Grad school Neuro Final

The disorder most strongly associated with anosognosia is:

a. cognitive-communication disorder secondary to right-hemisphere syndrome

b.Anomic aphasia

c. Broca's aphasia

d. Flaccid dysarthria

A

Anosognosia = lack of awareness of a deficit. This is classic right hemisphere damage, especially in the parietal region. These patients don’t realize anything is wrong — not their cognition, not their neglect, not even their paralysis.
Anomic aphasia? Broca’s? Flaccid dysarthria? → None of these involve denial of deficits.
So duh, RHD wins.

Right sensory loss at T6 dermatome only; flaccid paralysis of muscles in the general vicinity of the right T6 dermatome.

a) Right T6 ventral rootRight T6 ventral root

b) Right T6 dorsal rootRight T6 dorsal root

c) Right T6 spinal nerve

d) Right side of spinal cord at T6

The dysarthria that is most consistently associated with breathy voice quality is:

a. apraxia of speech

b. spastic dysarthria

c. flaccid dysarthria

d. aphasia

C

Why:
Flaccid = LMN damage → weak, hypotonic muscles → incomplete glottal closure → extra air escapes = breathy voice.
Spastic dysarthria = strained–strangled voice
AOS + aphasia = language/motor planning, not phonation.

The motor speech disorder that is characterized by greater consistency across differing communication acts is:

a. apraxia of speech

b. dysarthria

c. cognitive-communicative disorder in right hemisphere damage

d. aphasia

B

Dysarthria = muscle weakness. Weakness is consistent no matter what you’re saying or doing.
Apraxia = breakdown in motor planning, so performance varies depending on complexity.
Aphasia and cog-comm aren’t motor speech disorders.

A patient who has relatively fluent spontaneous speech, poor auditory comprehension, and relatively preserved verbal repetition is diagnosed as having:

a. global aphasia

b. anomic aphasia

c. transcortical sensory aphasia

d. Broca's aphasia

C

TSA is like Wernicke’s but repetition is intact because the arcuate fasciculus is untouched.
Breakdown happens in the posterior temporal-parietal region.
Fluent speech? Yes.
Poor comprehension? Yes.
Repetition preserved? ONLY transcortical sensory aphasia

A patient who has suffered a traumatic brain injury will most likely have: 

a. none of these choices

b. apraxia of speech

c. aphasia

d. cognitive-communication impairment

D

Why:
TBI = diffuse damage → attention, memory, executive functioning, pragmatics.
Aphasia is possible but less common; AOS is rare; “none of these” is wrong.
Cognitive-communication is the classic TBI profile.

A patient who has poor ability to follow one-stage verbal instructions, who can imitate one and even two-stage gestures, and has functional hearing acuity probably has:

a. dysarthria

b. aphasia

c. cognitive-communication disorder associated with right-hemisphere damage

B

Why:
This is a language comprehension breakdown → not hearing, not apraxia, not cognition.
If they can imitate gestures, motor planning is okay.
If they hear fine, it’s not hearing loss.
RHD? They’d have attention/neglect issues, not basic one-step command deficits.
Classic Wernicke’s or receptive aphasia sign.

The person with aphasia who has the best overall ability to communicate in a useful and function manner is probably the person with

a. Wernicke's aphasia

b. global aphasia

c. anomic aphasia

d. transcortical sensory aphasia

C

Why:
Anomic is the mildest. The main issue = word-finding.
Comprehension, grammar, repetition, reading, writing → mostly preserved.
Wernicke’s? → poor comprehension.
Global? → everything impaired.
TSA? → comprehension impaired.

Anomic = best everyday communicator 👑

A metabolic imbalance is most likely to cause:

a. flaccid dysarthria

b. an acute confusional state

c. aphasia

d. apraxia of speech

B

Why:
Metabolic issues (electrolytes, liver failure, hypoglycemia) → affect entire brain → delirium.
They do NOT selectively cause aphasia, dysarthria, or AOS.
Think global brain dysfunction = confusion.

The motor speech disorder that is most frequently associated with phonetic substitutions, additions, repetitions, and prolongations over distortions is

a. verbal apraxia

b. hypokinetic dysarthria

c. flaccid dysarthria

d. hyperkinentic dysarthria

A

Why:
AOS = difficulty planning/programming movements → results in
✨ trial-and-error
✨ groping
✨ inconsistent substitutions
✨ additions
✨ prolongations
Dysarthrias tend to cause distortions, not the weird substitutions/prolongations like AOS.

The motor speech disorder characterized by a noticeable difference between the quality of automatic speech and purposeful speech is: 

a. aphasia

b. apraxia of speech

c. dysarthria

d. cognitive-communication disorder in traumatic brain injury

Why:
AOS patients can often say automatic phrases (“hi,” “thank you,” counting) much easier than volitional speech.
Motor planning breaks when the speech is intentional.
Dysarthria is consistent across tasks.
Aphasia doesn’t show this specific split.
Cog-comm in TBI doesn’t cause this pattern either.

The pathways for proprioception and for pain and temperature sensation contain neurons that carry action potentials:

a. from the brain down to various muscles in the body

b. both down from the brain to various muscles of the body and up to the brain from various receptors in the body

c. from receptors of various types in the body up to the brain

d. none of the choices is correct

C

Why:
These are sensory pathways. Sensory = afferent = upward.
Motor = efferent = downward.
Nothing tricky here. Your proprioceptors, nociceptors, mechanoreceptors → all send signals UP.

An accidental transection of the right sixth thoracic spinal nerve occurs during a spinal fusion surgery. Which of the following most completely and accurately describes the deficits that the patient will have after the surgery? a. loss of fine touch, pain, and temperature sensation in the left T6 dermatome and all dermatomes on the left below that level

b. loss of fine touch, pain, and temperature sensation in the right T6 dermatome - contralateral

c. loss of fine touch, pain, and temperature sensation in the right T6 dermatome and all dermatomes on the right below that level

d. loss of fine touch, pain, and temperature sensation in the left T6 dermatome

D

Why:
This is NOT a spinal cord lesion — it's a spinal nerve lesion.
Spinal nerves contain BOTH pathways BEFORE they enter the cord.

So damage = ipsilateral, segmental loss only.
No below-level loss. No contralateral loss.
Just the right T6 dermatome.

