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Functional anatomy of cerebral cortex
1. Primary motor area (m1)
a) corresponds to area 6 of brodmann which is
present in post-central gyrus and posterior part
of paracentral lobule
b) cortex is granular
c) controls the movements of voluntary muscles
of ipsilateral side
d) most characteristic feature is the presence in
lamina v of extremely large pyramidal cells (of
betz), measuring 15-60 micrometer or more in
e) part of the body is not represented
proportionate to size but rather to intricacy of


areas of sensation are somatotopically

represented upside down with head below
and lower limb above
area for leg and foot is located in the anterior
part of paracentral lobule which also receives
the sense of distention of the urinary bladder
and rectum

4. Striate area of visual area

a) is situated along the lips of the posterior part of
calcarine sulcus, and exclude the cuneus and
lingual gyrus
b) anteriorly it extends upto the parieto-occipital
sulcus; posteriorly it is limited by the lunate
c) it has agranular cortex; the outer band of
baillarger in lamina 4 is significantly prominent
and forms the stria of gennari
d) receives fibres of optic radiation
e) it is connected to area 16 and 17 by short
association fibres
5. Areas receiving direct fibres from the olfactory bulb
a) prepiriform cortex
b) gyrus semilunalis
c) anterior olfactory nucleus
d) lateral geniculate body
e) amygdaloid complex

2. Premotor areas (areas 6, 8, 44, 45)

a) areas 6 and 8 are located in inferior and
middle frontal gyri
b) areas 44 and 45 ( brocas area) are located in
inferior frontal gyrus
c) area 6 integrates series of involuntary
movements to perform skillful acts
d) brocas area (motor speech area) regulates the
coordinated movements of lips, tongue, palate,
larynx and pharynx during speech.
e) Brocas area represented on the right sphere
of a right handed person

6. Regarding sensory area

a) Include somesthetic, visual, auditory and
olfactory area
b) Primary somesthetic area (S1) has three parts
which is 3, 1 and 2
c) Taste is received at upper part of post central
d) Area for leg and foot is located in the posterior
part of paracentral lobule which is also receives
the sense of distention of the urinary bladder and
e) Supplementary somesthetic area (S2), located
along the upper lip of the posterior ramus of
lateral sulcus

3. Functions of primary somesthetic area (s1)

a) area 2 receives cutaneous sensations of
touch, pressure, position and vibratory senses
and the pain and temperature senses also
upto certain extent.
b) area 1 receives projections from cutaneous
and joint senses
c) area 2 is primarily concerned with deep senses
from the muscles, joints etc.

7. Regarding visual area

a) It divided into striate area (Area 17), parastriate
area (Area 18) and peristriate area (Area 19)
b) Striate area receive fibers of optic radiation
c) Striate area are connected to area 18 and 19 by
short association fibers
d) Parastriate area and peristriate area contain
complex and hypercomplex visual cells


Complex cells respond to linear stimuli from the

retina and the hypercomplex cells are detectors
of angular or curved lines

8. Regarding auditory area

a) Primary auditory area (area 41) receives fibres of
auditory radiation from the lateral geniculate body
b) Area 41 is essential for the detection of frequency
and the direction from which the sound
c) Werniches area is located below areas 41 & 42
in superior temporal gyrus
d) Area 22 is concerned with the interpretation of
sounds and comprehension of spoken language
e) Auditory areas are divided into Primary auditory
area (Area 41), auditory association area (Area
42) and higher auditory association area or
Wernickes area (Area 22)
9. Regarding the functional areas of cerebral cortex
a) Primary motor area controls the movements of
voluntary muscles of contralateral side
b) Prefrontal are is essential for thinking, mature
judgement, foresight and tactfulness
c) Psychical cortex is concerned with hallucination,
memory and dreams
d) Brocas area represented on the right sphere of a
right-handed person
e) Representation of body at supplementary motor
area is lower limb anteriorly, face posteriorly and
rest of body in intermediate part
10. True or false
a) Psychical cortex located at the anterior part of
temporal lobe but not including the temporal pole
b) Olfactory cortex is applied to all areas of cerebral
cortex that receive direct fibers from the olfactory
c) Frontal eye field is located in the superior frontal
d) Premotor areas lie in front of area 4
e) Areas 6 and 8 are located in superior, middle and
inferior frontal gyri
Functional anatomy of brainstem
1. Nuclei of vagal nerve:
a) spinal nucleus of trigeminal nerve
b) dorsal nucleus of vagus
c) nucleus ambiguous
d) nucleus of solitary tract
e) inferior salivatory nucleus
2. These are major efferents of reticular formation,

a) red nucleus
b) corpus striatum
c) substantia niagra
d) olivary nucleus
e) limbic system
3. Regarding the medial medullary syndrome
a) result from occlusion of anterior spinal artery
b) ipsilateral upper motor neuron paralysis
c) involved spinal lemniscus, spinal nucleus and
tract of trigeminal nerve and nucleus ambiguous
d) loss of discriminative senses of the body in
contralateral side
e) involve hypoglossal nerve, corticospinal tract of
the pyramid and medial lemniscus
4. Clinical features of webers syndrome
a) ptosis
b) contralateral hemiplegia
c) contralateral loss of pain, touch, temperature,
vibratory and proprioceptive senses
d) tremor, chorea and athetosis
e) loss of accommodation
Pathology of cerebrovascular disease
1. Regarding the gross morphology of global cerebral
a) widened gyri & narrowed sulci
b) well demarcation bet. gray & white matter
c) fluid-filled cavity lined by dark gray tissue
d) brain edema
e) sickle-shaped band of necrosis in border zone
bet. anterior & posterior cerebral artery
2. Microscopic features of focal cerebral ischemia
a) red neurons (after 24hrs)
b) neutrophilic emigration (up to 48hrs)
c) macrophages predominate (2 to 3 wks)
d) gliosis developing esp around the cystic cavity
e) influx of macrophages (24 hrs to 2 wks)
3. The causes of the subarachnoid hemorrhage are
a) saccular (berry) aneurysm
b) vascular malformation
c) amyloid angiopathy
d) vasculitis
e) tumours
4. Based on the morphology of berry aneurysm
a) dark red, shiny surface & thin, translucent wall
b) rupture is usually at base
c) atheromatous plaques, calcification or thrombus


brown discoloration of the adjacent brain &

arterial adjacent to it shows intimal thickening

5. True or false
a) intracranial hemorrhage peak at the age of 30
b) mechanism of intracranial hemorrhage is rupture
of small intraparenchymal vessels
c) development of charcot-bouchard aneurysm due
to effects of hypertension
d) location of capillary telangiectasia is at pons
e) cigarette smoking may not lead to berry
Radiology of cerebrovascular disease
1. Ct scan can detect :
a) density change
b) vessel occlusion
c) effect to nearby structure
2. Features of ischaemic stroke on ct scan are:
a) mild focal oedema
b) hypodense area
c) usually follow arterial distribution
d) commonest region basal ganglia, internal
capsule, thalamus
e) hyperdense area
3. Stroke mimics are:
a) brain tumour
b) hypernatremia
c) systemic infection
d) hepatic encephalopathy
e) seizure
4. Role of ct scanning:
a) distinguish between ischaemic and hemorrhagic
b) identifies the site and size of the infarct
c) rule out life threatening process e.g hematomas,
neoplasm and abscess
d) defining the anatomic distribution of stroke
e) confirm the diagnosis
a) less sensitive than ct to detect stroke in very early
b) not practically possible to do as urgent case
c) t2, diffusion series are sensitive
d) t1-sf is white
e) t2 csf is black
Diagnostic approach to hemiplegia

1. Upper motor neuron lesion

a) spasticity
b) hypoactivity of deep tendon reflex
c) no muscular atrophy
d) no muscle fasciculation
e) barbinski reflex
2. Lower motor neuron lesion
a) flaccidity
b) barbinski reflex
c) hyperactivity of deep tendon reflex
d) fasciculation present
e) prominent muscular atrophy
3. Regarding cerebral lesion
a) subcortical lesion resulting in focal weakness
b) examples of acute etiology are vascular,
infarction, infection and trauma
c) chronic cerebral lesion is progressive weakness
exceed 3 months
d) cortical lesion is compact dense
e) demylinating disease is subacute
4. True or false
a) monoplegia is weakness of all muscle of one leg
or arm
b) hemiplegia is weakness of one side of body
c) paraplegia is weakness of both legs mostly from
spinal cord disease
d) quadriplegia is weakness of all four extremities
e) paraplegia and diplegia affects both lower limbs
5.True or false
a) weber syndrome consist of contralateral cranial
neuropathies, ipsilateral weakness
b) contralateral weakness, contralateral
hemisensory loss and aphasia due to dominant
MCA territory lesion
c) examples of peripheral lesion are neurofibroma
and schwanomma
d) spinal hemisection syndrome consist of
contralateral weakness and ipsilateral sensory
e) crossed sign is ipsilateral cranial cranial
f) neuropathies, contralateral weakness
Physiology of speech
1.Regarding cerebral control centre :
a) planum temporale involved in language related
auditory processing
b) wernickes area project to brocas area via
angular gyrus
c) angular gyrus transform visual information into
common speech


non-dominant hemisphere involve in verbal

emotional component
planum temporale is biggest area in left

2. Regarding wernickes area

a) interpreting motor experience
b) selection of speech
c) situated in the temporal lobe
d) is area of 24 of brodmann classification
e) it project to broca area via acuate fasciculus
3. Regarding cerebral control centre :
a) planum temporale involved in language related
auditory processing
b) wernickes area project to brocas area via
angular gyrus
c) angular gyrus transform visual information into
common speech
d) non-dominant hemisphere involve in verbal
emotional component
e) planum temporale is biggest area in left
4. Regarding wernickes area
a) interpreting motor experience
b) selection of speech
c) situated in the temporal lobe
d) is area of 24 of brodmann classification
e) it project to broca area via acuate fasciculus
5. Regarding speech system
a) consists of 2 system
b) phonation and speech occur during inspiration
c) articulation is the process of shaping of the
d) resonation is the prolongation and intensification
of sound
e) above pharynx are larynx, nasal and oral cavity
6. Regarding dysphasia
a) brocas dysphasia produce fluent aphasia
b) wernickes dysphasia
c) global dysphasia cause inability to speech only.
d) in conduction dysphasia, repetition is not
e) there are 5 types of dysphasia
Peadiatric stroke
1. Regarding perinatal stroke:
a) is a cerebrovascular event around the time of
birth with pathological or radiological evidence of
focal arterial infarction
b) mostly occur in posterior cerebral artery territory


risk factors include cardiac disorders and

clot formation is influenced by hypercoagulable
blood constituents, injury to vessel walls and
static of blood flow
same as adult stroke

