NP Book Questions

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NP Book Questions
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ABCN Study Guide questions
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  1. A patient with amnesia has a large lesion affecting many brain structures.  In each item below, a pare of structures is listed. Damage to which of these pairs is most likely to produce dense amnesia?
    A)  mammillary bodies, dorsomedial thalamus
    B) hippocampus, cingulate gyrus
    C) mammillothalmic tract, anterior thalamus
    D) amygdala, dorsomedial thalamus
    A) mammillary bodies, dorsomedial thalamus

    The two system-theory of amnesia states that amnesia results from damage to some element of the medial and lateral limbic circuit.  This alternative is the only one that contains an element from the medial system (mammillary bodies) together with an element from the lateral system (dorsomedial thalamus)
    (this multiple choice question has been scrambled)
  2. Which of the following structures is not part of the diencephalon?
    A)  hypothalamus
    B) epithalamus
    C) extended amygdala
    D) subthalamus
    C) extended amygdala

     the diencephalon appears at the upper end of the brain stem, situated between the cerebrum and the brain stem. It is made up of four distinct components: the thalamus, the subthalamus, the hypothalamus and the epithalamus.  All structures within the diencephalon end with "alamus".
    (this multiple choice question has been scrambled)
  3. Regions that appear important for mapping sounds to meaning in language include_______
    A)  the supplementary motor area and dorsolateral prefrontal cortex
    B) Herschl's gyrus and anterior temporal pole
    C) the inferior temporoparietal region and hippocampus.
    D)  the supramarginal and angular gyri
    D) the supramarginal and angular gyrus



    These cortical regions provide an interface between Wernicke's area and polymodal cortical areas that process meaning/semantics.

    The supramarginal gyrus is a portion of the parietal lobe. It is probably involved with language perception and processing, and lesions in it may causeReceptive aphasia or transcortical sensory aphasia.
    (this multiple choice question has been scrambled)
  4. Pure word deafness results from_____.
    a) destruction of primary auditory cortex
    b)  damage to auditory radiations within the accoustic nerve
    c)  bilateral disconnection of auditory receptive areas from Wernicke's area
    d)  disconnection of Wernicke's area from semantic regions of the anterior temporal bone.
    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 of nonspeech sounds.
  5. The classic cortico-striatal-pallidal-thalmo-cortical loop, the "input" to the basal ganglia is to the ______ and the output is via the _______.
    A) globus pallidus, nucleus accumbens
    B) globus pallidus; caudate nucleus
    C) striatum; globus pallidus
    D) striatum; nucleus accumbens
    C)  striatum; globus pallidus.  

    The striatum (caudate and putamen) recieve cortical input and project to the globus pallidus, with provides basal ganglia output to the thalamus.  Each loop differs with respect to the specific striatal or pallidal region involved, but the basic architecture is the same in all loops.
    (this multiple choice question has been scrambled)
  6. Describe the components of the basal ganglia.
    • The main components of the basal ganglia are the:
    • 1) striatum (caudate nucleus and putamen), 2) the globus pallidus,
    • 3) the substantia nigra,
    • 4) the nucleus accumbens, and the
    • 5) subthalamic nucleus.



    The largest component, the striatum, receives input from many brain areas but sends output only to other components of the basal ganglia. The pallidum receives input from the striatum, and sends inhibitory output to a number of motor-related areas. The substantia nigra is the source of the striatal input of the neurotransmitter dopamine, which plays an important role in basal ganglia function. The subthalamic nucleus receives input mainly from the striatum and cerebral cortex, and projects to the globus pallidus. Each of these areas has a complex internal anatomical and neurochemical organization.The basal ganglia play a central role in a number of neurological conditions, including several movement disorders. The most notable are Parkinson's disease, which involves degeneration of the dopamine-producing cells in the substantia nigra pars compacta, and Huntington's disease, which primarily involves damage to the striatum.[1][5] Basal ganglia dysfunction is also implicated in some other disorders of behavior control such as Tourette syndrome,hemiballismus, and obsessive–compulsive disorder.
  7. The two streams of visual processing is the analyzing of the __________ and the the _____.
    The "What" and the "Where".
  8. The ventral stream of visual processing determines the "____" and is associated with what disorders?
    "What" and Agnosias (occipital-temporal)
  9. The dorsal stream of visual processing is concerned with the "_____" and is associated with what types of disorders?
    "Where" and spatial analysis, processing impairments.  (Parietal-occipital)
  10. The hippocampal pathway (Papez circuit) includes what 5-brain structures?
    • 1.  entorhinal cortex
    • 2.  fornix
    • 3.  mammillary bodies
    • 4.  mammilothalmic tract
    • 5.  Cingulate cortex.
  11. Damage to the Papez circuit occurs with what amnestic disorder?
    Anoxia/hypoxia
  12. Damage to the diencephalon is associated with what amnestic disorder?
    Korsokoff's
  13. Medial frontal syndrome is characterized by what behaviors?
    decreased initiation and indifference;amnesia, incontinence and leg weakness.
  14. Dorsolateralprefrontal syndrome is characterized by?
    Poor problem solving, word generation, organization, abulia.
  15. Ideational apraxia is the....
    loss of the ability to plan and execute complex gestures (has lost the "idea" behind the gesture.)
  16. Ideomotor apraxia is the....
    loss of the ability to perform or pantomine gestures on command or imitate.  (i.e. body part as tool).
  17. Pseudobulbar affect is:
    Extreme involuntary emotional responses.  (laughing...crying).
  18. Which brain area plays a key role in motivating selective attention toward a salient stimulus?
    a) inferior parietal
    b) basal forebrain
    c) dorsolateral frontal
    d) anterior cingulate
    • d. Anterior cingulate
    • Motivation and saliency involve executive systems such as the anterior cingulate (limbic)
  19. Classification of aphasia is based primarily on which three parts of the language assessment?
    A)  fluency, comprehension, repetition
    B)  fluency, repetition, prosody?
    C) fluency, comprehension, naming
    D) comprehension, naming, repetition
    A)  fluency, comprehension, repetition

    fluent versus nonfluent speech localizes anterior from posterior aphasic syndromes; impairment in comprehension distinguishes Wernicke's from conduction aphasia, and the ability to repeat implies that perisylvian language areas are intact.
    (this multiple choice question has been scrambled)
  20. Which of the following is not a symptoms of Gerstmann syndrome?
    A) finger agnosia
    B) alexia
    C) agraphia
    D) acalculia
    B) alexia

