how to prepare for a neuropsychiatric exam

Upload: eric

Post on 28-Mar-2016

24 views

Category:

Documents


0 download

DESCRIPTION

Neuro

TRANSCRIPT

How to Prepare for a Neuropsychiatric ExamBy Donna PortereHow Contributor 20 Tweet Share Email27Found This HelpfulA neuropsychiatric exam is intended, in part, to measure cognitive and mental functioning, factoring in personality, intelligence, memory, learning ability and physical or mental illness or injury. Neuropsychiatric exams may be recommend following a head injury, to meet certain workers' compensation or medical insurance demands, and in a litigation process, for example. It may also be used in the diagnostic process for a variety of health concerns and provide a functional baseline for future comparison to determine disease or treatment progress. Read on to better prepare for the neuropsychiatric exam process.Instructions1. Select a psychologist or neuropsychiatric that is most qualified for your particular situation. For example, choose a professional experienced with learning disorders if the patient has ADD, or a neuropsychiatrist familiar with organic brain injury when a car wreck is involved. Check credentials to ensure that the professional is well-practiced in neurology, psychology or psychiatry.2. Prepare for a neuropsychiatric exam financially so that there are no surprises. Exams may take several hours over the course of one to several days. Costs for a neuropsychiatric exam often exceed $2,000. Contact your health insurance company, if applicable, to verify coverages.3. Familiarize yourself with the testing process, as it varies for each individual. The test is not invasive, though it may exacerbate some frustration if the patient has cognitive deficits, mental fatigue or illness; this is normal. The neuropsychiatric exam tests, in part, one's memory, intelligence and hand-eye coordination, which may not function as well or be better than expected.4. Discuss any concerns with the examiner or her staff. Discuss any medications or herbal supplements that you take, any physical limitations you have and any factors which may affect the testing schedule. While neuropsychiatric tests are less effective when divided into very short sessions, the examiner can work with you to accommodate some needs.5. Promote optimal exam performance, especially if the neuropsychiatric exam affects vocational and educational pursuits or rehabilitation. Drastic changes are not recommended. Getting a good night's sleep, avoiding late night caffeine and eating a healthy diet are recommended.6. Avoid performance enhancers, including energy drinks, as you prepare for a neuropsychiatric exam. While this may not dramatically affect the core results, the test results will serve the patient best if they take the neuropsychiatric exam under typical lifestyle conditions.

Read more :http://www.ehow.com/how_4457155_prepare-neuropsychiatric-exam.html10 things you should know about Neurological examinationVol.18, No.07, August 20101.Its not uncommon to meet circumstances where a full neurological examination is recommended. But a really thorough exploration of the nervous system takes hours. What can be done in the real world to screen quickly for neurological problems? Quite a lot, if you eliminate the nonessential.2.The key is to let symptoms point out the relevant areas of investigation. Its usually unproductive to test cognition unless the patient reports a problem. Even then, mild self-reported memory loss is unlikely to stem from a neurological condition, but is usually age or stress-related. Its only if daily life is being affected, or if friends and family report a decline, or if the patient seems newly incoherent, that a neurological diagnosis is likely and a cognition test necessary.3.Cognition is the most time-consuming part of neurological examination, and also the most subjective. Both of these problems can be minimized by the use of written questionnaires. Keep some validated depression questionnaires (i.e. Beck) and a few MMSEs or GPCOGs (General Practitioner assessment of cognition) handy.4.Remember, the MMSE can miss some forms of dementia, including Lewy body (relapsing-remitting, sleep disturbance, hallucination, delusion), and frontotemporal dementia (behavioural changes, possible aphasia, few physical signs).5.Its useful before testing cognition to test attention and look for dysphasia. If a patient can count down from 20 to zero, attention issues are excluded. Acute confusional states (in the absence of stroke warning signs) are usually related to drug toxicity (i.e. anticholinergic), metabolic disturbance or infection. Screen for dysphasia by asking the patient to name the outer parts of a complex machine like a computer.6.Many neurological signs are relative. Whats a diminished reflex? The only way to know is to test lots of normal reflexes. It helps to create your own standard package of the quickest and most useful neurological tests (i.e. fundoscopy, straight leg raise, ankle jerk, eye movement, tongue exam, gait) and apply it to all patients with possible neurological symptoms. This practice will quickly build up a mental reference library of whats normal and what isnt.7.Eye movements are important, especially those caused by the third (oculomotor) and sixth (abducens) cranial nerves. In 3rdnerve palsy the affected eye looks outward, causing double vision in straight ahead gaze. It cant move inward past centred, nor up and down. Eyelid may droop and pupil may not respond to light. Any accompanying pain or worsening is likely a sign of urgent problem, i.e. trauma, tumour, aneurysm or hemorrhage.8.In 6thnerve palsy the affected eye cant look outward, and diplopia results if the patient looks to that side. The possible causes are many, but most cases are vascular. Look for visual field defects hemianopia often signifies a stroke, and may have implications for driving safety. Slowness in eye adduction (medial rectus palsy) is suggestive of multiple sclerosis. Jerky eye movement with nystagmus suggests brainstem disease. Inability to look up is predictive of a neurological diagnosis.9.Tongue exam: it should protrude centrally, without fasciculation or wasting. Fasciculation is a possible sign of motor neuron disease, though it can also be due to fatigue, Lyme disease, benzodiazepine withdrawal, or dehydration. But almost any tongue may seem to writhe if the patient knows youre looking at it. Tell them youre examining the palate instead.10.Dont rely on the MRI to replace a neurological exam. This increasing practice generates time-consuming incidentalomas that rarely bear any relation to symptoms.Hand Gestures and their MeaningsIn non-verbal communication, the manner in which we move our hands and fingers say a lot of things, good and bad. These movements of our hands that convey meaning are known as hand gestures. This Buzzle article will speak about some popular hand gestures, and what they mean.Advertisement

"I spin around and give him the finger down low, hoping Monsieur Boutin can't see. St. Clair responds by grinning and giving me the British version, the V-sign with his first two fingers. Monsieur Boutin tuts behind me with good nature. I pay for my meal and take the seat next to St. Clair. "Thanks. I forgot how to flip off the English. I'll use the correct hand gesture next time."" Stephanie Perkins, Anna and the French Kiss

Hand gestures are expressive actions, which we display to communicate our messages. It is a non-verbal mode of communication, wherein we show up different movements of hands and fingers accompanied by various kinds of facial expressions. Hand gestures have a wide range of meanings, and they are also emblematic of different religious and cultural traditions. Every individual movement has a meaning symbolizing various forms of perceptions. We have explained you this in the underlying content.