2. Clinical presentation of perinatal stroke due to sinus

venous thrombosis include
a) seizure
b) visual disturbance
c) speech disturbance
d) preceding transient ischemic attack (tia)
e) hemiparesis
3. Below are investigations to assess pediatric stroke
a) laboratory studies like protein-c activity
b) cardiolipin antibodies
c) genetic studies such as factor v leiden mutation
d) urine test
e) ultrasound
4. The aim of pediatric stroke therapy is to
a) decrease collateral flow in brain
b) stops the ischemic cascade by disregard the
body homeostasis
c) prevent any complication such as seizures or
nosocomial infection
d) avoid dehydration or shock
e) removes any arteries or venous thrombus
Stroke therapeutics
1. Regarding stroke therapy
a) types of stroke should be identified before give
the treatment
b) warfarin is a antiplatelet group
c) monitoring of coagulation profile is required for
patient who takes heparin as a drug
d) heparin dissolve the blood clot that already exist
e) low-molecular-weight heparins have a longer
duration of action than heparin.
2. Antiplatelet agents
a) including aspirin, warfarin and ticlopidine aspirin
helps to keep platelets from clumping.
b) tinnitus is one of the symptoms of aspirin
c) clopidogrel is an analogue of ticlopidine which is
taken orally once a day
d) side effects of ticlopidine includes diarrhea and
skin rashes.
3. Long term treatment for haemorrhagic stroke are

a) speech therapy
b) repositioning and range of motion of exercise
c) occupational therapy
d) rehabilitation program by professional team
4. What is the primary prevention for stroke
a) aspirin, ticlopidine, clopidogrel
b) ace inhibitor and statins
c) surgical treatment
d) exercise
Neurochemistry of movements disorder
1. Regarding hyperkinetic:
a) is a rigid akinetic syndrome
b) is a stereotypic movement
c) hemibalismus define as a high amplitude flailing
of the limbs on one side of body
d) parkinson disease include in hyperkinetic
movement disorder
e) dystonia is a voluntary muscle
contraction,causing sustained twisted.
2. Basal ganglia
a) help monitor and coordinate slow,sustained
contractions related to posture and support
b) neurotransmitters at inhibitory synapses are
dopamine,glutamate and gaba
c) it inhibit muscle tone throughout the body
d) neuromodulator released together with a small
molecular weight transmitter
e) neuromodulator have less term effects than
3. Concerning dopamine
a) derived from tyrosine
b) high concentration of dopamine will inhibit
tyrosine hydoxilase
c) dopamine will undergoes methylation and
d) d2 receptors involve in indirect pathway
e) dopamine can cross blood brain barrier
4. Overall influence of the striatal dopaminergic
a) d1 receptors are activated by dopamine through
direct pathway
b) in direct pathway,dopamine stimulates cell firing
and increasing of gabaergic tone in basal ganglia
output nuclei.
c) inhibition of cell firing occur when dopamine
activates d2 receptor.
d) both pathways ultimately disinhibiting
thalamocortical relay neuron
e) direct pathway is like a gas pedal,while indirect
pathway is like a brake

5. Regarding parkinson disease..

a) loss of motor activity occurs due to increase
blocking of thalamic signals.
b) neurochemical abnormality only marked in basal
c) substantia nigra will appear pale due to reduce
number of dopaminergic neuron
d) dopamine deficiency is the main cause of
e) reduces direct pathway activities cause difficulty
to initiate movement.

Clinical approach of involuntary movement

a) acetylcholine cause excitatory effect
b) dopamine synthesized by small striatal cells
c) all are synthesized and stored postsynaptically
its effect usually diminished by neuromodulator
d) dopamine excess results in parkinsons disease
2. Positive features of movement disorder are
a) tremor
b) postural disturbance
c) bradykinesia
d) ballismus
e) athetosis
3. Regarding tremor
a) frequency of essential tremor are ranged from 412 hz
b) theophylline, caffeine and alcohol withdrawal
accentuate tremor
c) essential tremor occur at rest
d) essential tremor is autosomal dominant
e) anxiety, fever and physical exhaustion can cause


in cog-wheel rigidity the muscle tone increase

selectively in extensor of legs and flexors of arm
it is found in parkinsons disease
in parkinsons disease it predominates in flexor
muscles of neck, trunk and limbs
stretch reflexes are hyperactive in cog-wheel

Pathology of neurodegenerative disease

1. Rregarding neurodegenerative disease,
a) alzheimers disease(ad) and pick disease are part
of it.
b) there is selective neuronal loss without any
previous inciting event in neurologic patient.
c) amyloid beta protein is critical molecule in ad
disturbance of ubiquitin-proteasome system is
main causes.
d) can only cause memory disorder.
2. Below are parkinsons disease sign except.
a) festinating gait
b) clacp-knife rigidity
c) tremor
d) emotional changes
e) dementia
3. Regarding alzheimers disease,
a) cortical shrinkage and hydrosephalus are seen
b) tau protein, neuritic plaques, amyloid angiopathy
and globose neurofibliary tangles are found
c) the aetiology of disease is unknown
d) majority occur in patient more than 50 years old
e) amyloid beta is found.
4. Regarding parkinsons disease.
a) dopamine is produce by substantia nigra
b) phenothiazines also can cause parkinsonism sign
c) part of autosomal dominant disease
d) also known as diffuse lewy body disease (dlbd)
e) gene involve is 9q13

4. Regarding dystonia
a) it is a voluntary muscle contraction causing a
sustained, twisted or abnormal posture
b) it is not triggered by movement
c) frequently patients often have sensory tricks
d) viral encephalitis can cause dystonia
levodopa will work well in an inherited type of

5. Regarding huntington disease

a) the gene contain repetead cag sequences
b) is autosomal recessive inheritance disease
c) patient present with dementia, mood swing, and
autonomic dysfunction
d) in microscopic examination, glial cytoplasmic
inclusion are seen
e) patient suffered from the disease wiil regain
conciousness as soon they fall down.

5. Regarding rigidity
a) it is characterized by plastic resistance to active
movement affecting both agonist and antagonist

Tics myoclonus seizures in children

1. Involuntary movement differs from seizures in the

way of
a) seizures does not occur during sleep
b) involuntary movement have more stereotype
c) involuntary movement will cause loss of
d) seizures accompanied by epileptiform activity on
2. Regarding tics or habit spasm
a) it is a purposeful movement that commonly occur
in children
b) exacerbated by stress and disappear during
c) drugs are fundamental of treatment
d) female are more affected than males
e) compare to chorea, it is more harder to suppress
3. Myoclonus
a) in essential myoclonus, it is a benign course and
male are more affected
b) lysosomal storage diseases can lead to
symptomatic myoclonus
c) in benign myoclonus in infancy, drugs should be
given to avoid its become worse.
d) hereditary/familial myoclonus is transmitted by
autosomal recessive
e) onset of infancy benign myoclonus is started
before 1 year of age.
4. Seizures in children
caused by disturbance of ion channels
a) simple febrile convulsion is a focal seizure and
occur less than 15 minutes
b) febrile convulsion are malignant and has poor
c) myoclonic seizure is one of the partial seizure
d) myoclonic seizures is due to cerebellar ataxia
5. Myoclonic vs tic vs chorea
a) chorea is a rhythmic and localized involuntary
b) tic can be controlled voluntarily
c) three of them will increased with stress
d) chorea will interfere by movement
Diagnostic approach to headache
1. False or true
a) brain tissue is the pain sensitive structure and
could give rise to headache
b) in migraine, serum 5-hydroxytryptamine falls at
the onset of prodromal symptoms and increase
during headache


post lumbar puncture may result headache

cluster headache also is called histamine
classical migraine will manifest as unilateral
headache and may not become generalized


increased permeability to macromolecular serum

proteins in brain capillary endothelial
oedema may be localized and generalized
evolves over minutes to hour

Pathophysiology of cerebral edema

Diagnostic approach to comatose patient

1. Regarding cytotoxic edema

a) swelling of all the cellular elements of brain
b) due to failure of ATP dependent/ Na+ Ca+
c) release of O2 derived free radicals
d) the edema fluid rich in protein
e) swelling of neurons, glial and endothelial cells

1. Assessment of comatose patient includes;a) gag/cough reflex

b) corneal reflex
c) dolls head movement
d) cold caloric test
e) pattern of breathing
Sleep and consciousness

2. Vasogenic edema
a) increased permeability of capillary endothelial
cells caused by tissue necrosis
b) increased permeability of capillary endothelial
cells to serum proteins
c) edema fluid rich in electrolytes
d) increased interstitial space
e) may lead to cerebral herniation
3. Blood Brain Barrier(BBB)
a) cerebral capillary is the site of BBB
b) 10 times mitochondria compared to other
capillaries(3-4 times)
c) ATP ase is an important enzyme
d) Has a carrier mediated transport of glucose and
amino acid
e) Innervated by cholinergic and aminergic
only(para and simpa)
4. Vasogenic edema
a) grey matter edema >white (white>)
b) caused by mechanical failure of tight endothelial
junction of BBB
c) swelling of astrocytes
d) Focal inflammation
e) Reyes syndrome(in cytoyoxic edema)
5. Cytotoxic edema:
a) due to increased cell membrane Na+/K+
b) caused by disruption of blood brain barrier
c) edema bed rich in protein
d) no cell swelling
e) decreased interstitial space
6. Vasogenic edema
a) if severe can lead to cerebral herniation

