False: Anosognosia is the lack of awareness of disease. It usually results from non-dominant parietal lobe lesion. It is usually associated with unilateral neglect and left hemiplegia (Lishman 1997, p. 18; Mitchell 2004, p. 85).

False: The hippocampus receives its blood supply from the anterior temporal artery which is a branch of the posterior cerebral artery.

The anterior cerebral artery supplies the frontal pole and medial surface of the hemisphere (Fitzgerald 1996, p. 231).

False: Patients with chronic fatigue syndrome often ascribe their problem to an underlying physical cause and may be reluctant to accept a psychiatric element. Those who attribute their symptoms to exclusively physical causes have a worse prognosis (Gelder et al 2000, p. 1116).

True: In nv-CJD, prion protein can be found in peripheral lymphoreticular tissues, e.g. tonsils, lymph nodes, spleen and Peyer’s patches, as well as in the dorsal root and trigeminal ganglia. This is unique to nv-CJD. A negative biopsy does not rule out the possibility of nv-CJD (Sadock & Sadock 2005, p. 477).

False: All cognitive domains, i.e. orientation, attention, memory, visuospatial abilities and executive functions are affected in delirium. Tests of attention, concentration and memory such as the reverse calendar test are quick bedside tests which are often impaired in delirium (Mitchell 2004, p. 233; Yudofsky & Hales 2002, p. 536).

True: The EEG is very sensitive to delirium. The characteristic change is generalized slowing including the appearance of theta waves. An important exception to this is delirium tremens which is characterized by increased low-voltage fast activity (Yudofsky & Hales 2002, p. 539).

True: Absence or petit mal seizures occur primarily in children. They are primary generalized seizures associated with loss of consciousness from the start and without significant motor features. The EEG during seizures shows generalized synchronous 3–4-Hz spike and slow waves (Yudofsky & Hales 2002, p. 675).

False: There is usually an abrupt 3–4-fold rise in plasma prolactin level within 15–20 minutes of a generalized tonic-clonic seizure. The prolactin level returns to normal within 60 minutes. Recurrent seizures and greater frequency of seizures decrease the prolactin response. Prolactin levels are not raised following non-epileptic seizures. Post-ictal prolactin level is not reliable in differentiating between true and non-ictal seizures because only about 50% of complex partial seizures give a measurable stress hormone response (Gelder et al 2006, p. 348; Mitchell 2004, p. 124; Yudofsky & Hales 2002, p. 677).

False: The prefrontal cortex projects to subcortical structures in a series of distinct closed loops. Disruption of any of these produces a pattern of discrete deficits. However, these clinical syndromes seldom present as neatly in clinical practice as pathological lesions seldom respect anatomy. The syndromes are:

The mnemonic ‘Don’t Let Exam Demons Marr Any Opportunity For Passing’ can be used to help remember this. The initial letters spell DLEDMAOFP. Dorso Lateral – Executive function. Dorso Medial – Akinetic mutism (also apathy and attention). Orbito Frontal – Personality change.

Although clinical lesions seldom fall neatly into these categories, it is the orbito-frontal and dorsolateral syndromes which are generally associated with social judgement and decision-making respectively (Lindsay & Bone 2004, p. 109; Mitchell 2004, p. 77; Sadock & Sadock 2005, p. 325).

True: The proteome is the total number of proteins produced by the genome. There are many more proteins expressed than there are genes as there is variability in transcription, translation and post-translational modification (Pennington et al 2005).

False: Annergers et al reported that post-traumatic epilepsy with repeated seizures necessitating anticonvulsant medication occurs in approximately 12%, 2% and 1% of patients with severe, moderate and mild head injuries respectively within 5 years of the injury. Risk factors for post-traumatic epilepsy include severe injury, depressed skull fractures, penetrating wounds, chronic alcohol misuse, intracranial haemorrhage, and greater severity of injury. Head injuries with amnesia lasting greater than 24 hours are associated with greater severity of injury and are therefore more likely to be associated with epilepsy (Mitchell 2004, p. 131; Yudofsky & Hales 2002, p. 639).

True: CD4 counts are indicators of the stage of HIV infection. It may begin to decline slowly during the asymptomatic phase and decrease more dramatically during the early and late symptomatic phases (Lishman 1997, p. 317; Mitchell 2004, p. 182).

False: Although controversial, HIV-1 Associated Dementia has been described as a subcortical dementia affecting subcortical and frontostriatal brain processes. Cortical symptoms such as aphasia, agnosia, apraxia and other sensory perceptual dysfunctions occur later in the course of the disease, possibly as a result of opportunistic infections or neoplastic invasion of the CNS (Yudofsky & Hales 2002, p. 792).