Popular Hand Gestures

The meaning and significance of hand gestures can differ from one culture to another. Although people and cultures tend to interpret them in their own way, there are still some gestures which hold universal meanings, that is they mean the same everywhere in the world. In this write-up, we have listed some of the most widely used hand gestures.

The "V" Sign

Raise your index and middle fingers, and separate them so as to form the alphabet "V". Show it to people with your palm facing outwards, and you are showing them the sign of victory. This gesture was used widely at the time of WWII, in order to symbolize "V for Victory".

Then, in the 1960s, when the hippie movement gained impetus in the US, the same sign was used to indicate peace.

Interestingly, in some of the East Asian countries, like Japan, China, South Korea, Thailand, and Taiwan, the same gesture is often used (sometimes also with the palm facing inwards) to tell a person that he/she is looking cute, while being photographed.

However, be careful in the UK, Australia, South Africa, Ireland, and New Zealand with regards to whether your palm is facing inwards or outwards. They consider it to be an offensive gesture if your palm faces inwards; mind well, you might be in for some real trouble.

Okay or A-oK

Raise your hand, and touch the tip of your index finger to the tip of your thumb to form a circular shape. Hold the remaining three fingers straight. This gesture signals the word okay, which means that everything is fine.

This gesture is one of the most important diving signals, and is used by divers, while they are under the water, to indicate that everything is fine.

While the gesture indicates the same meaning in the US, in Europe, it signifies an insulting overtone, whereas in Latin America, it is regarded as an obscene action.

Stop or Stay

Hold your hand upright, with the back of your palm facing inwards. This hand gesture indicates that you want someone to stop or stay wherever he/she is.

In the United States, 'stop' is depicted by showing the palm with all the fingers pointing upwards. This hand gesture also has other connotations like 'stay away' or 'talk to the hand'.

In Malaysia raising the hand is explicitly done to summon waiters, or a person for conveying a message.

In Hinduism, Buddhism, and Jainism, this gesture (when done with a right hand) is known as the Abhayamudra, and symbolizes safety and reassurance.

Pointing Fingers

Pointing fingers normally mean indicating some person or some object. Extending the index finger to point something is probably the most common hand gesture. You will also find babies pointing their fingers at objects they want.

People also believe that pointing fingers could mean placing a blame on someone.

Western cultures consider finger-pointing to be one of the most obscene hand gestures. Pointing the middle finger towards someone is a symbol of sexual disgrace.

Finger Curling

Extending the index finger and curling its tip means beckoning someone. When you call someone or try to seek attention, you usually use this gesture.

In the US, it is generally used to summon waiters. However, sometimes it is also regarded as a seductive gesture.

In Japan, this gesture is considered to be extremely rude, while in Singapore, it indicates death.

Curling the index finger is popularly known as the 'dog call'.

Thumbs Up/Down

The thumb raised upwards, with the other fingers curled inwards is universally acknowledged as a gesture indicating "well done" or "things are great".

In Western cultures, it is a symbol of optimism. However, in the Middle East, Latin America, Greece, Russia, and West Africa, the "thumbs up" gesture signifies an insult.

Thumbs-down (thumb pointing towards the ground), on the other hand, signifies non-acceptance, failure, and rejection.

Crossed Fingers

This is one of the most popular hand gestures, used almost all over the world. When we cross the middle finger of either of our hands over the index finger of the same hand, this sign is formed.

Crossing fingers signifies anticipation and good luck. It also symbolizes fortune, hope, and expectation of something.

We keep our fingers crossed when we hope something good to happen, or even to nullify a promise.

In Christianity, crossing fingers signifies a plea to God for protection against evil. However, in some ancient folkloric traditions, such symbols represented 'lies'.

