Question 1
Question
Both major and mild neurocognitive disorders can increase the risk of delirium and complicate its course. Traditionally, delirium is distinguished from dementia on the basis of the key features of acute onset, impairment in attention,
and which of the following?
Answer
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Fluctuating course.
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Steady course.
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Presence of mania.
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Presence of depression.
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Cogwheeling movements.
Question 2
Question
The diagnostic criteria for major or mild neurocognitive disorder with Lewy bodies (NCDLB) include fulfillment of criteria for major or mild neurocognitive disorder and presence of “a combination of core diagnostic features and
suggested diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.” Another feature necessary for the diagnosis is that “the disturbance is not better explained by cerebrovascular disease, another
neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.” Which of the following completes the list of features necessary for the diagnosis?
Answer
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An acute onset and rapid progression.
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An insidious onset and gradual progression.
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An insidious onset and rapid progression.
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A waxing and waning presentation.
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A characteristic finding on ultrasound of the neck.
Question 3
Question
A 72-year-old man with no history of alcohol or other substance use disorders and no psychiatric history is brought to the emergency department (ED) because of transient episodes of unexplained loss of consciousness. His wife reports
that he has experienced repeated falls and syncope over the past year, as well as auditory and visual hallucinations. A thorough workup for cardiac disease has found no evidence of structural heart disease or arrhythmias. In the ED, he is found to have severe autonomic dysfunction, including orthostatic hypotension and urinary incontinence. What is the best provisional diagnosis for this patient?
Answer
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New-onset schizophrenia.
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New-onset schizoaffective disorder.
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Possible major or mild neurocognitive disorder with Lewy bodies.
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Possible major or mild neurocognitive disorder due to Alzheimer’s disease.
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New-onset seizure disorder.
Question 4
Question
In addition to documented infection with HIV and fulfillment of criteria for major or mild neurocognitive disorder (NCD), what other requirement must be met to qualify for a diagnosis of major or mild NCD due to HIV infection?
Answer
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Presence of HIV in the cerebrospinal fluid.
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A pattern of cognitive impairment characterized by early predominance of aphasia and impaired memory for previously learned information.
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Presence of progressive multifocal leukoencephalopathy.
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Inability to attribute the NCD to non-HIV conditions (including secondary brain diseases), another medical condition, or a mental disorder.
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Presence of Kayser-Fleisher rings.
Question 5
Question
Which of the following statements about the diagnosis of neurocognitive disorder due to Huntington's disease (NCDHD) is true?
Answer
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NCDHD is a laboratory-based diagnosis/disorder.
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NCDHD is a disorder that requires positive neuroimaging for diagnosis.
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NCDHD is a clinical diagnosis based on abnormal physical findings and
family history/genetic findings.
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NCDHD is a diagnosis that is best defined as patients who have a pill rolling tremor.
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NCDHD is a diagnosis mostly based on radiological examination.
Question 6
Question
Genetic testing is the primary laboratory test for the determination of Huntington’s disease. Which of the following best characterizes the genetic nature of Huntington’s disease?
Answer
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X-linked recessive inheritance with incomplete penetrance.
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Autosomal recessive inheritance with complete penetrance.
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Autosomal dominant inheritance with complete penetrance.
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Random mutation.
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X-linked dominant inheritance.
Question 7
Question
Prion disease has been reported to occur in individuals of all ages, from the teenage years to late life. Which of the following best characterizes the time frame of disease progression?
Answer
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Over a few months.
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Over several days.
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Over several weeks.
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Over 5 years.
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Over 10 years.
Question 8
Question
Expressed as a percentile, what is the typical performance on neuropsychological testing of individuals with major neurocognitive disorder (NCD)?
Answer
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Sixtieth percentile or below.
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Fiftieth percentile or below.
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Twenty-fifth percentile or below.
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Sixteenth percentile or below.
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Third percentile or below.
Question 9
Question
A 69-year-old semiretired radiologist with responsibility for chest x-ray interpretation at his academic medical center has been referred by the hospital’s Employee Assistance Program for clinical evaluation because of concerns expressed
by other clinicians that he has been making many mistakes in his x-ray interpretations over the past few months. Evaluation discloses a remote history of alcohol dependence with sobriety for the past 20 years, and a depressive episode
following the death of his wife 9 years before the current problem, treated with cognitive-behavioral therapy with full resolution of symptoms after 6 months and no recurrence. He acknowledges some trouble concentrating but no other symptoms, and he minimizes the alleged x-ray interpretation problems. He cannot state the correct date or day of the week and cannot recall the previous day’s news events, but he can describe highlights of his long career in medicine in great detail. Collateral history from his children reveals that on several occasions in the past year neighbors in his apartment building had complained that he forgot to turn off his stove while cooking, resulting in a smoke-filled apartment. He scores 21/30 on the Mini-Mental State Examination. What diagnosis best fits this clinical picture?
Question 10
Question
In major or mild frontotemporal neurocognitive disorder, which of the following is a diagnostic feature of the language variant?