True: Huntington’s disease patients do not show gradients of retrograde amnesia (Yudofsky & Hales 2002, p. 929).

False: The term ‘limbic’ was coined by Broca (1878) and originally referred to the limbus or rim of cortex adjacent to the corpus callosum and diencephalon. The term limbic system is most often used to describe the areas of the brain involved in emotion, memory or aggression. The precise constituents of the limbic system vary from book to book. Structures considered to be part of the limbic system include the hippocampal formation, septal region, parahippocampal gyrus, cingulate gyrus, insula and amygdala. The globus pallidus is part of the basal ganglia (Fitzgerald 1996, p. 267; Yudofsky & Hales 2002, p. 279).

True: Diencephalic amnesia, as exemplified by Korsakoff’s syndrome, results in specific memory impairment with other intellectual abilities preserved.

Anterograde memory is most severely affected. Retrograde episodic memory is also affected. Retrograde memory shows a temporal gradient, i.e. more distant memories are spared. Procedural memory and short-term memory (STM, working memory) are not affected. The ‘Primacy effect’ occurs when the first item on a list is remembered better than later items. The ‘Recency effect’ occurs when the last item on a list is remembered better than earlier items. In diencephalic amnesia, the recency effect, which is part of the STM, is preserved while the primacy effect, which is part of LTM, is not (Hodges 1994, p. 13).

True: Major depressive-like disorder due to multiple sclerosis differs from uncomplicated major depression. The typical picture commonly found in uncomplicated major depression, i.e. withdrawn and apathetic, with feelings of guilt and worthlessness, is unusual. Rather, symptoms such as irritability, worry and discouragement predominate (Feinstein 1999, p. 30; Mitchell 2004, p. 144).

False: Classically, normal pressure hydrocephalus presents with gait disturbance, urinary incontinence and dementia. In practice, the clinical picture is more variable (Lindsay & Bone 2004, p. 126; Mitchell 2004, p. 213).

True: Parkinson’s disease is characterized by Lewy bodies and Lewy neurites. They are intracellular aggregates composed of ?-synuclein (Gelder et al 2006, p. 341; Mitchell 2004, p. 150; Yudofsky & Hales 2002, p. 337).

True: Acute intermittent porphyria is an autosomal dominant disorder resulting in a 50% reduction of porphobilinogen deaminase activity. Attacks are caused by the accumulation of intermediates of haem synthesis. Psychiatric symptoms occur in attacks in 25–75% of cases. They include emotional disturbance, noisy disturbed behaviour, clouding of consciousness, delirium hallucinations and delusions. Coma can develop abruptly (Lishman 1997, p. 567).

True: Goldstein in 1939 coined the term ‘catastrophic reaction’ to describe the inability of the organism to cope when faced with physical or cognitive deficits. Catastrophic reaction may involve anxiety, tears, aggressive behaviour, swearing, refusal, renouncement and sometimes compensatory boasting. It occurs in about 20% of stroke patients. It is associated with anterior subcortical lesions, major depression and family or personal history of psychiatric disorders (Yudofsky & Hales 2002, p. 746).

False: After a few minutes of stage 1, sleep progresses through stages 2, 3 and 4 and then enters REM sleep. NREM and REM sleep then alternate in 90–110 minute cycles. In successive cycles the amount of NREM sleep decreases and the amount of REM sleep increases. Stage 3 has 20–50% and stage 4 has >50% slow wave sleep. Stages 3 and 4 are also called slow wave sleep, delta sleep or deep sleep and occur predominantly in the first third of a typical sleep cycle. Delta waves are most prominent in stage 4 sleep (Sadock & Sadock 2005, p. 282; Schneerson 2000, p. 2; Stern & Engel 2004, p. 116).

True: Somnambulism or sleepwalking is a manifestation of incomplete arousal from stages 3 and 4 NREM sleep in children and young adults. It usually occurs during the first third of the night. Sleepwalking individuals arise from bed and ambulate without awakening. They can engage in a variety of complex behaviours whilst asleep. They often interact with the environment inappropriately, sometimes resulting in injury, rarely committing acts of violence. They are difficult to awaken, and if woken usually appear confused. Sleep deprivation may exacerbate, or even provoke, sleepwalking in susceptible individuals. It has a familial pattern. Up to 17% of people report at least one episode of sleepwalking in childhood with a peak incidence between 4 and 8 years. It usually disappears spontaneously after adolescence. It is rare in adults (Schneerson 2000, p. 143; Wright et al 2005, p. 399; Yudofsky & Hales 2002, pp. 698, 717).

False: Breast conserving therapy does not reduce the high frequency of depression (Blichert-Toft 1992).

False: Hypothyroidism is typically associated with hair loss and thinning (Lishman 1997, p. 512; Sadock & Sadock 2005, p. 2155).