PRACTICE TEST for Clinical
Neuropsychology Board Exam Prep
Questions and Correct Verified Answers
SECTION I: FOUNDATIONAL KNOWLEDGE (NEUROANATOMY,
NEUROPATHOLOGY, & PSYCHOMETRICS)
Questions 1-50
1. A 65-year-old patient presents with a left homonymous hemianopia, apraxia,
and a profound neglect syndrome. An MRI is most likely to reveal a lesion in which
vascular territory?
• A. Anterior Cerebral Artery (ACA)
• B. Middle Cerebral Artery (MCA) - Right Hemisphere
• C. Posterior Cerebral Artery (PCA)
• D. Basilar Artery
Rationale: The right MCA supplies the lateral aspect of the frontal, temporal, and
parietal lobes. Lesions here, particularly in the inferior parietal lobule (temporo-parietal
junction), are the classic cause of left-sided hemispatial neglect. The optic radiations
(temporal lobe) causing the hemianopia and apraxia are also within this territory.
2. Which of the following pairs of structures is primarily associated with the limbic
system's role in emotional memory and contextual fear conditioning?
• A. Caudate and Putamen
• B. Amygdala and Hippocampus
• C. Hypothalamus and Thalamus
• D. Cingulate Gyrus and Insula
Rationale: The amygdala is crucial for the emotional component of memory and fear
conditioning (affective valence), while the hippocampus is essential for the contextual
(spatial/episodic) aspect of the memory. Both are core limbic structures.
,3. A patient exhibits severe anterograde amnesia with preserved intellect and
procedural learning. Post-mortem analysis reveals bilateral atrophy of the medial
temporal lobes. Which neuropathological finding is most specific to this
condition?
• A. Lewy bodies
• B. Neurofibrillary tangles (NFTs) in neocortex
• C. Severe neuronal loss in CA1 subfield of the hippocampus
• D. Amyloid plaques in the amygdala
Rationale: This describes Korsakoff's syndrome or an anoxic injury leading to
hippocampal sclerosis. While Alzheimer's disease (AD) involves the hippocampus, a pure
anterograde amnesia with spared procedural memory points to a circumscribed
hippocampal lesion. The CA1 subfield (Sommer's sector) is particularly vulnerable to
anoxia and ischemia, resulting in this classic amnestic syndrome.
4. The "Rule of 4" is a useful mnemonic for localizing brainstem lesions. If a
patient has a right-sided internuclear ophthalmoplegia (INO), where is the lesion?
• A. Right paramedian pontine reticular formation (PPRF)
• B. Right medial longitudinal fasciculus (MLF)
• C. Left PPRF
• D. Left MLF
Rationale: INO is caused by a lesion of the MLF. The MLF connects the abducens
nucleus on one side to the medial rectus subnucleus of the oculomotor complex on
the opposite side. A right INO (failure of adduction of the right eye on leftward gaze)
indicates a lesion of the right MLF.
5. In the context of the Wechsler Adult Intelligence Scale – IV (WAIS-IV), which
index is considered the most robust measure of "crystallized intelligence" and is
most resistant to the effects of diffuse cerebral insult?
• A. Perceptual Reasoning Index (PRI)
• B. Verbal Comprehension Index (VCI)
• C. Working Memory Index (WMI)
• D. Processing Speed Index (PSI)
Rationale: The VCI (comprised of Vocabulary, Similarities, and Information) draws upon
over-learned, culturally-familiar knowledge acquired through education and life
experience. It is the most resilient to neurological injury, serving as a "hold" test and a
benchmark for premorbid estimates.
,6. Which of the following is the BEST description of a "double dissociation" in
neuropsychology?
• A. Patient A has deficits in Language but not Memory; Patient B has deficits in
Memory but not Language.
• B. Patient A has deficits in Language and intact Memory; Patient B has
deficits in Memory and intact Language.
• C. Both patients have deficits in Language and Memory, but Patient A's are more
severe.
• D. A single patient shows a deficit in Language and a deficit in Memory.
Rationale: A double dissociation requires two patients/groups and two tasks. It is the
gold standard for inferring that two cognitive functions are mediated by independent
neural substrates. Patient A shows dysfunction on Task X but not Y, while Patient B
shows the opposite pattern (Task Y impaired, Task X spared).
7. A 72-year-old patient is diagnosed with Dementia with Lewy Bodies (DLB).
Which of the following symptom profiles is most characteristic at initial
presentation?
• A. Insidious onset of word-finding difficulties and visuospatial deficits.
• B. Fluctuating cognition, well-formed visual hallucinations, and
parkinsonism.
• C. Prominent apathy, loss of empathy, and executive dysfunction.
• D. Rapidly progressive dementia with myoclonus and gait ataxia.
Rationale: The core diagnostic features of DLB are fluctuations in attention/alertness,
recurrent detailed visual hallucinations, and spontaneous parkinsonian motor signs
(rigidity, bradykinesia). Option A is classic for Alzheimer's; C is behavioral variant FTD; D
is Creutzfeldt-Jakob disease.
