Mock Exam 4 Questions

1.	A neuropsychologist receives a subpoena on a case from an attorney commanding him to produce all materials associated with the case, including raw data, scientific or psychological tests and other testing materials, and technical manuals. Which of the following would be the most prudent first response? 
a.	Release all test materials to the attorney as commanded in the subpoena
b.	Do not submit any materials to opposing counsel; you are not obligated to reply to a subpoena
c.	Immediately seek a protective order regarding the testing material and manuals
d.	Offer to submit the raw data to a psychologist expert of the attorney’s choice

2.	Which of the following is not true regarding standard error of the estimate (SEE) and standard error of measurement (SEM)?
a.	SEM is the SD of the error distribution around the true score
b.	SEM takes into account the SD of the test and the test’s reliability
c.	SEE is the SD of true scores if the observed score is held constant
d.	SEM is used to calculate confidence intervals

3.	You have been using a particular measure for over a decade now. Earlier this year, an updated version of the test was released. This update collected new norms that account for demographic factors, whereas the previous version only accounted for age. What factors would you want to consider when determining if you will purchase the new version of the test?
a.	It is clear that the norms account for more individual differences. It is unethical to use obsolete tests, so the neuropsychologist should  transition to the new version, regardless
b.	It will be important to review empirical studies demonstrating utility above and beyond the previous version and/or the need to correct for demographics. It is acceptable and reasonable to continue using older versions of a test under certain circumstances
c.	The new version should have additional items to allow for increased range of scores, which will result in a normal distribution, thus aiding in interpretation. It is best to use newer versions of tests
d.	Any newer version of a test is preferred, as the normative data will be most relevant to one’s patient population. To use a previous version of a test is unethical

4.	Antiepileptic drugs are often used on inpatient units to manage behavior following a severe TBI. What is the most prominent side effect you want to monitor if your patient is on Depakote while completing a neuropsychological assessment?
a.	Behavioral dysregulation
b.	Tardive dyskinesia
c.	Drowsiness or sedation
d.	Nervousness

5.	Dr. McArthur sees pediatric patients with traumatic brain injuries in a rehabilitation hospital. She has become increasingly frustrated with the number of companies marketing their services for cognitive rehabilitation through the use of computer games.  Although they claim that “brain fitness”  is similar to physical fitness, Dr. McArthur knows that these programs may have some negative effects in children and there are also plenty of opportunities for cognitive exercise in daily life. Which of the following is inaccurate with respect to excessive time spent playing computer games: 
a.	Increased risk for eye strain
b.	Increased risk of obesity
c.	Increased risk of seizures in pediatric epilepsy patients 
d.	Increased risk of ulnar neuropathy 

6.	Mr. González is a 60-year-old man who is originally from Mexico. His first language was Mayan. He learned Spanish in school and then English when he immigrated to the United States as a teenager. He works as an accountant. Mr. González was referred to you following a concussion and vague complaints of memory problems in the context of headaches and poor sleep. He reports that he is fluent in English and has been speaking English in the work setting for 40 years; approximately half of his clients are English-only speakers. As such, you conduct the complete neuropsychological evaluation in English. What factors are most important to attend to when interpreting the data?
a.	Performance-based measures of language mastery, early life resources (e.g., nutrition, access to medical care), educational opportunities, and acculturation
b.	Mr. González’s report of language proficiency, his occupational attainment, leisure activities, and social support
c.	Length of time in the United States, number of languages he speaks, and frequency of speaking those languages
d.	Acculturation, community involvement, the percentage of time he spends speaking in English vs. Spanish

7.	You are reviewing test results from a 53-year-old gentleman with a medical history of obesity, obstructive sleep apnea, and well-controlled hypertension. He was referred for an evaluation due to a concussion two months ago. You note that he is having difficulty with vigilance, executive functioning, and visuoconstruction, but you are having trouble reconciling the profile with the patient’s  history of concussion. What other factors may be most relevant in your conceptualization?
a.	His age makes you concerned for Dementia with Lewy Bodies in the context of the cognitive profile.
b.	The medical history of hypertension makes you suspect small vessel ischemic disease that may be causing a mild vascular neurocognitive disorder.
c.	Obesity is associated with cognitive impairment, so you will be sure to recommend diet and exercise to support weight loss.
d.	Untreated sleep apnea causes diffuse cognitive impairments, but particularly problems with vigilance, executive functioning, and construction.

8.	James is attempting to examine two instruments measuring processing speed and two instruments measuring memory.  He is attempting to demonstrate that these two constructs can be reliably differentiated, demonstrating both convergent and divergent validity.  Which of the following would be most appropriate?
a.	Heterotrait-heteromethod coefficient
b.	Construct validity
c.	Monotrait-heteromethod coefficient
d.	Monotrait-monomethod coefficient

9.	You are seeing a patient with multiple sclerosis for a baseline cognitive assessment. He has had MS for 5 years with several relapses but has been stable on Tysabri for the last year. What would not be important to consider when designing the test battery?
a.	A battery that is repeatable with alternate forms and sensitive to change
b.	Making an attempt to reduce the motor demands
c.	Making the battery all auditory to reduce visual demands, given the high rate of optic neuritis
d.	Keeping the battery brief, as there are increased rates of fatigue in this population

10.	Dr. Jones, a White clinician, is working with a patient of Chinese descent.  To engage ethically and effectively, cultural self-awareness is essential in order to prevent: 
a.	An Ethnorelative interpretation
b.	Identification of a culture-bound syndrome
c.	An Ethnocentric interpretation 
d.	Acculturation misattribution
11.	A 20-year-old college student comes in for neuropsychological testing just after she completes her final exams. She generally only sleeps 2-4 hours each night. She has been concerned about ADHD and endorses relevant symptoms, such as trouble concentrating, forgetting assignments, and difficulty organizing herself for larger projects. If you hypothesize that this patient is suffering from sleep deprivation rather than ADHD, what pattern would you expect to find on testing?
a.	Impaired copy of a complex figure, impulsivity on a measure of sustained visual attention, deficits on set-shifting tasks, and self-report of poor emotion regulation.
b.	General slowing of response speed and increased variability in performance, particularly for simple measures of alertness, attention and vigilance. 
c.	Sleep deprivation is inconsistently found to be associated with objective cognitive deficits; however, responses on self-report would suggest significant perceived executive dysfunction.
d.	You are likely to observe inconsistent performance across neuropsychological tests; most important would be to obtain informant data, which should demonstrate narcoleptic behavior. 

