Mock Exam 2 Answers

1 c Whole brain radiation has been shown to have a significant adverse effect on overall IQ, processing speed and attention, due to white matter changes. These long-term cognitive effects are more pronounced in girls and are related to the radiation dose, total area of the brain radiated, and age at treatment.
2 d The hippocampus is involved in the formation of memories, not the retrieval.
3 d See Handbook of Neurodevelopmental and Genetic Disorders in Children (Chapter on Downs Syndrome, Actually language skills are acquired at a slower rate)
4 b
5 a
6 d In normal language lateralization, prosody can be localized to the right hemisphere.
7 a
8 b
9 c
10 b
11 c
12 b
13 c Based on observation of the asymmetry of the planum temporale with the left hemisphere being larger than the right in most right handed people. In males, however, there is less asymmetry – which is proposed to be an effect of testosterone in delaying the development of the left hemisphere, although greater development of the right. This theory provides rationale for the greater spatial skills in males, as well as the increased rate of autoimmune disorders in males. Kolb and Whishaw, Fundamentals of Human Neuropsychology – Fifth Edition, 2003, page 663).
14 c Apperceptive agnosia involves a failure in perceptual processing of the stimuli, and therefore can not copy stimuli. Associative agnosia involves a failure in object identification despite preserved ability to copy and even match stimuli. It often co-occurs with prosopagnosia. Optic aphasia is impaired naming of visual objects with the patient still able to identify the object by other means and able to explain characteristics.
15 a See for an explanation of the calculation of Sensitivity, Specificity, PPP, and NPP
16 a
17 b The distribution of weakness (face and arm, sparing the leg) and Broca aphasia suggests ischemia in MCA distribution. With carotid occlusion, the territory of MCA and ACA would be affected such that the face, arm and leg would be equally affected. Putaminal (subcortical) hemorrhage would not likely cause aphasia.
18 d
19 d
20 b
21 a
22 b
23 d
24 b
25 d
26 a
27 b
28 d One of the key features distinguishing Dementia with Lewy Bodies (DLB) from Parkinson’s Dementia is the visual hallucinations seen in DLB. Alzheimer’s patients typically have delusions rather than actual hallucinations.
29 a see Strauss, Sherman and Spreen
30 d see Strauss, Sherman and Spreen
31 b Gerstman’s syndrome is a controversial entity that consists of right-left confusion, dyslexia, dyscalculia, and finger agnosia. It is usually attributed to lesions in the dominant angular gyrus. In Anton’s syndrome (denial of blindness), blind patients typically confabulate or fantasize about the appearance of objects presented to them. It occurs most often in elderly patients who undergo opthalmogic surgical procedures and cannot see out of their eyes temporarily. Anosognoia (failure to acknowledge a deficit, usually left side hemiparesis) is often accompanied by confabulation, denial, and “other defense mechanisms” (clearly written by a psychiatrist). According to Kaufmann, the confabulations in Wernicke-Korsakoff are an uncommon symptom, unless the patients also have marked memory impairments.
32 b The dominant hemisphere planum temporale, which is integral to language function, has greater surface area than its counterpart. Heschl’s gyrus, which processes the auditory qualities of sound, is bilaterally symmetric.
33 a
34 d Echolalia, an involuntary repetition of another’s words, is a manifestation of diverse neurologic conditions. It also occurs within the context of dementia.
35 b
36 c
37 c
38 d AF may cause stroke recurrence. The occurrence of other factors should be avoided in stroke patients, as they worsen neurological deficit. If infection complicates stroke, e.g. pneumonia, urinary tract infection, neurological deficits can worsen.
39 a The answer is a) for most patients; however, PCA may supply the thalamus and also result in hemianesthesia. Alexia without agraphia may result
40 b This TIA is known as “amaurosis fugax” due to carotid atherosclerotic disease. This causes transient blindness. Optic nerve demyelination may cause sudden visual loss but would not resolve so quickly. Compression of the optic nerve would cause gradual visual loss and reduced papillary light response.
41 b Sudden onset indicates vascular etiology. Because patient appears confused and cannot comprehend normally, indicates Wernicke aphasia. This involves the posterior temporal lobe of the dominant hemisphere, and acalculia may also be present. The visual field fibers pass through this region and ischemia may cause right homonymous hemianopsia. Therefore, patients with Wernicke aphasia may also have accompanying right homonymous hemianopsia but no hemiparesis or hemianesthesia.
42 b Anteriograde amnesia: Carotid artery TIA, caused by emboli at common carotid bifurcation, leads to hemispheral TIAs with symptoms of contralateral hemiparesis, hemisensory loss, paresthesias, hemianopsia, transient aphasia, and hemi-inattention.
43 d Lower extremity hemiparesis. The homunculus shows that the motor strip for the lower extremity is perfused by the Anterior Cerebral Artery in the medial aspect of the hemisphere.
44 d Trazadone is actually used often as a hypnotic to help patients sleep.
45 d Left MCA infarcts cause Broca’s aphasia characterized by dysfluent speech, poor repetition, anomia, and intact comprehension and reading.
46 c Right upper homonymous quadrantanopsia – post optic chiasm, lower optic radiations affect the upper contralateral visual quadrant field, upper optic radiations affect the lower contraleteral visual quadrant field. See hand out.