Answer
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Severe semantic memory impairment.
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Severe deficits in perceptual-motor function.
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Receptive aphasia.
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Grammar, word-finding, or word-generation difficulty.
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Hyperorality.
Question 11
Question
Which of the following is a core feature of major or mild neurocognitive disorder with Lewy bodies?
Answer
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Fluctuating cognition with pronounced variations in attention and alertness.
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Recurrent auditory hallucinations.
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Spontaneous features of parkinsonism, with onset at least 1 year prior to development
of cognitive decline.
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Fulfillment of criteria for rapid eye movement (REM) sleep behavior disorder.
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Evidence of low striatal dopamine transporter uptake in basal ganglia as demonstrated by single photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging.
Question 12
Question
A 35-year-old man brings his 60-year-old father for evaluation of cognitive and functional decline, stating that he thinks his father has dementia; the son is also worried about the possibility of a hereditary illness. The physician notes to herself
that the patient has substantial cognitive impairment and features suggestive of the diagnosis of major neurocognitive disorder due to Huntington’s disease, but she is not sure about the cause of the neurocognitive disorder. She also notes that the patient’s son appears extremely anxious. She has a tight schedule and cannot provide a counseling session for the patient’s son until the next day. What is the most appropriate diagnosis to record on the insurance claim form that the patient’s son will submit on his father’s behalf?
Answer
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Unspecified central nervous system (CNS) disorder.
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Unspecified neurocognitive disorder.
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Unspecified mild neurocognitive disorder.
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Huntington’s disease.
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Problem related to living alone (V code category reflecting other problems related to the social environment).
Question 13
Question
Parkinson's disease result from cell loss in the substantia niagra, the brain area which produces
Answer
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adrenalin
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dopamine
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serotonin
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acetylcholine
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norepinephrine
Question 14
Question
Which of the following is a sort of mixed-variety dementia?
Question 15
Question
Which of the following symptom is NOT likely associated with Lewy body dementia?
Question 16
Question
K-MMSE에서 기억등록 문항을 실시할 때 환자가 세 단어를 모두 기억하지 못한 경우에는 여섯 번까지 반복하여 기억할 수 있도록 돕는다.
Question 17
Question
MMSE 총점이 21점 이하인 경우를 일반적으로 인지기능장애의 평가기준점(절단점)으로 삼는다.
Question 18
Question
기초 일상활동 기술(ADL)은 임상단계에서 중기를 지난 치매 환자의 임상적인 경과와 변화를 평가하고 비교하는데 유용하다.
Question 19
Question
다음 중 ADL 평가 항목에 해당하는 것을 모두 고르시오.
Answer
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홀로 남기
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식사하기
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대중 교통 이용
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전화 사용
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몸 단장 및 치장
Question 20
Question
다음 중 신경정신행동검사(Neuropsychiatric Inventory, NPI)에서 평가하는 항목에 해당하는 것을 모두 고르시오.
Question 21
Question
NPI 실시에 관한 다음 설명 중 틀린 것을 고르시오.
Answer
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NPI 실시에 소요되는 시간은 약 10~15분이다.
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NPI는 치매 환자가 흔히 나타내는 12가지의 이상 행동증상으로 구성되어 있다.
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NPI는 환자가 직접 보고하거나 실시할 수도 있다.
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해당 증상이 치매가 아닌 다른 원인질환이거나 치매 발병 이전에 나타난 것이라면 이를 평가에 포함하지 않는다.
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NPI 각 항목에 대하여 행동증상의 빈도와 심각도를 곱하여 각 항목별로 점수를 계산한다.
Question 22
Question
보호자는 K씨가 인지기능 저하로 인하여 직업활동이 불가능하다고 보고 있다. 혼자서 필요한 물건을 구입하기 어렵고 집밖의 사회활동에도 전혀 참여할 수가 없다고 하였다. K씨의 사회활동 수준에 해당하는 CDR 등급은?
Answer
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CDR 1
-
CDR 2
-
CDR 3
-
CDR 0.5
-
알 수 없음
Question 23
Question
보호자에 따르면 K씨는 혼자서 옷을 입기는 하지만 간혹 단추를 잘못 채우고 거꾸로 입기도 한다. 이전보다 옷을 입는 시간도 다소 길어졌다고 한다. 그러나 씻기, 식사, 대소변 가리기 등에서는 독립적인 수행에 전혀 어려움이 없는 상태이다. 위생과 몸치장의 영역에서 K씨의 적절한 CDR 등급에 해당하는 것은?
Answer
-
CDR 0.5
-
CDR 1
-
CDR 2
-
CDR 3
-
CDR 4
Question 24
Question
S-IADL 항목 중에서 <음식준비, 요리하기> 와 <집안일 하기>는 성별에 따른 영향을 가장 많이 받는 것으로 나타났다.
Question 25
Question
전반적퇴화척도(Global Deterioration Scale, GDS)의 실시에 필요한 소요시간은 대략 10~20분이다.