12.	A 32 year-old male was in a motor vehicle accident a few years ago and his head went through the windshield.  He lost consciousness for about 2 hours and then woke up the next day in the hospital. GCS was a 10.  What is the likely level of TBI severity?
a.	Severe
b.	Concussion
c.	Mild
d.	Moderate

13.	Dr. Reina works primarily with patients with Mild Cognitive Impairment (MCI) in her neuropsychological practice and is thinking of applying a cognitive rehabilitation therapy (CRT) intervention with this group. She should anticipate that CRT will most likely:   
a.	Have no impact on hippocampal activation in the short-term
b.	The effect on hippocampal activation is unknown in CRT
c.	Reduce hippocampal activation in the short-term
d.	Improve hippocampal activation in the short-term

14.	Your trainee has questions about test data from a  patient who sustained a stroke. Specifically, the patient performed poorly on a word-reading task (TOPF), despite his advanced degree. He demonstrated no difficulty writing the same words that he read incorrectly. Furthermore, he performed poorly on the Line Bisection test, drawing all of his lines left of midline. When you ask the student about the location of the stroke, they do not know. Based on this data, what would be your best hypothesis as to the location of injury?
a.	Left posterior cerebral artery, which supplies the occipital lobes and splenium of the corpus callosum. The infarct caused alexia without agraphia and a right visual field cut
b.	Left superior middle cerebral artery, which supplies the left frontal eye fields. Damage to this area results in fixed gaze to the right, thus resulting in the visual impairments and difficulty reading words
c.	Right internal carotid artery, which supplies the middle and posterior cerebral arteries, resulting in vision impairments and left neglect
d.	The anterior cerebral artery, resulting in bilateral frontal infarcts which results in generalized cognitive declines

15.	Mr. Walters is an 85-year-old male who presents to the ED due to a constellation of symptoms including dry mouth and constipation, attention difficulties, confusion and memory loss. A full workup was unrevealing. Upon examining his medications you are concerned that these symptoms could be due to his use of:
a.	Lisinopril for his hypercholesterolemia
b.	Levothyroxine for hypothyroidism
c.	Metformin for hyperglycemia
d.	Oxybutynin for urinary incontinence

16.	Mr. Jones is a 45-year-old White male with a history of cardiac arrest resulting in anoxic brain injury. Compared to someone of similar demographics with a moderate-to-severe traumatic brain injury, how might you expect Mr. Jones’ recovery and presentation to differ?
a.	He would be expected to make a faster recovery but is more likely to have residual fatigue secondary to heart defects
b.	Recovery is expected to be slower and outcomes will likely be poorer. Visual and insight deficits may complicate on-going care and treatment
c.	Mr. Jones would likely have stronger cognitive and motor performance compared to a similar individual with traumatic brain injury
d.	Language would be significantly more impaired due to the sensitivity of the language center to anoxic injury

17.	You receive a request to conduct a neuropsychological evaluation for a patient with locked-in syndrome secondary to a basilar artery infarct. The patient is only able to move her eyes and blink but otherwise has no control of her movements. How do you respond?
a.	Let them know that you cannot test someone who cannot verbally respond, point, 	or write. You offer to complete testing if she shows signs of improvement in the 
b.	You decline the referral, stating that individuals with locked-in syndrome have 
no cognitive difficulties, as it is purely a motor impairment
c.	You decline the referral because any obtained findings would be invalid due to a 
non-standard administration 
d.	You agree to complete the evaluation and use augmentative communication 
tools and modifications e.g., multiple choice, blinking, and non-motor 

18.	Mrs. Jamison is a 32-year-old female suffering from new onset epilepsy who has concerns about her cognition.  Which anti-epileptic medication should be avoided given its increased risk of cognitive dysfunction: 
a.	Valproic acid
b.	Levetiracetam
c.	Topiramate
d.	Gabapentin

19.	In his first forensic case related to traumatic brain injury, Dr. Robbins is exposed to a Daubert hearing challenge. Which of the following is most likely to be the basis of this hearing request?
a.	His degree in clinical psychology and completion of a 2-year neuropsychology residency
b.	His attempt to clarify the cognitive effect of the injury on day-to-day functioning
c.	His attempt to clarify the behavioral effect of the injury in the workplace
d.	His attempt to justify the presence of injury based on self-report alone

20.	You are new to a pediatric hospital’s oncology unit and quickly become aware of disagreements amongst clinicians. Some argue that comprehensive neuropsychological testing  should only be completed once treatment has concluded to prevent practice effects. Others argue that routine monitoring and brief but sensitive screening measures should be employed throughout treatment and follow-up. An additional comprehensive evaluation is recommended if cognitive changes are identified. Based on your review of the literature, which camp is correct and why?
a.	Testing should be completed only once at the end of treatment, as cancer treatment does not result in long-term neuropsychological deficits
b.	Testing should be completed only once at the end of treatment; otherwise, practice effects would negatively impact one’s interpretation of the data
c.	Cognition should be monitored throughout treatment, given the immediate and temporary effects of cancer treatment on cognition
d.	Cognition should be monitored throughout treatment, given the impact of disease and treatment factors on later neuropsychological functioning
21.	Dr. Nelson is teaching a geriatric neuropsychology lecture on conversion rates from Mild Cognitive Impairment (MCI) to dementia. Which factor has not been shown to influence conversion rates in research studies?
a.   Practice setting (e.g. primary care vs memory disorder clinic)
b.   Diagnostic criteria used
c.   Subtype of MCI
d.   Presence of caregiver support 

22.	Julie is crafting interventions and recommendations for a patient whom she has diagnosed with Probable Dementia of the Alzheimer Type (DAT). The family is concerned about this patient’s medical decision-making capacity. Based on published studies on cognitive abilities that correlate most with medical decision-making capacity, which of the following sources of neuropsychological data may best assist Julie in determining the patient’s capacity to make medical decisions?
a.	Working memory
b.	Prose learning and recall
c.	Verbal fluency
d.	Constructional praxis

23.	A 71-year-old patient has experienced progressive declines in memory and multitasking over 2 years, which limit his day-to-day functioning. His clinical presentation has been complicated by daytime sleepiness, visual hallucinations, and paranoia. Over the past year, he developed bradykinesia and rigidity, for which he has found only modest benefit from carbidopa-levodopa. Neuropsychological testing showed prominent deficits in executive functioning and visuospatial skills, as well as mild memory weaknesses. Based on these factors, you are most inclined to diagnose:
a.	Mild cognitive impairment due to Parkinson’s disease 
b.	Parkinson’s disease dementia
c.	Dementia with Lewy bodies
d.	Alzheimer’s disease

24.	You are conducting a re-evaluation of a patient who was previously diagnosed with Alzheimer’s disease. In her last evaluation, she showed severely impaired encoding and retention on memory tasks. Based on what you know about Alzheimer’s disease progression, what findings might you expect on this patient’s neuropsychological re-evaluation:
a.	Reduced semantic memory (e.g., a lower score on WAIS-IV Information)
b.	Globally impaired verbal fluency with phonemic/letter fluency scores lower than semantic/category fluency scores
c.	Increased perceptual errors on naming tests (e.g., “pencil” for an asparagus spear)
d.	Reduced performance on basic attention tasks (e.g., lower WAIS-IV Digit Span Forward score)

25.	A right-handed, 70-year-old male presents to your clinic with dense left hemiparesis, left-sided neglect, and left hemianopsia. His speech is quiet, fast, mildly dysarthric, and flat in tone. Occlusion of which vessel would explain this patient’s presentation and performances:
a.	Left MCA
b.	Right PCA
c.	Right MCA
d.	Right ACA

26.	Mr. Kilting is a 45-year-old gentleman with a diagnosis of Wilson’s Disease.  In terms of neuropsychological findings, Dr. Bates (neuropsychologist) will most expect to see:
a.	Neuropsychiatric symptoms
b.	Memory loss of a cortical pattern
c.	Difficulty reading
d.	Ataxia