I hope you have found the hand gestures interesting enough. However, always be sure of their underlying meaning before communicating anything through these forms of non-verbal communication.Read more at Buzzle:http://www.buzzle.com/articles/hand-gestures-and-their-meanings.htmlV FOR VICTORYWith the palm facing forward this gesture is seen as positive and meaning victory. It was popularised by Winston Churchill and other Allied leaders during WWII. During the 1960s and early 1970s it became a symbolic gesture of the alternative and anti war hippie movement and became to mean peace. It probably assumed this context because the anti Vietnam war movement believed that peace would be victorious. It was very common to make the gesture and say peace at the same time. As time passes and the 1960s are less relevant to people it is assuming its original meaning again.A OK PERFECTIts believed this gesture was popularised by divers because the thumbs up / thumbs down gesture meant go up or go down. Myth has it that the fingers form the O and K of OK. Again, this is probably just coincidence. The truth is that this gesture has been used for centuries by gem stone dealers. The gem would be placed between the forefinger and the thumb, held up to the light and moved back and forth to change the angle and check for flaws. We still use this motion today. It does not mean Your Anus unless the extended fingers are inline with the circular forefinger.THUMBS UP THATS GREATAs a gesture its one of the most common. Several references believe that is was used by Roman rulers at the Coliseum and other arenas to indicate whether a gladiator lived or died. This has recently been debunked as increasing evidence indicates that most gladiatorial battles did not end in death. It was popularised by American and Chinese pilots during WWII. In China this gesture means one or number one. Whatever the origin, it is generally considered a positive gesture. Dont jab it forward as this has a completely different connotation.FINGERS CROSSEDGenerally this means wishing for good luck or fortune. Another interpretation could be seen as heres hoping. The gesture probably has pagan / Christian origins where the gesture was believed to ward off evil. As such, folklore believes that crossing the fingers when telling a lie somehow offsets the evil of the lie. Some historians believe that crossing your fingers is a hidden or secret way of making the Christian sign of the cross a sure-fire way of defeating demons. As a gesture it is has both positive and negative symbolism. Luck or lies.THUMBS DOWNThere is no need to discuss origins as this is clearly the opposite of the thumbs up gesture and is one of the few hand signals to have an opposite. It generally indicates that something is bad or not accepted. It received the thumbs down has entered the English language as an expression to indicate that something has failed. Its use is nowhere near as common as the thumbs up gesture and is seen as a somewhat rude, callous and arrogant way of indicating failure or disapproval. It is usually made as a single downwards jab of the thumb.STOP THATS ENOUGHMothers and teachers are common users this hand gesture. In general it is used to admonish or warn a single individual. It is a variation of the you gesture. If translated into language it would say. Stop whatever you are doing and pay attention to me. I am your superior and I am warning you! Classed as a silent parent to child gesture, it is completely unacceptable in a professional environment where it will be interpreted as both rude and domineering. Some psychologists believe that it is a metaphor for the cane or whip.JUST STOP AND CALM DOWNTo the right and below are two very similar hand gestures that have subtly different meanings. The one to the right has the hand tilted forward implying control. It is an authoritarian signal that states Stop Enough. The forward tilted fingers are pushing down indicating that the person for whom the gesture is intended should sit or settle. The tilting of the hand indicates that the person doing the gesture feels confident and in control of the situation. It is not as defensive as it seems and is actually pushing down the person for which it is intended.STAY AWAY TALK TO THE HANDThis gesture is a metaphoric wall. The fingers and palm are vertical and indicate a barrier. In most cases it is clearly a defensive gesture that, if translated into language, would state: Stop! I am uncomfortable with this communication. Stay away. If done in a casual or off-hand manner it is the Talk to the Hand gesture and suggests that the user is completely uninterested in the communication. This second, and rude, interpretation is quite rare and implies both the confident superiority of the user and their disregard for the importance of the recipient.COME ON HURRY UPPeople actually look at their wrist in this way even when theyre not wearing a watch. Generally its a sign of impatience or irritation. When its done subconsciously it indicates that the person doing it feels that it is time for the communication to end. Where it is done consciously it is a subtle signal that the communication needs to move on or end. This gesture is rarely missed by people for whom it is intended. Certain cultures, particularly those from the Middle East will perceive this as extremely rude as their culture believes that once a communication has started it must take its time.YOU!According to most parents in the West pointing at people is rude. It falls into the same category as dont stare. The use of this hand gesture implies that a dominant- to-subordinate relationship is taking place. It is a brave or desperate employee that points their finger at a superior in this manner. In general, this is an aggressive signal that if translated into language would state: You! Im not happy. Youd better pay very close attention because this is very personal to you. As humans we dont like being pointed at. This gesture singles people out from the safe huddle of the crowd.National Board ReviewPractice question 1Which of the following isTRUEregarding a lesion of the right vestibular nuclei?

the left PPRF is more active than the right PPRF

the fast phase of nystagmus is to the right

stumbling to the left

the left lateral vestibulospinal tract is more active than the right

slow phase of nystagmus to the left

National Board ReviewPractice question 2Which of the following statements isFALSE?

weakness is a common sign of cerebellar lesions

Golgi cells in the cerebellum lie in the granule cell layer and are inhibitory

cells in the posterior parietal cortex send information to the lateral zone of the cerebellum (via the pontine grey)

basket cells in the cerebellum inhibit Purkinje cell firing

the fastigial nucleus receives input from Purkinje cells in the medial zone of the cerebellum

National Board ReviewPractice question 3Which of the following statements isTRUE?

spinal nerve C7 exits above vertebra C7

radiculopathy of spinal nerve C6 results in pain from dorsal aspect of the thumb and index finger

radiculopathy of spinal nerve C7 results in pain from the middle finger

spinal nerve C8 exits below vertebra C7

all of the above are true

National Board ReviewPractice question 4Which of the following statements isTRUE?

a complete transection of the spinal cord at C2 never results in urinary retention

a complete transection of the spinal cord at S2-S4 never results in urinary retention

a large lesion of the cauda equina will result in a spastic bladder, both acutely and chronically

a complete transection of the spinal cord at C2 results in a spastic bladder immediately after the injury (during spinal shock)

a bilateral lesion at C1 will result in cessation of breathing

National Board ReviewPractice question 5Which of the following statements is/areTRUEregarding the shaded area in the drawing below? There is only one correct response. The below are all components of one cranial nerve?

lesion results in a loss of pain and temperature from the ipsilateral "ear"

axon conveys taste information from the posterior one-third of tongue

axon arises from the superior ganglion IX

stimulation of the ipsilateral (to the lesion) side of the pharynx will result a consensual but NOT a direct gag reflex

axon is one component of CN X

National Board ReviewPractice question 6Which statement isTRUEregarding the shaded areas below?

lesion results in loss of pain and temperature from spinal levels T3 and below on the contralateral (right) side

cells project directly to the ipsilateral (left) sphincter of the pupil

axons arise from the ipsilateral (left) dorsal root ganglia T7 and below

lesion results in spasticity of the ipsilateral (left) intrinsic muscles of the hand

two of the above are true

National Board ReviewPractice question 7Which statement isTRUEregarding the shaded areas below? There is only one correct response.

axons carry unconscious proprioception information from the contralateral (right) big toe

cells provide ipsilateral (left) preganglionic parasympathetic input to the superior cervical ganglion

axons arise from the ipsilateral (left) cerebral cortex

axons terminate in the ipsilateral (left) dorsal horn at spinal level C7

cells project to biceps muscle

National Board ReviewPractice question 8Which statement isTRUEregarding the shaded areas below? There is only one correct response.

axons terminate in the lateral zone of the cerebellum

axons terminate in the ventral posteromedial nucleus

lesion results in deficit in first or pricking pain from the sole of the right foot

lesion results in loss of unconscious proprio. from spinal segment C6 on left side

lesion results in deficit in vibrational sense from the left arm

National Board ReviewPractice question 9Which statement isTRUEregarding the shaded areas below? All parts of the response must be correct. There is only one correct response.NOTE THAT THE ROOTLETS OF C.N. VI ARE NOT DAMAGED

cells could project to the medial zone of the contralateral (right) cerebellum

cells project to the ipsilateral (left) abducens nucleus

lesion of pathway results in a Babinski sign from the left big toe

axons terminate in the left hypoglossal nucleus

cells send axons into the intermediate nerve of CN VII

National Board ReviewPractice question 10Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

cells receive input from the fastigial nucleus

lesion results in a dilated pupil in the left eye

lesion results in loss of pain and temperature from the right side of the face

lesion results in a left nystagmus

lesion results in loss of consensual gag reflex upon stimulation of the right side of the pharynx

