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ABPP Clinical Neuropsychology study materials
ABPP Clinical Neuropsychology study resources

ABPP Clinical Neuropsychology practice questions

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Question 1Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient sustains a focal lesion in the left inferior frontal gyrus (Broca's area) but shows relatively preserved comprehension. Which pattern of language output is most characteristic?

  1. Nonfluent, effortful speech with relatively preserved comprehension Correct answer.
  2. Fluent speech with frequent neologisms and poor repetition
  3. Fluent, empty speech with impaired comprehension and preserved repetition
  4. Severely impaired comprehension with fluent, meaningless speech

Explanation

Broca's aphasia is a nonfluent syndrome in which articulation and grammar are impaired while comprehension remains comparatively intact. The lesion disrupts motor speech programming rather than the posterior comprehension system.

Question 2Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

The hippocampus receives its primary cortical input from the entorhinal cortex via which pathway?

  1. The fornix
  2. The stria terminalis
  3. The mammillothalamic tract
  4. The perforant pathway Correct answer.

Explanation

The entorhinal cortex projects to the hippocampus through the perforant pathway, which synapses on dentate gyrus granule cells. The fornix is a major output tract rather than the primary cortical input route.

Question 3Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a right parietal lesion shows neglect of the left side of space. When asked to copy a drawing of a flower, the most typical finding is that the patient:

  1. Copies the flower but misidentifies it
  2. Copies the flower with reduced overall size
  3. Copies the flower with extra petals added symmetrically
  4. Copies only the right half of the flower Correct answer.

Explanation

Left hemispatial neglect causes omission or distortion of the contralesional (left) side of drawings, reflecting a failure of spatial attention. The deficit is in spatial representation rather than object recognition or motor execution.

Question 4Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which basal ganglia pathway is primarily responsible for facilitating voluntary movement by disinhibiting the thalamus?

  1. The nigrostriatal dopaminergic pathway
  2. The direct pathway Correct answer.
  3. The hyperdirect pathway
  4. The indirect pathway

Explanation

The direct pathway inhibits the globus pallidus interna, reducing thalamic inhibition and facilitating movement. The indirect pathway acts in the opposite direction to suppress competing movements.

Question 5Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with longstanding alcohol use disorder presents with ataxia, confusion, and ophthalmoplegia. Which neuropathological finding best explains this triad?

  1. Amyloid plaques in the temporal cortex
  2. Demyelination and necrosis of the mammillary bodies Correct answer.
  3. Loss of Purkinje cells in the cerebellar vermis alone
  4. Lewy body deposition in the substantia nigra

Explanation

The triad of ataxia, confusion, and ophthalmoplegia is characteristic of Wernicke encephalopathy, which reflects thiamine deficiency with lesions of the mammillary bodies and periaqueductal gray. Untreated, it can progress to Korsakoff syndrome.

Question 6Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which structure is the principal relay station for sensory pathways (except olfaction) en route to the cerebral cortex?

  1. The amygdala
  2. The hypothalamus
  3. The hippocampus
  4. The thalamus Correct answer.

Explanation

The thalamus relays sensory information from the periphery to the cortex for all modalities except olfaction. It also participates in motor and limbic circuits.

Question 7Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient shows impaired recognition of familiar faces despite intact visual acuity and object recognition. This deficit most specifically implicates which region?

  1. The fusiform gyrus of the right temporal lobe Correct answer.
  2. The primary visual cortex
  3. The orbitofrontal cortex
  4. The angular gyrus of the left parietal lobe

Explanation

Prosopagnosia is associated with lesions of the fusiform face area, typically in the right or bilateral inferior temporal/fusiform region. Object recognition and acuity are preserved because the deficit is specific to face processing.

Question 8Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which cranial nerve is most directly implicated in the impaired swallowing (dysphagia) seen in bulbar palsy?

  1. The vestibulocochlear nerve (CN VIII)
  2. The olfactory nerve (CN I)
  3. The hypoglossal nerve (CN XII) Correct answer.
  4. The optic nerve (CN II)

Explanation

Bulbar palsy involves lower motor neuron lesions of the medullary cranial nerves, prominently CN IX, X, and XII, producing tongue weakness, dysarthria, and dysphagia. The hypoglossal nerve supplies the tongue and is a core component.

Question 9Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a lesion in the left angular gyrus presents with which classic acquired cognitive syndrome?