Sensation from the posterior 1/3 of the tongue and the surrounding pharyngeal area projects to

a. the main trigeminal nucleus

b. nucleus solitarius

c. nucleus cuneatus

d. the spinal trigeminal nucleus

B

Posterior 1/3 tongue = CN IX (glossopharyngeal).
CN IX brings taste + visceral sensation to nucleus solitarius.

Other options:

• Main trigeminal nucleus → face touch

• Spinal trigeminal → face pain/temp

• Nucleus cuneatus → upper body fine touch

So IX → solitarius. Period.

Sensation over the hard and soft palate and upper aveolar ridges is carried by

a. the maxillary division of the trigeminal nerve

b. the mandibular division of the trigeminal nerve

c. the ophthalmic division of the trigeminal nerve

d. the facial nerve

A

Which of the following most completely and accurately describes where a person's right visual field projects?

a. the right hemiretina of each eye 

b. the right primary visual receiving area (BA 17)

c. the optic chiasm

d. the left hemiretina of each eye - Opposite side

D

Visual fields CROSS before retinas receive them.

RIGHT visual field lands on:

• left nasal hemiretina of the right eye

• left temporal hemiretina of the left eye

Mnemonic:
👉 Field → opposite retina
(it gets flipped before it even enters the brain)

The fasciculus gracilis carries information pertaining to fine touch and proprioception from

a. the entire body

b. the lower half of the body

c. the upper half of the body

d. the facial area

B

Why:
Gracilis = “graceful legs” → lower body
Cuneatus = upper body
Easy.

The decussation of neurons within the the system subserving fine touch and proprioception occurs

a. at the level of the mid-medulla

b. at the level each neuron enters through a dorsal root within the spinal cord

c. at the level of the corpus callosum

d. at the level of the thalamus

A

Why:
The dorsal column system goes:

1. Enters spinal cord → stays ipsilateral

2. Ascends gracilis/cuneatus

3. Crosses in the medulla at the internal arcuate fibers

That’s why spinal cord lesions cause ipsilateral loss.

The mandibular division of the trigeminal nerve carries sensory information pertaining to fine touch, proprioception, pain and temperature from

a. the entire face

b. the entire oral cavity

c. the skin of the lower one-third of the face, the tissue deep to the skin, and the floor of the mouth back to the facial arches 

d. the upper one-third third of the face

C

Why:
Breakdown:

• V1 → forehead/eyes

• V2 → midface (upper teeth, palate, upper lip)

• V3 → lower jaw, lower teeth, chin, floor of mouth

So that description is exactly V3.

An accidental partial transection of the spinal cord at C6 occurs on the right side of the spinal cord as a result of a gunshot injury. Which of the following most completely and accurately describes the deficits the patient will have after the injury?

a. loss of fine touch and proprioception on the right side of the body at C6 and all levels below on the right and loss of pain and temperature sensation on the left side at C6 and all levels below on the left

b. loss of fine touch, proprioception, pain, and temperature on the right side of the body at C6 and all levels below on the right

c. loss of fine touch, proprioception, pain, and temperature on the left side of the body at C6 and all levels below on the left

d. loss of fine touch and proprioception on the left side of the body at C6 and all levels below on the leftt and loss of pain and temperature sensation on the right t side at C6 and all levels below on the right

A

Why:
This is literally Brown-Séquard syndrome.

Pathways:

• Dorsal column (fine touch/proprio.) stays ipsilateral until MEDULLA → so damage = ipsilateral loss

• Spinothalamic (pain/temp) crosses 1–2 levels ABOVE entry → so damage = contralateral loss below level

Therefore:
RIGHT cord cut =
👉 right-sided loss of touch/proprio
👉 left-sided pain/temp loss

Perfect match to the answer.

The decussation of neurons within the system subserving pain and temperature sensation occurs

a. at the level of the corpus callosum

b. at the level each neuron enters through a dorsal root within the spinal cord

c. at the level of the midmedulla

d. at the level of the thalamus

B

Why:
Spinothalamic pathway:

• First-order neuron enters dorsal horn

• Synapses

• Second-order neuron CROSSES within 1–2 segments
  → then ascends

NOT the medulla.
NOT the thalamus.
NOT cortex.
It happens right there when it enters.

Where does the reflex arc occur?

a. at the level of the lower motor neuron 

b. in the cerebellum

c. in the basal ganglia

d. at the level of the upper motor neuron

AWhy?

Reflexes DO NOT go to the brain.
They are spinal cord only, between:

• sensory neuron (afferent)

• interneuron

• LMN → muscle

UMN = voluntary, cortical, purposeful
LMN = reflexive, automatic

So those knee-taps doctors do?
👉 LMN-level party

Excessive involuntary movements are most likely to be associated with which of the following?

a. spasticity

b. ataxia

c. flaccidity

d. dyskinesia

D

Why?

Dyskinesia = extra, uncontrolled, too-much movement.
That's basal ganglia dysfunction (like Huntington’s, PD side effects).

Spasticity = too much tone, but not “extra dancing moves”
Ataxia = drunk-coordination
Flaccidity = no tone

Ataxic dysarthria is most like to be caused by which of the following?

a. bilateral damage or dysfunction of the BA 4

b. bilateral cerebellar damage or dysfunction

c. bilateral lower motor neuron damage or dysfunction

d. bilateral damage or dysfunction of the basal ganglia

B

Why?

Cerebellum = coordination
Damage = sloppy, irregular movement → ataxia
Ataxic dysarthria = drunk-sounding speech because timing is off.

So:
cerebellum = ataxia
Always.

The neurons going out to synapse on the muscles of the right hand receives approximately which percentage of corticospinal neurons from the left motor strip?

a. approximately 90%

b. approximately 50%

c. approximately 20%

d. approximately 70%

A

Why?

About 90% of corticospinal fibers cross at the pyramidal decussation → lateral corticospinal tract → controls distal muscles, like the hand.

So right hand movement = mostly LEFT hemisphere

Which of the following is not part of the pyramidal system? 

a. the lateral corticospinal tract

b. the dorsal column system

c. the corticospinal tract

d. the medial corticospinal tract

B

Why?

Pyramidal = motor
Dorsal column = SENSORY (fine touch + proprioception) → automatic NO.

Everything else listed is motor.