    Gerstmann syndrome is finger agnosia, acalculia, right-left disorientation, and agraphia
    (this multiple choice question has been scrambled)
  21. You desire to calculate a confidence intervbal around an obtained test score to determine how confident you are that the obtained score reflects the person's true ability in this domain. for the most appropriate estimate of the confidence interval, you should use the following in your calculation:
    a) validity coefficient for the test
    b) standard error of the mean
    c) standard error of the estimate
    d) standard error of the measurement
    c.  standard error of the estimate
  22. You have created a new thest that you want to use clinically, but its psychometric properties are unknown.  You want to know about the incremental validity of the test, and you have knowledge of the base rate of the condition that the test was designed to detect.  To calculate
  23. You desire to calculate a confidence interval around an obtained test score to determine how confident you are that the obtained score reflects the person's true ability in this domain. for the most appropriate estimate of the confidence interval, you should use the following in your calculation:
    A) validity coefficient for the test
    B) standard error of the estimate
    C) standard error of the mean
    D) standard error of the measurement
    B) standard error of the estimate

    the SEE is based on the obtained score and requires no knowledge of the true score and includes extra consideration of the reliability of the test.
    (this multiple choice question has been scrambled)
  24. You have created a new test that you want to use clinically but its psychometric properties are unknown.  You want to know about the incremental validity of the test, and you have knowledge of the base rate of the condition that the test was designed to detect.  To calculate the incremental validity if you are equally worried about false positives and false negatives, you need to know the test's ____
    A) positive predictive value
    B) sensitivity
    C) overall hit rate
    D) specificity
    C) overall hit rate

    Although positive predictive value could be used to calculate incremental validity, it is only useful if we are interested in our test's incremental ability to make a positive diagnosis, not as an indicator for overall diagnostic accuracy.  Thus, the overall hit rate is the best choice in this situations because we are interested in both yes and no decisions based on the test (both PPV and NPV).
    (this multiple choice question has been scrambled)
  25. Which of the following will not affect the reliability of an intraindividual difference score (i.e., the reliability of difference in performance between two tests within one individual?
    A) correlation between the tests
    B) reliability of test one
    C) variance of the distribution of the difference scores
    D)  actual difference between the two scores
    D) actual difference between the two scores.

    The reliability of the tests, the association between them, and the error variance are all included in the formula required to calculate the reliable chance interval.  The actual difference between the score is only a point of reference and is compared to the calculated interval.
    (this multiple choice question has been scrambled)
  26. Two individuals are administered the same test.  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 2's percentile rank will increase more than Person 1's.
    C) person 1's percentile rank will increase more than person 2's
    D) neither percentile rank will change
    C) Person 1's percentile rank will increase more than Person 2's.

    Score differences in the middle of the distribution of percentiles are exaggerated compared to those at the extremes.
    (this multiple choice question has been scrambled)
  27. "Sensitivity" refers to what in NP tests?
    How sensitive the test is to presence of the disorder.  A negative result suggests an absence of the disorder.
  28. The mnemonic for "sensitivity" is:
    SN-NOut (sensitivity - negative score rules out)
  29. Specificity refers to what in NP tests?
    How specific a positive (present) test result is to the disorder being measured.
  30. What is the mnemonic for specificity?
    Sp-Pin (A positive test result on a test with high specificity rules in a disorder/condition.
  31. What is the cranial nerve mnemonic for identifying sensory and motor?
    "Some say marry money, but my brother says big brains matter more."
  32. What is the cranial nerve mnemonic for recalling all the nerves?
    OLd OPie OCcasionally TRies TRIGonometry And Feels VEry GLOomy, VAGUe, And HYPOactive.

    "Oh, oh, oh, to touch and feel very good velvet...ah, heaven.
  33. CN I is:
    Olfactory Nerve
  34. CN II is:
    Optic Nerve -- test visual fields
  35. CN III:
    Oculomotor Nerve -- moves eyes up, down, or to the nose
  36. CN IV:
    Trochlear Nerve -- from the midbrain to superior oblique muscle of the eye.
  37. CN V:
    Trigeminal Nerve.  Projects from pons and innervates upper, middle and lower portions of the face.
  38. CN VI:
    Abducens Nerve.  Goes from pons to lateral rectus of the eye.
  39. CN VII:
    Facial nerve.  controls motor fx of the upper and lower nerve, and salivary glands
  40. CN VIII
    Vestibulocochlear Nerve.  Auditory function
  41. CN IX:
    Glossopharyngeal nerve.  tested by inducing a gag reflex.
  42. CN X:
    Vagus Nerve.  projects to viscera, incuding gut, heart and lungs.  Also tested with gag reflex
  43. CN XI:
    Spinal Accessory Nerve.  projects from spinal cord to shoulder muscles and others.
  44. CN XII:
    Hypoglossal Nerve:  Medulla to the tongue muscles.
  45. 5  When performing the Dix-Hallpike maneuver, elicitation of vertigo and nystagmus suggest ____dysfunction that is _____to the side of the downward ear.
    A) oculomotor; contralateral
    B) vestibular ipsilateral
    C)  oculomotor; ipsilateral
    D) vestibular; contralateral
    B) vestibular; ipsilateral

    Although nystagmus presents as eye movement, it is a vestibular function mediated by dysfunction involving the vestibular branch of the CN VIII, and effects are observed ipsilaterally.
    (this multiple choice question has been scrambled)
  46. Which pairs of these nerves are tested together when eliciting a gag reflex?
    A) CN VII, IX
    B) CN IX and X
    C) CN VII, X
    D) CN V and VI
    B)  CN IX and X  