1. Components of consciousness
a) Arousal- concurrent functioning of both cerebral
cortex and RAS
b) Wakefulness - concurrent functioning of both
cerebral cortex and RAS
c) Content cerebral cortex
d) Cognition cerebral cortex
2. The reticular activating system
a) Is primarily an antomic area in the midventral
portion of medulla and midbrain
b) Consists of diffuse, primitive system of interlacing
polysynaptic nerve cells
c) Consists of fibers in the brain stem
d) Axons of neurons have only ascending branches
e) Ascending fibers originate in the reticular
f) Ascending fbers carry signals upward to arouse
and activate cerebral cortex
g) Ascending fibers involved in alertness
3. Levels of consciousness
a) Conciousness alertness
b) Confusion disturbed consciousness, impaired
ability to think clearly, perceive and respond to
c) Delirium disturbed consciousness, motor
restlessness, transient hallucination,
disorientation, delusion
d) Obtundation decreased alertness, psychomotor
e) Stupor exhibits more spontaneous activity,
f) Coma state of being unarousable and
unresponsive to external stimuli or internal
4. Sleep


Is a state of conciousness
Person can aroused by sensory or other stimuli
Follows a 24 hours diurnal and nocturnal rhythm
circadian rhythm
Is a restorative function
Sleep disorder will alter immune function, normal
circadian pattern of hormone secretion, and
physical and psychological functioning

5. Physiology of sleep
a) Stage I muscle contracted, dreaming
b) Stage II sleep spindles ( burst of alphalike
waves )
c) Stage III EEG showed lower frequency and
high amplitude
d) Stage IV maximum slowing ith large waves,
deep sleep
e) Progression from stage I to stage IV normally
takes 30-45 minutes, then it reverse by itself
f) REM follows NREM sleep
Pathology of brain and spinal cord tumor
1. The following are true regarding the symptoms
caused by a tumor according to its site;
a) Motor area: paraesthesia of a part of the body
b) Basal ganglia: weakness
c) Cerebellum: increased tone
d) Brainstem: problem with sensation, hearing and
facial movement
e) Spinal cord: loss of bladder and bowel control
2. Major classes of brain tumors include;
a) gliomass
b) peripheral nerve sheath tumor
c) neuronal tumors
d) lymphoma
e) papilloma
3. Astrocytoma
a) arises from neuroglial cells
b) is graded from grade I to VI by microscopic
examination of biopsy specimen
c) can either be fibrillary or anaplastic
d) is common in adolescent
e) may present with seizures and headache
4. Meningioma
a) is a malignant tumor seen in children
b) is more frequently seen in males
c) arises from meningothelial cells of the arachnoid
and stromal cells of choroids plexus
d) always present with a distinct localizing symptom
e) compresses underlying brain but is easily
separated from it

5. Regarding peripheral nerve sheath tumors;

a) glioma is the most common tumor seen
b) neurofibromatosis type 1 is autosomal recessive
c) schwannoma is a malignant tumor
d) neurofibroma can occur in skin and peripheral
e) malignant peripheral nerve sheath tumor arises
from schwannoma
Drug treatment of headache and pain
1. Regarding dopamine agonist
a) include bromocriptine, pergolide, ropinirole and
b) more effective in late Parkinson disease
c) duration of action shorter than levodopa
d) non-selective drug
e) can cause GIT disturbances
2. Amantadine is a drug which..
a) increase released and decrease reuptake of
b) decrease synthesis of dopamine and
anticholinergic activity
c) initial therapy of severe Parkinson disease
d) excretes via bile and urine
e) can cause congestive heart failure
3. Regarding prodrug of dopamine
a) Combine with carbidopa to increase availability of
levodopa for brain entry
b) it increase dopamine synthesis
c) will convert to dopamine by dopa carboxylase
d) cannot cross the blood brain barrier
e) absorption delayed with presence of food
4. Tolcapone is.
a) MAO-B inhibitor which is to treat mild Parkinson
b) Short acting
c) Drug which act only at central inhibition of COMT
d) Can decrease symptoms of wearing off in
combination levodopa and carbidopa
e) Can cause hepatotoxicity
5. Drugs which can increase nigostriatal dopaminergic
activity such as.
a) Benztropine
b) Selegiline
c) Levodopa
d) Bromocriptine
e) ropinirole
6. Regarding ergot alkaloids


It is vasodilation
Partial agonist 5HT2 and partial antagonist
Cerebral vessel not sensitive to it
Good to take after prodrome
Adverse effect usually GIT upset and prolonged
refractory vasospasm and gangrene

7. Regarding serotonin effects

a) Vomiting
b) Platelet aggregation
c) Delay peristalsis
d) Bronchodilation
e) Heart contraction
8. Triphans
a) Is a vasodilator
b) Can be given to patient who got migraine
c) Can cause tingling sensation as side effect
d) Is a serotonin antagonist
e) Effect at vomiting centre
9. Regarding drugs for headache
a) Paracetamol is one of them
b) Paracetamol increase uric acid level in body
c) Adverse effect for ergoid alkaloid is vasospasm
d) Ergotamine is vasoconstrictor
e) Example for analgesic drugs is triphan and
Head injury
1. Which patients need airway protection?
a) airway injury
b) unstable midface trauma
c) Glasgow Coma Scale <9 or sustained seizure
d) High aspiration risk
e) Large flail segment

4. Regarding the radiographic feature for diffuse brain

a) The CT scan appear normal
b) Very small white dots lesion seen
c) Poor GCS with normal CT scan
d) It is important to repeat CT scan after 24-48
e) Treatment is based on GCS, ICP and CPP
5. Regarding acute hemorrhage
a) The outcome of acute extradural hemorrhage is
worst compare to subdural hemorrhage
b) There is no direct injury to brain in acute
extradural hemorrhage
c) The cause of acute subdural hemorrhage can be
due to brain laceration, burst lobe or direct brain
d) For the acute extradural hemorrhage, the blood
clot is between dura and brain surface
e) Both of acute hemorrhage usually occur in young
Physiology of motor endplate
1. Drugs acting at d NMJ:
a) Botulinum toxin prevent Ach release by
enzymatically clearing the protein required for
docking of vesicles within the presynaptic
b) Gentamicin may cause neuromuscular blockade
by inhibiting the calcium influx
c) Competitive neuromuscular blocking drug pass
the blood brain barrier or placenta
d) Vecuronium has no cardiovascular effects
e) Atracurium may cause histamine release with
flushing ang hypertension

2. Which are the components of full examination?

a) visual acuity in an alert patient
b) papillary light reflex
c) reflexes
d) spinal tenderness
e) motor weaknesses

2. Neuromuscular junction:
a) has only Ach receptor
b) synaptic transmission are excitatory and
c) area of synaptic membrane is small
d) action potential causes release of Ca2+ from
sarcoplasmic reticulum and triggers muscle
e) choline is synthesized in the cytoplasm of the

3. What are the signs of SkullBase fracture?

a) Raccoon eyes
b) Battle sign after 8-12 hours
c) CSF rhinorrhea
d) Hemotympanum
e) Kernigs sign

3. Regarding Myasthenia Gravis

a) is acquired condition characterized by weakness
and fatiguability of proximal limb, ocular and
bulbar muscles.
b) It is twice as common in men as in women, with a
peak age incidence round 30.



Immune complexes are deposited at the

postsynaptic membranes, causing interference
with and later destruction of the acetylcholine
These disease-specific IgG antibodies are
present in 90% of cases of generalized
myasthenia gravis.
Pyridostigmine is the drug most widely used.

4. Drugs that affect transmission at the NMJ

a) methacoline, carbachol, and nicotine are not
destroyed by cholinesterase or are destroyed so
slowly that their action persists for many minutes
to several hours.
b) Curariform drugs affect the muscle fiber
membrane by blocking the action of acetylcholine
on the acetylcholine receptor sites.
c) Neostigmine inactives the acetylcholinesterase
for up to several hours.
d) Physostigmine and diisopropyl fluorophosphates
causes muscles spasm.
e) Diisopropyl fluorophosphates, which has military
potential as powerful nerve gas poison,
inactivates acetylcholinesterase for weeks, which
makes this a particularly lethal poison.

4. Features of Brown-Sequard syndrome

a) Impaired pain and temperature sensation on
contralateral side
b) Impaired light touch and vibration sense at
ipsilateral side
c) Segmental zone of hyperpathia/ spontaneous
pain at the site of lesion
d) Lower motor neuron signs at the site of lesion
e) Pyramidal tract signs at ipsilateral side
5. Features of cauda equine lesion
a) Always painful
b) Asymmetric
c) Multiple root involvement
d) Knee jerk present
e) Ankle jerk absent
Anti-epileptic Drug
1. True or false
a) Primidone is less effective than Phenobarbital
b) High dose of Phenobarbital may cause CNS
c) Phenytoin acrs by blocking Na+ channels
d) Toxicity of carbamazepine lead to hyponatremia
e) Sodium valproate is used for all types of seizures

Localisation of sc lesion
1. True or false
a) Spinal cord supply by spinal artery
b) 2/3 of the spinal cord supply by anterior spinal
c) 2/3 of the spinal cord supply by anterior spinal
d) 1/3 of the spinal cord supply by posterior spinal
e) 1/3 of the spinal cord supply by posterior spinal
2. When compression occur...
a) Should have pain and progression of the
b) pain at the vertebral body is aggravating by
c) Referred pain is due to chronic disease
d) Radicular pain; the lesion is at the anterior root
e) Radicular pain is aggravating by increase in
spinal pressure
3. Ascending tracts
a) Tectospinal tract
b) Pontine reticulospinal tract
c) Dorsal spinocerebellar tract
d) Rubrospinal tract
e) Spinothalamic tract

2. Hydatoins:
a) Phenytoin
b) Phenobarbital
c) Primidone
d) Lamotrigine
e) Mephetoin
3. Regarding drugs for epilepsy
a) vigabatrin inhibit GABA degradation
b) felbamate can cause severe hepatitis
c) gabapentin excreted in the urine
d) Ethosuximide used in treatment of generalized
e) Oxazolidinediones can cause nephritic syndrome
4. Drugs that give effect of dizziness
a) febamate
b) gabapentin
c) vigabatrin
d) ethosuximide
e) oxazolidinediones
5. Drugs for generalized seizures
a) Benzodiazepins
b) Valproic Acid
c) Ethosuximide
d) Gabapentin
e) Vigabatrin