27.	You are conducting a neuropsychological assessment to determine whether your patient with Parkinson’s disease is a viable candidate for deep brain stimulator (DBS) placement surgery. The DBS treatment team has recommended DBS placement in the subthalamic nucleus (STN) instead of the globus pallidus interna (GPi) based on the patient’s clinical symptoms. Regarding cognitive outcomes for STN DBS placement in research studies, you inform the patient:
a.	There is no risk of cognitive decline following DBS placement in either the STN or the GPi, as both target motor symptoms only
b.	DBS placement in the STN has shown a greater frequency of cognitive decline than placement in the GPi
c.	STN is a cognitively safer alternative to GPi, as individuals with GPi placement tend to progress more rapidly to dementia
d.	Either STN or GPi placement can cause significant visuospatial deficits beyond what may be expected from typical Parkinson’s disease progression

28.	Dr. Mitchell is consulting with a large national retailer on work-related (pain) injuries in an effort to help the company identify factors that may contribute to return to work and disability. Based on the number of injuries occurring each year, the company is highly interested in improving their work-injury processes from a human resources/compensation perspective. Which contextual/systemic factors below are most likely to be impactful in the prognosis of pain related injuries? 
a.	Delays in treatment, job satisfaction, and satisfaction with care
b.	Fear avoidance, education, and catastrophizing
c.	Depression, anxiety, and somatization
d.	Childhood adversity, somatization, and depression

29.	Dr. Marcus is evaluating a preschool-aged girl who underwent a liver transplant 6 months ago due to biliary atresia. During the interview, the child’s parents inquire about the impact of their daughter’s liver disease and transplant on her cognitive functioning, developmental trajectory, and quality of life. After reviewing expected outcomes in preschool-aged children, Dr. Marcus is likely to inform the parents that:  
a.	Post-transplant functioning often returns to a pre-established baseline and long-term cognitive sequelae are rarely observed 
b.	High base rates of liver disease have led to a robust research with well-defined deficits
c.	Studies have traditionally focused on functioning post-transplant, which could result in over identification of associated cognitive related developmental delays 
d.	Despite fewer studies in preschool-aged children, studies associated with other age groups should be applicable given the relatively homogenous nature of this disease process

30.	Tina presented to neurology with concerns of congenital hydrocephalus.  Given the most common causes of congenital hydrocephalus, one would not expect a diagnosis of:
a.	Dandy Walker Syndrome
b.	Spina bifida myelomeningocele
c.	Aqueductal stenosis
d.	Lennox-Gastaut Syndrome

31.	Dr. Feenstra is conducting a forensic evaluation for a local attorney and is considering best practices regarding what tests of engagement to administer. Which of the following is not best practice?
a.	Stand-alone effort measures should always be deployed.  
b.	The evaluation of self-reported symptoms is best accomplished using instruments containing proven validity measures
c.	Substantial inconsistencies between test data and self-report/historical records should be considered
d.	Embedded measures should be given if stand-alone measures are failed

32.	Your patient was diagnosed with Parkinson’s disease (PD) 2 years ago, and he presents for a baseline neuropsychological evaluation due to reported cognitive changes. He asks about his risk for cognitive decline and dementia. Based on prevalence rates, you could relay that XX% of people have mild cognitive impairment (MCI) within the first 5 years of a PD diagnosis, and XX% of individuals develop dementia after 20 years of their PD diagnosis.
a.	<5%; 30%
b.	<5%; 80%
c.	15%; 50%
d.	30%; 80%

33.	Although a patient’s self-report is not concerning for cognitive impairment, based upon neuropsychological testing, he did meet diagnostic criteria for mild cognitive impairment.  You would be most concerned about the patient converting to dementia if he displayed:
a.	Non-amnestic impairment in a single domain
b.	Memory impairment of greater than 2 standard deviations
c.	Word-finding difficulties without word substitution errors
d.	Memory impairment less than 2 standard deviations with decreased processing speed

34.	A 65-year-old man presents for neuropsychological evaluation due to complaints of gradually worsening memory, slower movements, slurred speech, and imbalance with recurrent falls, and he has not shown any benefit carbidopa levodopa. Your primary differentials are Dementia with Lewy bodies (DLB) or progressive supranuclear palsy (PSP). Which clinical feature would be least helpful in differentiating between the two disorders? 
a.	Presence of psychotic symptoms such as visual hallucinations and delusions
b.	Executive dysfunction on neuropsychological testing
c.	Gait instability
d.	Difficulty with downward eye movements (vertical gaze palsy)

35.	Dr. Johnson recently evaluated a 65-year-old male reporting an 18-month history of cognitive complaints whose history is notable for Generalized Anxiety Disorder treated with alprazolam .25 mg qam for 15 years and moderate-severe white matter ischemia seen on brain MRI. Test findings revealed slowed information processing speed and difficulties with sustained attention and working memory. Which of the following statements regarding the impact of benzodiazepine use might Dr. Johnson consider making in her impressions?
a.	The test findings are more likely than not due to a combination of the impact of vascular disease and long-standing benzodiazepine use
b.	The research literature is clear that long-standing use of a benzodiazepine is likely to result in dementia
c.	Long-standing benzodiazepine use is believed to be fairly benign, particularly in those with high levels of education
d.	The precise impact of long-standing benzodiazepine use on cognition has not been fully elucidated in the literature, though some studies have found an association with cognition 

36.	Dr. Phillipe was referred an adult patient with a history of  congenital hydrocephalus. He completed a robust neuropsychological battery.  Given research on congenital hydrocephalus, one would expect the patient to display:
a.	Impaired vocabulary and expressive language
b.	Impaired memory for rote associative material
c.	Impaired processing speed with a graphomotor component
d.	Lower verbal comprehension than perceptual reasoning

37.	Mark sustained a moderate TBI 4 months ago and since that time has struggled with depression and anxiety. About 6 weeks ago, his primary care provider started him on an SSRI and a benzodiazepine. In addition to a possible worsening of gait/balance and cognitive sedating side effects, what other concern should his primary care provider look out for?
a.	Tremor
b.	Increased disinhibition
c.	Bone marrow toxicity
d.	Hyperarousal 

38.	Dr. Luther is reviewing data from a case in which a patient was diagnosed with amnestic Mild Cognitive Impairment (aMCI) 3 years ago following administration of a battery of neuropsychological measures that included 1 memory test. Repeat testing one year ago was completed using the same test battery, and findings indicated that the patient performed better, and her performance on the memory test had in fact reverted to normal. What concerns, if any, might Dr. Luther have about these findings?
a.	None, this is known to be a typical finding from the literature
b.	MCI diagnoses based on a single memory test are as stable as diagnoses based on more than one memory test 
c.	MCI diagnoses based on a single memory test are more unstable than findings based on 2 or more memory tests
d.	Dr. Luther should not trust the findings from another neuropsychologist and should instead conduct her own testing

39.	Dr. Copeland has just reviewed the report of a colleague in another state who administered a test known to have a high level of sensitivity (.90) in the setting of a 50% base rate for a particular condition of interest (COI). In the report, the colleague had administered this same test to an individual in which the COI (different from the original) is only known to occur with a 5% base rate. She concluded that the COI was present with a 90% probability. What can Dr. Copeland conclude in his review of this report?
a.	Specificity would be more useful to establish probability for the new COI
b.	Probability is easily established via sensitivity regardless of the base-rate
c.	The difference in base rates for the COI will greatly reduce the true sensitivity
d.	The colleague interpreted this finding accurately