    The glossopharyngeal and vagus nerves co-mediate the gag revelxx.  CN VII is involved in swallowing and coughing, but only at the level of the neck muscles, not the pharynx.
    (this multiple choice question has been scrambled)
  47. When asked to stand with feet together and arms held palms up and extended at shoulder level, a patient is unable to maintain the position and her left arm slowly turns toward a palm-down position.  She is exhibiting a _____, which suggests ____dysfunction.
    A) Wartenberg sign; ipsilateral cerebellar
    B) Romberg sign; ipsilateral cerebellar
    C)  pronator drift; contralateral pyramidal tract
    D)  Hoffman reflex; contralateral pyramidal tract
    C) pronator drift; contralateral pyramidal tract

    A Romberg sign refers to sway when standing, but no upper extremity signs.
    (this multiple choice question has been scrambled)
  48. Which of the following does not involve patient exposure to ionizing radiation?
    a) computed tomograph
    b) magnetic resonance imaging
    c) single photon emission tomography
    d) positron emission tomography
    • b) magnetic resonance imaging.  
    • MRI uses high field magnetization and radiowave pulses.  Computed tomography, SPECT, and PET all use ionizing radiation in the form of radioactively tagged binding agents.
  49. The primary dependent variable that is measured using diffusion tensor imaging is _____.
    A) cerebral metabolic rate of glucose metabolism
    B) fractional anisotropy
    C) blood oxygen level dependent response (BOLD)
    D) diffuse axonal injury
    B) fractional anisotropy.  Fractional anisotropy is the primary dependent variable in DTI.
    (this multiple choice question has been scrambled)
  50. Which of the following is accurate about the radioisotope used in neuroimaging technologies such as SPECT and PET?
    A) they are absorbed by neurons and provide a direct index of neural activity.  
    B) They cross the blood-brain barrier and provide an indirect index of regional activity.
    C)  They are absorbed by glia and provide an indirect index of regional activity.
    D) They remain in the blood stream and provide an indirect index of neural activity.
    C) They are absorbed by glia and provide an indirect index of regional activity.
    (this multiple choice question has been scrambled)
  51. Electroencephalographic alpha activity is _____ during relaxation and ____ during mental activity.
    A) never present; increased
    B) decreased; increased
    C) increased; disappears
    d) none of the above; it is only present during sleep.
    C) increased; disappears.  EEG alpha activity has been consistently demonstrated to increase with relaxation and disappear when persons engage in mental activity.  It is not specific to sleep.
    (this multiple choice question has been scrambled)
  52. The best estimate of male to female sex ratio in cases diagnosed with high-functioning ASD is _______.
    A) two females for every male
    B) four males for every female
    C) two males for every female
    D) one male for every female
    B)  four males for every female
    (this multiple choice question has been scrambled)
  53. Which symptoms of an ASD would be least likely to be observed in an infant or toddler, but is more likely to be present by 5-years of age?
    A) delayed language acquisition
    B) absent referential pointing
    C) atypical/absent eye contact
    D) stereotyped interests and/or repetitive behaviors
    D) stereotyped interests and/or repetitive behavior.  

    Stereotyped interests and repetitive behaviors are often not observed in infants who are later diagnosed with ASDs, whereas delayed language, an absence of pointing, and atypical eye contact are.
    (this multiple choice question has been scrambled)
  54. Rett's disorder can be differentiated from autistic disorder by_____.
    A) presence of a significant regression within the socialization domain
    B) presence of repetitive stereotypic movements
    C) age of symptoms onset
    D) loss of purposeful hand movements
    D) loss of purposeful hand movements.  

    The onset of Rett's is marked by a regression and the presence of deficits in socialization and communication; and the presence of repetitive hand mannerisms.
      
    Key differences include the physical abnormalities including loss of purposeful hand movements, deterioration of motor skills and presence of hand wringing and motor deficits.
    (this multiple choice question has been scrambled)
  55. What is the earliest age at which the diagnosis of autism tends to be reliable and stable across time?
    A) 18-24 months
    B) 0-6 months
    C) 36-48 months
    D) 48-60 months
    A) 18-24 months.
    (this multiple choice question has been scrambled)
  56. There are _____known genetic causes of ID
    A) 500
    B) more than 1,000
    C) 10
    D) 100
    B) more than 1,000

    The number of known genetic causes of ID is growing exponentially with advances in genetic testing.
    (this multiple choice question has been scrambled)
  57. An individual with ID and standard score of 30 on measures of intellectual abilities and adaptive functioning falls in the ______ range.
    A) moderate
    B) profound
    C) mild
    D) severe
    D)  severe
    (this multiple choice question has been scrambled)
  58. Which of the following statements is consistent with the trajectory of cognitive functioning in individuals with Down syndrome?

    a) With enough support and education, individuals with Down syndrome show improvement in scores on measures of intellectual functioning as they age
    b)  Intelligence test scores of individuals with Down syndrome remain constant over time
    c) Individuals with Down syndrome exhibit a progressive decline on measures of developmental and intellectual functioning beginning in the first year of life.
    d)  Individuals with Down syndrome exhibit steady increases in performance on measures of intellectual functioning until they reach early adulthood, when their scores drop precipitously.
    C. Individuals with Down syndrome exhibit a progressive decline on measures of developmental and intellectual functioning beginning in the first year of life.
  59. 3.  What is the rate of comorbidity between ADHD and developmental dyslexia?
    A) 35-50%
    B) 25-40%
    C) 60-75%
    D)  10-25%
    B) 25-40%
    (this multiple choice question has been scrambled)
  60. Which of the following conditions is not an environmental cause of ADHD?
    A) moderate to severe traumatic injury
    B) exposure to tobacco smoke in utero
    C) lead poisoning in early childhood
    D) exposure to antiepileptic drubs in utero
    D) exposure to antiepileptic drugs in utero
    (this multiple choice question has been scrambled)
  61. Abnormalities in which brain structure have been most consistently associated with ADHD?
    A) cerebellar vermis
    B) substantia nigra
    C) frontal lobes
    D) basal ganglia
    D) basal ganglia