Clinical approach to convulsion

1. True or false
a) Recurrent febrile convulsions is significant with
b) Fits is electrical manifestation of a cerebral
c) Convulsion is a paroxysmal voluntary disturbance
of brain function
d) Febrile seizure in adult is same like febrile
seizure in children
e) Ictal period of seizure can divert by patients
2. True or false
a) The aetiology of seizure is same in all ages
b) In simple partial seizure, the consciousness is
c) In complex partial seizure, the consciousness is
not impaired
d) All generalised seizures is convulsive
e) Aura is the latest portion of a seizure
3. The following statements are true regarding
investigation of convulsion
a) Electroencephalography is necessary to confirm
the presence of abnormal electrical activity
b) The electroencephalography (EEG) cannot be
used to determine the type of seizure.
c) Beta rhythm of EEG occurs at rates of 5-7 Hz
d) Delta rhythm consists of slow waves of very low
to extremely high voltage at rates of 1-4 Hz
e) Metabolic screening is necessary in order to rule
out the convulsion.
4. The following statements are true
a) Aura is the earliest portion of a seizure and may
act as a warning
b) The doctor should ask the about the
manifestation of a seizure
c) Important activities of daily living are not
significant in diagnosis of convulsion
d) The doctor should ask any history of febrile
convulsion to adult patient
e) Post ictal event is the time immediately after the
attack of convulsion
5. Anti convulsant.
a) the commonest anti convulsant are:
carbamazapine, sodium valproate,
phenobarbitone, phenytoin, clonazepam
b) sodium valproate is the second-line drug in the
treatment of the generalized epilepsies


carbamazapine is the first-line drug in the

treatment of partial seizures and partial evolving
tonic/clonic seizure
not preferably use one anti convulsant
Iamotrigine is anti convulsant drug

6. Status epilepticus.
a) epileptic seizure that prolonged
b) others definitions is not repeated seizures in brief
c) duration is 5 minutes
d) serial seizure is like status epilepticus
e) serial seizure not uncommonly evolve into status
Epileptic syndrome in children
1. Regarding epilepsy in children
a) seizure (electrical or clinical) not provoked by
fever on more than 2 occasion within 12 months
b) electrical seizure (partial or generalized) can
occur itself without clinical seizure
c) clinical seizure can occur without electrical
d) clinical seizure is motor movement disorder due
to electrical seizure
2. Pathophysiology of seizure include
a) activation of peripheral nerve action potential
b) potassium channel involvement
c) excitatory and inhibitory neurotransmitter
d) causative agents such as trauma, poison,
infection, metabolic and endocrine
e) clinical seizure
3. True or false
a) in neonate, seizure is presented by subtle clinical
features such as abnormal breathing and
unpredictable swing of body temperature
b) neonate suffering with meningitis will have
seizure, eye move to one side and arching of the
c) in infant all causes of epilepsy are due to brain
d) infantile spasm start in neonatal state
e) febrile convulsion begins in infancy (within 6
months until 6 years old) and do not occur in
4. True or false
a) myoclonic epileptic syndrome occur in toddler
b) a child who is walking and suddenly fell down is a
feature of myoclonic epileptic syndrome


EEG shows 5 spikes in one second in Absence

Treatment of epilepsy is discontinued after 2
years if the patient do not suffering from fits
anymore within that period of 2 years

Pathology of peripheral nerve diseases

1. Below is on Guillain- Barre syndrome
a) Causes ascending paralysis with subacute or
chronic course
b) Macrophages penetrating the BM of schwann
c) No demyelinating lesion
d) Associated with infection of herpesvirus,
mycoplasma pneumoniae, and borrelia
e) Affects respiratory function
2. Regarding vasculitis of middle size arteries
a) PAN is vasculitis with granulomatosis
b) Churg-Strauss syndrome is allergic angiitis with
c) Leukocytoclastic vasculitis disease of middle size
d) Martius Scarlet Blue stai highlights fibrinoid
necrosis in PAN
e) Wegener granulomatosis is necrotizing angitis
with granulomatosis
3. True or false
a) hereditary neuropathy is one of the peripheral
nerve disease
b) There are three different types of hereditary
c) Familial amyloid polyneuropathy is not included in
hereditary neuropathy
d) Heriditary neuropathy is a homogenous and
rapidly progressive syndromes that affect
peripheral nerve
e) Peripheral neuropathy can accompany inherited
metabolic disorder.
4. True or false
a) One of the common cause of metabolic and
nutritional neuropathy is diabetes mellitus
b) Acute respiratory insufficiency cause metabolic
c) Diabetic neuropathy affects small and large
myelinated and unmyelinated nerve fibers
d) Thiamine,vitamin B12 and B6 deficiency
contribute to nutritional neuropathy
e) Other cause of metabolic neuropathy is chronic
liver failure

5. Regarding peripheral neuropathy,

a) It is not associated with malignancy
b) Brachial plexopathy,obturator palsy,and cranial
nerve palsy occur due to compression effect of
c) Malignant lymphoma cause symmetric, diffuse
d) Distal axonal degeneration is a feature of
peripheral neuropathy
e) POEMS syndrome is significant in monoclonal
6. Toxic neuropathies:
a) Diphteria toxin can cause early loss of
b) Lead causes respiratory paralysis
c) Organophosphorus compound acute :
peripheral neuropathy
d) Arsenic can cause encephalopathy and distal
e) Amiodarone can cause toxic neuropathy
7. Neuropathy:
a) Carpel tunnel syndromes is a result of ulnar
nerve compression
b) Saturday night palsy is due to ulnar nerve,
radial nerve and peroneal nerve compression.
c) plexiform neurofibroma has potential for
malignant transformation
d) Malignant Peripheral Nerve Sheath Tumor
(MPNST) can arise commonly from
e) The sites usually affected in Schwannomas
include cranial nerves and peripheral nerve
1. Regarding tuberculous meningitis
a) Route of infection is through inhalation
b) Caused by viral infection
c) Presence of granulomataous inflammation
d) Usually confined to subarachnoid space
e) Rifampicin is used in treating tuberculous
2. Toxoplasma encephalitis
1. caused by viral infection
2. Toxoplasma gondii develops its sexual cycle
leading to oocysts, tachyzoites and
bradyzoites production
3. Presented with multifocal symptoms such as
seizure and visual field deficit


Rising IgG titers indicate reactivation of

Meats such as pork and lamb have high risk of
Toxoplasma gondii infection

3. True or false
a) Cognitive and motor syndromes are common
CNS complications of primary HIV infection
b) Crytococcal meningitis involve T cells mediated
c) Primary HIV infection presented with fever and
d) Route of infection in cryptococcal meningitis is
hematogenous spread
e) Cryptococcal meningitis presented with subacute
or chronic meningitis
4. Regarding primary HIV infection
a) Its infect the meninges early and persist in the
CNS after initial infection
b) Viral load high in hippocampus and basal
ganglia can lead to dementia
c) HIV-1 free viral particles and infected
monocyte penetrate brain tissue through BBB
d) Most common features are headache, fever
and meningeal signs
e) the illness is self-limited or recurrent rather
than progressive
5. Regarding encephalitis
a) It is inflammation of the brain parenchyma
b) Not always accompanied by inflammation of
the adjacent meninges
c) Routes of infection are hematogenous and
d) Common viruses that can cause encephalitis
are enterovirus, Herpes Simplex virus,
arbovirus, St Louis and JE
e) Primary site of entry in hematogenous spread
are respiratory tract, gastrointestinal tract,
genital tract and subcutaneous tissue
6. Regarding tuberculous meningitis
a) There is hematogenous spread of the tubercle
bacilli in military tuberculosis
b) There is fibrotic thickening of the meninges
c) Typical caseous granuloma is formed in the
subarachnoid space
d) The brain tissue reveals edematous change
e) Treat with antimicrobial agents like Rifampicin,
Ethambutol, Streptomycin, Pyrazinamide and

1. What are the symptoms of brain abscess

a) Headache
b) Focal neurological deficits
c) Papilloedema ( with increase intracranial
pressure )
d) Fever with chills and rigors
e) Nausea and vomiting ( with increase
intracranial pressure )
2. Regarding brain abscess
a) It is spread by direct extension about 50% of
b) It is spread by hematogenous extension about
25% of cases
c) It is spread by trauma or direct inoculation about
10% of cases
d) There are 4 stages of brain abscess
e) The frontal lobe is the most common part for
brain abscess
3. Indication to do surgery in neurosurgical aspect
a) Failed medical management
b) Multinucleated abscess with daughters
c) Raised intracranial pressure signs
d) Gas outside the abscess
e) Large abscess <3cm in diameter
4. Regarding epidural empyema
a) Resides in the space between the dura and the
b) Often manifest with subtle non specific symptoms
c) Symptoms of sinusitis or otitis frequently mask
those of intracranial infection
d) Focal neurological symptoms not depend on size
and location of abscess
e) Seizures, alterations of mental status and
increase intracranial pressure are examples of
focal neurological symptoms
5. True or false about subdural empyema
a) Patient with subdural empyema is usually afebrile
b) 90% of patient of subdural empyema developing
c) Hematogenous spread are one of causes
d) Meningitis is common in adult and rare in children
e) Surgery is the only one of the treatment
6. Symptoms of subdural abscess are
a) Fever
b) Loin pain
c) Chest tightness
d) Bladder dysfunction
e) No sensory problem involved



1. Special clinical circumstances that affect the

spectrum of bacterial pathogens include:
a) Age
b) Surgery
c) Trauma and focal suppurative infections of the
d) Immunosuppression
e) Genetic predisposition
2. The complications of Haemophilus influenza type II
a) subdural effusion
b) hydrocephalus
c) deafness
d) mental retardation
e) paralysis of various muscles
3. Streptococcus pneumonia
a) alpha hemolytic
b) Gram positeive
c) Lancet shape diplococci
d) can be cultured on blood agar
e) Optochin to differentiate with viridans group
4.Regarding viral meningitis
a) Initiation of infection should come across the
host mechanism first
b) In GI and respiratory tract, virus may be
coated by IgA
c) Viral grows in lymphatic system
d) Can spread via olfactory nerve
e) Viral enter the subarachnoid space via the
choroids plexus
5.Symptoms of meningitis
a) Rapid breathing
b) Bradycardia
c) Opisthotonas
d) Kernigs sign
e) Brudzinskis sign
6.According to the bacterial meningitis
a) causes increase permeability of BBB
b) Increased intracranial pressure
c) Causes alterations in cerebral blood flow
d) Induction of subarachnoid space inflammation
e) Bacterial capsule inhibit neutrophil phagocytosis
7.The common etiologic agents of acute meningitis are
a) Enteroviruses
b) Streptococcus pneumoniae
c) Listeria monocytogenes
d) Mycobacterium tuberculosis
e) Treponema pallidum