  1. Klüver-Bucy syndrome
  2. Anton syndrome
  3. Balint syndrome
  4. Gerstmann syndrome Correct answer.

Explanation

Gerstmann syndrome comprises agraphia, acalculia, finger agnosia, and right-left confusion, classically from a left angular gyrus lesion. The other syndromes have different localizations and symptom clusters.

Question 10Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

In Alzheimer disease, which neuropathological change is most closely associated with hippocampal atrophy and memory decline?

  1. Spongiform change in the cortex
  2. Alpha-synuclein inclusions in cortical neurons
  3. Neurofibrillary tangles of hyperphosphorylated tau Correct answer.
  4. Demyelinating plaques in white matter

Explanation

Neurofibrillary tangles of hyperphosphorylated tau, together with amyloid plaques, are the defining pathology of Alzheimer disease and correlate with neuronal loss and atrophy in the medial temporal lobe. Tangles spread in a characteristic topographic sequence that tracks cognitive decline.

Question 11Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient has a lesion of the left optic tract. Which visual field deficit is expected?

  1. Binasal hemianopia
  2. Bitemporal hemianopia
  3. Right homonymous hemianopia Correct answer.
  4. Left homonymous hemianopia

Explanation

The left optic tract carries fibers from the left temporal retina and the right nasal retina, which together represent the right visual field. A left tract lesion therefore produces a right homonymous hemianopia.

Question 12Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which white matter tract connects the two cerebral hemispheres and is most often involved in callosal disconnection syndromes?

  1. The corpus callosum Correct answer.
  2. The cingulum
  3. The corona radiata
  4. The internal capsule

Explanation

The corpus callosum is the major commissural tract linking homologous cortical regions of the two hemispheres. Its section produces disconnection signs such as left-hand apraxia to verbal command and agraphia.

Question 13Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with Parkinson disease shows a shuffling gait, rigidity, and resting tremor. Which neurochemical deficit underlies these motor signs?

  1. Loss of cholinergic neurons in the nucleus basalis of Meynert
  2. Loss of GABAergic neurons in the striatum
  3. Loss of noradrenergic neurons in the locus coeruleus
  4. Loss of dopaminergic neurons in the substantia nigra pars compacta Correct answer.

Explanation

Parkinson disease results from degeneration of dopaminergic neurons in the substantia nigra pars compacta, reducing striatal dopamine and disrupting basal ganglia motor circuits. This produces the classic triad of tremor, rigidity, and bradykinesia.

Question 14Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient is unable to perform a previously learned motor act to command but can do it spontaneously, with intact strength and sensation. This finding is best described as:

  1. Constructional apraxia
  2. Dressing apraxia
  3. Optic ataxia
  4. Ideomotor apraxia Correct answer.

Explanation

Ideomotor apraxia is a disorder of the execution of learned skilled movements to command despite intact motor and sensory function, often from left hemisphere lesions. The preserved spontaneous performance distinguishes it from a primary motor deficit.

Question 15Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

The arcuate fasciculus is most closely associated with which clinical deficit when damaged?

  1. Impaired naming with intact repetition
  2. Impaired comprehension with fluent, meaningless speech
  3. Mutism with preserved writing
  4. Impaired repetition with otherwise fluent speech and intact comprehension Correct answer.

Explanation

Conduction aphasia results from damage to the arcuate fasciculus connecting Wernicke's and Broca's areas, producing disproportionately impaired repetition with relatively fluent output and preserved comprehension. The disconnection prevents transfer of phonological information between the posterior and anterior language regions.

Question 16Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which structure lies at the medial temporal lobe and is critical for forming new declarative memories?

  1. The hippocampus Correct answer.
  2. The caudate nucleus
  3. The globus pallidus
  4. The pulvinar

Explanation

The hippocampus and adjacent medial temporal structures are essential for encoding new declarative memories. Bilateral damage produces dense anterograde amnesia.

Question 17Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a frontal lobe lesion performs poorly on the Wisconsin Card Sorting Test, showing perseverative errors. This most directly reflects impairment in:

  1. Set-shifting and cognitive flexibility Correct answer.
  2. Phonological processing
  3. Visuospatial construction
  4. Episodic memory encoding

Explanation

Perseverative errors on the WCST reflect difficulty shifting cognitive set, a core executive function mediated by frontal-striatal circuits. The task requires adapting to changing sorting rules.

Question 18Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which arterial territory is most commonly affected in a stroke producing dense contralateral hemiparesis and hemisensory loss with aphasia?