National Board ReviewPractice question 11A strange virus has attacked all of the shaded areas below. Which statement (remember that all parts of the statement must be true) is TRUE regarding the neurological deficits that would be present following lesions of these shaded structures? There might be deficits that are not included in the responses. IF THE LESION INVOLVES NUCLEUS SOLITARIUS, ASSUME THAT ONLY THE ROSTRAL PORTION OF THE NUCLEUS IS INVOLVED. There is only one correct response.

a left Babinski

loss of salivation from the right submandibular gland

deviation of the tongue to the left upon protrusion

bilateral loss of pain and temperature from the face, tongue, and pharynx

loss of taste from the left side of the tongue

National Board ReviewPractice question 12Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

lesion results in deafness in the left ear

pathway terminates in the ventral (lower) part of the left motor VII, and axons arise from the right abducens nucleus

cells contain dopamine, and pathway terminates in the right VPL

lesion results in a loss of taste from the left side of the tongue, and deviation of the uvula to the right

lesion results in inability to turn the left eye medially past the midline upon attempted horizontal gaze to the right

National Board ReviewPractice question 13Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

axons innervate the right orbicularis oculi muscle

lesion results in loss of the direct gag reflex upon stimulation of the right side of the pharynx

lesion results in loss of direct corneal reflex upon stimulation of the cornea of the left eye

axons enter brain stem and enter right TTT

lesion results in deviation of the jaw to the right upon jaw opening

National Board ReviewPractice question 14Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

axons terminate in the left oculomotor nucleus, and cells project to the right VPM

cells project to the right side of the cerebellum as climbing fibers

pathway arises from cells in the right dorsal horn

pathway terminates in the left superior cervical ganglion, and cells project to the muscles of mastication on the left

two of the above statements are true

National Board ReviewPractice question 15Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

lesion results in inability to turn the left eye laterally upon attempted gaze to the left

axons arise from cells in the dentate nucleus, but not the interpositus nucleus

lesion results in incoordination of the left arm and leg

lesion results in loss of 2 point discrimination from the left side of the face

axons arise from the right nucleus solitarius (rostral pole)

National Board ReviewPractice question 16Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

lesion results in right hemiplegia, and axons arise from the left dorsal horn of the spinal cord

lesion results in loss of the direct gag reflex upon stimulation of the right side of the pharynx

lesion results in a dilated pupil in the left eye

cells project to the right and left nucleus ambiguus

axons are central processes of delta fibers whose cell bodies lie in dorsal root ganglia

National Board ReviewPractice question 17Which statement isTRUEregarding the shaded areas below? There might be deficits that are not included in the responses. There is only one correct response.

axons arise from the inferior colliculus

cells project to the contralateral (right) spinal cord and travel in the lateral funiculus close to the LCST

lesion results in weakness of the contralateral (right) facial muscles below the eye

lesion results in rigidity

all of the above are true

National Board ReviewPractice question 18Which of the following statements/associations isINCORRECT?

stimulation of structure labeledCexcites deep cerebellar cells

the effect ofBontoDis excitatory

structure labeledEinhibits deep cerebellar nuclei

structure labeledDis a Golgi cell

structure labeledAexcites Purkinje cells

National Board ReviewPractice question 19Which of the following statements/associations isINCORRECT?

ZoneD: lesion involving Purkinje cells on the right results in left nystagmus

ZoneB: updating, interpositus

ZoneC: motor planning; dentate

ZoneD: vestibular nerve and vestibular nuclei input

ZoneA: fastigial nucleus, unconscious proprioception

National Board ReviewPractice question 20Which of the following statements isFALSE?

the caudate, putamen and globus pallidus are parts of the basal ganglia

the substantia nigra and subthalamic nucleus are often included in the basal ganglia because of their close functional involvement

the caudate and putamen make up the striatum, while the putamen and globus pallidus make up the lenticular nucleus

the basal ganglia exert control of movement via direct connections to the spinal cord

the ansa lenticularis and the lenticular fasciculus are both output pathways of the basal ganglia

National Board ReviewPractice question 21Which of the following statements isFALSE?

cortical cells projecting to the striatum are excitatory

striatal interneurons (cells whose axons do not leave the striatum) are cholinergic and excitatory in the direct pathway

striatal projections to the globus pallidus are inhibitory

cells in both segments of the globus pallidus are inhibitory

cells in the subthalamic nucleus excite cells in the inner segment of the globus pallidus

National Board ReviewPractice question 22Which of the following statements isFALSE?

in primary motor cortex (MI) the representation of the face is located medial to that of the upper limb

the supplementary motor area (SMA) and premotor cortex (PM) are both in Brodmann's area 6

the SMA and PM are both involved in premotor planning, and are at a high hierarchical level in the motor system

the MI is involved in the execution of a movement and is at a relatively low level of the motor system in spite of being in the cortex

pyramidal tract neurons fire before the muscles contract in an intended movement

National Board ReviewPractice question 23Which of the following statements isFALSEregarding the shaded areas in the figure below?

areaAcontains the premotor area (PM) and some of the supplementary motor area (SMA), while areaBis MI

cells in the areaAbecome active when thinking of a complex motor task, even when the task is not actually performed

neurons in areasAandBfire prior to a given movement, but cells inAfire before cells inBfor a given movement

lesions inAresult in apraxias, while lesions inBresult in contralateral paresis and upper motor neuron signs

cells in areasAandBcode for the force of a movement

National Board ReviewPractice question 24Which of the following statements isTRUEregarding the shaded area in the figure below?

a lesion here will result in a weakened left upper limb

a lesion here will result in a weakened tongue on the right

a lesion here can result from an occlusion of the posterior cerebral artery

the lesion is in area 6

this area receives input from VA/VL

National Board ReviewPractice question 25Which of the following statements regarding the labeled structures in the diagram below isFALSE?