8. Which of the following neuroimaging techniques is most appropriate for
evaluating the structural integrity of white matter tracts and connectivity?
• A. Functional Magnetic Resonance Imaging (fMRI)
• B. Diffusion Tensor Imaging (DTI)
• C. Positron Emission Tomography (PET)
• D. Magnetic Resonance Spectroscopy (MRS)
Rationale: DTI measures the directional diffusion of water molecules. In healthy white
matter, water diffuses anisotropically (along the axis of the tract). Disruption of these
, tracts (e.g., by edema, Wallerian degeneration) reduces anisotropy, allowing for
quantitative measurement of tract integrity (via Fractional Anisotropy).
9. A patient has trouble reproducing complex geometric figures (e.g., Rey-
Osterrieth) and has difficulty locating objects in space. He can, however, recognize
faces and objects. This is most consistent with a lesion to the:
• A. Right fusiform gyrus
• B. Right occipito-parietal pathway (Dorsal Stream)
• C. Left occipito-temporal pathway (Ventral Stream)
• D. Right temporal pole
Rationale: The dorsal "where/how" stream projects from occipital cortex to posterior
parietal lobe. Damage here causes optic ataxia, difficulty with spatial navigation, and
constructional apraxia. The ventral "what" stream (fusiform gyrus) is for object/face
recognition and is spared here.
10. In signal detection theory, the term 'criterion' or 'bias' (β) refers to:
• A. The inherent difficulty of the cognitive task.
• B. The participant's level of fatigue during testing.
• C. The participant's willingness to say "yes" to a signal when uncertain.
• D. The objective probability of a stimulus being presented.
Rationale: Signal detection theory separates sensitivity (d', the ability to discriminate
signal from noise) from response bias (β/criterion, the decision rule or threshold). A
liberal criterion means a tendency to say "yes" (leading to more hits and false alarms),
while a conservative criterion means a tendency to say "no" (more misses and correct
rejections).
11. Damage to the fornix would most directly impact which of the following?
• A. The dopaminergic pathway from the substantia nigra to the striatum.
• B. The cholinergic pathway from the basal forebrain to the cortex.
• C. The efferent pathway from the hippocampus to the mammillary bodies.
• D. The noradrenergic pathway from the locus coeruleus.
Rationale: The fornix is the primary output tract of the hippocampus, projecting to the
mammillary bodies of the hypothalamus and then to the anterior thalamus. Disruption
of this circuit (e.g., in Wernicke-Korsakoff syndrome) leads to profound anterograde
amnesia.
Neuropsychology Board Exam Prep
Questions and Correct Verified Answers
SECTION I: FOUNDATIONAL KNOWLEDGE (NEUROANATOMY,
NEUROPATHOLOGY, & PSYCHOMETRICS)
Questions 1-50
1. A 65-year-old patient presents with a left homonymous hemianopia, apraxia,
and a profound neglect syndrome. An MRI is most likely to reveal a lesion in which
vascular territory?
• A. Anterior Cerebral Artery (ACA)
• B. Middle Cerebral Artery (MCA) - Right Hemisphere
• C. Posterior Cerebral Artery (PCA)
• D. Basilar Artery
Rationale: The right MCA supplies the lateral aspect of the frontal, temporal, and
parietal lobes. Lesions here, particularly in the inferior parietal lobule (temporo-parietal
junction), are the classic cause of left-sided hemispatial neglect. The optic radiations
(temporal lobe) causing the hemianopia and apraxia are also within this territory.
2. Which of the following pairs of structures is primarily associated with the limbic
system's role in emotional memory and contextual fear conditioning?
• A. Caudate and Putamen
• B. Amygdala and Hippocampus
• C. Hypothalamus and Thalamus
• D. Cingulate Gyrus and Insula
Rationale: The amygdala is crucial for the emotional component of memory and fear
conditioning (affective valence), while the hippocampus is essential for the contextual
(spatial/episodic) aspect of the memory. Both are core limbic structures.
,3. A patient exhibits severe anterograde amnesia with preserved intellect and
procedural learning. Post-mortem analysis reveals bilateral atrophy of the medial
temporal lobes. Which neuropathological finding is most specific to this
condition?
• A. Lewy bodies
• B. Neurofibrillary tangles (NFTs) in neocortex
• C. Severe neuronal loss in CA1 subfield of the hippocampus
• D. Amyloid plaques in the amygdala
Rationale: This describes Korsakoff's syndrome or an anoxic injury leading to
hippocampal sclerosis. While Alzheimer's disease (AD) involves the hippocampus, a pure
anterograde amnesia with spared procedural memory points to a circumscribed
hippocampal lesion. The CA1 subfield (Sommer's sector) is particularly vulnerable to
anoxia and ischemia, resulting in this classic amnestic syndrome.
4. The "Rule of 4" is a useful mnemonic for localizing brainstem lesions. If a
patient has a right-sided internuclear ophthalmoplegia (INO), where is the lesion?