Which of the following is functionally equivalent to the corticospinal tract with the difference being that the neurons within the tract synapse on motor nuclei that project their lower motor neurons to the striated muscles of the face, oral region, pharynx, and larynx? 

a. the corticoreticular tract

b. the medial and lateral corticospinal tract

c. the rubrospinal tract

d. the corticobulbar tract

A

Why?

Corticospinal → body
Corticobulbar → brainstem motor nuclei → face, larynx, tongue, swallowing muscles.

Think:
bulbar = bulb / brainstem

Which of the following is most likely to have a highly observable weakness as a result of damage in the right motor strip? 

a. the left genioglossus muscle

b. the right masseter muscle

c. the right genioglossus muscle

d. the left masseter muscle

A

Why?

Genioglossus = tongue protrusion

• mostly contralateral innervation

• so RIGHT UMN → LEFT tongue weakness → tongue deviates toward weakness

Masseter = mostly bilateral → wouldn’t show big weakness
Genioglossus is the one that reveals lesions clearly.

Which of the following is most associated with setting the trajectory of voluntary movements?

a. the tectospinal tract

b. the corticospinal tract 

c. the rebrospinal tract

d. the cerebellum

B

Why?

Corticospinal = planning the pathway, speed, direction → “trajectory”.
Cerebellum = refines + coordinates
Rubrospinal = flexor bias
Tectospinal = head/eye reflexes

For voluntary limb movement?
👉 corticospinal is the boss.

Which of the following is an upper motor neuron? 

a. an alpha motor neuron 

b. a neuron found within a spinal nerve 

c. a neuron found within the corticospinal tract

d. a neuron found within the the ventral root

C

Why?

UMN = brain + descending tracts (corticospinal, corticobulbar)
LMN = in brainstem nuclei + anterior horn of spinal cord
Alpha motor neuron = LMN
Spinal nerve = LMN
Ventral root = LMN

Which of the following is best described as being associated with weakness or paralysis, hypertonicity, and hyperreflexia?

a. flaccidity

b. ataxia

c. spasticity

d. hyokinesia

C

Why?

That triad = UMN syndrome:

• weakness

• ↑ tone

• ↑ reflexes

Spasticity = “everything is turned UP”
Flaccidity = everything DOWN
Ataxia = coordination problem
Hypokinesia = PD-like slowness

Deviation of the tongue to the right on protrusion is a demonstration of weakness in which muscle?

a. the left intrinsic muscles of the tongue

b. the right intrinsic muscles of the tongue

c. the right genioglossus muscle

d. the left genioglossus muscle

C

Why?

Genioglossus = pushes tongue OUT and pushes it to the OPPOSITE side.
So if right GG is weak, the left GG pushes the tongue toward the weak side → to the right.

👉 “Tongue deviates TOWARD the lesion.”

What would be an appropriate instruction to assess the motoric function of the facial nerve?

a. Smile as wide as you can while raising your eyebrows

b. Ask the patient: have you had any changes in taste? (this would test the sensory part of the facial nerve anterior 2/3 of tongue)

c. Stick out your tongue

d. (brushes cheeks with q-tip) Does this feel the same on both sides?

A

Why?

Facial nerve (VII) controls:

• upper face muscles

• lower face muscles

A good test must check both:

• Raise eyebrows → upper face

• Smile big → lower face

Other options:

• Taste? sensory (VII)

• Stick tongue out? CN XII

• Light touch to cheek? CN V sensory

Following surgical removal of a cancerous thyroid gland, the patient has vocal hoarseness. This is most likely due to:

a. accidental cutting of one of the vagus nerves above the pharyngeal branch of the vagus nerve

b. accidental cutting of one of the recurrent laryngeal nerves

c. accidental cutting of the internal branch of one of the superior laryngeal nerves - – superior largngeal nerve would cause changes in pitch

d. accidental cutting of the pharyngeal branch of one of the vagus nerves

B

Why?

Recurrent laryngeal nerve controls:

• ALL intrinsic laryngeal muscles except CT

• vocal fold opening/closing
  → Damage = breathy/hoarse voice

Superior laryngeal nerve damage → pitch problems
Pharyngeal branch → swallowing + palatal issues
Cutting vagus above everything → BIG problems, not just hoarseness

Most common injury?
👉 recurrent laryngeal

The instruction "open your mouth and don’t let me close it" is appropriate for testing which cranial nerve?

a. the facial nerve

b. the glossopharyngeal nerve

c. the trigeminal nerve – testing muscles of the mandible, trigeminal is responsible for that 

d. the vagus nerve

C

Why?

This tests jaw opening strength → lateral pterygoid + muscles of mastication.

All mastication muscles = CN V3 (mandibular branch).

Not CN VII (face muscles)
Not IX or X (pharynx, palate)

The presence of strabismus indicates damage involving which one of the following?

a. the motor strip of the cortex 

b. the spinal cord

c. the corticobulbar tract xxxxxx

d. CN III, IV, or VI

D

Why?

These are the extraocular muscle nerves:

• CN III: most movements

• CN IV: superior oblique

• CN VI: lateral rectus

Strabismus = eyes not aligned = these guys.

Corticobulbar tract damage gives weakness, not true misalignment.

The muscle of mastication that is responsible for jaw protrusion is the 

a. medial pterygoid muscle

b. lateral pterygoid muscle

c. temporalis muscle

d. masseter muscle xxxxx

B

Why?

Easy way to remember:
👉 Lateral = lower jaw forward
👉 Medial = elevates jaw
Temporalis = elevates + retracts
Masseter = elevates jaw

Only lateral pterygoid pushes forward.

A patient's failure to respond to light tactile stimulation only on the right side of the anterior two thirds of the tongue indicates damage of which of the following

a. the facial region of the left postcentral gyrus

b. the mandibular branch of the right trigeminal nerve

c. all of the other choices could be correct

d. the trunk of the right trigeminal nerve

B

Why?

Anterior 2/3 general sensation = CN V3
Taste = CN VII (chorda tympani)
But this test is light touch, so it’s V3.

Could it be trunk of trigeminal?
Not likely — that would take out whole face sensory.
Just tongue → mandibular branch.