40.	Ms. Thompson is a 70-year-old African American woman with 18 years of formal education. She was self-referred due to concerns of feeling "scatterbrained" over the past year. While you and the patient were walking down the hallway to your office, you noticed she was walking slowly and her posture was stooped. She took very small steps and had a slight resting tremor in her right hand while seated. After your evaluation, you refer Ms. Thompson to your colleagues in neurology due to concerns regarding the potential presence of  ________
a.	Huntington's Disease
b.	Amyotrophic Lateral Sclerosis
c.	Multiple Sclerosis
d.	Parkinson's Disease

41.	You evaluate an 80-year-old male with a long-standing history of anxiety treated with a benzodiazepine with a short half-life. He is found to have mild impairments in verbal reasoning, processing speed and working memory. Based on the literature, what are you likely to conclude about the impact of his benzodiazepine use on his cognition?
a.	His cognitive deficits are likely a product of his long-standing benzodiazepine use
b.	Benzodiazepines with a short half-life have been shown to have little impact on cognition
c.	Benzodiazepines with a short half-life tend to cause mild to moderate changes in cognition
d.	The half-life of the benzodiazepine really does not mean much in terms of the impairment seen in this group

42.	Dr. Lindsey has been in forensic practice for many years and is well versed in the applicable cases under Frye associated with admissibility. She has a current forensic head injury case in which the retaining (plaintiff) attorney has informed her that he would like to use the SPECT findings of his client in trial testimony. Given multiple normal structural brain imaging studies, an initial Glasgow Coma Scale (GCS) of 15, and no loss of consciousness, the use of single photon emission computed tomography (SPECT) in this case:
a.	May be admissible because it is both sensitive and specific to head injury 
b.	May be admissible if consistent with other forms of diagnostic testing
c.	May be admissible because SPECT is routinely included for diagnostic purposes
d.	May be admissible because of its correlation with neuropsychological test performance

43.	Jason’s WAIS-IV FSIQ score was 115. His highest scaled score was a 17. Mark’s WAIS-IV FSIQ score was 85, and his highest scaled score was a 10. The examiner is interested in subtest scatter and low scores (as defined by those falling 1.5 SD below the mean). Based on the literature, and without seeing the remainder of their data, what might be reasonable to conclude:
a.	One cannot make any assumptions about the level of variability or scatter between their profiles
b.	Jason is likely to have more subtest scatter but fewer low scores
c.	Mark is likely to have more subtest scatter and more low scores
d.	Jason is likely to have less subtest scatter and fewer low scores

44.	Neuropsychological test results of a 9-year-old boy with history of complicated mild traumatic brain injury reflect relatively strong cognitive recovery 3 months later but also quantitative indications of emotional distress, with no elevated symptom validity scales.  Upon further discussion, the boy describes intrusive flashbacks of the accident scene, a need to avoid bicycling near the area where the accident occurred and a general feeling of being “jumpy”.  The neuropsychologist should refer for what kind of evidence-based behavioral intervention?
a.	Systematic progressive muscular relaxation to reduce the muscle tension and spasms
b.	Trauma-focused cognitive behavioral therapy 
c.	Applied behavioral analysis 
d.	Rebirthing therapy to mimic the trauma and thereby desensitize the patient

45.	Dr. Morgantheau evaluated a 70 year old patient and administered a test for which one set of norms was very exclusionary with respect to medical conditions (healthy), and a second set of norms for the same test were much less exclusionary (includes some with medical/psychiatric conditions). Both normative sets are equivalent in terms of education, age and ethnicity. What will be the potential impact on the possibility of detecting impairment with each set of norms?
a.	No impact; the rates of impairment will likely be similar
b.	Normative sets should not include individuals with medical conditions
c.	The second set may be less sensitive to detection of cognitive impairment
d.	The findings from the first set will definitely be more accurate 

46.	You recently completed testing with a patient who sustained a moderate-to-severe traumatic brain injury one year ago. You are not recommending they return to work. Which characteristics most likely describe your patient with the poorest prognosis for returning to work?
a.	Age over 50, less than high school education, unstable pre-injury work history, severe TBI
b.	Age over 50, premorbid psychiatric history, stable employment history, moderate TBI
c.	Age under 25, less than high school education, severe TBI, physical disability
d.	Five days post traumatic amnesia, unstable pre-injury work history, age over 50

47.	Dr. Malone’s evaluation of a 65-year-old female with 12 years of education showed equivocal findings not clearly consistent with a neurocognitive disorder. Dr. Malone hypothesizes that the patient’s complaints may be associated with factors related to the normal aging process. Which of the following factors would not be consistent with this hypothesis?
a.	Decreased cognitive and divided attention
b.	Reduced cognitive flexibility
c.	Less efficient rates of learning new information 
d.	Decreased basic arithmetic problem solving 

48.	Mr. Baker is a 68-year-old male who has been diagnosed with Parkinson’s Disease within the last 5 years.  He is being referred for a baseline evaluation. If Mr. Baker presented with any mood symptoms, which of the following is LEAST LIKELY to be present?
a.	Psychosis	
b.	Apathy
c.	Depression
d.	Loss of Social Comportment

49.	Dr. Michaels is referred a 38-year-old male patient with 10 years of education for a pre-surgical pain evaluation. In the context of a history of reported childhood abuse, a prior history of depression and prominent focus on somatic related symptoms, Dr. Michaels considers the risks for a poor outcome associated with surgery to be elevated. Based on the literature, he believes which of the following interventions will result in the best chance for recovery, specifically with regard to pain and disability?
a.	Symptom-focused treatment 
b.	Functional restoration
c.	Cognitive Behavioral Therapy
d.	Psychiatric management

50.	A 12-year-old girl presents for a neuropsychological evaluation with a personal medical history of neurofibromatosis, type 1. You know that this condition is associated with tumors. Which type of brain tumor would you be most concerned about in this particular patient?
a.	Medulloblastoma
b.	Craniopharyngioma
c.	Juvenile Pilocytic Astrocytoma
d.	Pineoblastoma

51.	Mr. Thompson arrives at your office accompanied by his daughter for an evaluation. He was referred by his primary physician who noted he initially presented with memory loss and an MMSE of 28/30 6 years ago, but he has declined over time and scored a 19/30 approximately 1 month ago. You note in the interview that in addition to word-finding difficulty and problems recalling his history, he has a mild gait disturbance and ideomotor apraxia. Before initiating testing, what are your initial hypotheses regarding this patient?
a.	Parkinson’s disease
b.	Alzheimer’s disease
c.	Corticobasal Degeneration
d.	Lewy Body Dementia

52.	You look at your schedule for the week and notice that two of your cases are very similar. They both sustained severe traumatic brain injuries, had two weeks of posttraumatic amnesia, and had diffuse axonal injury on neuroimaging. Which characteristic would most likely explain the poorer prognosis for recovery for one of the patients?
a.	Glasgow Coma Scale; one child’s GCS was 3 whereas the other’s was 5.
b.	Premorbid learning skills; one child had an IEP in place.
c.	Age; one child was 4 years old whereas the other was 17 years old.
d.	Location; one child lived in a rural area whereas the other lived in the city  

53.	Mark is evaluating an 80-year-old male who has been admitted to the ER due to concerns about hallucinations that are well formed and characterized by small objects and people. The patient knows the hallucinations are not real. He was diagnosed with an amnestic form of MCI 6 months ago. The patient’s pertinent medical history is otherwise remarkable for a long-standing history of falls, mild depression, macular degeneration and hypertension. What might be the etiology of this patient’s hallucinations based on the history?
a.	Lewy Body Dementia
b.	Charles Bonnet Syndrome
c.	Alzheimer’s Dementia 
d.	Delirium