47 a
48 a
49 c
50 a
51 d
52 d
53 d
54 a In Alzheimer’s disease, muscarinic acetylcholine receptors are depleted, especially in the limbic system and association areas. Although they are also found in the brain, nicotinic acetylcholine receptors are found predominantly in the spinal cord and the neuromuscular junction.
55 b
56 a
57 d
58 a
59 d While the occipital lobe (and therefore Calcarine fissure) and orbitofrontal areas are both injured in the classic contracoup injury, the occipital lobe does not have a jagged bony prominence to contend with. The rostral or anterior edge of the temporal lobe and the orbitofrontal area of the frontal lobe abut jagged bony prominences.
60 d Hoover’s sign is a common psychogenic symptom. All of the other three are typical signs of cerebellar lesions.
61 b MRI and other tests are generally unrevealing (Blumenfeld), so Dx is based on clinical presentation. The other statements are completely accurate.
62 d Dementia is the least closely associated with tremor. According to Kaufman, if dementia occurs at the onset of an illness with parkinsonism, consider diffuse Lewy Body disease in individuals older than 50. In young adults, consider Wilson’s disease, juvenile Huntington’s disease, and drug abuse.
63 c Pseudobulbar palsy is typical of progressive supranuclear palsy (Feinberg & Farah), a subcortical dementia. DLB is considered a mixed dementia, as it is difficult to classify as either cortical or subcortical (Lezak and Feinberg). The other three choices are all classic features of Dementia with Lewy bodies.
64 c the basilar artery and the anterior communicating artery do not have a “match” if you will on the other side to make it a pair. The PCOMM does, as do all the others mentioned. These two are important with regard to Top of the Basilar vascular diseases and Anterior Comm being the site for many berry aneurysms.
65 d Along with A-C, duration of the illness, enlarged cerebral ventricles, corpus callosum atrophy, and cerebral hypometabolism are also associated with MS related cognitive impairment.
66 b Vertebrobasilar Artery TIA’s symptoms include those mentioned plus, tinnitus, circumoral paresthesias or numbness, dysarthria, dysphagia, drop attacks, ataxia, and cranial nerve abnormalities.
67 b : It’s a hallmark Sx that usually comes on very early in the course of HD
68 a Remember ACE for ataxia, confusion, and eye mov’t diff’s. Confabulation and retrograde amnesia are also associated with this disorder, but more so with the more chronic form of the disorder called either Wernicke-Korsakoff Syndrom or Korsakoff’s. Kaufman also discusses peripheral neuropathy as part of the symptom picture. And, of course, for WKS, anterograde memory deficits is the hallmark feature. So, really no new learning and w/ regard to retrograde amnesia, remote memory for public and personal autobiographical information is better than more recent memory.
69 c
70 d See the Pocket Handbook and Kaufman. Partial seizures begin in one part of the brain and may or many not spread to other regions. They usually consist of specific motor, sensory, or psychic alterations, that are often accompanied by stereotyped automatic movements. These seizures often stem from temporal lobe (although about 10% frontal) and accompanied by emotionally changes (fear, sadness, pleasure, déjà vu) Hallucinations or misperceptions are also common ictal phenomena of simple-and complex- partial seizures. Simple partial seizures have no alteration in consciousness as result of seizure discharge. In complex partial seizures there’s always alteration of consciousness.
71 a A Type I Error has been made. This type of error occurs when the null hypothesis is rejected when it is true—in other words, when one concludes that a difference exists when it really does not. It’s “thinking you have something when you really don’t.”
72 c The one sample t-test is appropriate when a study involves only one sample. It is designed to compare the mean of a single sample to a known population mean. It is a seldom used test as we don’t often have a known population mean (EX of population mean = if we knew from a government survey the national average income for psychologists, then we could take a sample of female psychologists and compare to the known population mean).
73 b If the results are significant at the .01 level, then you reject the null hypothesis and conclude that the alternative hypothesis is true (i.e., that the means are significantly different).
74 d An ANOVA is designed to test the hypothesis that group means were drawn from the same population; i.e., that means are equal in the population.
75 d Norm-referenced interpretation involves comparing an examinee’s score to the scores of others who have taken the same test. A drawback of this type of interpretation is that is does not provide absolute standards of “good” or “bad” performance—the examinee’s score must be interpreted in light of the performance of the norm group as a whole.
76 d According to Blumenfeld, “pathologically, these patients have bilateral necrosis of the mammilary bodies and a variety of medial diencephalic and other periventricular nuclei.” He associates the anterograde and retrograde amnesia with bilateral diencephalic lesions, as well as impairments in judgment, initiative, impulse control and sequencing tasks to frontal lobe dysfunction.
77 d
78 b Rourke, B. (1995). Syndrome of Nonverbal Learning Disabilities
79 b from Behavioral Neurology and Neuropsycholgy (Feinberg and Farah, 1997) pages 775-778.
80 a
81 d
82 c
83 b
84 c
85 a
86 c
87 a
88 c
89 b
90 d
91 d
92 c
93 b
94 c
95 c
96 b
97 b
98 d
99 c
100 d