the greatest amount of refraction is done at this interface(A)

this is the anterior chamber(B); it contains aqueous humor produced by the ciliary body

parasympathetic innervation of this muscle(C)results in pupillary constriction

this is the posterior chamber(D); it contains vitreous humor

parasympathetic innervation of this muscle(E)results in accommodation

National Board ReviewPractice question 26Which of the following statements isFALSE?

application of a noradrenergic agonist at the iris results in pupillary dilation

contraction of the ciliary muscle results in an increase in the refractive power of the lens

in myopia, the eye is too short for its refractive power

one advantage of a constricted pupil is increased depth of field

in hyperopia, accommodation is needed to bring distant images into focus

National Board ReviewPractice question 27Which of the following statements about photoreceptors isFALSE?

the maintenance and disposal of discs in the outer segments is performed by cells in the retinal pigment epithelium

there are more rods than cones in the retina, but cones predominate at the fovea

neural convergence contributes to greater sensitivity in the rod system at the expense of acuity

all rods contain rhodopsin, while each cone contains one of three different photopigments

the central retinal artery supplies all layers of the retina

National Board ReviewPractice question 28Which of the following isTRUEregarding the diagram below of a normal retina?

light approaches the photoreceptors from the bottom of the figure

Bis a bipolar cell

the outer segment of cellCis supplied by the central retinal artery

the part of the axon that is shown for cellAis myelinated

two of the above statements are correct

National Board ReviewPractice question 29Which of the following statements regarding the labeled structures in the diagram below isTRUE?

a complete lesion of the cortical area marked byAresults in left homonymous hemianopsia

cells marked byBare innervated by axons that travel in Meyers loop

the receptive field of a cell located atCis closer to the foveal representation than the receptive field of a cell located atE

cells atDhave receptive fields in the contralateral lower visual quadrant

two answers are true

National Board ReviewPractice question 30Which of the following statements is/areFALSE?

glaucoma does not affect visual acuity until the disease becomes end-stage

the etiology of age-related macular degeneration is progressive loss of function of retinal pigment epithelial cells, resulting in loss of ganglion cells and optic nerve cupping

in early stages, neither of the following diseases have significant warning symptoms: age-related macular degeneration, and glaucoma

even if a patient suspected of having a pituitary abnormality has normal visual acuity and a normal pupillary light reflex test, it is stillNOTsafe to reassure the patient that there is no lesion compressing the optic chiasm

patients with stroke in the visual cortex usually do not suffer a marked loss of visual acuity

National Board ReviewPractice question 31Which of the following statements isFALSE?

the middle ear is normally filled with air

the major function of the Eustachian tube is to maintain a pressure equilibrium across the tympanic membrane

the malleus is attached directly to the tympanic membrane and articulates with the incus

the middle ear muscles are vestigial structures that play no role in human hearing

the ossicles of the middle ear are essential for efficient transmission of sound from air to the inner ear

National Board ReviewPractice question 32Which of the following statements isFALSEabout the middle ear?

if sound traveling in air hits the fluid of the inner ear, about 99.9% of the sound energy will be reflected back into the air

impedance matching refers to the contraction of middle ear muscles in response to sound

the main function of the middle ear is to transfer sound energy from air to cochlear fluid

the force acting on the tympanic membrane is concentrated into the small area of the footplate of the stapes

the malleus is longer than the incus; this can help overcome the mismatch in the impedance of air and fluid

National Board ReviewPractice question 33Which of the following statements isFALSEregarding the inner ear?

the inner ear consists of osseous and membranous labyrinths

the membranous labyrinth is filled with endolymph

the round window opens into the scala tympani

the organ of Corti lies in the scala media

the helicotrema is a connection between the scala tympani and the scala media

National Board ReviewPractice question 34Which of the following statements isFALSE?

the medial superior olive detects interaural time differences

the lateral superior olive detects interaural intensity differences

axons in the auditory portion of CN VIII terminate in the inferior colliculus

at high frequencies, we depend upon interaural intensity differences for sound localization in the horizontal plane

at low frequencies, we depend upon interaural time differences for sound localization in the horizontal plane

National Board ReviewPractice question 35Which of the following statements isFALSE?

a rupture of the tympanic membrane will result in conductive hearing loss

malfunction of the Eustachian tube results in a conductive hearing loss

low frequencies are represented along the base of the cochlea

otitus media results in a conductive hearing loss

hearing loss in children may result in speech and language impairments

National Board ReviewPractice question 36Which of the following isTRUEregarding the audiogram shown below?

hearing loss doesNOTinvolve frequencies associated with conversational speech

thresholds to air conducted stimuli are normal

there are abnormal thresholds to bone conducted sound stimuli

data show a conductive hearing loss

the data reveal presbycusis

National Board ReviewPractice question 37Which of the following pairings isFALSE?

area 3a --- conscious proprioception

area 3b --- heavy input from VPL

lesion of SI --- contralateral astereognosis

area 2 --- heavy input from VPL

lesion of area 1 --- impaired texture discrimination

National Board ReviewPractice question 38Which of the following structures isINCORRECTLYpaired with all or part of its blood supply?

anterior limb of internal capsule--medial striates

dorsal part of the posterior limb of internal capsule--anterior choroidal

visual cortex--posterior cerebral

Broca's motor speech area--middle cerebral

hippocampus--posterior cerebral

National Board ReviewPractice question 39A lesion in the frontal association cortex on the left would most likely result in:

contralateral homonymous hemianopsia

intention tremor

receptive aphasia

expressive aphasia

contralateral hemianesthesia

National Board ReviewPractice question 40Antidiuretic hormone (ADH) is produced by cells in the:

anterior pituitary

thalamus

supraoptic region of the hypothalamus

tuberal region of the hypothalamus

mammillary region of the hypothalamus

National Board ReviewPractice question 41A lesion of the ventromedial nucleus of the hypothalamus (which lies in the tuberal level) has been shown (in experimental animals) to produce:

diabetes insipidus

voracious appetite (hyperphagia) and rage

loss of appetite (anorexia)

memory loss

lack of oxytocin production

National Board ReviewPractice question 42Bilateral lesions of the ventral portion of the temporal lobes involving the hippocampal formation would most likely result in which of the following signs and symptoms?