A large stroke involving the right internal capsule is most likely to cause

a. deviation of the tongue to the right during protrusion

b. inability to protrude the tongue at all

c. deviation of the tongue to the left during protrusion - damage is contralateral; tricky

d. droop on the left side of the velum at rest but not the right side

C

Why?

Internal capsule = UMN motor fibers
Tongue weakness from UMN lesion = contralateral genioglossus weakness
→ left GG weak
→ tongue pushed towards weakness = left

“Stroke = crosses.”

Ipsilateral stasis in the epiglottic vallecula and the pyriform sinus is most likely indicative of damage to which branch of the vagus nerve?

a. none of these choices are correct 

b. the pharyngeal branch

c. the internal branch of the superior laryngeal nerve

d. the recurrent laryngeal nerve xxxxx

B
Why?

Pharyngeal branch controls:

• pharyngeal constrictors

• soft palate muscles

If those muscles are weak → bolus sits in:

• vallecula

• pyriform sinuses

Recurrent laryngeal → vocal folds
Internal superior laryngeal → sensation
External SLN → pitch (CT muscle)

Only pharyngeal branch matches that residue pattern.

Drooping of the entire right side of the face at rest plus the inability to (1) elevate the right eye brow, (2) close the right eye tightly, and (3) retract the right side of the lips is an indication of damage involving the

a. left corticobulbar tract

b. left facial nerve

c. right corticobulbar tract

d. right facial nerve – drooping of the entire right side of the face

D
Why?

Facial nerve lesion = the entire ipsilateral face is paralyzed:

• top half (eyebrow)

• bottom half (smile)

• eye closure

• resting droop

Corticobulbar (UMN) lesion?
→ upper face spared (because bilateral innervation!)
→ only lower face weak

So when everything on right droops, it’s a right LMN (nerve) lesion.

You are an SLP in an acute hospital who receives an order to do a speech, language, cognitive, and swallowing evaluation on a 71 year-old patient in the emergency department. The patient had experienced the rapid onset of a left hemiparesis about one hour earlier. The patient wanted water while undergoing tests and had failed the nursing screening for swallowing. That is why you received the order for evaluation. A CVA is suspected but there is not yet a definite diagnosis because testing is still underway. So far, a CT scan of the head was negative except for mild cerebral atrophy, an EKG showed the patient to be in atrial fibrillation, and a carotid Doppler scan showed showed 20% occlusion of the left ICA near the bifurcation of the common carotid and a 40% occlusion on the right. What do you believe the medical diagnosis will probably turn out to be?

a. hydrocephalus

b. an embolic infarction – Stroke

c. an intracerebral hemorrhage xxxx

d. a thrombotic infarction

B

Clues:

• Sudden onset = embolic

• Atrial fibrillation = MAJOR embolus risk (blood pools → clots form → shoot to brain)

• Carotid occlusion only 20–40% → not enough to cause a stroke

• CT negative early ischemia doesn’t show on CT

• Left hemiparesis = right hemisphere possible embolus

This pattern = textbook embolic stroke.

A cerebral infarction is caused by which one of the following

a. cerebral ischemia 

b. intracerebral hemorrhage

c. subdural hemmorrhage

d. subarachnoid hemorrhage

A

A cerebral infarction = brain tissue dies because it’s not getting blood + oxygen.
That’s literally ischemia — insufficient blood supply.

Hemorrhages = bleeding, not infarction.

So:

• Ischemia → infarction

• Hemorrhage → bleed, not infarction

Which of the following is NOT a localizing neurologic sign? 

a. spastic paresis of the right upper extremity

b. right hemianopia

c. aphasia

d. confusion

D

A “localizing sign” means you can point to a specific brain region.

• Right hemianopia → optic radiations/occipital lobe

• Spastic R UE → left motor cortex

• Aphasia → left perisylvian cortex

But confusion?
🫠 That’s a global, non-localizing symptom.

One of the last steps in the thrombotic disease process to occur before ischemic infarction is

a. proliferation of smooth muscle cells within the walls of an artery

b. breakdown of arterial endothelium and formation of a thrombus

c. depositing of cholesterol crystals among the smooth muscle cells within the walls of an artery

d. blockage by an embolus xxx

B

Why?

• Left atrium → left ventricle → aorta → carotids → brain

• Right atrium → lungs → pulmonary embolism, NOT stroke

So for a brain stroke, the clot must originate on the left side.

Which of the following can be identified by a CT scan of the head when done as soon as possible following onset of signs and symptoms? 

a. thrombotic cerebral infarction

b. embolic cerebral infarction

c. cerebral anoxia

d. intracerebral hemorrhage – CT can see bleeding (hemmorage)

D

Why?

Ischemic strokes (thrombotic/embolic) usually appear NORMAL on CT for the first hours.

But…
Blood shows up immediately on CT.

So:

• CT = great for bleeds

• CT = bad for early ischemia

Which of the following arteries directly provides blood supply to a cortical region of the brain?

a. Sub-clavian artery xx

b. Middle cerebral artery

c. Vertebral artery

d. Basilar artery

B

Why?

Think:

• Subclavian → not directly to brain cortex

• Vertebral + basilar → brainstem + cerebellum

• MCA → cortex (frontal, temporal, parietal)

The MCA is the “queen bee” of cortical strokes.

Which of the following statements is NOT true regarding normal pressure hydrocephalus:

a. CSF pressure is in normal range (150-180 mm H2O)

b. Acute, dangerous condition that can result in death within 24 hours (LOC can occur within a few hours)

c. Associated with chronic non-localizing signs and symptoms xxx

d. Chronic and not life-threatening

B

Why?

Normal pressure hydrocephalus (NPH):

• Chronic

• Gradual

• Not dangerous immediately

Symptoms = WET, WOBBLY, WACKY
(incontinence, gait issues, cognitive changes)

It’s NOT an acute emergency.

Most TIAs are associated with 

a. coma

b. no signs or symptoms

c. localizing neurologic signs

d. confusion

C

Why?

TIAs = transient ischemic attacks.
They cause temporary focal deficits like:

• unilateral weakness

• aphasia

• vision loss

• sensory changes
  That’s what makes them a TIA.

Confusion = not typical.
Coma = not TIA.
No symptoms = then it’s not a TIA.

