Mock Exam 1 Answers
3 c From Cummings & Trimble (2002). Neuropsychiatry and behavioral neurology, 2nd edition, Washington, DC, American Psychiatric Publishing.
4 b Same as above
5 c The diagnostic criteria for dementia requires impairment in 2 or more cognitive functions, which interfere with social/occupational functioning. There must not be clouding of consciousness. Clouding of consciousness, especially in the context of confusion, disorientation, hallucinations, disturbance of attention, or marked behavioral change is typically indicative of delirium. Dystonia involves slow, involuntary, arrhythmic muscle contractions that produce forced, distorted postures. Dystonia may occur as a separate disease entity, or may be the symptom of another disease (Parkinson’s). Levodopa may induce dystonia. (INS Dictionary).
6 a Standardized achievement testing may not be sensitive to the effects of closed head injuries. Long term follow-up studies are needed, however, to determine whether the academic achievement of children with severe injuries gradually lags behind that of their uninjured peers. (Yeates, Ris, & Taylor, Page 102).
7 b Use the mnemonic “ace” if it helps. Acute Wernicke-Korsakoff syndrome causes ataxia, confusion, and eye movement abnormalities. The other symptom sets listed are related to other disorders, though not pathognominic for any of them (e.g., increased intracranial pressure with downward herniation for “a”, Lewy Body Dementia for “b”, and Alzheimer’s for “c”).
9 a Alexia without agraphia (aka Posterior alexia, associative alexia) may spare the angular gyrus, but generally involves white matter tracts in the posterior dominant hemisphere and underlying inter-hemispheric commissures (e.g., splenium of the corpus callosum). Frontal alexia is defined in #3, below.
10 b Huntington’s is most strongly associated with dementia. Parkinson’s Disease can result in dementia, but dementia is less common, especially in middle-aged populations. The others are not uniquely associated with dementia.
14 a Interestingly, other than age of onset, there are not consistent clinical differences between familial and nonfamilial AD. Familial cases tend to have earlier onset (middle adulthood vs over 65).
15 a The olfactory nerve travels across the cribiform plate of the ethmoid bone to synapse in the olfactory bulbs. The sense of smell may be lost following head trauma due to damage to the olfactory nerves as they penetrate the olfactory plate.
16 d Agnosia handout, page 2. Prosopagnosia is the inability to recognize known faces, and to learn new ones. Lesions are typically bilateral in the occipitotemporal cortex and underlying white matter; if unilateral, it results from right hemisphere lesions.
17 b Page 354 in Kaufman “Since the cerebral cortical ‘gray matter’ which has no myelin is relatively spared, MS patients rarely develop signs of cerebral cortical dysfunction, such a seizures or aphasia.”
19 a “More than 50 different illnesses produce symptoms of dementia. Available studies indicate that, on average, 5% of all causes of dementia are reversible and 11% have some specific treatment available, although not typically resulting in symptom reversal. Kasniak, A. (2002). Dementia. In Encyclopedia of the human brain, Vol. 1. Elsevier.
22 c There is a brief discussion of PTA in Yeates, Ris, & Taylor, but the definition is in the INS dictionary.
25 a Page 368 of Blumenfeld. Figure 10.1 / and text. The primary visual cortex for the contralateral hemifield lies along the calcarine fissure of the occipital lobe.
32 a From Lezak. On acute exposure to pesticides we see headaches, blurred vision, restlessness, anxiety, depression, mental slowing, slurred speech, and ataxia. For chronically exposed individuals, the most frequent complaints are irritability, confusion and depression, as well as attention, memory, and response speed deficits.
38 c Kasniak, A. (2002). Dementia. In Encyclopedia of the human brain, Vol. 1. Elsevier. Among the more common potentially reversible causes are those due to prescription and nonprescription drug toxicity, metabolic disorder, brain tumors, subdural hematoma, and depression. The more common dementia types that are presently irreversible include Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies, Huntington’s disease, frontotemporal dementias, vascular dementia, and traumatic brain injury.”
44 a Page 360 in Kaufman “The late development of intellectual changes in MS distinguishes it from AD and CVA’s. In AD, which affects the gray matter exclusively, intellectual impairment occurs first and becomes profound long before the onset of physical impairments. In CVAs, both gray and white matter damage cause simultaneous intellectual and physical impairment. Particularly in multi-infarct dementia, intellectual and physical deficits progress together.
45 d Kasniak, A. (2002). Dementia. In Encyclopedia of the human brain, Vol. 1. Elsevier. Cognitive deficits in depression tend to be less severe and extensive than in AD. AD patients show more consistent impairment on memory tests than depressed patients. Persons with depression are less likely than those with AD to show impaired naming ability, verbal fluency, and visuospatial ability. Depressed patient are more likely to appear to exert less effort, and may complain more about their cognitive difficulties.
46 a According to the Fletcher et al chapter, when hydrocephalus occurs, the ventricles expand in a posterior to anterior direction and white matter is damaged. Due to these factors, the posterior regions of the brain may be particularly susceptible. This may partially explain the PIQ < VIQ findings… interestingly, children who show proportionally greater thinning of the posterior brain regions relative to anterior tend to show the PIQ < VIQ pattern. When the thinning is comparable, so too are the IQ scores. (Dennis et al, 1981).
49 a This came from a chapter by Fletcher et al (??? which book). This finding is somewhat controversial. On average, this is true, but there is substantial variability between cases with shunted hydrocephalus.
50 b Page 442 Blumenfeld. Lesions of the temporal lobe can cause contralateral superior quadranopia due to interruption of the lower portions of the optic radiations. This is sometimes referred to as the “pie in the sky” phenomenon.
54 b Although Alzheimer’s is more than a simple degeneration of the nucleus basalis of Meynert, this is a key site of degeneration and likely accounts for the prominent early memory decline. The other disorders may also involve the nucleus basalis of Meynert and/or cholinergic systems at one point or another, but less directly or centrally.
56 a Most chemotherapies do not cause mental status changes because they cannot cross the blood brain barrier. The exception is methotrexate, which is administered intrathecally (into the subarachnoid space usually by spinal tap). The benefit of this med is that it often protects from leukemic cells entering the CNS… but it has a cost. It often induces confusional states, LD’s, and ‘permanent intellectual impairment.’
57 d The cerebellum is involved in both a variety of motor and cognitive processes. Anosmia is a deficit of olfaction, where the sense of smell the is diminished or lost . It is also known as olfactory loss and can occur to single or to both nostrils.
58 c The lateral cerebellar hemisphere affects distal limb coordination and motor planning. Trunk control, posture and balance, and gait result from medial cerebellar lesions.
59 b The right hemisphere has more white matter, less gray matter, more association cortex, and more interconnections.
72 e Options a, c, and d are all associated with Gertsmann Syndrome, which would be compatible with the probable lesion location. Right visual field defects are common in central alexia, which makes sense unless the lesion is tiny.
95 d FSIQ and GMI scores are highly correlated in patients with IQ’s in the average range, but are less related for patients at the lower and upper ends of the intelligence spectrum. It is not uncommon to see 25 point differences between FSIQ and GMI scores in patients with very low or very high IQ’s.
96 a This question refers to reliable change indices (RCI’s) which take into account measurement error, practice effects and regression to the mean.
98 b In anosognosia the patient is unaware or does not admit to the condition, whereas in anosodiaphoria the patient will admit to the impairment, but is not concerned. The other two options are unrelated agnosias.