54.	You are conducting feedback with the family of a child who sustained a severe traumatic brain injury. The parents are asking many questions, including whether or not their child will continue to have neurobehavioral issues. Which factors are most consistent with your concerns for future difficulties?
a.	Limited academic exposure prior to the injury, previous learning difficulties, low socioeconomic status
b.	Young age, severe injury, few resources, family dysfunction
c.	Young age, few friends, history of psychological treatment
d.	Older age, severe injury, few resources, poor support at home

55.	Mr. White is a 60-year-old male who presents with complaints of inattention and word finding difficulty. He is very quiet with limited expression and a wide-eyed stare. According to his family, he suffered a few backward falls over the last year. He evidenced difficulty gazing down, slowed mentation, and rigidity. Neuropsychological results showed intact memory and impaired phonemic fluency and processing speed.  Which is the most likely diagnosis and possible sign that may be evidenced on neuroimaging?
a.	Corticobasal syndrome (CBS) and the “light bulb sign” which entails marked hyperintensity seen on heavily T2 weighted sequences that has been likened to a glowing light bulb.
b.	Multiple System Atrophy (MSA) and selective degeneration of pontocerebellar tracts referred to as the “hot cross buns” sign.
c.	Progressive Supranuclear Palsy (PSP) and prominent midbrain atrophy with no pontine atrophy, referred to as the “hummingbird” or “penguin” sign
d.	Parkinson’s disease dementia (PDD) and markedly reduced volume in the dorsal midbrain, with relative sparing of the tectum and cerebral peduncles, giving rise to a "Mickey Mouse" sign.

56.	A 19-year-old man sustained a head injury after striking the concrete curb while skateboarding without a helmet. He did not lose consciousness based on a witness’ report, but he appeared confused after the fall. EMS documented a Glasgow Coma Scale (GCS) rating of 13 at the scene. The patient reported significant headache with nausea at the ED, and a head CT revealed evidence of a depressed right temporal bone skull fracture. He was discharged home the next day. He was referred to you 4 months from his injury date. What additional information would be most important to obtain in order to accurately determine the severity of his brain injury?
a.	The presence of other ongoing symptoms (e.g., vision issues, etc.)
b.	Findings from repeat neuroimaging
c.	Length of posttraumatic amnesia
d.	Onset and course of his cognitive symptoms

57.	You see a patient with newly diagnosed autism spectrum disorder and history of macrocephaly. What related finding has been most replicated in the literature?    
a.	Brain size is typically larger at all ages
b.	Brain size is larger than average in younger patients but returns to average later in childhood
c.	Larger than average brain size is typically observed in utero 
d.	Brain size is typically normal with rapid growth at 24 months 

58.	You work in a rural area and have limited experience with ethnically diverse populations. You received a referral for a  6-year-old bilingual boy who immigrated from Guatemala at 3 years old. Both parents are monolingual and Spanish is solely spoken in the home. The nearest city is 4 hours away and the family has limited resources. What is your first course of action for the evaluation?  
a.	Schedule testing with your hospital interpreter and meet prior to the appointment to ensure the test battery is interpretable. 
b.	Prior to the assessment, consult with a neuropsychologist with relevant cross-cultural training and expertise in assessing bilingual children.  
c.	Proceed with your traditional battery in English and apply Western norms. The patient has had adequate exposure to English and his academic performance should be based on the language of his education. 
d.	Defer services to a bilingual neuropsychologist in a metro area and encourage the parents to find a family member or friend who can provide transportation.

59.	Ms. Doe is a 52-year-old Caucasian woman presenting  to the emergency department with a recent onset of paranoia, disorganized thoughts, and auditory hallucinations. It was difficult to obtain a linear history from the patient and therefore collateral information was obtained from her husband. Mr. Doe first noticed his wife’s paranoia about 5 weeks ago when she expressed some concerns about their neighbors getting involved in a government conspiracy.  As time went on, her paranoia and delusional thinking became more prominent. His decision to take his wife to the emergency department was specifically made after he found her in their bedroom closet crying, holding a butter knife, and stating that their neighbors were on their way to abduct her. Mr. Doe reported his wife experienced a period of depression 20 years ago in response to situational stressors, but her psychiatric history was otherwise unremarkable. Based on this information, what diagnosis is highest on your differential? 
a.	Bipolar disorder, with psychotic features
b.	Autoimmune encephalitis
c.	Schizophrenia
d.	Neurodegenerative dementia

60.	Ms. Baker is a 20-year-old female who was recently diagnosed with multiple sclerosis (MS). She presents with frustration related to the impact of MS on her social and academic functioning. She noted that she never used to have to try in school, but now she is having trouble keeping up in class. She reported a number of physical symptoms that also cause problems in functioning, e.g., fatigue, tingling, foot drop. Neuropsychological testing revealed subtle weaknesses in attention, processing speed, visuospatial/visuoconstruction skills, and learning and memory. What recommendation(s) do you want to ensure you offer during the feedback session?
a.	Recommend that she not attempt college courses, as MS is neurodegenerative and she will only experience more challenges
b.	Take vitamin B12, avoid cold weather (heat is better for MS), and engage in psychotherapy
c.	Avoid pharmacologic interventions that address fatigue/inattention as they are contraindicated in MS
d.	Academic accommodations and additional therapies (e.g. psychotherapy, exercise, speech therapy)

61.	Dr. Smith, a neurologist, is going to prescribe carbidopa-levodopa to his 65-year-old male patient who, on initial presentation, exhibits parkinsonian symptoms consistent with idiopathic Parkinson's disease (PD). During their discussion of benefits/risks of the medication, which of the following points would Dr. Smith not make to his patient:
a.	“You should be aware that carbidopa-levodopa can often cause an increase in appetite, excessive eating, and weight gain.”
b.	“Because carbidopa-levodopa is a dopaminergic medication, you should watch out for increased impulsive behaviors and urges for gambling, sex, or hobbies.”
c.	“Although carbidopa-levodopa might help your tremors, it can also cause uncontrolled, repetitive twitching or twisting movements of your neck, trunk, arms, or legs.”
d.	“A substantial response to carbidopa-levodopa is very common in idiopathic PD, with >90% of patients showing an improvement in symptoms with the medication.”

62.	A 6-year-old sustained a severe TBI and was just transferred to an inpatient rehabilitation unit from the hospital. As the neuropsychologist on this neurorehabilitation unit, you are asked by the child’s mother to help predict her son’s functional outcome. What information from the records would be most important to inform your early prognosis?
a.	GCS at the time of admission to the ED
b.	Time to follow commands following injury
c.	Personal and family history of ADHD
d.	Academic ability 

63.	In choosing which performance validity tests (PVTs) to administer to today’s patient, Dr. Jamison decides not to administer the Reliable Digit Span.  He does this because there is insufficient support for use of Reliable Digit Span as a PVT in this patient’s population.  Keeping this in mind, Dr. Jamison’s patient may present with any of these characteristics/conditions except:
a.	A patient with a history of mild TBI
b.	A patient with an IQ<70
c.	A patient with dementia
d.	A patient who speaks English as a second language 

64.	You are conducting brief neuropsychological evaluations within a multidisciplinary team of providers in a memory disorders clinic that sees patients with a broad range of clinical presentations. Frequently, cholinesterase inhibitors (e.g., donepezil, galantamine, rivastigmine) are recommended by the team, so you conduct a literature review to improve your knowledge on the efficacy of CHEIs. Based on your readings, which of the following statements is false: 
a.	Cholinesterase inhibitors improve attention and alertness and reduce hallucinations in patients with early Dementia with Lewy bodies.
b.	Donepezil and galantamine in particular improve cognition and global function in patients with vascular dementia.
c.	Cholinesterase inhibitors have not been shown to delay the onset of Alzheimer's disease or dementia and are not FDA-approved for individuals with mild cognitive impairment.
d.	Cholinesterase inhibitors have been shown to improve cognition, activities of daily living, and quality of life for patients with rarer causes of dementia including Huntington’s disease, CADASIL, and multiple sclerosis.