Battle's Sign is an indication of basilar skull fracture, characterized by: 

a. leakage of cerebral spinal fluid from the nose xx

b. bruising around the eyes

c. fixed, dilated pupil in one eye

d. bruising behind the ears

D

Why?
Battle’s sign = ecchymosis (bruising) over the mastoid process → located behind the ear.
This happens when a basilar skull fracture causes blood to pool downward due to gravity.

Other options:

• Bruising around eyes = raccoon eyes

• CSF leaking from nose = rhinorrhea

• Fixed pupil = CN III compression

But Battle’s sign = mastoid bruising, period.

A brain hemorrhage sustained during an automobile accident is an example of a

a. a type of CVA

b. primary brain injury

c. secondary brain injury

d. a brain abscess

B

Why?
Primary injury = occurs at the moment of impact.
Hemorrhage from trauma = immediate → so it's primary.

Secondary injuries occur minutes to hours later, like:

• swelling

• ischemia

• elevated ICP

So hemorrhage = primary.

Parkinson's disease is likely to cause an impairment of which of the following functions first in the progression of the disease?

a. language functions

b. sensory functions

c. motor functions

d. cognitive functions

C

Why?
Parkinson’s = degeneration of dopamine neurons in the substantia nigra.
Dopamine controls movement → so the first deficits are:

• bradykinesia

• tremor

• rigidity

Cognition + language decline happen much later.

Which of the following is a potentially fatal secondary consequence of cerebral edema?

a. subdural hematoma xx

b. herniation into the brain stem

c. a cerebral infarction

d. none of the choices is correct

B

Which of the following is the best predictor of cognitive outcome following TBI:

a. severity of injury

b. the duration of post-traumatic amnesia

c. pre-morbid intelligence

d. the Rancho Cognitive Function Scale in the first hour following injury

B

Why?
The longer the patient is:

• confused

• disoriented

• unable to form new memories
  …the worse the long-term cognitive outcome.

PTA duration correlates directly with severity of diffuse brain injury.

Severity rating & premorbid IQ matter, but PTA is strongest predictor.

When is the most likely stage for an SLP to be involved in the care of a patient with an intracranial neoplasm?

a. before they start chemotherapy

b. after tumor resection surgery

c. none of these choices are correct

d. when it is first diagnosed

B

Why?
Before surgery → still unstable, mass may be growing
After resection:

• swelling

• surgical damage

• new neurologic deficits
  → THIS is when SLPs evaluate swallowing, speech, language, cognition.

A statement of "Prior Level of Function" in an initial evaluation report typically

a. all of the choices are correct

b. focuses on functional skills, not on test scores

c. is written in a way that is comprehensible to most people

d. is one or two sentences in length

A

Why?
A PLOF must:

• Be short

• Clear

• Functional

• In plain English
  Example: “Patient lived independently, cooked meals, and handled finances.”

Everything listed is correct.

The type of healthcare setting where an SLP is most likely to be called upon to perform an initial evaluation on a patient who does not have all of the medical testing completed and who may not yet have a definitive medical diagnosis is most likely which of the following?

a. an acute rehabilitation hospital

b. an LTAC

c. an acute care hospital

d. a skilled nursing facility

C

Why?
Acute care = FIRST STOP after emergency.
Patients often arrive:

• mid-stroke

• mid-workup

• before MRI/CT results

• undiagnosed

Rehab and SNF require stable patients.

Which of the following typically presents with localizing deficits?

a. metabolic diseases 

b. TBI

c. normal pressure hydrocephalus

d. CVA

D

Why?
Stroke knocks out one specific vascular territory, so deficits are:

• focal

• predictable

• localizable

Ex:

• Right MCA → left face/arm weakness

• Left MCA → aphasia

The others (TBI, metabolic disorders, NPH) = diffuse.

A patient is described in a chart as having the following responses "in the field": eye opening 1, motor response 2, verbal response 1. To what TBI assessment is this referring?

a. RIPA

b. Rancho Levels

c. Glasgow Coma Scale

d. GOAT

C

Why?
GCS uses:

• Eye opening (1–4)

• Verbal response (1–5)

• Motor response (1–6)

Example given fits EXACTLY into that scoring structure.
Rancho uses behavior, not scores.
GOAT = orientation + memory test.
RIPA = cognitive-linguistic battery.

An SLP who adheres to a holistic view of aphasia would describe someone with Broca's aphasia as having which of the following? 

a. a transcortical sensory aphasia with impaired ability to imitate speech 

b. a transcortical motor aphasia with impaired ability to imitate speech

c. a mild to moderate aphasia accompanied by spastic dysarthria

d. a mild to moderate aphasia accompanied by an apraxia of speech

D

Why?
Holistic = “Everything is connected. Aphasia types are just severity variations of one same disorder WITH possible motor speech disorders.”

Broca’s typically comes with:

• non-fluent speech

• agrammatism

• apraxia of speech (very common)

Holistic people would NOT label it as transcortical anything — they fold AOS + aphasia together.

Broca's aphasia is usually associated with a lesion involving which of the following?

a. the posterior one-third of Brodmann's areas 22 in the dominant cerebral hemisphere

b. Brodmann's areas 44 and 45 in the dominant cerebral hemisphere

c. the posterior one-third of Brodmann's areas 22 in the non-dominant cerebral hemisphere

d. the facial area of Brodmann's area 4 in the dominant cerebral hemisphere

B

Why?
Classic Broca’s aphasia = lesion in the inferior frontal gyrus, specifically:

• Brodmann 44 (pars opercularis)

• Brodmann 45 (pars triangularis)

Posterior BA22 = Wernicke’s.
Facial area of BA4 = motor strip → would cause dysarthria, not aphasia

Which of the following is an area covered in the language assessment section of an SLP evaluation?

a. information on prior level of function

b. none of the choices is correct

c. auditory comprehension skills

d. summary of oral mechanism function

C

Why?
Language section evaluates:

• verbal expression

• auditory comprehension

• repetition

• naming

• reading & writing

PLOF is part of history.
Oral mech is separate.

Which type of aphasia is likely to have the poorest functional communication in daily life?

a. Conduction

b. Broca's

c. Anomic

d. Global

D

Why?
Global = large lesion → severe deficits in:

• comprehension

• expression

• naming

• repetition

Functionally, they communicate the least with spoken language.
All other types retain some significant strengths.