• A. Right paramedian pontine reticular formation (PPRF)
• B. Right medial longitudinal fasciculus (MLF)
• C. Left PPRF
• D. Left MLF
Rationale: INO is caused by a lesion of the MLF. The MLF connects the abducens
nucleus on one side to the medial rectus subnucleus of the oculomotor complex on
the opposite side. A right INO (failure of adduction of the right eye on leftward gaze)
indicates a lesion of the right MLF.
5. In the context of the Wechsler Adult Intelligence Scale – IV (WAIS-IV), which
index is considered the most robust measure of "crystallized intelligence" and is
most resistant to the effects of diffuse cerebral insult?
• A. Perceptual Reasoning Index (PRI)
• B. Verbal Comprehension Index (VCI)
• C. Working Memory Index (WMI)
• D. Processing Speed Index (PSI)
Rationale: The VCI (comprised of Vocabulary, Similarities, and Information) draws upon
over-learned, culturally-familiar knowledge acquired through education and life
experience. It is the most resilient to neurological injury, serving as a "hold" test and a
benchmark for premorbid estimates.
,6. Which of the following is the BEST description of a "double dissociation" in
neuropsychology?
• A. Patient A has deficits in Language but not Memory; Patient B has deficits in
Memory but not Language.
• B. Patient A has deficits in Language and intact Memory; Patient B has
deficits in Memory and intact Language.
• C. Both patients have deficits in Language and Memory, but Patient A's are more
severe.
• D. A single patient shows a deficit in Language and a deficit in Memory.
Rationale: A double dissociation requires two patients/groups and two tasks. It is the
gold standard for inferring that two cognitive functions are mediated by independent
neural substrates. Patient A shows dysfunction on Task X but not Y, while Patient B
shows the opposite pattern (Task Y impaired, Task X spared).
7. A 72-year-old patient is diagnosed with Dementia with Lewy Bodies (DLB).
Which of the following symptom profiles is most characteristic at initial
presentation?
• A. Insidious onset of word-finding difficulties and visuospatial deficits.
• B. Fluctuating cognition, well-formed visual hallucinations, and
parkinsonism.
• C. Prominent apathy, loss of empathy, and executive dysfunction.
• D. Rapidly progressive dementia with myoclonus and gait ataxia.
Rationale: The core diagnostic features of DLB are fluctuations in attention/alertness,
recurrent detailed visual hallucinations, and spontaneous parkinsonian motor signs
(rigidity, bradykinesia). Option A is classic for Alzheimer's; C is behavioral variant FTD; D
is Creutzfeldt-Jakob disease.
8. Which of the following neuroimaging techniques is most appropriate for
evaluating the structural integrity of white matter tracts and connectivity?
• A. Functional Magnetic Resonance Imaging (fMRI)
• B. Diffusion Tensor Imaging (DTI)
• C. Positron Emission Tomography (PET)
• D. Magnetic Resonance Spectroscopy (MRS)
Rationale: DTI measures the directional diffusion of water molecules. In healthy white
matter, water diffuses anisotropically (along the axis of the tract). Disruption of these
, tracts (e.g., by edema, Wallerian degeneration) reduces anisotropy, allowing for
quantitative measurement of tract integrity (via Fractional Anisotropy).
9. A patient has trouble reproducing complex geometric figures (e.g., Rey-
Osterrieth) and has difficulty locating objects in space. He can, however, recognize
faces and objects. This is most consistent with a lesion to the:
• A. Right fusiform gyrus
• B. Right occipito-parietal pathway (Dorsal Stream)
• C. Left occipito-temporal pathway (Ventral Stream)
• D. Right temporal pole
Rationale: The dorsal "where/how" stream projects from occipital cortex to posterior
parietal lobe. Damage here causes optic ataxia, difficulty with spatial navigation, and
constructional apraxia. The ventral "what" stream (fusiform gyrus) is for object/face
recognition and is spared here.
10. In signal detection theory, the term 'criterion' or 'bias' (β) refers to:
• A. The inherent difficulty of the cognitive task.
• B. The participant's level of fatigue during testing.
• C. The participant's willingness to say "yes" to a signal when uncertain.
• D. The objective probability of a stimulus being presented.
Rationale: Signal detection theory separates sensitivity (d', the ability to discriminate
signal from noise) from response bias (β/criterion, the decision rule or threshold). A
liberal criterion means a tendency to say "yes" (leading to more hits and false alarms),
while a conservative criterion means a tendency to say "no" (more misses and correct
rejections).
11. Damage to the fornix would most directly impact which of the following?
• A. The dopaminergic pathway from the substantia nigra to the striatum.
• B. The cholinergic pathway from the basal forebrain to the cortex.
• C. The efferent pathway from the hippocampus to the mammillary bodies.
• D. The noradrenergic pathway from the locus coeruleus.
Rationale: The fornix is the primary output tract of the hippocampus, projecting to the
mammillary bodies of the hypothalamus and then to the anterior thalamus. Disruption
of this circuit (e.g., in Wernicke-Korsakoff syndrome) leads to profound anterograde
amnesia.