    A meta-analysis of structural brain imaging studies has shown that the most consistent finding in ADHD are abnormalities in the basal ganglia and, in particular, the caudate nucleus.
    (this multiple choice question has been scrambled)
  62. Visuospatial skills appear particularly vulnerable in patients with a history of prematurity due to_____________.
    A) the proximity of the vulnerable periventrical region to the optic radiations
    B) the use of prenatal corticosteroids to hasten lung development
    C)diagnosis of PVL
    D) vulnerability of cranial nerves II, III, and VI to hypoxic injury
    A) the proximity of the vulnerable periventricular region to the optic radiations

    (PVL = periventricular leukomalacia) from ischemic injury to the white matter surrounding the lateral ventricles.
    (this multiple choice question has been scrambled)
  63. During an intake interview with the parents of a 7-year-old, they report that their child was diagnosed with a grade III IVH as the result of preterm birth.  A grade III IVH is associated with which of the following neurological sequelae?
    A)  bleeding confined to the germinal matrix
    B) large hemorrhage with associated PHI in the parenchya
    C)  bleeding resulting in ventricular dilation
    D) bleeding into the ventricles, but without ventricular dilation.
    C) bleeding resulting in ventricular dilation.
    (this multiple choice question has been scrambled)
  64. Despite having different cognitive, behavioral, and neurological phenotypes, which of the following two disorders are caused by an absence or lack of expression of the same region of chromosome 15?
    A) Turner syndrome and Williams syndrome
    B)  neurofibromatosis and tuberous sclerosis
    C) Klinefelter syndrome and fragile X
    D)Prader-Willi syndrome and Angelman syndrome
    D) Prader-Willi syndrome and Angelman syndrome
    (this multiple choice question has been scrambled)
  65. A child presents to your clinic for evaluation of developmental delays,  In reading the history, you note that he has a history of seizures and migraines.  Upon meeting the child, he has a large facial capillary malformation.  This child is most likely to have which disorder?
    A)  neurofibromatosis type I
    B) tuberous sclerosis
    C) neurofibromatosis type 2
    D) Sturge-Weber syndrome
    D) Sturge-Weber syndrome
    (this multiple choice question has been scrambled)
  66. One of the first clinical symptoms of adrenoleukodystrophy is _____.
    A) symptoms consistent with ADHD
    B) a decline in verbal skills
    C) severe psychiatric symptoms
    D) motor impairment
    A) symptoms consistent with ADHD

    Following an initial period of normal development, ADHD-like symptoms are the first to present between 3 and 8 years of age.  This period is then followed by progressive behavioral, cognitive, and neurological decline.  Psychiatric symptoms are seen in adult onset.
    (this multiple choice question has been scrambled)
  67. Individuals with early-treated PKU tend to show ______:
    A) deficits in visuospatial and math skills
    B) deficits in language and reading skills
    C) no cognitive deficits
    D) significant cognitive deficits
    A) deficits in visuospatial and math skills

    Children with treated PKU tend to have IQ scores in the Average range.  Language and reading skills are better than visuospatial and math skills.  Deficits in visuospatial skills may be partially related to executive functioning problems.
    (this multiple choice question has been scrambled)
  68. Autism is seen most commonly in which of the following disorders?
    A) PKU
    B) tuberous sclerosis
    C)  adrenoleukodystrophy
    D) neurofibromatosis type 1
    B) tuberous sclerosis
    (this multiple choice question has been scrambled)
  69. Schizophrenia is most common in which of the following disorders?
    A) PKU
    B) 22q11.2 deletion syndrome
    C) Fragile X
    D) neurofibromatosis type 1
    B)22q11.2 deletion syndrome
    (this multiple choice question has been scrambled)
  70. Adults with congenital hydrocephalus ________.
    A)  develop neuropsychological deficits unlike those seen in childhood.
    B)  live independently because of their strong verbal skills
    C)  are underemployed relative to their IQ and literacy level
    D) live for many years with difficulties related to their motoric difficulties
    C)  are under employed relative to their IQ and literacy level.
    (this multiple choice question has been scrambled)
  71. On memory tests, children with congenital hydrocephalus typically perform ____
    A) within normal limits on tests of verbal and 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 retrieval
    D) more poorly on tests of verbal than nonverbal learning and retrieval
    C) perform comparably poorly on tests of verbal and nonverbal learning and memory.
    (this multiple choice question has been scrambled)
  72. Hydrocehphalus develops in infants born prematurely most often ____.
    A) because of secondary effects of cerebral palsy
    B) as a consequence of an IVH
    C) primarily in infants with extremely low birth weight
    D) due to another disorder that causes hydrocephalus
    B)  as a consequence of an IVH
    (this multiple choice question has been scrambled)
  73. Processing speed in people with acquired or congenital hydrocephalus _______.
    A) is best assessed with paper and pencil tests
    B) is inconsistently impaired depending on the severity of hydrocephalus
    C) is impaired in congenital, but not acquired hydrocephalus
    D) must take into account the motor requirements of the task
    D) must take into account the motor requirements of the task
    (this multiple choice question has been scrambled)
  74. Spina bifida occulta is _____.
    A)  is another term for myelomeningocele
    B) shows a neuropsychological profile like other forms of spina bifida
    C) a common disorder not obviously related to other forms of spina bifida
    D) can be identified through prenatal screening.
    C) a common disorder not obviosly related to other forms of spina bifida.
    (this multiple choice question has been scrambled)
  75. Cerebral palsy most often results from brain insult that occurs during which stage of development? 
    A) prenatal
    B) infancy
    C) newborn
    s) toddlerhood
    A) prenatal

    The vast majority of cases involve insult to the brain or abnormal brain development during the prenatal period.  Perinatal and postnatal causes are much less  common.
    (this multiple choice question has been scrambled)
  76. Cerebral palsy is unlikely to be diagnosed at birth because of all but which one of the following:
    A) Abnormal reflex patterns and muscle tone in the newborn can resolve
    B)  Babies are not yet able to perform the motor functions that are affected by CP
    C) Head ultrasound studies are contraindicated to medically fragile newborns
    D) Low APGAR scores should not be used to predict future functioning
    C) Head ultrasound studies are contraindicated to medically fragile newborns
    (this multiple choice question has been scrambled)
  77. For a child with CP, a favorable prognostic indicator is ________
    A) standing by 8-months
    B) pincer grasp by 11-months
    C) hand preference by 15-months
    D) sitting by 24-months
    D) sitting by 24-months.  