Which of the following describes "jargon?"

a. a form of dysarthria that is unintelligible

b. a form of apraxia of speech that is unintelligible

c. a word that is fluent and articulate but unintelligible 

d. connected speech that is fluent and articulate but unintelligible

D

Why?
Jargon means the speech flows but the words don’t make sense.
You hear this often in:

• Wernicke's aphasia

• Sometimes conduction aphasia

Not dysarthria. Not apraxia. It’s language-based nonsense.

A holisitic view of aphasia generally recognizes which of the following? 

a. none of the choices is correct

b. a single aphasia that varies in severity and in accompanying disorders such as apraxia of speech

c. qualitatively different forms of aphasia such as fluent and non-fluent aphasias 

d. qualitatively different forms of aphasia such as Broca's aphasia and Wernicke's aphasia

B

Why?
Holistic model = “Aphasia is ONE disorder but severity and co-occurring issues change the presentation.”
So:

• Broca’s vs Wernicke’s = not different “types”

• Just different expressions of the same underlying language system issue.

Textbook view = different types
Holistic view = one spectrum.

Aphasia generally results from which one of the following:

a. a brainstem injury

b. a focal injury involving the non-dominant cerebral hemisphere

c. a diffuse brain injury

d. a focal injury involving the dominant cerebral hemisphere

D

Why?
Aphasia = language impairment.
Language lives in dominant hemisphere (left in 98% of people).

Non-dominant hemisphere → pragmatics/prosody issues, NOT aphasia.
Brainstem? No.
Diffuse injury? More confusion/cognitive-communication disorder.

Aphasia is a language impairment caused by brain injury and not caused by an impairment of

a. sensation

b. arousal or attention

c. all of the choices are correct

d. movement

C

Why?
Aphasia = language system damage.
Even if:

• sensation is intact

• motor function is intact

• attention is intact

Language is broken.
So “all choices” is correct

A form of aphasia that features significantly impaired auditory comprehension, imitation of speech that is proportional to comprehension, relatively preserved fluency, and significantly impaired word-finding is which one of the following?

a. conduction aphasia

b. Wernicke's aphasia

c. transcortical sensory aphasia

d. transcortical motor aphasia

B
Why?

• Wernicke’s = poor comprehension + poor repetition

• Fluent, but meaningless

• Severe anomia

Which components of the Western Aphasia Battery comprise the Spontaneous Speech score? (check all that apply)

a. sequential commands

b. object naming

c. fluency, grammatical competence, and paraphasias

d. information content

C

Why?
The WAB’s spontaneous speech section = 2 subtests:

1. Information Content → “Are you saying meaningful stuff?”

2. Fluency, Grammar, Paraphasias → how the speech actually sounds

Sequential commands = auditory comprehension.
Object naming = naming section.

1. If a patient fails to produce a correct response on a trial in the first attempt and again after the first cue is provided, what is the best thing that the SLP should do or say next?

a. The SLP should say, "We'll try that one again next time."

b. The SLP should provide the patient with enough stimulus support to enable the patient to produce the correct response

c. None of the choices is correct.

d. The SLP should give up and move on the the next item

B

👉 Why?
In rehab for aphasia, the goal is successful practice, not repeated failure. If the patient misses twice, they need more support to experience the correct production. This strengthens the neural network through correct trials (“errorless learning” principles).
If you stop the trial or skip it, the patient loses the opportunity to learn.

A well-designed interventional procedure for acquired aphasia will ensure that patients produce successful, target responses with which of the following levels of accuracy in the very first attempt in each trial?

a. 100%

b. around 70% 

c. around 50%

d. over 90%

B

👉 Why?
70% is the “sweet spot” in therapy:

• Not too easy (100% = no challenge → no neuroplasticity boost)

• Not too hard (50% → too much failure → frustration)

• 70% = optimal challenge point where the brain learns best.
  So the first try shouldn’t be perfect—just challenging enough.

A rehabilitative approach to intervention for acquired aphasia would have which one of the following characteristics?

a. None of the options is correct.

b. It would attempt to restore linguistic skills and competence as much as is possible.

c. It would be likely to include AAC.

d. It would attempt to facilitate the patient's effective communication via any modality possible. ??

B

👉 Why?
There are two approaches:

• Rehabilitative = restore the damaged language system

• Compensatory = find ways AROUND the impairment (AAC, gestures, etc.)

Rehabilitative therapy focuses on rebuilding language skills themselves—syntax, semantics, phonology, etc.

The following goal is an example of what? "The patient will be able to communicate verbally all wants, needs, preferences, comments, questions, and instructions to others in all situations without assistance in four weeks."

a. A long-term goal in a compensatory approach to intervention for acquired aphasia.

b. A short-term goal in a rehabilitative approach to intervention for acquired aphasia.

c. A short-term goal in a compensatory approach to intervention for acquired aphasia. 

d. A long-term goal in a rehabilitative approach to intervention for acquired aphasia.

C

👉 Why?

• This goal is super broad (“all situations,” “all wants/needs”). → long-term

• It’s also functional communication, not rebuilding linguistic skills. → compensatory

• Also unrealistic in 4 weeks → further sign it's meant as an LTO.

A compensatory approach is likely to be the best option for which of the following?

a. a patient who has been newly admitted to acute rehab with a right hemiparesis and a moderate acquired aphasia

b. a patient who has had a moderate to severe acquired aphasia for more than a year.

c. no patients who have acquired aphasia 

d. any and all patients who have acquired aphasia

B

👉 Why?
After 1 year post-stroke:

• Spontaneous recovery has mostly plateaued

• Rebuilding the damaged system becomes harder
  So we shift from restoration → compensation (AAC, scripts, gestures).

Someone newly admitted to rehab should still get restorative therapy first.

"Point to the cup after you give me the Kleenex." The impairment being addressed in this activity for therapeutic intervention in a case of acquired aphasia is most likely which one of the following?

a. in impairment in the use of the upper extremities for communication

b. an impairment of verbal expression

c. an impairment of auditory comprehension

d. an impairment of attention

C

👉 Why?
This is a verbal command processing task.
You’re testing:

• understanding vocabulary (“cup,” “Kleenex”)

• understanding syntax

• processing multi-step directions

Not motor skills, not expression.

