective disorder
(d) major depression with psychosis

Answer 68

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Question 69

A pediatrician refers a patient to you for a neuropsychological evaluation because of an elevated blood lead level. You evaluate the child and find deficits in executive functioning and visuospatial functions. One year later, the pediatrician contacts you about this patient. The patient has undergone chelation treatment and the pediatrician wonders if a follow-up neuropsychological evaluation would be able to document treatment-related changes. Based on the literature, what should you tell the pediatrician?

(a) Chelation treatment improves executive functioning only.
(b) Chelation treatment improves visuospatial and attentional skills only.
(c) Chelation treatment improves intellectual functioning only.
(d) Chelation treatment does not reverse cognitive deficits.

Answer 69

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Question 70

On neuropsychological tests, children with hydrocephalus secondary to spina bifida myelomeningocele and aqueductal stenosis ____.

(a) show similar patterns of performance except in the motor domain
(b) show qualitatively different patterns of performance across multiple domains
(c) show similar levels of overall cognitive and motor performance
(d) are differentiated by the absence of language deficits in spina bifida

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Answer 70

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