  1. The middle cerebral artery Correct answer.
  2. The posterior inferior cerebellar artery
  3. The posterior cerebral artery
  4. The anterior cerebral artery

Explanation

The middle cerebral artery supplies the lateral convexity, including the motor and sensory cortices for the face and arm and the language areas of the dominant hemisphere. Occlusion therefore produces contralateral face/arm weakness, sensory loss, and aphasia when the dominant side is involved.

Question 19Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with Huntington disease shows choreiform movements and progressive cognitive decline. Which pathological process underlies this disorder?

  1. Deposition of amyloid in cerebral vessels
  2. Demyelination of the corticospinal tracts
  3. Expansion of CAG repeats with striatal neuron degeneration Correct answer.
  4. Loss of lower motor neurons in the spinal cord

Explanation

Huntington disease is an autosomal dominant trinucleotide repeat disorder in which CAG expansion in the HTT gene leads to degeneration of striatal neurons, particularly in the caudate. This produces chorea and progressive cognitive and psychiatric decline.

Question 20Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient shows a classical dissociative pattern in which they can name objects placed in the left hand but not in the right hand, with intact callosal transfer for other modalities. This finding most likely reflects:

  1. A right hemisphere lesion affecting somatosensory cortex
  2. A peripheral neuropathy of the right hand
  3. A callosal lesion disconnecting the right hemisphere from language areas Correct answer.
  4. A left hemisphere lesion affecting the primary motor cortex

Explanation

Tactile information from the left hand projects to the right hemisphere, which must transfer it across the corpus callosum to the language-dominant left hemisphere for naming. A callosal lesion blocks this transfer, producing left-hand anomia without a primary sensory deficit.

Question 21Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which cerebellar region is most associated with the vestibular and truncal ataxia seen in midline lesions?

  1. The cerebellar vermis Correct answer.
  2. The dentate nucleus
  3. The cerebellar hemisphere
  4. The flocculonodular lobe only

Explanation

The cerebellar vermis controls axial and proximal musculature, so midline lesions produce truncal and gait ataxia. Hemispheric lesions instead produce limb dysmetria on the ipsilateral side.

Question 22Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a thalamic stroke reports severe spontaneous pain and hypersensitivity on the contralateral side. This syndrome is best termed:

  1. Wallenberg syndrome
  2. Locked-in syndrome
  3. Dejerine-Roussy syndrome Correct answer.
  4. Brown-Séquard syndrome

Explanation

Dejerine-Roussy syndrome is central post-stroke pain following a thalamic lesion, characterized by contralateral spontaneous pain and hypersensitivity. It reflects altered central pain processing after damage to thalamic sensory nuclei.

Question 23Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which neurotransmitter is most directly depleted in the basal ganglia in Parkinson disease, accounting for the therapeutic effect of levodopa?

  1. Dopamine Correct answer.
  2. Acetylcholine
  3. Serotonin
  4. Glutamate

Explanation

Dopamine depletion in the striatum from nigral neuron loss is the core deficit in Parkinson disease, and levodopa replenishes dopamine precursors. This restores dopaminergic modulation of basal ganglia motor circuits.

Question 24Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a large left hemisphere lesion shows profound comprehension deficits, fluent but meaningless speech, and poor repetition. This pattern localizes most typically to:

  1. The inferior frontal gyrus of the dominant hemisphere
  2. The arcuate fasciculus
  3. The posterior superior temporal gyrus of the dominant hemisphere Correct answer.
  4. The supplementary motor area

Explanation

Wernicke's aphasia reflects damage to the posterior superior temporal gyrus of the language-dominant hemisphere, disrupting acoustic-phonological analysis and comprehension. Output is fluent but devoid of meaning, and repetition is impaired.

Question 25Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a lesion in the right dorsolateral prefrontal cortex is most likely to show which pattern on neuropsychological testing?

  1. Impaired confrontation naming with circumlocutions
  2. Impaired visual field detection in the left hemifield
  3. Impaired verbal list learning with rapid forgetting
  4. Impaired planning and set-shifting with preserved memory Correct answer.

Explanation

Right dorsolateral prefrontal lesions impair executive functions such as planning, working memory, and cognitive flexibility while leaving medial temporal memory relatively intact. The dorsolateral region supports higher-order cognitive control.

Question 26Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient sustains a lesion of the medial longitudinal fasciculus (MLF) on the right side. Which clinical sign is most expected?