little or no trouble comprehending speech, but great difficulty speaking

trouble understanding speech, and also trouble with verbal expression

loss of the bothersome nature of pain, without loss of pain sensitivity or discrimination

a deficit of long term memory

recent memory deficit

National Board ReviewPractice question 43An embolus enters the left middle cerebral artery and lodges immediately, blocking all of its branches. What would you expect to see in a set of C-T scans?

a lesion destroying cortex over the entire medial extent of the left hemisphere, but not extending to white matter

a lesion that includes the medial part of the occipital lobe

a lesion that destroys the entire extent of the pre- and postcentral gyri including the portions that wrap around onto the medial aspect of the hemisphere

destruction of cortex that includes both Broca's and Wernicke's speech areas

all of the above

National Board ReviewPractice question 44Following a blockage of the anterior cerebral artery to the left cortex, which of the following functionswould be preserved?

the ability to speak

the ability to understand speech

the ability to move the right toes

the ability to move the right fingers

three of the above

National Board ReviewPractice question 45The mammillary bodies:

are damaged in Korsakoffs syndrome

receive input from the fornix

project to the medial dorsal nucleus of the thalamus

are involved in temperature regulation

two of the above statements are true of the mammillary bodies

National Board ReviewPractice question 46Which of the following statements isFALSEregarding the paraventricular nucleus of the hypothalamus?

cells are involved in the regulation of circadian rhythm

cells are involved in the production of oxytocin

cells are involved in the regulation of H2O balance

cells project to the posterior lobe of the pituitary

cells release CRF

National Board ReviewPractice question 47Which of the following characteristics areTRUEregarding a highly synchronized EEG??

occurs during REM sleep

low amplitude

25 Hz

occurs in deep (delta) sleep

is happening now as you study

National Board ReviewPractice question 48Which of the following statements isTRUE?

patients with prosopagnosia do not know that they are looking at a face

disorders of reading are called dysphagia

Brocas aphasia can be accompanied by hemiplegia

agnosias are more common than aphasias

awkward articulation is an essential characteristic of fluent aphasia (Wernickes)

National Board ReviewPractice question 49Which of the following statements isTRUEregarding apraxias?

lesion in ideomotor apraxia involves temporal parietal junction

patient with ideomotor apraxia will use the wrong object to perform correct action

apraxias are always associate with hemiparesis

patient with ideational apraxia is unable to use correct motor sequence

lesion in ideomotor apraxia involves parietal lobe and supplementary motor area

National Board ReviewPractice question 50Which of the following statements isFALSE?

in coma the patient cannot be aroused from unconsciousness

in sleep apnea there is excessive daytime sleep

in narcolepsy the patient goes directly into REM sleep

the most common cause of comas are metabolic derangements

in the persistent vegetative state, the patient appears alert and has meaningful cognitive responses

National Board ReviewPractice question 51Which of the following statements isTRUE?

corticobulbar fibers course within the anterior limb of the internal capsule

corticospinal fibers course within the genu of the internal capsule

a lesion of the optic tract results in a bitemporal hemianopsia

the superior and inferior longitudinal fasciculi are association fiber bundles of the cerebral cortex

blockage of the middle cerebral artery results in little cortical damage due to the collateral circulation of the Circle of Willis

National Board ReviewPractice question 52Which of the following statements isTRUEregarding the mesocorticolimbic dopamine system?

arises from the ventral tegmental area and innervates limbic structures and visual cortex

is involved in reinforcement and reward

arises from the substantia nigra and innervates limbic and prefrontal cortical region

arises from the raphe nucleus and innervates the limbic cortical region

arises from cells which lie ventral to the substantia nigra

National Board ReviewPractice question 53The human circadian pacemaker is located in the:

pituitary

thalamus

suprachiasmatic nucleus

pons

spinal cord

National Board ReviewPractice question 54Which of the following statements isFALSEregarding serotonin?

cell bodies lie in the substantia nigra and innervate the cortex and limbic system.

is increased by MAOIs and tricyclics.

is likely decreased in impulsive individuals

is kept in synaptic cleft longer by Prozac

produced in raphe nuclei

National Board ReviewPractice question 55The severe short term (explicit) memory deficits characteristic of Alzheimers disease would most likely be due to:

plaques and tangles in hippocampal regions

plaques and tangles in basal ganglia

degeneration of ventral tegmental area

loss of norepinephrine in the amygdala

loss of epinephrine producing cells in the adrenal cortex

National Board ReviewPractice question 56Which of the following associations isINCORRECTregarding the figure below?

lesion atAwould result in complete blindness in the LEFT eye

lesion atBwould result in bitemporal hemianopsia

lesion atCwould result in unilateral nasal hemianopsia on the left side

lesion atDwould result in complete blindness in the LEFT eye

lesion atEwould result in RIGHT upper quadrant hemianopsia

HuntDiseaseFAQS

Tests Commonly Used -Neuropsychological Examination

Home

Index

GENETIC TESTING INFO

EARLY HD

MEDICATIONS~DRUGS

Movement Disorder Medicines

Anxiety-Antidepressant Medications

Antidepressant Adverse Effects

Warnings~Adolescents Under 25

Sertraline ~Zoloft

SSRI's

Anti-psychotic Medications

Prozac, Luvox, Paxil, Zoloft & Celexa

Olanzipine & Risperidone and blood tests

Creatine

Drugs~General

Cutting Prescriptions

Sites That Help the Medicine Go Down

Vitamins & Minerals

SYMPTOMS

Why Certain Symptoms Occur In HD

Tests Commonly Used -Neuropsychological Examination

Symptom vs Medication

HD-Disability

HD~Communications

Speech & Swallowing Difficulties~Lynn Rhodes

Swallowing Problem Warning Signs

Swallowing Tests

Nutrition and HD~Anna Gaba (Recipes)