65.	Kristen is a 78-year-old female who presents to the ED with chief complaint of confusion.  If the attending, Dr. Webb mentions the Beers criteria, he is likely referring to:
a.	Criteria related to use of neuroimaging 
b.	Criteria related to use of potentially inappropriate medications
c.	Criteria related to potential kidney dysfunction
d.	Criteria related to a well-known stroke scale

66.	Ms. Smith is a 47-year-old woman who presented to the Emergency Department after slipping on ice in her driveway. Her husband witnessed this fall and noted his wife lost consciousness after hitting the left side of her head on the concrete. Ms. Smith was conscious, responsive, and generally oriented upon initial EMS examination. She had a documented Glasgow Coma Scale (GCS) rating of 14 at the scene. While being monitored, Ms. Smith reported worsening headache pain, she had an episode of emesis, and she was observed to have trouble following commands. Reexamination revealed a GCS of 12. A head CT revealed a midline shift and hyperdense crescent-shaped abnormality. What type of intracranial injury did Ms. Smith most likely experience?  
a.	Diffuse axonal injury
b.	Subdural hematoma
c.	Subarachnoid hemorrhage
d.	Epidural hematoma

67.	You received a referral for a 25-year-old man with schizophrenia whose psychiatrist has noticed significant memory issues. You have no other information about him, and you have not evaluated many patients with severe mental illness, so you conduct a literature review before you prepare your test battery. Based on your reading, which of the following statements is false?
a.	Individuals with schizophrenia frequently exhibit cognitive impairment, and deficits often persist into residual phases after psychotic symptoms have remitted.
b.	Cognitive results can vary widely among individuals with schizophrenia, but global cognitive impairment is common, with many individuals showing more specific deficits on tests of visuospatial and visuoperceptual ability.
c.	Individuals with schizophrenia often show poor performance on performance validity tests, even when there is no apparent secondary gain.
d.	Severity of cognitive impairments for individuals with schizophrenia often range from 1.0 to 1.5 standard deviations below average when compared to demographically-matched groups.

68.	Nyeem sustained a severe TBI in a motor vehicle collision.  During his second night in the ICU, he decompensated. Which secondary injury is the most likely cause of his decompensation?
a.	Contrecoup cerebral contusion
b.	Diffuse axonal injury.
c.	Petechial hemorrhage
d.	Increased intracranial pressure

69.	Mr. Jordan has been diagnosed with Parkinson’s disease (PD) for five years. He noted some cognitive deficits to his neurologist who recommended a referral for speech therapy for cognitive rehabilitation. What can Mr. Jordan expect as a result from participation in cognitive rehabilitation?
a.	Substantial improvement in visuospatial skills, attention, and processing speed
b.	Moderate improvements in memory, but no significant changes in processing speed
c.	Although there is limited evidence, gains are possible for executive functions, memory, and processing speed; but improvements may not necessarily translate to perceived improvements in functioning
d.	Participation in a manualized cognitive rehabilitation program for PD has been shown to improve functional performance in instrumental activities of daily living

70.	You have been asked to complete cognitive screenings for older adults in a geriatric cancer clinic. You have limited time to interview and screen, so in preparation, you are creating a list of factors that can cause or contribute to cognitive impairment in this population. Which of the following factors would be least important, as it has less of an impact on cognition in these patients?
a.	Prior cancer-related surgeries with anesthesia, as older adults have an increased risk of postoperative cognitive decline. 
b.	Prior brain radiation, as there can be cognitive effects of early and/or delayed toxicity in geriatric patients.
c.	Use of immunotherapies (e.g., cytokines, monoclonal antibodies, etc.), as related post-treatment cognitive impairment has been reported in older adults.
d.	Use of psychostimulants (e.g., methylphenidate) for cancer-related fatigue, as such medications can increase the likelihood of cognitive impairment in geriatric patients. 

71.	Dr. Millman is preparing for an upcoming forensic case knowing he will need to determine which Performance Validity Tests (PVTs) he will administer. The examinee is a plaintiff, although Dr. Millman was hired by the defense team to evaluate this individual. What should Dr. Millman be most concerned about related to this evaluation and the use of PVTs? 
a.	Dr. Millman should not encourage the examinee to try his/her best on testing
b.	Prior to testing, he should warn the examinee that PVTs will be administered
c.	Three total PVTs should be administered per testing session: 1 at the beginning, 1 in the middle, and 1 at the end
d.	The plaintiff attorney may have reviewed PVTs and response strategies with the examinee prior to testing 

72.	A 13-year-old girl presents for an evaluation with complaints of persistent dull headache, inattention, irritability, and fatigue. She sustained a concussion during a soccer game 5 months ago. There was no loss of consciousness or other acute alternations in her mental status. Due to persistent symptoms, she has not been cleared to return to play and continues to receive post-injury academic accommodations. Of the following, which is the most likely explanation for this clinical presentation?
a.	Attention Deficit/Hyperactivity Disorder, Inattentive Presentation
b.	Adjustment Disorder with depressed mood
c.	Mild Neurocognitive Disorder due to late effects of concussion 
d.	Migraine, unspecified

73.	When examining Mr. Williams, Dr. VanEyes observes many symptoms concerning for Parkinson’s disease.  Which of the following symptoms would be least helpful in making a PD diagnosis, as this symptom is not a cardinal symptom of Parkinson's disease?
a.	Chorea
b.	Postural Instability
c.	Tremor
d.	Bradykinesia

74.	A psychiatry resident reached out to you for consultation regarding an 85-year-old patient with cognitive decline, delusional thoughts, and depression. The resident is questioning whether the patient has Alzheimer’s disease with psychosis versus “pseudodementia.” The resident plans to refer the patient to you for evaluation, but in the meantime, he would like input on what symptoms or behaviors he may ask the family about that may help to differentiate the two diagnoses. Which of the following is not accurate:
a.	The onset of depression symptoms. With depression that results from a dementia process, the onset may be acute and well demarcated, whereas with depression not due to dementia, the onset may be more insidious.
b.	Details on recent mood itself. Patients with depression without dementia tend to present with low, sad mood, whereas patients with dementia may present more with apathy symptoms.
c.	The patient’s subjective cognitive report. The depressed patient may present with more detailed cognitive complaints, whereas the dementia patient may have no cognitive complaints.
d.	The content of the delusions. Depressed patients more frequently present with mood-congruent delusions, whereas dementia patients may more frequently have mood-independent delusions.