    Sitting by age of 24 months predicts future ambulation.
    (this multiple choice question has been scrambled)
  78. Spastic CP is considered a hallmark sign of _____.
    A) periventricular leukomalacia
    B) an anoxic-hypoxic event
    C) pyramidal motor involvement
    D) a nonaccidental head injury
    C) pyramidal motor involvement

    Damage to the pyramidal motor system is associated with the spastic subtype of CP.  Damage to the extrapyramidal motor system is associated with periventricular leukomalacia and birth asphyxia.
    (this multiple choice question has been scrambled)
  79. Children with spastic diplegic CP are least likely to have___________.
    A) abnormalities involving the pyramidal system
    B) magnetic resonance imaging (MRI) findings of periventricular leukomalacia
    C) more upper than lower extremity involvement
    D) a history of premature birth
    C) more upper than lower extremity involvement  

    This subtype of CP is more strongly associated with premature birth and neuroimaging findiings of periventricular leukomalacia or intraventricular hemorrhage than other subtypes.
    (this multiple choice question has been scrambled)
  80. Cerebral palsy is associated with intellectual disability in ________,
    A) most individuals with the extrapyramidal subtype
    B)  approximately 75% of all individuals with the disorder
    C) approximately 50% of all individuals with the disorder
    D) the minority of individuals with spastic quadriplegia
    C)  approximately 50% of all individuals with the disorder

    Spastic quadriplegia is the subtype most highly associated with intellectual disabilities.  Intellectual functioning is normal in more than 75% of individuals with the extrapyramidal subtype.
    (this multiple choice question has been scrambled)
  81. Structural neuroimaging studies f children exposed to alcohol in utero show ______
    a) reduction in size of the posterior portio of the cerebellar vermis
    b) a reduction in the size of the frontal lobes, particularly the right hemisphere
    c) greater gray matter than white matter hypoplasia
    d) greater white matter than gray matter hypoplasia
    D.  Greater white matter than gray matter hypoplasia.  

    Compared with controls, white matter volumes in individuals with severe prenatal exposure were more affected than gray matter volumes in the cerebrum, and parietal lobes were more affected than temporal and occipital lobes.
  82. The highest exposure risk to mercury is _____:
    A) dropping a compact fluorescent bulb, which then shatters
    B) spilling dimethylmercury on your latex gloves while conducting an experiment.
    C) eating canned tuna every day of the week for 1 week
    D) accidentally ingesting a drop of liquid mercury from a broken thermometer.
    B) spilling dimethylmercury on your latex gloves while conducting an experiment.

    This is extremely toxic and only a tiny drop has been shown to cause death.
    (this multiple choice question has been scrambled)
  83. In the US, in utero exposure to lead is most likely to occur through exposure from_____.
    A) gasoline
    B) imported toys
    C) maternal occupation
    D) cosmetics
    C) maternal occupation
    (this multiple choice question has been scrambled)
  84. Which patient is most likely to demonstrate pronounced cognitive deficits after treatment for childhood acute lymphoblastic leukemia?
    A) male treated in early childhood with chemotherapy only
    B) male treated in adolescence with chemotherapy only
    C) male treated in middle childhood with radiation and chemotherapy
    D) female treated in early childhood with chemotherapy and radiation
    D) female treated in early childhood with chemotherapy and radiation therapy. 

    Younger age of treatment, female gender, and radiation therapy have been identified as factors associated with more severe NP impairment
    (this multiple choice question has been scrambled)
  85. A 13-year old treated for a brain tumor with surgery, craniospinal radiation, and chemotherapy at age 6 demonstrates a substantial decline in IQ scores compared to prior evaluation at age nine. These findings suggest______.
    A)  relapse of brain tumor
    B) late effect of radiation therapy on brain development
    C) loss of previously acquired skills (regression)
    D)  significant emotional adjustment difficulties interfering with learning
    B) late effect of radiation therapy on brain development.    

    Studies of children treated for medulloblastoma with surgery, craniospinal radiation, and chemotherapy demonstrate decline in IQ (approximately a 10- to 20- point decline in scores 5-10 years after treatment) that has been related to loss of normal appearing white matter.
    (this multiple choice question has been scrambled)
  86. Studies of depression in epilepsy have found that ______:  
    A) both patients with right TLE and left TLE show depression
    B) neither patients with right TLE or left TLE show depression
    C) patients with right TLE are more depressed than patients with left TLE
    D) patients with left TLE are more depressed than patients with right TLE
    A)  both patients with right TLE and left TLE show depression.  Factors of depression are severity of epilepsy and seizure frequency.
    (this multiple choice question has been scrambled)
  87. In terms of treatment of cognitive dysfunction in MS, the best support appears to be for _____.
    A) cognitive rehabilitation
    B) acetylcholinesterase inhibitors
    C) Gingko biloba
    D) amphetamines
    D) amphetamines
    (this multiple choice question has been scrambled)
  88. Which of the following tests would be most sensitive in detecting cognitive impairment in an adult with MS?
    A) Symbol Digit Modalities
    B) CVLT
    C) Boston Naming Test
    D) Controlled Oral Word Association
    A) Symbol Digit Modalities.  

    Complex multifactorial tests of sustained attention and procession speed are most sensitive to NP impairment in these individuals
    (this multiple choice question has been scrambled)
  89. Which of the following has not been associated with poorer cognitive or behavioral outcomes in bacterial meningitis? 
    A) treatment with dexamethasone
    B) Male gender
    C) acute neurological complications
    D) neonatal onset
    A) treatment with dexamethasone

    Treatment with dexamethasone has not been shown to lead to worse outcomes in studies with both adults and children with bacterial meningitis.
    (this multiple choice question has been scrambled)
  90. Which of the following is true regarding HIV-associated dementia?
    a) cognitive symptoms often mimic those seen in Alzheimer dementia
    It is most commonly seen in individuals in the CDC-A classification.
    c) It cannot be caused by a CNS opportunistic infections
    d) symptoms are typically reversible with treatment
    c)  It cannot be caused by a CNS opportunistic infection.