HD & Diet~HSA Fact Sheet 7

HD~Swallowing & Nutrition

Weight Gain

Taste

5 Levels Difficulty In Swallowing

Feeding Tube~Advanced Stages of HD

Feeding Tube~Jean Miller

One more word on feeding tubes

PEG Tubes and baby foods

Feeding Tubes-More Info

Dehydration

HD~Chorea

HD~Falling/Safety Issues

HD~Cognitive/Decision Making/Impulsivity

Cognitive-Short Tips

HD-Apathy

HD~Perceptual/Unawareness/Attention

Denial of HD

HD~Irritability/Temper Outbursts

Managing behavioral problems

HD~Depression

Depression - Treatment Resistant Patient

HD~Anxiety/Apathy/Irritability

HD~Mania, Obsessive Disorders

HD~Hallucinations & Psychosis

HD~Rigidity, Spasticity, and Dystonia

HD~Seizure/Convulsion/Epilepsy/Tics

Nails

MISCELLANEOUS

Adaptive Products

HD~Suicide

Teen Suicide~Let's Talk Facts

HD~Incontinence

Stress Explained-Easy/Fun Format

How To Help Someone Chronically Ill

Legal Planning for Incapacity

Out-of-Home Care Options FAQ

Preparing for Emergencies

Brain Source:http://www.brainsource.com/nptests.htmTests Commonly Used In a Neuropsychological ExaminationNeuropsychologists use scientifically validated objective tests to evaluate brain functions. While neurological examination and CT, MRI, EEG, and PET scans look at the structural, physical, and metabolic condition of the brain, the neuropsychological examination is the only way to formally assess brainfunction. Neuropsychological tests cover the range of mental processes from simple motor performance to complex reasoning and problem solving. In almost all objective tests,quantitativeresults are compared with some normative standard, including data from groups of non-brain injured persons and groups of persons with various kinds of brain injury. If the norms are based on age and educational achievement, valid comparison can be made between an individual's performance and that of persons in known diagnostic categories as well as persons who do not have a diagnosis of brain injury.Qualitativeassessment of neuropsychological tests provides a look at theprocessesan individual may use in producing the quantitative scores. Analysis of the pattern of performance among a large number of tests is key to a neuropsychological assessment. Thus, the selection of tests used in a neuropsychological test battery should sample a wide range of functional domains. The combination of objective scores, behavioral process observations, and consistency in emerging pattern of results, along with comprehensive clinical history, constitute the art and science of neuropsychological assessment. Most neuropsychologists select a unique combination of tests focused on the diagnostic and examination questions of interest for an individual.The following alphabetical listing includes some of the more frequently used tests used in a neuropsychological assessment. Brief descriptions indicate what each test is intended to measure. Some tests are included here that are not, strictly speaking, neuropsychological tests, but that may be used in a comprehensive examination. In order to keep test content and applications confidential to preserve their clinical usefulness, this information is restricted to general comments.Test NamePurpose of Test

Ammons Quick TestThis test has been used for many years to help assess premorbid intelligence. It is a passive response picture-vocabulary test.

Aphasia Tests (various)Several aphasia and language tests examine level of competency in receptive and expressive language skills. (e.g., Reitan-Indiana Aphasia Screening Test)

Beck Depression or Anxiety ScalesThese scales provide quick assessment of subjective experience of symptoms related to depression or anxiety.

Bender Visual Motor Gestalt TestThis test evaluates visual-perceptual and visual-motor functioning, yielding possible signs of brain dysfunction, emotional problems, and developmental maturity.

Boston Diagnostic Aphasia ExaminationBroad diagnosis of language impairment in adults.

Boston Naming TestAssessing the ability to name pictures of objects through spontaneous responses and need for various types of cueing. Inferences can be drawn regarding language facility and possible localization of cerebral damage.

California Verbal Learning TestThis procedure examines several aspects of verbal learning, organization, and memory. Forms for adults and children.

Cognitive Symptom ChecklistsSelf-evaluation of areas of cognitive impairment for adolescents and adults.

Continuous Performance TestTests that require intense attention to a visual-motor task are used in assessing sustained attention and freedom from distractibility. (e.g., Vigil; Connors Continuous Performance Test)

Controlled Oral Word Association TestDifferent forms of this procedure exist. Most frequently used for assessing verbal fluency and the ease with which a person can think of words that begin with a specific letter.

Cognistat (The Neurobehavioral Cognitive Status Examination)This screening test examines language, memory, arithmetic, attention, judgment, and reasoning. It is typically used in screening individuals who cannot tolerate more complicated or lengthier neuropsychological tests.

d2 Test of AttentionThis procedure measures selective attention and mental concentration.

Delis-Kaplan Executive Function SystemAssesses key areas of executive function (problem-solving, thinking flexibility, fluency, planning, deductive reasoning) in both spatial and verbal modalities, normed for ages 8-89.

Dementia Rating ScaleProvides measurement of attention, initiation, construction, conceptualization, and memory to assess cognitive status in older adults with cortical impairment.

Digit Vigilance TestA commonly used test of attention, alertness, and mental processing capacity using a rapid visual tracking task.

Figural Fluency TestDifferent forms of this procedure exist, evaluating nonverbal mental flexibility. Often compared with tests of verbal fluency.

Finger Tapping (Oscillation) TestThis procedure measures motor speed. By examining performance on both sides of the body, inferences may be drawn regarding possible lateral brain damage.

Grooved PegboardThis procedure measures performance speed in a fine motor task. By examining both sides of the body, inferences may be drawn regarding possible lateral brain damage.

Halstead Category TestThis test measures concept learning. It examines flexibility of thinking and openness to learning. It is considered a good measure of overall brain function. Various forms of this test exist.

Halstead-Reitan Neuropsychological BatteryA set of tests that examines language, attention, motor speed, abstract thinking, memory, and spatial reasoning is often used to produce an overall assessment of brain function. Some neuropsychologists use some or all of the original set of tests in this battery.

Hooper Visual Organization TestThis procedure examines ability to visually integrate information into whole perceptions. It is a sensitive measure of moderate to severe brain injury.

Kaplan Baycrest Neurocognitive AssessmentAssesses cognitive abilities in adults, including attention, memory, verbal fluency, spatial processing, and reasoning/conceptual shifting.

Kaufman Functional Academic Skills TestA brief, individually administered test designed to determine performance in reading and mathematics as applied to daily life situations.

Kaufman Short Neuropsychological AssessmentMeasures broad cognitive functions in adolescents and adults with mental retardation or dementia.