1. Regarding myopathies
a) In Duchene/ Becker Muscular Dystrophy,
destruction of cell is due to efflux of intracell
Ca2+ b) Polymyositis is a cell-mediated
immune response to antigen on muscle fibers
b) Segmental necrosis with myo-phagocytosis
occur in Duchenne Muscular Dystrophy
c) Onset of autosomal dominant inheritance in
Spinal Muscular Atrophyn occur during later in
d) Small, angulated muscle fibers can be found in
infants with Spinal Muscularn Atrophy.
2. In Duchene/Becker Muscular Dystrophy, microscopic
findings are as below except
a)increased central nuclei >30%
b)variability of muscle fiber
c)myocyte hypertrophy
d)lymphocyte infiltration and replacement
e)atrophy of muscle fibers
3. Belows are true regarding hypokalemic periodic
a) the onset is infantile/childhood
b) attacks last from 4-24 hours, long duration
c) Bulbar muscles/respiration unaffected
d) Precipitated by exercise, carbohydrate load
e) Precipitated by rest after activity or by cold
4. Belows are examples of metabolic myopathies
a) McArdles disease
b) Emery-Dreifuss syndrome
c) Systemic carnitine deficiency
d) Acid Maltase deficiency
e) Desmin myopathy
5. These endocrine abnormalities can cause myopathy
a) acromegaly
b) hypoparathyroidism
c) hyperadrenalism
d) Hypoadrenalism
e) hypothyroidism
1. Morphology of skeletal muscle
a) Skeletal muscles is composed of a large number
of muscle fibers separated by epimysium
b) Myofibril contain filamens of myosin and actic
c) Type 1 muscle fiber is fast twitch and fatigue

When a nerve fiber reaches the muscle it losses

it myelin sheath and its neurilemma
Each motor unit can have more than 1 types of
muscle fibers

2. Myopathy
a) Myopathy is a disease of voluntary muscle
b) Myositis indicates inflammation
c) Muscular dystrophy describes inherited disorder
with progressiven weakness
d) Myasthenia means fatiguable ( worse on exercise
) weakness
e) Myotonia is sustained contraction /slow relaxation
seen in myotonia-T
3. Features of muscle disorder
a) Proximal weakness will produce difficulty in
descending stairs
b) Distal weakness causes difficulty in rising from a
low chair
c) In disorder of glycolysis, a cramp develops in the
exercising muscle after a minutes
d) Fatiguability
transmission disorder and mitochondrial disease
e) Muscle wasting is not a sign of muscle disorder
4. Myasthenia gravis
a) A disease characterized by weakness and
fatiguability of proximal limb, ocular and bulbar
b) Heart is affected
c) It is twice as common in women as in men
d) Facial expression is not affected
e) Respiratory difficulties may occur
5. Investigations for muscle disorder
a) Serum creatine phosphokinase
b) Electromyography
c) Muscle biopsy
d) Electrocardiogram
e) MRI
Diagnostic approach peripheral neuropathy
1. Regarding nerve fibers and its function
a) A-alpha for proprioception
b) A-delta for temperature
c) C fiber at dorsal root for pain, temperature and
d) B fiber for preganglionic autonomic
e) A-gamma act from motor to muscle spindle
2. Signs and symptoms of peripheral neuropathy
a) paresthesia
b) Tinnels sign


distal asymmetric glove and stocking distribution

present of deep tendon reflex

3. In acute generalized neuropathy, which one are

predominantly motor affected
a) Guillan-Barre syndrome
b) Diabetes mellitus
c) paraneoplastic neuropathy
d) Porphyria
e) Diphteria
4. Differential diagnosis clinically in subacute onset of
peripheral neuropathy are
a) Guillan-Barre syndrome
b) Chronic inflammatory demyelinating
c) Persisting nutritionaldeficiency
d) hereditary motor sensory neuropathies
e) Diptheric neuropathy
5. Investigation for peripheral neuropathy
a) chest x-ray
b) serum protein electrophoresis
c) nerve conduction study to differentiate from
d) nerve biopsy is not indicated in cases unknown
e) urine FEME
saat paling indah setelah
berhempas pulas berusaha ialah
saat menuai kejayaankejayaan
bagi orang yang bijaksana ialah
kejayaan mengusahakan ladang
yang subur untuk bekal bertemu
ALLAH..berusaha dan terus
berusaha, jangan kenal lelah.
Semoga semua beroleh kejayaan.

1.True or false
a) There are 3 major types of psychiatric
b) Asymptomatic disabled person is normal
c) Psychoses is a major physiological disorder


Abnormal behaviour will give comfort to other

Abnormal behaviour is a violation of moral and
ideal standard

2. In psychoses
a) There is impaired ability to test reality
b) The patient is able to distinguish reality from
c) It is not as severe as neuroses
d) Affective and somatoform disorders are 2 of the
main illnesses in psychosis
e) Does not involve total personality
3. True or false
a) In neuroses, there is no disturbance in affect and
b) People with neuroses have poor insight
c) Perseveration is common in neuroses
d) Delusion is not a sign of psychoses
e) There may be abnormal in affect in psychoses
4. Organic Mental Disorder
a) This term is used in DSM-IV
b) It was divided into 3 sections
c) Substance-related disorders are 1 of the category
in OMD
d) Judgment of people with OMD cannot be trusted
e) Cognition is intact
5. Abnormal behaviour
a) The percentage of heritability in schizophrenia is
b) Failing a major exam maybe the cause of
abnormal behaviour
c) A persons personality, childhood development
and social support are
a) important in the development of abnormal
d) Genetic vulnerability is an important precipitating
e) Genetic and environmental factor are the key
points in Three-hit hypothesis
1. Definition of mental illness are
a) Absence of health only
b) Complete physical, mental and social wellbeing]
c) Mental illness means evidence disturbance of
part of function as well as general efficacy
2. Disorder that usually diagnosed in infancy are
a) Communication disorderSchizophrenic
b) MDD

c) Tics disorder
d) Learning disorder
3. True about behavior and mood disorder
a) Bipolar 1 = manic + hypomaniac + MDD
b) Paraphillia is under dissociative disorder
c) Orgasmic disorder is identify under sex
d) Kleptomania is a disorder of impulse control
morbid tendency to steal
e) Trichotillomania is a compulsion to pull out
ones own hair
4. Regarding multiaxial system,
a) Five axes are included in DSM-IV which refers
to a different domain of
a) information.
b) It facilitates comprehensive and systematic
evaluation with attention to the various mental
disorders only.
c) It does not include other general medical
d) Personality disorders and mental retardation
are in the same axis.
e) It provides a convenient format for describing
the heterogeneity of individuals presenting with
the same diagnosis.
5. Regarding psychosocial and environmental
a) Reported in Axis IV.
b) It may be a negative life event.
c) It includes discord with teachers or
d) It does not include birth of a sibling.
e) It may develop as a consequence of a persons
1. According to Kurt Schnieder, First rank symptoms are
a) thought broadcasting
b) visual hallucination
c) delusional perception
d) pathognomonic for schizophernia
e) catatonic behaviour
2. Positive symptoms of schizophernia are
a) avolition and anhedonia
b) hallucination and bizzare behaviour
c) due to loss of loss brain mechanism
d) responds to typical antipsychotics
e) present in Type 1 schizophernia
3. Schizophernia


type II has poorer prognosis

type I has enlarged ventricles
type I patient has good response to medication
type II associated with increased dopaminergic
type I is insidious onset

4. Good prognosis for schizophernia patient

a) female
b) has previous psychiatric history
c) young age
d) acute onset
e) good social relationship
5. Aetiologies theories
a) neurodevelopmental anomalies during mid
b) reduced dopamine activity within the mesolimbicmesocortical system
c) move to lower socioeconomic status
d) positive high expressed emotion (HEE)
e) conflict in family
1. Regarding neuroleptics
A. It is also known as antipsychotics
B. It is only effective in treating schizophrenia
C. They are only typical type of neuroleptics
D. Atypical neuroleptics block D2 receptors only
E. Typical neuroleptics block D2, D2-like receptor
and 5HT receptors
2. Below are atypical antipsychotics
A. Chlorpromazine
B. Risperidone
C. Olanzapine
D. Haloperidol
E. Clozapine
3. Below are adverse effects of neuroleptics to cortex
and limbic system
A. Mental confusion
B. Drowsiness
C. Lethargy
D. Impaired performance
E. Depression
4. Regarding potency of neuroleptics
A. Chlorpromazine is a high potency drug
B. Haloperidol is a low potency drug
C. Thioridazine is a low potency drug
D. Olanzapine is a high potency drug
E. Risperidone is a high potency drug

5. Regarding chlorpromazine
A. It is typical antipsychotics
B. It is one type of butyrophenones
C. Parenteral form is not available
D. It is an expensive drug
E. It cause many adverse effects especially

delusion of jealousy common in women


Tranquilizer ex,Chlorpromazine inhibit both

reward and punishment centers.


4. Primary delusions:
a. derived from preceding morbid
b. classify according to onset
c. out of blue delusion
d. can be present with delusional
e. anxiety is a part of delusional mood

1. Regarding disorder of perception:

a. hallucination is a sensory perception
with an external stimuli and similar
quality to a true percept
b. Illusion is more likely to occur when
attention is not focus on sensory
c. Pseudohallucination is beyond voluntary
d. Depersonalization is a feeling that the
external environment is abnormal or
e. The only true factor that can distinguish
between hallucination and
pseudohallucination are voluntary
control and insight


1) Regarding limbic system
a) Brain structure between
hypothalamus and its related and
cerebral cortex
b) System of brain that mainly control
the person emotional behavior and
visceral activity
d) Its function for integration of olfactory,visceral
,visual and somatic impulse reaching the brain.
a) System that controlactivities necessary for
survival of the spesies including sex behavior
e) System that control vegetative function of bodt
as well as many aspect of emosional behavior
f) Part of limbic system including gyrus
anguli,Diagonal band and fornix

2. Hallucination:
a. experienced as originating in the mind
not in outside world
b. Olfactory and gustatory hallucinations
common in temporal lobe epilepsy
c. feeling like viscera being pulled out is
hypnogogic and hypnopompic
d. according to sensory modalities can be
divided into auditory and visual only
e. visual hallucination rarely associated
with organicity

2) Regarding Hypothalamus
a) It is the principles motor output pathway of limbic
b) Anterior part is involve in sympathetic and
posterior part involve in
a) parasympathetic
b) Ablation of medial zone cause hypophagia and
ablation of lateral zone cause
c) hyperphagia
d) Person can learned activities satisfactorily if the
hypothalamus is damage, but
e) they cannot learn new thing and have short term
f) Its function as cerebral association area for
control of behavior.