    HIV dementia is considered a more sobcortical dementia and thus does not mimic AD, it is seen in later stages of the disease (CDC-C) and is not reversible.
  91. Which of the following is most true regarding adult survivors of encephalitis?
    A) The majority do not return to work within 5 years following diagnosis.
    B) The mean IQ score is typically -2sd below controls in follow-up studies.  
    C) Long-term personality changes are more common in the HSV type
    D) They are unlikely to have persistent problems with executive functioning.
    C) Long-term personality changes are more common in the HSV type

    Significant IQ decrements are not common, and most individuals do eventually return to work.
    (this multiple choice question has been scrambled)
  92. What is the most common route for infections to be spread to the CNS?
    A) through the bloodstream
    B) through direct access (e.g. from a skull fracture of penetrating wound)
    C) from infected cranial cavities (e.g. sinuses, middle ear)
    D) along motor and sensory axons
    A) through the bloodstream

     The most common mechanism is the bloodstream, though the other methods can spread infection as well.
    (this multiple choice question has been scrambled)
  93. Individuals with HIV infection_______.
    A) may show CNS pathology not related to the HIV infection itself.
    B) often show signs of language impairments in the early stages of the disease
    C) have been shown to have stable rates of HIV dementia since the introduction of highly active antiretroviral therapy (HAART) treatment
    D) do not show MRI changes during the asymptomatic phases of the disease
    A)  may show CNS pathology not related to the HIV infection itself.  

    They may show CNS pathology related to the oppportunistic infects (e.g. toxoplasmosis) that is unrelated to the HIV infection itself.  MRI abnormalities have been shown in some individuals in the earlier asymptomatic stages of the disease.  Language impairments do not typically occur in HIV, particularly not in the early stages.  HAART has actually decreased the rates of HIV dementia.
    (this multiple choice question has been scrambled)
  94. A 16-year old patient undergoes a work-up for new-onset deficits in attention and motor weakness and is found to have nonspecific CSF abnormalities and diffuse lesions in the white matter of the brain and spinal cord suggestive of an inflammatory demyelinating disorder.  Which of the following disorders is least likely to be on the differential diagnosis list?
    A) Devic disease
    B) multiple sclerosis
    C) transverse myelitis
    D) ADEM
    C) transverse myelitis.  

    Although all of these diseases are considered demyelinating conditions, transverse myelitis is only associated with lesions in the spinal cord and thus not likely to cause cognitive symptoms (such as new-onset attention problems).  Acute disseminating encephalomyelitis, MS, and Devic disease can all be associated with lesion in both the brain and spinal cord.
    (this multiple choice question has been scrambled)
  95. An agitated 45-year-old patient who experienced a ruptured aneurysm 1 week ago is still in the ICU.  He develops new symptoms of fever, increased blood pressure, and stiffness in his extremities over the weekend.  Which of the following would you want to explore first?
    A) changes in medication
    B) stroke extension
    C) increased ICP.
    D) hyponatremia
    A) changes in medication

    These are signs of NMS.  There should be concern that a neuroleptic may have been started to address agitation, thus leading to these new symptoms.  Hyponatremia would not be expected to cause stiffness or rigidity in all four extremities.  Stroke extension and/or increased ICP alone would not be expected to result in this specific symptom cluster
    (this multiple choice question has been scrambled)
  96. The frequency of ischemic and hemorrhagic stroke in adults is about ___ and ___, respectively.
    A) 60% and 40%
    B) 40% and 60%
    C) 88% and 12%
    D) 12% and 88%
    C) 88% and 12%

    The incidence of ischemic stroke is higher than that of hemorrhagic stroke.
    (this multiple choice question has been scrambled)
  97. What is the most important factor to consider when assessing prognosis for mortality after stroke?
    A) size of infact
    B) hemorrhagic or ischemic etiology
    C) location of infarct
    D) time since stroke
    B) hemorrhagic or ischemic etiology

    Hemorrhagic stroke has a much higher mortality rate in the first 6 months (about 50%) than ischemic stroke.
    (this multiple choice question has been scrambled)
  98. Ischemic strokes are most common in what vascular distribution?
    A) PCA
    B) MCA
    C) basilar arter
    D) vertebral artery
    B) MCA  

    The MCA, which along with the ACA, is part of the internal carotid arterior circulation.
    (this multiple choice question has been scrambled)
  99. A 13-year old boy is accidentally hit on the head with a baseball bat.  He is knocked unconscious and taken to the emergency room.  A CT scan of the head reveals a concave hyperdensity in the left frontal epidural space, with mild mass effect evidenced.  Which of the following likely occurred?
    a) tearing of the left uncinate fasciculus
    rotational acceleration and deceleration injuries
    c) impact of the brain over bony skull prominences
    d) laceration of the middle meningeal artery
    d)  laceration of the middle meningeal artery.
  100. Following TBI, problems with initiation are most likely related to damage to the _____.
    A) supplemental motor cortex
    B) orbitofrtonal cortex
    C) anterior cigulate cortex
    D) dorsolateral prefrontal cortex
    C) anterior cingulate cortex

    The cingulate gyrus is a medial structure that surrounds the corpus callosum.  Damage to the anterior portion has been associated with mutism, akinesia, and impaired initiation.  

    NB:  The text states that the dorsolateral frontal cortex is involved in initiation....
    (this multiple choice question has been scrambled)
  101. A neuropsychologist has been referred a patient who reportedly sustained a TBI 12- months ago.  Which combination of information would be most helpful in determining the injury severity? 
    A) brain MRI, length of PTA, extended MSE 1-month post-injury
    B)  LOC, length of PTA, brain CT
    C) GCS, length of PTA, first hospital MMSE score
    D)  GCS, length of PTA, time to follow commands.
    D)  GCS, length of PTA, time to follow commands.
    (this multiple choice question has been scrambled)
  102. A 70-year-old woman is referred for assessment 2-months following a fall down her basement steps.  Injury parameters indicate mild injury (GCS=15, LOC = <1 minute, PTA = 1 hour).  Neuropsychological assessment reveals moderate visuospatial impairments and evidence of mild left hemispatial inattention.  Based on these findings, what type of pathology should be ruled out?
    A) slowly developing subdural hematoma
    B) lacunar infarction in the right hemisphere
    C) ocular disturbances impacting visual acuity
    D) focal seizure activity in the right hemisphere
    A) slowly developing subdural hematoma