What is the main reason you should not spend too long explaining tasks to aphasic patients?

a. because aphasic patients typically have poor attention 

b. because aphasic patients typically do not process long explanations well

c. because aphasic patients will tend to forget what they are told due to memory deficits

d. because aphasic patients typically will be able to read better than they can understand verbal instructions

B

👉 Why?
Aphasia primarily affects:

• comprehension of spoken language (not usually attention!)

• long, complex sentences are harder to understand
  So shorter instructions = more success.

The stimulus is the following printed, incomplete sentence: "You write and erase with a _________." The patient is instructed to write in the last word of the sentence. The impairment that is most likely being addressed in this interventional activity for acquired aphasia is which one of the following? 

a. purposeful movement of the upper extremities

b. written expression

c. auditory comprehension

d. verbal expression

B

👉 Why?
Even though the stimulus is printed, the required output = WRITING the answer.
This is literally a writing task → written expression.

A cue is designed to elicit a correct response in the trial after a failure by doing which of the following?

a. none of the choices is correct 

b. adding enough stimulus support in the next attempt to evoke the correct response

c. showing the patient the correct response in the next attempt to evoke a correct response 

d. telling the patient what the correct response is

B

👉 Why?
Cueing ≠ giving the answer.
Cueing = helping them reach the correct response (semantic cue, phonemic cue, visual cue).
The whole purpose is:
💛 “I’m gonna help you succeed, not do it for you.”

The following goal is an example of what? "The patient will point to objects named in a field of 10 familiar objects with 90% accuracy within two week."

a. A short-term goal in a rehabilitative approach to intervention for acquired aphasia.

b. A long-term goal in a compensatory approach to intervention for acquired aphasia.

c. A long-term goal in a rehabilitative approach to intervention for acquired aphasia.

d. A short-term goal in a compensatory approach to intervention for acquired aphasia.

D

👉 Why?

• Very specific → STG

• Focuses on restoring auditory comprehension + lexical access

• Not functional communication → NOT compensatory

• Rebuilding language system → rehabilitative

The Rancho Los Amigos Level of Cognitive Functioning Scale-Revised (RLAS-R) is a more useful scale for TBI patients who are in acute rehabilitation than the Glasgow Coma Scale.

a. True

b. False

A

👉 Why?

• GCS is used right after the injury, in the ER or ICU, to check severity of coma (eye, verbal, motor).

• RLAS-R is used later, when the person is medically stable and in rehab → tracks cognitive + behavioral recovery across Levels I–VIII.
  Since acute rehab happens after medical stabilization, RLAS-R gives way more meaningful info.

The Ross Information Processing Assessment-Revised (RIPA-R) is appropriate for what type of patient?

a. A TBI patient with a Rancho Los Amigos Scale of I-III.

b. All persons who are over 18.

c. All TBI patients.

d. A TBI patient with a Rancho Los Amigos Scale of V or higher.

D

👉 Why?
RIPA-R tests:

• problem solving

• memory

• reasoning

• organization

• language comprehension

Patients below Level V (especially I–III) are:

• minimally responsive

• not participating in sustained cognitive tasks

• often not following commands

So RIPA-R is for people who are alert, oriented enough, and able to follow tasks = Level V+.

---

The following statement "Patient made no visible response to intensive calling of name and application of ice to ear lobes" is assessing what cognitive modality? 

a. reasoning

b. none of the choices are correct

c. working memory 

d. arousal and attention

D

👉 Why?
Those are sensory stimulation tests used with low-level (I–III) TBI patients.
You're checking:

• do they wake up?

• do they orient?

• do they respond to stimuli?

NOT memory. NOT reasoning.
Just basic arousal.

A patient may be somewhat confused, remembering main points of a conversation but forgetting details. They may be able to follow a schedule but become confused if the schedule changes. What is this patient's level on the Rancho Los Amigos Level of Cognitive Functioning Scale-Revised (RLAS-R)?

a. Level VI

b. Level I

c. Level III 

d. Level IV

A

👉 Why?
RLAS descriptions you should memorize:

• Level V = confused, inappropriate, needs structure, poor memory

• Level VI = confused, appropriate

  • can follow routine/schedule

  • learns with structure

  • forgets details

  • needs cues
    Exactly what the question describes.

5. Which of the following is considered to be a primary result of traumatic brain injury?

a. seizures

b. hypoxia

c. diffuse axonal injury

d. elevated intracranial pressure xx

C

👉 Why?
Primary injuries = directly caused by the impact.
These include:

• skull fractures

• contusions

• diffuse axonal injury (DAI) ← huge hallmark of TBI

Secondary injuries happen after the impact:

• swelling

• hypoxia

• seizures

• increased intracranial pressure

So only DAI is a primary injury.

Which of the following aspects of memory is most susceptible to impairment as a result of TBI? 

a. immediate memory

b. long-term memory

c. all aspects of memory are equally susceptible to impairment as a result of TBI 

d. recent memory

D

👉 Why?
TBI commonly damages:

• hippocampus

• frontal lobes

These are critical for encoding new memories, so:

• recent memory = most affected

• long-term memory (old memories) is usually preserved

• immediate memory (digit span) is often okay

• the main issue is forming and stabilizing NEW memories

Which of the following statements applies to the Glasgow Coma Scale (GCS)? 

a. The GCS is used in the earliest phases of medical care following traumatic brain injury. 

b. The GCS is a 15-point scale based upon ratings of eye opening, verbal response, and motor response.

c. All of the other choices are correct. 

d. Patients with a GCS rating of less than 8 generally require intubation

C

👉 Why?
GCS facts:

• used in early medical care

• based on eye, verbal, motor

• max score = 15

• scores <8 usually require intubation
  So all given statements are true.

8. A patient's best responses at the time of assessment are to turn in the direction of a source of sound, track visual stimuli for 2-3 seconds, and to move the particular upper extremity or lower extremity that is stimulated. What is this patient's level on the Rancho Los Amigos Level of Cognitive Functioning ScaleRevised (RLAS-R)?

a. Level III 

b. Level II

c. Level IV

d. Level I

A

👉 Why?
RLAS cheat notes:

• Level I = no response

• Level II = generalized response (same response to any stimulus)

• Level III = localized response

  • turns toward sound

  • visually tracks

  • withdraws to pain appropriately
    This patient is clearly Level III.