Luria-Nebraska Neuropsychological BatteryThis is a set of several tests designed to cover a broad range of functional domains and to provide a pattern analyses of strengths and weakness across areas of brain function. The tests reflect a quantitative model of A. R. Luria's qualitative assessment scheme.

MMPI-2 (Minnesota Multiphasic Personality Inventory)This well-known and well-respected personality assessment is often used to accompany neuropsychological tests to assess personality and emotional status that might lend understanding to reactions to neurofunctional impairment.

Memory Assessment ScalesThis is a comprehensive battery of tests assessing short-term, verbal, and visual memory.

MicroCogThis computerized assessment measures nine functional cognitive areas sensitive to brain injury

Millon Clinical Multiaxial InventoryA self-report assessment of personality disorders and clinical syndromes. This is sometimes used as an adjunct instrument in comprehensive neuropsychological assessment.

Mooney Problem ChecklistThis instrument helps individuals express their personal problems. It covers health and physical development; home and family; morals and religion; courtship, sex, and marriage.

Multilingual Aphasia ExaminationThis set of subtests provides comprehensive assessment of a wide range of language disorders.

North American Reading TestThis reading test is often used to help assess premorbid intelligence, for comparison with current intelligence as measured by more comprehensive tests.

Quick Neurological Screening TestThis is a rapid assessment to identify possible neurological signs, primarily in motor, sensory, and perceptual areas.

Paced Auditory Serial Attention TestTests for attention deficits including concentration, speed of processing, mental calculation, and mental tracking. Sensitive for diagnosing cognitive impairment in individuals 16 and up.

Paulhus Deception ScalesThis instrument measures the tendency to give socially desirable responses, useful for identifying individuals who distort their responses.

Personality Adjective ChecklistThis self-report measure evaluate several personality patterns, primarily focusing on personality disorders

Rey Auditory Verbal Learning TestThis procedure evaluates the ability to learn word lists. It is the forerunner of other tests of verbal learning using lists of words.

Rey Complex Figure TestThis drawing and visual memory test examines ability to construct a complex figure and remember it for later recall. It measures memory as well as visual-motor organization.

Rey 15-item Memory TestThis test is used to evaluate potential for malingering in memory.

Rey-Osterrieth Complex Figure TestAnalyzes aspects of visuospatial ability and memory in all ages.

Rivermead Behavioural Memory TestEvaluates impairments in everyday memory related to real life situations.

Rogers Criminal Responsibility ScaleThis instrument is designed to assess the impairment of an individual at the time a crime was committed.

Rorschach Projective TechniqueThis familiar inkblot test is used to evaluate complex psychological dynamics. Persons with brain injury have been shown to produce certain kinds of responses that can complement other tests and help to understand personality changes associated with brain injury.

Ruff Figural Fluency TestThis visual procedure complements verbal fluency tests in assessing ability to think flexibly but using visual stimuli rather than words.

Sensory Screening TestVarious procedures include the assessment of tactile sensitivity to various objects, the ability to recognize objects by touch, and the ability to detect numbers written on the hands by touch alone. By examining both sides of the body, inferences may be drawn regarding possible lateral brain damage.

SCL-90 (Symptom Checklist 90)This checklist evaluates the individual's subjective complaints.

Shipley Institute of Living ScaleComparison of vocabulary knowledge and ability to figure out abstract sequential patterns has been established as a sensitive measure of general brain functioning.

Stroop TestThis brief procedure examines attention, mental speed, and mental control.

Symbol Digit Modalities TestScreening test for children and adults to detect cognitive impairment.

Tactual Performance TestAssesses speed of motor performance, tactile perception, spatial problem-solving, and spatial memory in all ages.

Test of Memory MalingeringThis test is used to evaluate potential for malingering in memory.

Test of Memory and Learning (TOMAL)This test for children and adolescents measures numerous aspects of memory, assessing learning, attention, and recall.

Test of Memory MalingeringFor ages 16-84, this visual recognition test helps discriminate malingered from true memory impairments.

Thematic Apperception TestThis projective test is most commonly used to examine personality characteristics that may aid in understanding psychological or emotional adjustment to brain injury.

Tower of LondonA test for all ages, assessing higher-level problem-solving, valuable for examining executive functions and strategy planning.

Trail Making Tests A and BThese tests measure attention, visual searching, mental processing speed, and the ability to mentally control simultaneous stimulus patterns. These tests are sensitive to global brain status but are not too sensitive to minor brain injuries.

Verbal (Word) Fluency Tests (various)There are a variety of verbal fluency tests in use. Each is designed to measure the speed and flexibility of verbal thought processes. (e.g., Controlled Oral Word Association Test; Thurstone Verbal Fluency)

Wechsler Adult Intelligence ScaleIIIThis set of 13 separate "subtests" produces measures of memory, knowledge, problem solving, calculation, abstract thinking, spatial orientation, planning, and speed of mental processing. In addition to summary measures of intelligence, performance on each subtest yields implications for different neurofunctional domains. The set of tests takes about an hour or more to administer. The WAIS-III is often the foundation for a comprehensive neuropsychological assessment.

Wechsler Intelligence Scale for ChildrenIIIComparable to the Wechsler Adult Intelligence Scale, this procedure contains subtests that measure similar domains in children.

Wechsler Memory ScaleIIIThis set of 18 separate "subtests" yields information about various kinds of memory and learning processes. Summary memory indices are provided in addition to the individual scores of the subtests. The whole set of tests takes about an hour to administer. The WMS-III provides a comprehensive assessment of memory. It is co-normed with the WAIS-III and is usually used in conjunction with it.

Wechsler Test of Adult ReadingProvides estimate of pre-morbid intellectual functioning in persons 18-89, normed with the WAIS-III and WMS-III.

Wide Range Achievement TestProvides level of performance in reading, spelling, and written arithmetic. The reading and spelling tests are often used in estimating premorbid intellectual functioning.

Wisconsin Card Sort TestSimilar in concept to the Category Test, this procedure also measures the ability to learn concepts. It is considered a good measure of frontal lobe functioning.

Wonderlic Personnel TestThis personnel test is not a neuropsychological instrument per se, but is used to help evaluate vocational abilities and potential for comparison with other neuropsychological tests in making practical prognostic decisions.