75.	Amelia was diagnosed with Turner Syndrome in the first grade. You are asked to complete a neuropsychological evaluation to assist with academic recommendations. Considering the most common difficulties observed in Turner Syndrome, what are some recommendations you might propose?
a.	Academic accommodations to address weaknesses in processing speed, motor skills, and math. Treatment with estrogen and androgen may also help address some cognitive and academic issues
b.	Verbal weaknesses should be addressed, such as allowing Amelia to use a dictionary, providing a word bank on quizzes, and providing resource support for reading and speech 
c.	Cognitive deficits are not typical, so environmental accommodations are recommended to assist with the physical deficits
d.	Turner Syndrome tends to be more severe in males than females, so basic recommendations, such as ensuring front row seating and a quiet testing environment should suffice

76.	Johnnie is a 41-year-old male who has recently experienced new onset symptoms including high blood pressure, headache, fatigue and weight gain.  Dr. Samuelson (neurologist) recommended an MRI, and findings were remarkable for a small brain tumor.  Based upon Johnnie’s symptoms, where is the likely location of this tumor?
a.	Frontal Lobes
b.	Pituitary
c.	Basal Ganglia
d.	Hypothalamus

77.	Dr. Garcia completed an evaluation of a 65-year-old with a history of cognitive and functional decline over the last 24 months. The patient has a strong family history of dementia and no history of substance use or pre-morbid mental health problems. Further, the patient has no current or past legal problems. Which of the following is most accurate with respect to Dr. Garcia’s consideration of Performance Validity Tests (PVTs) for this patient?
a.	PVTs are not necessary in non-forensic settings and/or when there is no other evidence of primary/secondary gain
b.	Clinicians are skilled at determining an examinee’s effort and detecting sub-optimal effort through behavioral observations alone
c.	PVTs, such as the TOMM, have high specificity and low sensitivity to detect non credible effort
d.	PVT performance may be affected by genuine cognitive impairment in some instances

78.	A patient presents to your office for evaluation three months following a motor vehicle collision (MVC) that resulted in no loss of consciousness (LOC), a Glasgow Coma Scale (GCS) of 13, and no post-traumatic amnesia (PTA), but positive CT findings of a small subarachnoid hemorrhage. He also presents with marked depression and anxiety. Which of the following is accurate with respect to the association of depression and anxiety with functional impairment?
a.	Functional impairment is related to depression and anxiety, but only if the head CT is positive
b.	Functional impairment is related to depression and anxiety, but only if the head CT is negative
c.	Functional impairment is related to depression and anxiety, but less so if the head CT is positive
d.	Functional impairment is not associated with depression and anxiety at 3-months post mTBI

79.	Sean is a 9-year-old boy who was referred for suspicion of ADHD and learning disorder. Medical records from dermatology indicate 8 café-au-lait macules. He underwent an MRI a few months ago that showed an optic glioma and enlarging T2 signal hyperintensities in the basal ganglia. Given his presentation, he and his parents were referred for genetic testing but those results are pending. Which diagnosis would be consistent with the patient’s symptoms and diagnostic workup?
a.	Tuberous Sclerosis
b.	Neurofibromatosis Type I
c.	Sturge-Weber Syndrome
d.	Turner Syndrome

80.	Mr. Boone is a 67-year-old Asian American man with 13 years of formal education. He was referred for a neuropsychological evaluation by his neurologist within the context of an 9 year history of Parkinson’s disease. His medical and psychiatric history are otherwise unremarkable. Compared to age-matched peers, Mr. Boone is most likely to demonstrate weaknesses in ____ and ___.
a.	Attention/Learning and Delayed Memory/Recognition
b.	Attention/Learning and Executive Functioning
c.	Visuospatial Abilities and Delayed Memory/Recognition
d.	Language and Delayed Memory/Recognition

81.	A patient presents to your office complaining of memory problems three weeks after sustaining a mild traumatic brain injury in a motor vehicle accident. What combination of complicating features would you be most likely to see?
a.	Headache, nausea, disorientation, decreased recognition memory
b.	Photosensitivity, headache, irritability, cognitive inefficiency
c.	Irritability, insomnia, decreased verbal fluency, aura
d.	Cognitive inefficiency, headache, memory retrieval deficits, hypersomnia 

82.	Sarah is a 20-year-old female with cognitive concerns related to systemic lupus erythematosus (SLE). She was prescribed warfarin to reduce the risk for venous thrombotic events after blood tests revealed antiphospholipid antibodies. Sarah recently found out she is 4 weeks pregnant. She asks if there are any risks associated with warfarin. What should you tell her? 
a.	Warfarin is linked to congenital malformations. She should discuss alternatives with her physician 
b.	There are no documented adverse effects of warfarin in pregnancies
c.	Warfarin increases the risk for ADHD but treatment is not contraindicated 
d.	Warfarin can lead to neonatal abstinence syndrome. Long-term effects are unknown  
83.	You evaluated a child with Williams Syndrome.  What is the most likely finding from your neuropsychological evaluation? 
a.	Schizophrenia 
b.	Stronger visual memory compared to auditory memory 
c.	Deficits in word reading with intact math skills
d.	Intellectual disability but better verbal than nonverbal skills

84.	Jonathan is a 30-year-old Caucasian male undergoing a surgical workup for treatment resistant epilepsy.  He has experienced seizures since the age of 3.  Seizure focus has been identified to localize to the left temporal lobe.  His neurosurgeon Dr. Patra noted that his neurocognitive prognosis of surgery is thought to be favorable given numerous factors including:
a.	Normal brain imaging
b.	His current intact neurocognitive abilities
c.	Language dominant seizure focus
d.	Functional reorganization indicated on fMRI due to his early age of seizure onset 

85.	Mr. Smith is a 69-year-old man who was referred to your outpatient neuropsychology clinic due to reported cognitive concerns in the context of a 20+ year history of alcohol abuse (2 months sober) and bipolar disorder (with psychotic features during periods of non-compliance with mood-stabilizing medications). Mr. Smith denied cognitive, psychiatric, or motor symptoms.  However, his wife has noticed increasing issues with memory and periods of confusion over the past year, possible hallucinations recently, and numerous falls over the past 6 months. Due to these symptoms, his wife has managed his medication over the last 9 months with 100% adherence with her oversight.  You are considering Mr. Smith’s alcohol abuse, bipolar disorder, and a possible neurodegenerative disorder as potential contributing factors. What additional information would be most beneficial to have when forming your initial diagnostic impressions? 
a.	Lithium lab values 
b.	Family neurological history
c.	Recent polysomnogram results
d.	Gait assessment results

86.	Ms. Parker was diagnosed with Dementia with Lewy Bodies (DLB) a year ago. On current assessment, her partner is reporting significant visual hallucinations around bedtime and reduplicative paramnesias that are causing distress in the home. They are asking if there are any medications that could help treat the symptoms. What would you recommend?
a.	Antipsychotics have been shown to be effective in managing hallucinations and delusions 
b.	Cholinesterase inhibitors are the safest option, as they can reduce hallucinations and delusions and avoid the risk of neuroleptic malignant syndrome
c.	Antipsychotics are most effective but need to be prescribed at a lower dose than younger adults and those with non-neurologic psychiatric conditions
d.	Cholinesterase inhibitors are only effective in Alzheimer’s disease and, unfortunately, there are no medications that have been demonstrated to be effective for managing DLB symptoms