  1. Complete ptosis of the right eyelid with a dilated right pupil
  2. Impaired adduction of the left eye with nystagmus of the abducting right eye on rightward gaze Correct answer.
  3. Downward and outward deviation of the right eye at rest
  4. Loss of the corneal reflex on the right side

Explanation

The MLF carries internuclear fibers linking the abducens nucleus to the contralateral oculomotor nucleus, so a right MLF lesion causes an internuclear ophthalmoplegia with failure of adduction of the left eye and abducting nystagmus of the right eye. The pattern is defined by the side of the MLF relative to the adducting eye.

Question 27Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which vascular territory supplies the medial surface of the frontal and parietal lobes, including the leg region of the motor and sensory cortices?

  1. Middle cerebral artery
  2. Anterior choroidal artery
  3. Anterior cerebral artery Correct answer.
  4. Posterior cerebral artery

Explanation

The anterior cerebral artery supplies the medial hemispheric surfaces and the cortical leg area, which is why its occlusion preferentially affects contralateral leg strength and sensation. The other named arteries serve lateral convexity, choroidal, or posterior occipital and temporal regions.

Question 28Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient shows a profound anterograde amnesia after bilateral damage to the medial temporal lobes, yet performs normally on a mirror-tracing task across repeated sessions. Which memory system is best demonstrated as intact?

  1. Working memory for digit span
  2. Semantic memory for word meanings
  3. Procedural skill learning Correct answer.
  4. Episodic memory for everyday events

Explanation

Repeated improvement on mirror tracing without recall of prior practice reflects preserved procedural (nondeclarative) learning supported by the basal ganglia and cerebellum. Medial temporal damage impairs declarative memory while leaving skill learning relatively intact.

Question 29Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which structure is the principal output nucleus of the basal ganglia, projecting inhibitory GABAergic fibers to the thalamus through the direct and indirect pathways?

  1. Globus pallidus interna Correct answer.
  2. Ventral lateral thalamus
  3. Subthalamic nucleus
  4. Caudate nucleus

Explanation

The internal segment of the globus pallidus serves as the major basal ganglia output, tonically inhibiting the thalamus and thereby modulating cortical motor activity. The caudate and subthalamic nucleus are upstream nodes, and the thalamus is the target rather than the source of this output.

Question 30Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a right parietal lesion shows left-sided neglect, but when the examiner holds up a single object on the left, the patient reports it correctly. When two objects are presented simultaneously, one on each side, the patient reports only the right object. What phenomenon is demonstrated?

  1. Balint syndrome
  2. Anton syndrome
  3. Visual extinction Correct answer.
  4. Prosopagnosia

Explanation

Extinction is present when a stimulus is detected in isolation but is missed on the affected side during simultaneous bilateral presentation, reflecting an attentional competition deficit. It is distinct from the complete unawareness of Anton syndrome and the spatial deficits of Balint syndrome.

Question 31Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which cranial nerve provides motor innervation to the muscles of mastication?

  1. Facial nerve
  2. Trigeminal nerve Correct answer.
  3. Hypoglossal nerve
  4. Glossopharyngeal nerve

Explanation

The mandibular division of the trigeminal nerve supplies the muscles of mastication, including the masseter, temporalis, and pterygoids. The other listed nerves serve facial expression, pharyngeal and tongue movement, or taste and sensation.

Question 32Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a lesion in the left inferior frontal gyrus shows effortful, telegraphic speech with relatively preserved comprehension. Which classic syndrome is most consistent with this presentation?

  1. Wernicke aphasia
  2. Transcortical sensory aphasia
  3. Conduction aphasia
  4. Broca aphasia Correct answer.

Explanation

Nonfluent, agrammatic speech with preserved comprehension is the hallmark of Broca aphasia, localized to the left inferior frontal region. Wernicke and transcortical sensory aphasias are fluent with impaired comprehension, and conduction aphasia is fluent with repetition impairment.

Question 33Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which neuropathological feature is the defining microscopic hallmark of multiple sclerosis?

  1. Demyelinating plaques with relative axonal preservation Correct answer.
  2. Neurofibrillary tangles of hyperphosphorylated tau
  3. Lewy bodies containing alpha-synuclein
  4. Spongiform change with prion protein deposition

Explanation

Multiple sclerosis is an inflammatory demyelinating disorder producing plaques of myelin loss with relative preservation of axons in the central nervous system. The other listed features define tauopathies, prion disease, and Lewy body disease respectively.