2. Major depressive disorder

A) Common in male
B) Mean onset is about 60 year old
C) Occurred more often divorce individual
D) Recurrent is about 35% after 2 episodes
E) Rarely cause disability

3) Regarding Reward and punishment centre

a) Reward center is located in the central gray
matter surrounding cerebral aqueduct of
midbrain and extending into the periventicular
region of the
hypothalamus and thalamus
b) Punishment centers are located in the septal area
and hypothalamus(major part) and amygdaloid
complex(less potent part)
c) Almost everything we do depends on reward and

4) Risk factor for recurrent depression.

A) multiple episodes
B) Onset after age 60
C) Family history of affecting disorder
D) Substance abuse
E) Poor symptoms control during continuation

3. All the following are true EXCEPT:

a. loosening of association is loss of the
normal structure of thinking
b. nihilistic delusion is a belief about nonexistence of some person / thing plus
with pessimistic ideas
c. flight of ideas is characterized by
preservation of the ordinary logical
sequence of ideas
d. Over-valued ideas is disorders of
thoughts content which comes to mind,
again and again and may prevent the
patient from performing his day to day

4) True statements include

a) Stimulation of different area of hyppocampus
can cause any one of the different behavior
pattern such as rage and passivity.
b) Limbic cortex function as a cerebral association
area for control of behaviors
c) Structures related to hypothalamus include
epithalamus,amygdala,anterior nuclei of
thalamus,portion of basal
ganglia,hippocampus,septum and paraolfactory
area and preoptic area.
d) Supraoptic nucleus of hypothalamus
predominantly secretes Vasopressin and
paraventricular nucleus predominantly secretes
1. Regarding depressive disorder.
A) Persist for at least 3 week
B) marked functional impairment
C) Cause disabling physical symptoms
D) Cause disabling psychological symptoms
E) Present with psychomotor disturbance

3. How to diagnose Major Depressive Disorder

A) History of one or more major depressive
B) With history of manic
C) Markedly diminish interest or pleasure in almost
all activity
D) Insomnia or hypersomnia nearly every days
E) Energetic almost every day


1.Type of genetic diseases include


tumor suppressor gene
somatic mutation

2.Disease that caused by single gene are..

A Diabetis Mellitus
B hypertension
C thalassemia
D hemophilia
E Huntingtons disease
3. Regarding to X linked recessive
A Carrier mother will transmit the condition to
half of her son and half of daughter will be
B Affected father will not transmit the condition to
his son but all her daughter will be carrier.
C Colour blindness and thalassemia are the
D G-6PD deficiency will lead to rapidly
developing intravascular hemolysis.
E Occurs in a person whose healthy parent both
carry the same recessive gene.
4 .Regarding the genetic disease
A Schizophrenia is a multifactorial inheritance.
B Only a single gene with major effect are
required to cause the illness
C Genetic play a minor role in anxiety neurosis.
D Multifactorial inheritance is a disease that
caused by the interaction between genetic and
E Adoption study provide a second means of
estimating the influence genes on the
multifactorial disease.
1. True or false
a) Limbic system is expanded to mean the entire
neuronal activity that controls emotional,
behaviour and motivational drives
b) Limbic system consist of limbic cortex and
subcortical limbic structures
c) Limbic
communication and association linkage between
neocortex and limbic structures
d) Limbic structures are of affective nature of
sensory sensations that also called reward or


More potent rewards areas are found in septum

and amygdala
Stimulation of reward centers will cause the
animal to show signs of pleasure
Punishment center found in grey areas around
aqueduct of sylvius and some areas of
hypothalamus and thalamus
Reward can take precedence over punishment
Animal in RAGE phenomenon will developed
defense posture and extend its claw

3. Regarding Emotional Theory (circuit and

a) Papez theory was incorrect when he stated that
cingulate cortex and parahippocampal are
involve in perception of feeling and emotion
b) Amygdala rather than hippocampus intervenes
between hypothalamus and neocortical areas
c) External manifestation of emotions are produce
by reticular formation and hypothalamus
d) Exteriorization of emotion only has autonomic
e) Autonomic nervous system provides major
mechanism by which elements of mood and
emotion are expressed by body
4. Tue or false
hypothalamus and amygdala
Ablation of amygdala increased fear in humans
Memory is control by hippocampus
Hippocampus organizes formation of engram
that distributed throughout cerebral cortex and
mostly in temporal lobe
Removal of temporal lobe in temporal lobe
epilepsy will causes partial memory deficit
5. Relation between limbic system and psychiatric
a) Anxiety disorder is due to inappropriate activity of
b) Excessive activity of sympathetic nervous system
will altered the activity of amygdala
c) Anatomical studies show hippocampal formation,
amygdala and parahippocampal formation are
smaller than normal in brain of schizophrenia
d) Most neurons that use norepinephrine and
serotonin are in brainstem, grey matter and
throughout forebrain include parts of limbic


altered precursors concentration from diet.

altered synthesis and structure of
altered sensitivity of receptors.
increase of CNS monoamine neurotransmitter
(5HT & NA) activity/transmission.
deficiency of CNS monoamine neurotransmitter
leads to major depression.

2. Classification and action

a) tertiary amine action is only NA reuptake
b) drug examples for secondary amine is
c) Atypical antidepressant action is block post
synaptic 5HT1D/2A or 2- receptors.
d) MAOI action is inhibit the degradation of
monoamine at adrenergic, serotonergic
e) Drug examples SSRI is Fluoxetine.
3. Adverse effect
a) tertiary amine TCA can make patient get
b) for reduce the adverse effect for GIT symptoms
can take SSRI with food.
c) TCA is suitable for obese patient.
d) SSRI can make patients agitation/insomnia
esp fluoxetine.
e) TCA can produce postural hypotension to
4. True or false
a) Amitriptyline, Imipramine, Clomipramine acts as
NA & 5HT reuptake inhibitors
b) Tertiary Amine only acts as NA reuptake
c) Nefazodone is one the secondary amine
d) Administration of TCA or NRI will give positive
feedback to 2-adrenergic receptor
e) Maprotiline is an example of Tertiary amine
5. True or false
a) TCA is best given early in the day
b) SSRI and TCA block neuronal reuptake of 5HT
c) With repeated treatment of 5HT reuptake
inhibitor, it cause upregulation and sensitization
of autoreceptor mechanism
d) Tertiary amine TCAs are best avoided in cardiac
or elderly patient
e) TCA can cause weight gain

2. Regarding limbic function

6. Regarding TCA
1. Pathogenesis of antidepressant


Is contraindicated in patient having MAOIs

treatment within last 2weeks
Is uses in severe anxiety disorder
SSRI will increase TCA level to toxic
Inhibit the degradation of monoamines
Maprotiline is an example of secondary amine


7. Regarding atypical antidepressant

a) Enhance release of serotonin/ NA by blocking
presynaptic autoreceptor
b) Enhance release of serotonin/ NA by stimulate
directly on the post synaptic 5HT1A.
c) Block postsynaptic 5HT2A/ presynaptic 5HT1D/2A

or 2 receptors.
trazodone & nefazadone will cause
omnolence, increased appetite, weight gain,
Mirtazapine is one of the example of atypical

8. The following statements are true regarding atypical

a) Have minimal effect on cardiovascular system.
b) Mirtazapine will cause somnolence, increased
appetite, weight gain, dizziness.
c) Trazodone will cause drowsiness, dizziness,
insomnia, nausea, agitation
d) Intended effects of antidepressants occur within
2-3 days
e) Decrease the number of awakenings, increase
stage-4 sleep
1. Regarding bipolar disorder
a) Bipolar disorder is an illness characterized by
either elevated mood or depressed mood
b) Manic patient shows flight of ideas, decreased
the need of sleep and grandiose ideas
c) Depress patient has loss of energy and interest
and also difficulty in concentration
d) Bipolar I disorder characterized by at least one
manic or mixed episode
e) Bipolar II disorder characterized by at least one
major depressive episode and at least two
hypomanic episodes
2. True or false
a) Bipolar disorder affects women more than men
b) Serotonin and norepinephrine in low level when
there is manic episode
c) Etiology of bipolar disorder include stressful
events in life and endocrine abnormalities


Classification of bipolar disorder include bipolar

type I, type II, cyclothymic disorder and bipolar
disorder NOS

3. Duration of various episodes in order to diagnose

bipolar disorder
a) Manic episode occur at least 1 week
b) Hypomanic episode occur at least 4 days
c) Depressive episode occur at least for 2 weeks
d) Mixed episode occur at least 1 week
4. In the treatment of manic patients
a) For mixed episodes, divalproex may be
preferred than lithium
b) For the less ill patients, the treatment must be
include divalproex, lithium and antipsychotics
c) For severe case, initiate lithium and divalproex
plus an antipyschotics
d) For breakthrough episodes, optimize the
maintenance medication dose
e) Typical antipsychotics are preferred than
atypical antipsychotics
5. Psychotherapy in bipolar disorder
a) The role is to increase adherence to
b) In cognitive therapy, it helps in increase
compliance to pharmacotherapy
c) It helps in enhancing social and occupational
d) It is not helpful in detecting early warning signs
of impending recurrence
e) The role of family therapy is to help ensuring
drugs compliance at home
1. Barbiturates:
a) have large therapeutic index
b) have lower selectivity
c) less toxicity compare to benzodiazeines
d) Quazepam is classified as barbiturates
e) mostly are now used as sedative hypnotic to
replace benzodiazepines