Which of the following could be used to assess recent memory?

a. Asking the patient to recall three words that had been presented with instructions to "remember these words" and then doing 10 minutes of other assessment activities before circling back and asking for the recall of the three words.

b. Asking the patient what country we are in. 

c. Asking the patient what their name is. 

d. Testing digit span.

A

👉 Why?
Recent memory = ability to store NEW info over minutes–hours.
3-word delayed recall is the classic test.
Immediate recall? → immediate memory.
“What country?” → orientation.
Digit span → attention/working memory.

Which of the following best describes the digit span of the typical adult?

a. There are no normative data available on digit span

b. None of the other choices is correct.

c. 5 plus or minus 2 

d. 7 plus or minus 2

D

👉 Why?
This is Miller’s classic psych finding:
Working memory capacity ≈ 7 items (5–9)

Digit span shorter than that? → working memory impairment.

What is the most accurate statement regarding pharmacological intervention and TBI recovery?

a. Some medications are known to reduce PTA duration, but have little other effectiveness in treating TBI

b. Medications should not be used to manage TBI symptoms

c. There is limited evidence for the efficacy of medications on TBI recovery, but they can help manage some secondary behaviors

d. There is limited evidence for the efficacy of medications on TBI recovery and TBI secondary behaviors

C

👉 Why?

• Meds don’t heal the brain or magically improve the core injury.

• BUT they can help with:

  • agitation

  • sleep

  • depression

  • attention problems

  • impulsivity
    These behavior changes make therapy more effective.
    So they don’t fix TBI, but they help with managing symptoms that interfere with rehab.

What is the most important prognostic indicator for TBI recovery?

a. Having good insurance

b. Emergence from post-traumatic amnesia

c. History of previous TBI 

d. Baseline intelligence

B

👉 Why?
PTA = the period when the person:

• can’t form new memories

• is disoriented

• may be confused/agitated

Shorter PTA = better outcome.
Longer PTA = poorer long-term recovery.

This is more predictive than:

• insurance (lol)

• baseline IQ

• number of previous TBIs

PTA duration is the gold-standard predictor.

Which of the following treatment ideas most likely has the most functional meaning for a TBI patient?

a. Playing a card game

b. Advancing to the next level on a brain game app on an iPad

c. Making a budget for a trip to Target

d. Retelling details of a story randomly chosen from a magazine

C

👉 Why?
Functional = tied to real life, independence, community living, safety.
This task requires:

• memory

• attention

• planning

• reasoning

• organization

Playing cards or brain games → not functional.
Random story retell → not functional.
Budgeting → TOTALLY functional for TBI rehab.

What is the most important step in initially establishing a cognitive rehab program with a TBI patient?

a. Scoring above a certain percentile on a standardized TBI assessment

b. Establishing structure and routine

c. Going on an outing to Starbucks so they can order their favorite drink

d. Returning to work

B

👉 Why?
TBI brains crave:

• predictability

• a schedule

• reduced chaos

A structured routine:

• decreases anxiety

• increases learning

• helps orientation

• prevents overload

• stabilizes behavior

You cannot begin higher-level tasks until structure is set.

At what Rancho level, and in what way might group treatment be appropriate for a TBI patient?

a. Rancho IV, to practice pragmatics and role-playing with other TBI clients 

b. Rancho V, to independently plan an outing

c. Rancho VI, to complete deductive reasoning worksheets with 90% accuracy 

d. Rancho VII, to practice pragmatics and role-playing with other TBI clients

D

👉 Why?
Group treatment requires:

• sustained attention

• impulse control

• social awareness

• ability to stay on topic

• moderate independence

Rancho VII = automatic–appropriate
These patients can:

• go through routines

• participate socially

• role-play

• practice pragmatics

• tolerate groups

Rancho IV → too agitated
Rancho V → too confused
Rancho VI → still poor carryover
Rancho VII → ready for social/pragmatic training

Which of the following is the most appropriate statement for when to begin orientation training?

a. When the patient's agitation begins to diminish

b. At Rancho III

c. Whenever you feel it is appropriate, use your best clinical judgment 

d. None of these choices are correct

A

👉 Why?
Orientation training is only useful once the patient:

• is calm enough

• can attend

• can engage

• can process info

Rancho III = not alert enough.
“Whenever you feel like it” → no.
Start when agitation drops → typically Rancho V–VI.

Which of the following is an example of negative reinforcement? 

a. Giving choices or rewards

b. Saying "if you do this, I'll leave you alone"

c. Punishing the behavior

d. Ignoring the behavior

B

👉 Why?
Negative reinforcement = removing something unpleasant to increase a behavior.

Here:

• removing the therapist’s presence = the “negative”

• patient doing the desired behavior → makes that negative go away

Not punishment.
Not ignoring.
Not rewards.

Adding a distractor during a treatment activity targets which type of attention? 

a. Sustained 

b. Selective 

c. Alternating 

d. Divided

B

👉 Why?
Selective attention = focusing on the relevant task while ignoring distractions.

Examples:

• adding background noise

• adding people talking

• adding objects on the table

Sustained = keeping attention for long time
Alternating = switching tasks
Divided = multitasking

Distractors = selective.

Which of the following is the best description of emerging awareness? 

a. some awareness of the deficit in theory but not in practice 

b. some awareness of the deficit in practice but only at the moment when it happens

c. some awareness of the need to account for deficits before beginning the task

d. None of these choices are correct

B

👉 Why?
3 levels of awareness:

1. Intellectual awareness – “I know I have a problem.”

2. Emerging awareness – they notice the problem while it’s happening.

3. Anticipatory awareness – they predict the problem before it happens.

Emerging = “OMG I keep forgetting this,” but they can’t plan ahead.

What is the most likely reason families can become frustrated during the TBI rehabilitation process?

a. Because they have not become accommodated to the injury 

b. Because they lack understanding of TBI

c. Because the patient’s recovery fails to meet expectations

d. Because they don't understand why the patient is in rehab

C

👉 Why?
TBI recovery is:

• slow

• unpredictable

• non-linear

• emotionally draining

Families often think:
“He should be back to normal by now.”
When progress slows, they feel fear, grief, frustration.

Not because:

• they’re uneducated

• they don’t understand rehab

• they’re not accommodating

It’s the mismatch between expectations and reality that hurts.