87.	Sarah is an 8-year-old girl with concerns for ADHD. She daydreams in class and seems confused when called upon. Her parents report a history of staring episodes with brief unresponsiveness. The patient states that she does not recall periods of her class instruction. You refer Sarah to a neurologist and EEG recordings show 3 Hz spike-wave discharges. Based on her semiology and EEG, what would explain the patient’s presentation?  
a.	West syndrome
b.	Childhood absence epilepsy
c.	Landau-Kleffner syndrome
d.	Rolandic epilepsy

88.	Jennifer is a right handed 30-year-old female presently undergoing Wada testing due to left temporal lobe epilepsy.  With left injection, Jennifer became aphasic, and her memory score was 14/15. With right injection, she was slightly dysarthric, and her memory score equated 9/15.  These findings would suggest that if Jennifer underwent left temporal lobe resection:
a.	She would not be at risk of experiencing any language based decline
b.	She would not be at risk of experiencing memory based decline given the fact that her memory is 14/15 with left injection and 9/15 with right injection
c.	She will be at risk of memory decline given the fact that her memory is 14/15 with left injection and 9/15 with right injection.
d.	Determinations regarding risk of memory and language decline cannot be made based upon Wada testing

89.	Mr. Bell is a 41-year-old man referred by his infectious disease provider due to cognitive concerns in the context of a recent diagnosis of HIV. Mr. Bell was hospitalized a few months ago due to persistent and worsening respiratory problems. He was found to have pneumocystis pneumonia (PCP) and to be HIV+.  The date of his initial infection is unknown. Which of the following would be most useful to know when predicting Mr. Bell’s risk for cognitive problems secondary to HIV? 
a.	CD4 nadir
b.	Current HAART regimen
c.	Date of infection
d.	Current HIV viral load

90.	Peter is a 37-month-old boy who presents with significant motor delays. His mother described him as a “floppy baby” during his infancy. His movements gradually became more restricted. You gather additional details about Peter’s birth history. He was born at 31 weeks gestation weighing 3 lbs. and was cyanotic from nuchal cord. What is your hypothesis about his diagnosis?
a.	Cerebral palsy
b.	Aqueductal stenosis 
c.	Spinal muscular atrophy
d.	Myotonic dystrophy

91.	You see a 3-year-old patient with phenylketonuria (PKU). She recently started a Phe-restricted diet. All are true of her treatment except:
a.	White matter abnormalities can be reversible with treatment
b.	A Phe-restricted diet is ineffective after 2 years of age
c.	Early treatment results in better cognitive and developmental outcomes
d.	Untreated infants can develop progressive psychomotor retardation

92.	Dr. Hodson and Dr. Rey are boarded neuropsychologists in the same city. They frequently consult on cases and conduct research together. During a recent meeting about a potential study, they realize that they have highly differing rates of diagnosing vascular dementia. Dr. Hodson has been using the NINDS-AIREN criteria and Dr. Rey has been using the DSM-5. Which clinic is likely to have the higher rates of VaD diagnoses and why?
a.	Dr. Hodson, because the NINDS-AIREN criteria has few diagnostic shortcomings
b.	Dr. Rey, because the DSM-5 has a lower threshold for impairment in the criteria
c.	Dr. Hodson, because the NINDS-AIREN criteria has a lower threshold for impairment in the criteria
d.	Dr. Rey, because the DSM-5 is the gold standard for diagnosing VaD

93.	You evaluated a patient in your clinic and diagnosed Primary Progressive Aphasia-semantic variant (PPA-sv) based on multiple factors, including imaging data that revealed deterioration in the bilateral anterior temporal region. What did your neuropsychological results show?
a.	Spared motor speech, phonologic errors in naming, and impaired single word retrieval
b.	Impaired confrontation naming, spared repetition, and surface dyslexia
c.	Agrammatism in language production, effortful halting speech, and spared object knowledge
d.	Absence of frank agrammatism with impaired repetition of sentences and phrases

94.	You are supervising a practicum student who is shocked by the unusual neuropsychological profile of a boy with spastic cerebral palsy. Despite his right-sided paresis, the patient’s language is intact but his visual-spatial skills are impaired. What would explain the patient’s test results? 
a.	Language was spared and is well preserved in the left hemisphere
b.	Right-sided paresis is generally seen in spastic cerebral palsy regardless of hemispheric involvement
c.	In addition to focal deficits of cerebral palsy, the patient also has a capillary-venous malformation in the right hemisphere, which is common in this population
d.	Language has reorganized to the right hemisphere   
95.	Dr. Jones knows that positive bias can present in forensic cases with respect to self-report and school records and the same bias can occur in clinical settings with patients who have: 
a.       Less than 12 years of education
b.      A premorbid history of stroke
c.       A history of progressive memory loss
d.      A history of poly-substance abuse 

96.	You are planning an evaluation for a 10-year-old boy with sickle cell disease (SCD) who carries the Hb-S-beta-zero-thalassemia trait. You should consider all of the following factors in terms of test selection, test administration, and interpretation except: 
a.	Dichotic listening tasks often show decreased right ear advantage for verbal materials in patients with SCD
b.	The patient may have pulmonary hypertension, which could cause diminished stamina and associated neuropsychological impairment 
c.	Medications used to manage pain can cause drowsiness and distractibility 
d.	Specific cognitive and behavioral characteristics could be related to history of chronic anemia, cerebrovascular ischemia, and/or infarct 

97.	Six months ago, in a Motor Vehicle Collision (MVC), Tom experienced a concussion with a 1-2 minute loss of consciousness (LOC) with normal brain imaging. Based on the literature, which factor would likely account for a continued delay in his return to work status?
a.	Initial Glasgow Coma Scale 
b.	Loss of consciousness
c.	Compensation
d.	Post-traumatic amnesia

98.	Mr. Baker is a 78-year old right-handed male who presented for a neuropsychological evaluation due to concerns of cognitive decline.  Based upon his report, the neuropsychologist conceptualizes his presentation as related to the normal aging process.  Which of the following would cause the provider to be more concerned about a mild cognitive impairment?
a.	Decreased sustained and divided attention
b.	Less efficient and slower rates of learning new information
c.	Decreased cognitive flexibility
d.	Word finding deficits

99.	Your neuropsychological results of a 10-year-old boy are concerning for a reading disability due to the patient’s performance on measures of his reading fluency, word recognition, decoding, and spelling. Based on the literature, which model has shown substantial validity for diagnosing learning disabilities? 
a.	Intraindividual Differences Model
b.	Response to Intervention Model
c.	Low-Achievement Model
d.	Aptitude-Achievement Discrepancy Model

100.	You are completing inpatient rounds on a patient with coma. Upon entering the room, her family states that their loved one has awoken and is responding. You conduct a neurobehavioral exam to determine her current level of consciousness. You find that she has progressed from the vegetative state to a minimally conscious state. What behaviors would you expect to see?
a.	Follows simple commands, makes intelligible verbalizations, visually follows family members in the room, demonstrates functional object use inconsistently
b.	Consistently oriented, can accurately communicate her desires, impaired memory and attention
c.	Sleep/wake cycle is present, she responds to noxious stimuli, reflexively reacts to objects, but does not demonstrate functional use
d.	She does not open her eyes but startles in response to loud sounds and pulls away from painful stimuli, and even appears to smile or cry in response to emotional content

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