2. Regarding mode of action of barbiturates:

a) Phenobarbitone acts by modulation of
GABAA receptor to give anticonvulsant effect
Phenobarbitone act by direct stimulation of
GABAA receptor to give anaesthetic effect
Phenobarbitone block high frequency Sodium
channel to give anaesthetic effect.
block excitatory Glutamate receptor to increase
the neuronal excitation


e) thiophental and phenobarbital are still being

used as anaesthetic and antiepileptic

3. Regarding benzodiazepine
a) decrease potency of GABA
b) flumezil antagonize CNS depressant induce by
c) high dose cause delirium
d) benzodiazepine have narrow therapeutic index
than barbiturates
e) benzodiazepine has lesser tolerance
4. Non benzodiazepine :
a) duration of effect of zolpidime is 7 to 10 hours
b) zolpidime act on GABA A receptor
c) zalephon has rapid onset
d) zalephon causes dizziness,headache and
e) zolpidine has little effect on sleep stage than
5. Regarding anxiolytic drugs,
a) Zolpidime is one of anxiolytic drug
b) -blockers such as propranolol is not used to
treat anxiety
c) Hydroxine is one of the antihistamine drug
which has antiemetic activity
d) Buspirone act on 5HT(2A) receptor
e) TCA is relatively safe if taken in overdose
6. True or false
a) Clorazepam and Lorazepam are anxiolytic drug
which has not produce any active metabolites
b) SSRI and TCA are effective in treating panic
c) Benzodiazepines drug has low abuse potential
d) SSRI is an anxiolytic drug which has slow onset
e) There is marked interaction between buspirone
and alcohol
7. Below are anxiolytic drugs,except
a) Benzodiazeoines
c) TCA
e) Barbiturates

The aim of psychotherapy is/are

A. Altered brain patterning and function
B. To modify patients behaviour only
C. To modify patients behaviour,
thoughts and emotions







Increase patients insight

Decrease painful constricting

A. Supportive
B. Helps clients solve their problems
C. In short duration which require 1-3
D. Need undergo special training and
E. Conducted in secondary and tertiary
care center
F. Done at primary care settings/schools
A. Supportive
B. Not directly helps clients to solve their
C. Longer term(12 sessions or more)
D. Need to undergo special training and
need supervision
E. Conducted at secondary and tertiary





Indication for counseling

A. Loss problem
B. Interpersonal problems
C. Change problems
D. Problems from the past
E. Environmental factors
Indication for supportive psychotherapy
A. Acute crisis
B. Severe/persistent ego deficits
C. Fragile, demanding untreatable
D. Chronic crisis
E. Adjunct to treatment for medically ill
Important elements in supportive therapy is/are
A. Education
B. Reassurance
C. Listening
D. Acceptance
E. Catharsis
F. Medication
G. Practical support
In group therapy
A. Adolescent and personality disorder
are the target group

The duration is weeks to years and

not frequently done
it is cost effectives
instillation of hope and universality
are the curative factors
interpersonal learning is also
important factor to cure the
psychiatric problems



Behaviour therapy
A. is a class of psychotherapy
B. operant conditioning is the sole basic
theory underlying behaviour therapy
C. involves the application of
experimentally derived principles of
learning to maintain maladaptive
thoughts, feelings and behaviours
D. is equivalent to supportive therapy
E. can be applied for anxiety and
Cognitive behaviour therapy (CBT)
A. is not indicated by schizophrenia
B. takes into concern only cognitive
formulation of psychotherapy
C. is structured and focused to
understand normal behaviour
D. can be done both individually and in
E. is not helpful in preventing relapse in
Depressive Disorder
Application of classic conditioning to anxiety
A. anxious behaviour will increase when
anxiety is uncoupled from situation
and avoidance
B. includes positive and negative
C. shows that a person can be
conditioned to feel fear in neutral
situation that has come to be
associated with anxiety
D. is taken after the Skinners mice
E. includes response prevention
Automatic thoughts
A. can only be seen in people with
B. are normal in individuals suffering
from anxiety, depression and other
psychiatric condition


can generate emotional reactions and

dysfunctional behaviour
are faulty in cognitive errors
are influenced by attitude, rules and

Operant conditioning
A. was demonstrated by Pavlovs dog
B. shapes the Social Learning Theory by
C. depends of whether positive
reinforcement is applied or removed
after the behaviour is performed as its
principle procedures
D. is seen in Time Out
E. is the basis of Flooding

6. Applied clinical technique from Pavlovs theory are

a) token reward
b) flooding
c) systematic desensitization
d) modeling
e) response prevention
7. Indication for CBT
a) Anxiety
b) Bulimia
c) Manic
d) Agoraphobia
e) Schizophrenia
8. Categories of cognitive error
a) Selective abstraction
b) arbitary inference
magnification and minimization
9. CBT method
a) Limited to certain age
b) Can be done in individual or group
c) Eliciting and modifying automatic thought
d) Building CBT skills to prevent relapse
e) Session acquired depends on the success
1. Statements below regarding defense mechanism are
true except:
a) conscious intra-psychic process
b) protective in nature
c) relieve anxiety and conflict arising from ones
impulses and drives
d) Relieve the anxiety by distracting people


defend a person against anxiety by distorting

reality in some way

2. Defense mechanism:
a) Does not alter the objective conditions of
b) Simply change the way the person perceives
or think about it
c) Is always pathological
d) mostly interfere with a persons ability to
function or disturb inter-personal relationships
e) observational constructs inferred from their
own hypothesis of the way people behave.
3. True or false :
a) Narcissistic defenses are the most primitive
and appear in children and people who are
psychotically disturbed
b) Immature defenses are seen in adolescents
and some psychotic patients
c) Neurotic defenses are encountered merely in
obsessive compulsive and hysterical patients
d) Immature defenses include acting out,
introjections, identification and repression
e) Immature defenses include acting out,
introjections, identification and regression
4 Repression :
a) voluntary exclusion of thoughts, impulses or
memories, often not painful or conflictual to the
b) individuals themselves are unaware of
whatever it is that is repressed
c) The thoughts and feelings may return in a
disguised manner but are not consciously
d) Intentionally exclusion of material from
e) An unconscious assimilation of an external
object, which may be loved or hated, into
oneself in a symbolic fashion
5.True or false :
a) reaction formation- a mechanism which is
represented by behaviour that becomes the
exact opposite of what is consciously or
unconsciously decided.
b) sublimation- manifestation of emotional conflict
by physical symptoms.
c) somatization - mechanism in which
unacceptable drives or impulses are channeled
into socially acceptable
d) Regression-An unconscious defense mechanism
in which a person undergoes a partial or total
return to earlier patterns of adaptation

1. Regarding somatizaton disorder
A. begins after 30 years old
B. commonly associated with major depression
C. according to DSM 4, 2 sexual symptoms have
been met
D. associated with significant distress
E. the symptoms are not intentionally feigned or
2. Clinical features of conversion disorder are
A. blindness
B. pseudoseizure
C. movement better when attention is given
D. bilateral motor dysfunction
E. gait disturbances
3. Differential diagnosis for hypochondriasis included
A. Myasthenia gravis
B. Dementia
C. Multiple sclerosis
D. Conversion disorder
E. Factitious disorder
4. According to pain disorder
A. defined as the presence of pain that is the
predominant focus of clinical attention.
B. the associated symptom is pain
C. associated with emotional distress or emotional
D. antidepressdant such as TCAD & SSRIs are
E. analgesics are generally helpful
5. Hypochondriasis can be diagnosed when
A. the belief is not of delusional intensity or about
body appearance
B. it causes significant distress & impairment of
C. the duration is less than 6 months
D. the symptoms are not intentionally feigned or
E. one or more symptoms or deficits affecting
voluntary motor or sensory function that
suggest a neurological or other medical condition
6.Commonly associated with:
A. A Major depressive disorder
B. Personality disorders
C. Substance related disorders
D. Generalized anxiety disorder
E. Phobias

7.Conversion disorder
A. A person preoccupation with the fear of
contracting, or the belief of having, a serious
B. La belle indifference: the patient seems to be
unconcerned about what appears to be a major
C. Hypnosis, anxiolytics and relaxation exercise are
effective in some cases
D. Patients believe that they have a serious illness
that has not yet been detected & cannot be
persuaded to the contrary
E. Most commonly associated with passiveaggressive, dependent, antisocial & histrionic
personality disorder
8.Pain disorder
a) primary symptom is pain, in one or more sites,
which is not fully accounted for by a medical
or neurological condition.
b) it may not be possible to reduce the pain, the
treatment approach must address
c) Analgesic are helpful
d) Nerve block and surgical ablation procedure
are ineffective as pain returns after 6 to 18
e) May accompanied by symptoms of depression
& anxiety.
a) A person preoccupation with the fear of
contracting, or the belief of having, a serious
b) B The belief is not of delusional intensity or
about body appearance.
c) C The duration is more than 6 months
d) D May accompanied by symptoms of
depression & anxiety
e) E Usually pt is not resistance to psychiatric
10. Body dysmorphic disorder
A. Cause significant distress or impairment of
B. Treatment with surgical or medical procedures
is almost invariably unsuccessful
C. If a slight physical anomaly is present, the
persons concern is marked excessive.
D. fear arises when a person misinterprets bodily
symptoms or functions
E. The fear arises when a person misinterprets
bodily symptoms or functions

1. Characteristic features of delirium are
a) disturbance of consciousness
b) perceptual disturbance
c) memory impairment
d) may have illusion
e) irreversible
2. Causes of delirium
a) dehydration
b) antihypertensive drugs
c) alcohol
d) steroid drugs
e) Urinary tract infection
3. Delirium also can be associated with
a) Anxiety
b) Depression
c) Tremor
d) dysnomia
e) irratibility

4. Regardind delirium
a) need medical emergency
b) can happen after recovery from anesthesia
c) chronic onset
d) fluctuating characteristic with lucid interval
e) duration usually brief


Retrograde amnesia is demonstrate by

patients memories of recent and remote past
that antedate the onset of illness.
Antegrade amnesia is severe but incomplete.