    In this case the clinician would want a CT scan of the brain to rule out the possibility of a right-sided chronic subdural hematoma.  This occurs more frequently in the elderly population following TBI, secondary to stretching of bridging veins which are often a consequence of atrophy, but older veins are also more prone to shearing effects or rupture.  Another less likely possibility would be a recent or remote RH stroke, and CT would identify this as well.
    (this multiple choice question has been scrambled)
  103. A patient who has all the neurocognitive features of AD on formal neuropsychological assessment but also displays parkinsonian symptoms most likely _____
    a)  has FTD
    b) has a Lew body variant of AD
    is in the late stages of AD
    d) does not have AD
    c) is in the late stages of AD

    Changes such as rigidity, gait disturbance, and bradykinesia are parkinsonian signs that occur iwth later progression of AD.  Additionally ideational and ideomotor apraxia typicall occur in the middle to late stages fof the disease.  LBD is an unlikely choice, as visuospatial impairment is more signifcant than memory dysfunction, the later of which is the cardinal sx of AD, and patients with LBD also experience early EPS symptoms and visual hallucinations, whereas patients with AD typically do not.
  104. Which of the following is commonly seen in VaD
    A) early impairment in episodic memory
    B) marked dysnomia and micrographia
    C) deficits in letter fluency and set-shifting tasks
    D) dissociation between Trails A and B performance.
    C)  deficits in letter fluency and set-shifting tasks
    (this multiple choice question has been scrambled)
  105. In VaD, delusions and visual hallucinations____.
    a) Suggests a toxic or metabolic cause
    b) occur in a sizable minority of patients
    c)  suggest mixed dementia, not pure VaD
    d) are considered to be quite rare
    b.  occur in a sizable minority of patients
  106. In VaD, donepezil and galantamine____.
    A) significantly increase risk of major stroke.
    B) are most effective when memory deficits are present
    C) are ineffective as a treatment modality
    D) may delay cognitive decline over a 6-month period
    D)  may delay cognitive decline over a 6-month period.
    (this multiple choice question has been scrambled)
  107. In VaD, memantine_____.
    A) is most effective when small vessel disease predominates
    B) is similar in efficacy to donepezil
    C) is most effective in cases of Binswanger's diesease
    D) is far less efficacious than donepezil
    B) is similar in efficacy to donepezil
    (this multiple choice question has been scrambled)
  108. An effective caregiver coping strategy is _____.
    A) journaling about problems
    B) venting about problems
    C) confronting problems
    D) self-distraction in response to chronic problems
    C)  confronting problems
    (this multiple choice question has been scrambled)
  109. In diagnosing the dementia in VaD, motor deficits secondary to cortical infarction ____.
    A) suggest silent infarction as an underlying pathophysiologic process
    B) are to be excluded when evaluating functional impairments in ADLs
    C) suggest leukoaraiosis as an underlying pathophysiologic process
    D) can account for significant functional impairment secondary to dementia
    B) are to be excluded when evaluating functional impairments in ADLs
    (this multiple choice question has been scrambled)
  110. The FTD motor variant consists of three subtypes:  Progressive supranuclear palsy, FTD with motor neuron disease, and which of the following?
    A) striatal degeneration
    B) precentral gyrus atrophy
    C) frontotemporal degeneration
    D) corticobasal degeneration
    D) corticobasal degeneration
    (this multiple choice question has been scrambled)
  111. PSP is characterized by astrocytic lesions, tau-positive neurofibrillary tangles, and neuropil threads, primarily within which brain regions/structures?
    A) brainstem and cerebellum
    B) brainstem and basal ganglia
    C) basal ganglia and motor cortex
    D) bilateral premotor cortex
    B)  brain stem and basal ganglia
    (this multiple choice question has been scrambled)
  112. With FTD-MND, the average age at onset is ____.
    A) 59 years
    B) 69-years
    C) 55-years
    D) 65 years
    C) 55-years.  

    With FTD-MND, the average age at onset is 55 years, there is an equal male to female ration, and there is a rapic progression from diagnosis to death, with death typically occurring when patients are in their late 50's.
    (this multiple choice question has been scrambled)
  113. Onset of Parkinsonism and cognitive dysfunction in close proximity occurs in which of the following disorders?
    A) HD
    B) PD
    C) LBD
    D) PSP
    C) LBD

    Co-occurring (with 1 year) cognitive and motor sx are most common in LBD and are, in fact, part of the diagnostic criteria.  Dementia is inevitable in LBD.  Cognitive impairment in PSP can occur before, simultaneious with, or after motor symptoms and may not eventually progress to dementia.  Dementia in PD can occur, but tends to be 10-years after dx, although milder deficits can be seen earlier.  Cognitive and personality symptoms may represent the initial stages of HD, although the motor sx are not typical parkinsonian sx seen in PD, LBD, or PSP
    (this multiple choice question has been scrambled)
  114. What percent neuronal loss in the substantia nigra is likely present by the time of sx onset in Parkinson's disease?
    A) 50%
    B) 25%
    C) >60%
    D) 10%
    C) >60%

    Neuronal depletion may be as great as 85% before clinical sx of PD are evident.
    (this multiple choice question has been scrambled)
  115. A patient presents with axial rigidity, falls, and memory loss.  The spouse does not report REM sleep behavior disorder.  Which of the following diagnosis is most likely?
    A)PD
    B)PSP
    C) HD
    D)LBD
    B) PSP

    Axial rigidity and falls are common early symptoms of PSP
    (this multiple choice question has been scrambled)
  116. Which of the following findings can be seen early in both PD and CBD? (Cortical Basal Degeneration)
    A) personality change
    B)  asymmetric motor dysfunction
    C) alien hand syndrome
    D) resting tremor
    B)  asymmetric motor dysfunction

    Motor symptoms are generally greater on one side for both PD and CBD.
    (this multiple choice question has been scrambled)
  117. Each of the following can represent a side effect from Levodopa, except:
    A) vivid dreams
    B) compulsive behaviors
    C) dyskinesias
    D) visual hallucinations
    B) compulsive behaviors