Question 34Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient who has had a left middle cerebral artery stroke shows fluent speech with impaired repetition and frequent phonemic paraphasias, while comprehension of single words is largely intact. A disconnection of which fiber bundle best explains this pattern?

  1. Fornix
  2. Cingulum
  3. Corpus callosum genu
  4. Arcuate fasciculus Correct answer.

Explanation

Conduction aphasia classically reflects disruption of the arcuate fasciculus connecting Wernicke and Broca regions, impairing repetition while leaving comprehension and fluency relatively spared. The other tracts subserve limbic or interhemispheric functions rather than this perisylvian loop.

Question 35Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient develops progressive cognitive decline with early prominent visual hallucinations, fluctuating attention, and parkinsonism. Which pathological finding is most likely at autopsy?

  1. Amyloid plaques without tangles
  2. Multiple lacunar infarcts
  3. Frontotemporal lobar degeneration with TDP-43
  4. Cortical Lewy bodies Correct answer.

Explanation

Dementia with Lewy bodies is characterized by cortical Lewy bodies containing alpha-synuclein and presents with fluctuating cognition, visual hallucinations, and parkinsonism. The other findings correspond to Alzheimer disease, frontotemporal dementia, and vascular dementia.

Question 36Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which thalamic nucleus relays auditory information to the primary auditory cortex?

  1. Ventral posterior lateral nucleus
  2. Pulvinar
  3. Medial geniculate nucleus Correct answer.
  4. Lateral geniculate nucleus

Explanation

The medial geniculate nucleus of the thalamus is the auditory relay projecting to Heschl gyrus in the temporal lobe. The lateral geniculate relays vision, and the ventral posterior lateral nucleus relays somatosensory input.

Question 37Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a lesion of the right dorsolateral prefrontal cortex is administered a task requiring maintenance and updating of information while ignoring distractors. Which deficit is most likely?

  1. Deficits in visual acuity
  2. Impaired naming of objects on confrontation
  3. Impaired recognition of familiar faces
  4. Poor performance on working memory and set-shifting tasks Correct answer.

Explanation

The dorsolateral prefrontal cortex supports working memory, cognitive flexibility, and set-shifting, so lesions impair tasks requiring maintenance and updating under distraction. Face recognition, naming, and acuity depend on more posterior or sensory systems.

Question 38Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

Which cerebral artery supplies the inferior and medial temporal lobes, including the hippocampus, and its occlusion can produce a profound amnesic syndrome?

  1. Middle cerebral artery
  2. Anterior cerebral artery
  3. Posterior cerebral artery Correct answer.
  4. Basilar artery

Explanation

The posterior cerebral artery supplies the medial temporal and occipital regions, and its occlusion can damage the hippocampus and produce memory impairment. The middle and anterior cerebral arteries serve lateral and medial frontal-parietal territories.

Question 39Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient shows impaired recognition of familiar faces despite intact visual acuity and object recognition. Which region is most implicated?

  1. Fusiform gyrus Correct answer.
  2. Superior temporal sulcus
  3. Postcentral gyrus
  4. Primary visual cortex

Explanation

Prosopagnosia most commonly reflects damage to the fusiform gyrus, particularly on the right, which supports face processing. Intact acuity and object recognition distinguish it from general visual or somatosensory deficits.

Question 40Foundations of Clinical Neuropsychology (brain-behavior relationships, neuroanatomy, neuropathology)

A patient with a lesion of the left optic tract is examined. Which visual field deficit is expected?

  1. Binasal hemianopia
  2. Bitemporal hemianopia
  3. Right homonymous hemianopia Correct answer.
  4. Left homonymous hemianopia

Explanation

The left optic tract carries fibers from the temporal retina of the left eye and the nasal retina of the right eye, which correspond to the right visual field. A lesion therefore produces a right homonymous hemianopia.

Question 41Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

A neuropsychologist wants a brief screening measure of general cognitive status that is widely used and validated in older adults and takes about 10 minutes to administer. Which instrument best fits this purpose?

  1. Wechsler Adult Intelligence Scale (WAIS)
  2. Minnesota Multiphasic Personality Inventory (MMPI)
  3. Trail Making Test Part A
  4. Mini-Mental State Examination (MMSE) Correct answer.

Explanation

The MMSE is a brief, widely used cognitive screening tool designed to quantify general cognitive status in older adults. The WAIS is a comprehensive ability battery, the MMPI is a personality inventory, and Trails A is a single attention task.

Question 42Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

A patient with suspected dementia scores well below the cutoff on the MMSE but has only 6 years of formal education. Which interpretation is most defensible?

