CH 8 Neurologically Based CD Review

1.A clinician in a hospital setting is asked to evaluate a 64-year-old patient who appears to have dementia. In gathering the case history from the patient’s adult daughter, the clinician finds out that the patient began drinking alcohol as a 15-year-old and has been a heavy drinker since that time. A detailed evaluation shows that the patient presents with memory problems, difficulty processing abstract information, and visual-spatial deficits. This patient most likely has

1. Dementia of the Alzheimer’s type

2. Parkinson’s disease

3. Wernicke’s-Korsakoff syndrome

4. Aphasia

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2.Conduction aphasia is caused by lesions

1. in the areas supplied by the middle cerebral arteries and the anterior and posterig arteries

2. in the region between Broca's area and Wernicke's area, especially in the supramarginal gyrus and the arcuate fasciculus.

3. in Brodmann's areas 44 and 45 in the posterior-inferior gyrus of the left hemisphere.

4. in the angular gyrus, the second temporal gyrus, and the juncture of the temporoparietal lobe.

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3.Dementia associated with Pick’s disease is part of

1. Alzheimer’s disease

2. Frontotemporal dementia

3. Semantic variant of primary progressive aphasia

4. The non fluent variant of the primary progressive aphasia

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Questions 4-6 refer to the following scenario:

A hospital-based clinician receives a referral of a woman, Fran, who is 76 years old and enjoys walking, swim-ming, and giving her grandchildren rides. During the initial interview, Fran tells the clinician that she would have to stop her daily walks with her dog, because she believes she is slow when she begins walking and then she would take short, rapid, shuffling steps. She also shares that her writing has become smaller and that her friends and family say that she has been found "expressionless" in the recent days. The clinician also notices decreased intelligibility.

4.Fran probably has

1. Right hemisphere syndrome

2. Unilateral upper motor neuron dysarthria

3. Alzheimer’s dementia

4. Parkinson’s disease

5.Based on your diagnosis, you would expect Fran's speech and language to be characterized by

1. fluency problems, including silent pauses as well as repetitions because of false starts and attempts at self-correction.

2. quality and rate that are "drunken" and slow, with excessive and even stress.

3. incoherent, slurred, and rapid speech accompanied by metathetic errors

4. monopitch, a harsh and breathy voice, short rushes of speech, imprecise consonants, and respiratory problems.

6.Other symptoms the clinician might expect Fran to manifest would include

1. chorea, emotional outbursts, schizophrenic-like behaviors, and dysarthria.

2. hallucinations, mask-like face and confabulation.

3. mask-like face, slow voluntary movements,tremors in resting muscles, and disturbed posture

4. circumlocutions, repetitive verbal responses, and festinating speech.

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7.Functional communication assessment targets

1. communication in natural or everyday situations.

2. grammatically correct and complex communication.

3. comprehension of both daily and academic vocabulary necessary for effective functioning in the "real world."

4. phonemically correct communication.

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8.A hospital-based clinician receives a referral of Mary, a 71-year-old woman. Mary's 35-year-old son says. "Mom just isn't herself anymore; we don't know what's wrong or what to do. We don't know if she had a stroke or what's going on." After talking with Mary in the initial interview, the clinician realizes that he will have to assess Mary in depth to evaluate whether she has aphasia or DAT (dementia of the Alzheimer's type). If Mary has DAT, which of the following symptoms will she show?

1. Normal syntax except for word-finding problems; good auditory comprehension of spoken language; slurred and rapid speech; disorientation to time and place; visuospatial problems; difficulty with self-care and daily routines; intact repetition skills

2. Severe problems in recalling remote and recent events; relatively intact syntactic skills; appropriate humor and laughter; disorientation to time and place; intact ability to initiate interactions

3. Severely impaired fluency; severe echolalia; agrammatic and telegraphic speech; intact auditory comprehension skills; no difficulty with self-care or managing daily routines

4. Poor judgment; impaired reasoning; disorientation in new places; widespread intellectual deterioration; empty speech; jargon; incoherent, slurred, and rapid speech; problems in comprehending abstract messages

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9.A 54-year-old pastor, Rev. Johnson, has a stroke and takes a leave of absence from his job while he recovers. After a 3-4-month period, he goes back to work, which include preaching sermons on Sunday mornings and visiting church members who are sick. He says that he is "100% back"; however, his parishioners and family notice that he tends to bump into people who walk on his left; when he writes, he does not use the left side of the page. He does not recognize parishioners whom he has known for 30 or more years until they begin to speak. When people tell jokes, he does not laugh or appear to understand the jokes as he used to. He does not detect sarcasm in other people's speech. Rev. Johnson probably has

1. dementia.

2. Wernicke-Korsakoff syndrome.

3. right-hemisphere syndrome.

4. apraxia of speech.

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10.A 90-year-old woman in a skilled nursing facility is in the end stages of Alzheimer's dementia. The top treatment priority would be

1. improving her sentence structure.

2. facilitating communication with the staff during daily routines.

3. working on her word retrieval skills.

4. increasing orientation to date and time.

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11.You are working with Mr. Thomas, who has been diagnosed with Parkinson's disease. Primary symptoms you can expect to see include

1. difficulty with sequencing motor movements of speech.

2. word retrieval problems and agrammatism.

3. confusion, disorientation, and emotional outbursts.

4. bradykinesia, festination, and cogwheel rigidity.

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12.Dementia of the Alzheimer's type is caused by

1. thiamine deficiency.

2. pathological changes of the corpus callosum

3. neurofibrillary tangles and neuritic plaques.

4. deterioration of neurons in the brainstem

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13.The most significant communication problem associated with right hemisphere disorder is

1. agrammatic speech.

2. impaired morphologic production.

3. severe voice disorders

4. overall communicative effectiveness

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14.Primary progressive aphasia is a form of

1. fluent aphasia.

2. dementia.

3. nonfluent aphasia.

4. subcortical aphasia.

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15.You are assessing a 20 year-old man who was involved is an auto accident with severe head injury. The medical report says that the patient has nonpenetrating head injury. In this case, you expect to observe

1. intact meninges.

2. torn meninges.

3. no skull fracture.

4. an open wound.

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