    Side effects of levodopa agents include hallucinations, dyskinesias, and vidi dreaming.  Dompamine agonists are expecially implicated in the addictions seen in PD, which include addition to one's medications, compulsive behaviors, pathological gambling, compulsive shopping, or hypersexuality.
    (this multiple choice question has been scrambled)
  118. Which neurotransmitter is associated with the recognition of stressful stimuli and the initiation of a response to the stressor?
    A) norepinephrine
    B) serotonin
    C) dopamine
    D) GABA
    A) norepinephrine

    Norepinephrine is an excitatory neurotransmitter and also a stress hormone that helps maintain alertness and preparation to respond to external threats, as in the "fight or flight" response
    (this multiple choice question has been scrambled)
  119. Which of the following is the most important indicator of severity in mood and anxiety disorders?
    A) scores on objective measures of mood/anxiety
    B) frequency of hospitalization
    C) impairment in social and occupational functioning
    D) number of symptoms and intensity
    C) impairment in social and occupational functioning
    (this multiple choice question has been scrambled)
  120. Which neuroanatomical area is not typically associated with depression?
    A) anterior cingulate
    B) amygdala
    C) hippocampus
    D) prefrontal cortex
    B) amygdala

    The amygdala is involved with fear-related responses and memories.
    (this multiple choice question has been scrambled)
  121. This serves as the major inhibitory neurotransmitter that helps induce relaxation and sleep and prevents overexcitation.
    A) norepinephrine
    B) dopamine
    C) GABA
    D) serotonin
    C) GABA
    (this multiple choice question has been scrambled)
  122. A number of neuroanatomical structures have been associated with anxiety responses.  Which structure is thought to sense and identify fear and anxiety-laden stimuli and initiate the emotional response?
    A) amygdala
    B) insula
    C) caudate nucleus
    D) prefrontal cortex
    A) amygdala
    (this multiple choice question has been scrambled)
  123. Abnormalities in what neuroanatomical structure are felt to result in the obsessive and compulsive behaviors seen in OCD and Tourette syndrome?
    A) prefrontal cortex
    B) insula
    C) amygdala
    D) caudate nucleus
    D) Caudate nucleus.  The Caudate nucleus has been found to be dysfunctional in persons with OCD as well as in Tourette's, PANDAS and other disorders.  It is thought that poor functioning of the caudate results in an inability to properly regulate the transmission of information regarding worrying events or ideas between the thalamus and the orbitofrontal cortex.
    (this multiple choice question has been scrambled)
  124. A major benefit of second generation antipsychotic drugs is:
    A) amelioration of social skills deficits
    B) amelioration of cognitive deficits
    C) amelioration of EPS sx
    D) amelioration of positive symptoms
    D) amelioration of positive sx.  

    The major action of both conventional and atypical antipsychotic medications is reduction of frequency and severity of positive sx:  neither yield consistent, significant cognitive or social cognitive benefits.  EPS motor symptoms are side effects of conventional antipsychotics.
    (this multiple choice question has been scrambled)
  125. Which method has resulted in increased likelihood of securing competitive employment for people with schizophrenia?
    A) vocational rehabilitation
    B) on-the-job training
    C) individual placement with support
    D) targeted strategy-based interventions
    C) individual placement with support
    (this multiple choice question has been scrambled)
  126. Early-onset schizophrenia is defined as development of symptoms ______.
    A) prior to age 12
    B) between the ages of 13 and 17
    C) after age 18 but before 21
    D) prior to age 6
    B) between the ages of 13 and 17.
    (this multiple choice question has been scrambled)
  127. Individuals with non-KS alcoholism most frequently show neuropsychological impairments on measures of problem solving skills, abstraction, and _____.
    A) reading comprehension
    B) word list generation
    C) perceptual motor skills
    D) manual dexterity
    C) perceptual motor skills

    Perceptual-motor deficits are common in people suffering from alcoholism.  (i.e. the TPT)
    (this multiple choice question has been scrambled)
  128. A recently detoxified patient with alcoholism demonstrates neuropsychological impairment 1 week post abstinence.  To assess the persistent neurotoxic effects of alcohol, one should retest the patient in at least ____.
    A) 1 year post treatment
    B) 1 month post treatment
    C) 6-months post treatment
    D) 2 weeks post treatment
    C) 6-months post treatment

    The recovery process from the neurotoxic effects of alcohol can be divided into acute (1-2 weeks), subacute (3 weeks to 2 months), and intermediate (2-6 month) duration phase.  Thus a clinician should wait at least 6- months to be sure the individual moved through the recovery phase before drawing conclusions about enduring neurotoxic effects of alcoholism.
    (this multiple choice question has been scrambled)
  129. Thiamine deficiency in relation to patients with Korsakoff syndrome has been identified as the principal pathogenetic factor in degeneration of which brain structure?
    A) basal ganglia
    B) hypothalamus
    C) prefrontal cortex
    D) cerebellum
    D) cerebellum
    (this multiple choice question has been scrambled)
  130. Twelve months outpatient treatment follow-up studies reveal the substance abuse relapse rate to be ___.
    A) 50%
    B) 85%
    C) 70%
    D) 30%
    A) 50%

    Many follow-up studies show a 50% relapse rate among substance users whether or not they receive psychosocial intervention
    (this multiple choice question has been scrambled)
  131. Hallucinogens have a chemical structure similar to serotonin.  The serotonin system is involved in controlling all of the following except:  
    A) attention
    B) mood
    C) sensory perception
    D) muscle control
    A) attention.  

    The serotonin system is involved in the control of behavioral, perceptual, and regulatory systems, including mood, hunger, body temperature, sexual behavior, muscle control and sensory perception.
    (this multiple choice question has been scrambled)
  132. The chronic effects of opiates are limited to all of the following except ____.
    A) executive functions
    B) working memory
    C) processing speed
    D) impulsivity
    C) processing speed.  The chronic cognitive effects are limited to executive function, working memory, and decision making (i.e. impulsivity).
    (this multiple choice question has been scrambled)

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