  1. Low education can depress MMSE scores, so results should be interpreted cautiously with education-adjusted norms Correct answer.
  2. The MMSE should be discarded entirely for anyone without a college degree
  3. The score is diagnostic of dementia regardless of education
  4. A high score would have been more diagnostic than a low score in this patient

Explanation

MMSE performance is influenced by education, and low educational attainment can produce false-positive screens. Interpretation should use education-adjusted norms and be corroborated with history and other measures.

Question 43Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

Which Wechsler Adult Intelligence Scale index is designed to estimate general intellectual ability from a reduced set of subtests?

  1. Verbal Comprehension Index
  2. Full Scale IQ Correct answer.
  3. Working Memory Index
  4. Processing Speed Index

Explanation

Full Scale IQ is the composite estimate of general intellectual functioning derived from the core subtests across domains. The other indices reflect narrower cognitive domains.

Question 44Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

On the WAIS, a patient shows a Verbal Comprehension Index of 120 and a Processing Speed Index of 78. What is the most appropriate interpretive step?

  1. Report only Full Scale IQ because index discrepancies are unreliable
  2. Conclude that the patient is malingering
  3. Assume the patient has a language disorder
  4. Investigate the discrepancy by examining subtest scatter and behavioral data before drawing conclusions Correct answer.

Explanation

Large index discrepancies reduce the interpretability of Full Scale IQ and warrant examination of subtest patterns, effort, and behavioral observations. The discrepancy itself does not establish a specific diagnosis.

Question 45Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

Which memory measure requires the examinee to recall a list of words after a delay without any cues, assessing free recall?

  1. Recognition trial of a word list
  2. Digit span forward
  3. Semantic fluency
  4. Delayed free recall of a word list Correct answer.

Explanation

Delayed free recall requires unprompted retrieval of previously presented material after an interval. Recognition provides cues, digit span tests attention, and fluency tests generative verbal ability.

Question 46Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

A patient recalls 8 of 15 words on learning trials but only 2 after a delay, while recognition performance remains near normal. This pattern most strongly suggests:

  1. A retrieval deficit with relatively preserved storage Correct answer.
  2. Impaired encoding with preserved storage
  3. Malingering
  4. Global amnesia

Explanation

Preserved recognition with poor free recall indicates that information was stored but is difficult to retrieve without cues, consistent with a retrieval deficit. Poor encoding would also impair recognition.

Question 47Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

Which test is primarily designed to assess visuospatial construction and is commonly used to screen for visuoperceptual deficits?

  1. Judgment of Line Orientation
  2. Rey-Osterrieth Complex Figure copy Correct answer.
  3. Boston Naming Test
  4. Controlled Oral Word Association Test

Explanation

Copying the Rey-Osterrieth Complex Figure requires visuospatial analysis and constructional ability. Line orientation assesses perception without construction, while the other tasks assess language.

Question 48Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

On a confrontation naming test, a patient produces semantically related but incorrect words (e.g., 'dog' for 'cat'). This error type is best described as:

  1. Phonemic paraphasia
  2. Perseveration
  3. Circumlocution
  4. Semantic paraphasia Correct answer.

Explanation

Semantic paraphasias are substitutions with words from the same meaning category. Phonemic errors involve sound substitutions, circumlocution is descriptive talking around the word, and perseveration is repetition of a prior response.

Question 49Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

A patient with a left-hemisphere stroke shows effortful, nonfluent speech with relatively preserved comprehension. Which aphasia syndrome is most consistent with this profile?

  1. Wernicke's aphasia
  2. Broca's aphasia Correct answer.
  3. Anomic aphasia
  4. Conduction aphasia

Explanation

Broca's aphasia is characterized by nonfluent output with relatively spared comprehension, typically from anterior left-hemisphere damage. Wernicke's aphasia features fluent but meaningless speech with poor comprehension.

Question 50Assessment and Diagnosis (test selection, administration, interpretation, differential diagnosis)

Which executive function measure requires the examinee to sort cards by a rule that shifts without warning, assessing cognitive flexibility?

  1. Wisconsin Card Sorting Test Correct answer.
  2. Rey Auditory Verbal Learning Test
  3. Digit Symbol Coding
  4. Grooved Pegboard

Explanation

The Wisconsin Card Sorting Test requires inferring and shifting sorting rules, tapping set-shifting and cognitive flexibility. The other tasks assess processing speed, verbal memory, and motor dexterity.