3. dissociative disorder which is psychogenic causes

a) Localized amnesia
b) Selective amnesia
c) Generalized amnesia
d) Continous amnesia
e) Episodic amnesia
4. true or false
a) Confabulation is false statement that are not
made to deceive, are typically more coherent
than thought produced during delirium
b) Confabulation is under dissociative disorder.
c) Short term memory can be disturbed by
d) Sensory memory has echoic memory and
iconic memory.
e) Multi store model suggest depth of processing
as process of thinking.
1. Middle dementia
a) forget spouses name
b) no thirst or hunger response
c) can feed and toilet with reminders
d) unaware of surroundings
e) loss of verbal abilities

1. Theories of forgetting
a) Consist of decay and interference.
b) Decay will lead to retrieval failure.
c) Interference will lead to storage failure.
d) Decay happen when the strength of
connection between neuron establish by
learning fade away over time.
e) Interference is distruption of the ability to
remember one piece of information by the
presence of other information
f) Interference can be cause by same retrieval
for certain memories
2. disorder of memory
a) Consist of amnesia and paramnesia
b) Amnesia is error of memory
c) Amnesia can be due to organic cause or
psychogenic cause.

2. Causes of dementia
a) drug toxicity
b) Wilsons disease
c) Cortical microinfarction
d) Biswangers disease
e) Normal pressure hydrocephalus
3. Criteria for dementia
a) more introvert
b) catastrophic reaction
c) loss sense of humour
d) dyslexia
e) dyscalsulia
4. Vascular dementia
a) abrupt decline in cognitive function
b) cause atrophy of the brain
c) affect both male and female equally
d) due to multiple infarct with multiple size
e) ventricle not dilated

5. Features of vascular dementia:

a) the course is fluctuating
b) patient may have history of stroke
c) seizure never occur
d) plantar reflex maybe positive
e) patient may have mood and
personality changes
6. Alzeimers disease ;
a) more common in men
b) progressive neurogenerative disorder
involving memory, language, personality &
c) Increase with age
d) Neuritic plagues and neurofibrillary
tangles are characteristic
neuropathological features of AD
e) Decrease high affinity choline uptake and
Ach synthesis
7. Risk factors of AD ;
a) age > 65 years old
b) genetic
c) aluminium exposure
d) gender
e) down syndrome
1. Regarding frontal lobe syndrome
a. Also known as dysexecutive syndrome
b. Diffuculty in problem solving
c. Maybe not incapable of creative thinking
d. Difficulties with holding complex structures in
e. Mean as social behaviour, insight and
appropriateness in different
social contexts
2. True or false
a) Perseveration is tendency to repeat the
previous response
b) Utilization behavior is tendency to grasp
common object when presented and perform
the function commonly associated with the
c) Echopraxia is repeating the examiners words
d) Echolalia is imitating the examiners gestures
e) Grasping reflex is example of motor release
3. Test of executive function
a) Tower of Hanoi
b) Word fluency test

c) Stroop test
d) Wisconsin card-sorting test
e) Trail making test
4. Characteristic features of frontal lobe syndromes
a) difficulties initiating behaviour
b) inability to stop a behavioural pattern once started
c) visual hallucination
d) sleep pattern disturbances
e) difficulties in planning and problem solving
5. Those are motor release phenomena except
a) perseveration
b) grasping reflex
c) manual groping behaviour
d) imitation and utilization behaviour
e) alien hand sign

Dalam kehidupan yang begitu singkat ini,

jangan kita golongkan diri kita dalam
golongan orang yang rugi. Rebutlah setiap
saat hidup kita untuk mengumpul sebnyak
mungkin saham buat bekalan mengadap
Tuhan. Ikhlaskan niat. Laksanakan setiap
amalan, amanah dan tanggungjwag dengan
niat LILLAHITAALA. Moga Allah memelihara
kita semua dari kemurkaanNYA

1. Below are communicable diseases in
A) Tuberculosis
B) Viral hypertitis
C) Leprosy
D) Asthma
E) Chronic Ischemic heart disease
2. Below are elements that are needed for
communicable disease to occur.


Infectious agent
Susceptible host

3. Reasons for increasing prevalence of

communicable disease
A) climatic change
B) Human demography and
C) Changing ecosystem
D) Antibiotic abuse
E) Trade
4. Primary prevention of communicable
A) chlorination of water supply
B) Early diagnosis of disease
C) Isolate the patient
D) Inspection of restaurant
E) Proper disposal of solid waste
1. Innate immunity in CMIR consists of
A) Complement
B) Macrophage
C) Neutrophil
D) NK cell
E) cytokines
2.Regarding immunity to bacterial infection
A. extracellular bacteria require cell
mediated immune response
B. bacterial inhibit complement or
inactivation of complement products
to survive
C. bacterial secrete repellents or toxins
that inhibit chemotaxis,
capsule or outer coats inhibit
attachment by phagocytes.
D. Mycobacterium tuberculosis and
Legionella pneumophila disrupt
phagosome membrane and escape
into cytoplasm
E. Mycobacterium leprae inactivate
reactive oxygen and nitrogen

3.Regarding immunity to infection

A. Fatty acids produced by skin are toxic
to many orgs.
B. Peptidoglycan activates the
alternative complement pathway by
promoting formation of the C3
C. Viral infected cells secrete IFN to
protect neighboring cells that are
not yet infected
D. helminths have thick teguments that
make them resistant to the
cytocidal mechanism of neutrophils
and macrophages
E. parasites conceal themselves by living
inside host cells or by
developing cyst that are resistant to
immune effectors.
F. fungi can live in extracellular tissue
and within phagocytes
4.Regarding body immunity towards viral
A. Inhibition of infection by type 1 IFNs
and NK cell-mediated killing of
infected cells is the principle
mechanism of inate immunity in viral
B. In adaptive immunity, antibodies are
effective against viruses only
during the intratracellular stage.
C. Elimination of viruses that reside
within cells is mediated by CTLs
D. Evasion of immune mechanism by
viruses by altering their antigens
by point mutations or by reassortment
of RNA genomes in
RNA viruses (antigenic variation)
E. Poxvirus encode molecules that bind
to cytokines eg IFN-,TNF,
IL-1, IL-18 and. function as
competitive antagonist of the
cytokines in order to survive.
5.Regarding body immunity towards protozoa
A. The principle of innate immunity is
phagocytosis, but many of

parasites are resistant to phagocytic

killing and may even
replicate within macrophages
B. adaptive immunity is a protective
immunity against protozoa that
survive within macrophage and it is
humoral mediated.
C. Parasites change their surface
antigens during their life cycle in
vertebrate hosts in oder to escape
from immune system action.
D. Innate immunity activated classical
pathway of complement.
1. Regarding AGE
A. Incubation period of Shigella is 1-4
B. Mostly due to virus infection
C. Rotavirus most commonly affects
children less than 2 years old
D. Norovirus is a most common cause of
E. Symptoms of viral gastroenteritis are
low grade fever, nausea, vomiting,
abdominal cramp and watery
2. Vibrio Cholera
A. A Can cause rice stool diarrhea
B. B 01 serotype can cause watery diarrhea
and dehydration
C. C 01 serotype common occur in traveler
D. D non 01 serotype associated with
travelers diarrhea
E. E non 01 serotype cause nausea,
vomiting, fever and blood in stool
3. Regarding viral gastroenteritis
A. A rotavirus is the leading cause of
hospitalization for diarhoea in children
B. B norovirus is the most common cause of
diarhoea outbreaks
C. C enteric adenovirus is caused by
adenovirus 14 & 10
D. D epidemic outbreaks of diarhoea in adult
are caused by astrovirus
E. E rotavirus and norovirus gastroenteritis
are most common.

4. The differences between small and large bowel

diarhoea,small bowel
A produce large volume
B painful stool
C watery
D blood and WBC are common
E less frequent

a. Clonorchis sinenesis is a parasite of the bile

b. Size of adult worms are 10-25mm long and 35mm wide
c. Mature cercariae hatch in the water and infect
freshwater fish
d. Encysted metacercariae occur in the fish
muscle of family Cyprinidae
e. Stage of redia undergo in human

1. Trematodes divided into for group:
a. hermaphroditic liver flukes known as
b. Hermaphroditic spleen flukes known as
c. Hermaphroditic lung flukes known as
d. Blood flukes which also known as
e. Hermaphroditic intestinal flukes known as
2. About schistosomes
a. they reside in human mesenteric and vesicle
b. acute schistosomiasis after infection,
especially by S. mansonia and
c. It induce granulomatous inflammation in the
d. Urinary symptoms occur in S. japonicum
e. The female worm lies within the male at
gynecophoral canal.
3. regarding Fasciola hepatica
a. its intermediate host is variety of lymnaeid
b. the site of infection is at the human liver
c. the cysts release immature flukes that migrate
to the liver and gallbladder
d. association of Fasciola with Schistoma
japonicum is common
e. rafoxanide is used for the treatment of
4. True statement about liver trematodes


Clinical features of Katayamas fever

abdominal pain
colonic polyposis

6. Regarding platyhelminth
a. Nematodes and trematodes are included in
this phylum
b. These helminth consists of body cavity
c. It covered by cytoplasmic tegument
d. These helminth consist it own digestive
e. Most species are hermaphrodite
7. Clonorchis sinensis
a. Is a liver trematodes
b. Will infect bile duct by eating undercooked
c. Stages of sporocyst, redia and cercaria
are occurring in final hosts.
d. Snail is the final hosts
e. In acute infection abdominal pain and
eosinophila are sign for the infection.
8. Intestinal trematodes
a. Opisthorchis and fasciolopsis is include in
this class
b. The prevalence is lowest in children under
5 years old
c. Diagnosis is make by present of eggs in
the feaces
d. Acute fascioliasis will accur when < 10000
of metacercaria have been ingested at
e. Drug therapy are not effective
9. Schistosoma

a. It reside in the blood vessels of

intermediate host
b. Asexual multiplication occur in the
intermediate host
c. Acute schistosomiasis will presented with
fever, cough, diarrhea, and
a. hepatosplenomegaly
d. S.haematobium can cause cystitis and
e. Pulmonary hypertension usually occur in
1. Regarding Disease Control Program of WHO
a) Improve maternal and child health care
b) Improved case management on
chemotherapy in acute diarrhea
c) Improved use & maintenance of drinking
water, sanitation facilities and food
d) Detection and control of pandemic.

Potential intervention for reducing

diarrhea morbidity and mortality among
children under 5 years include
by controlling and preventing diarrhea
by reducing transmission of the pathogenic
agents of diarrhea
by case management
by increasing host resistance to infection,
illness and death
by promoting using antibiotic

3. Potential intervention for reducing diarrhea

morbidity and mortality by case management
A. oral dehydration therapy
B. Non oral dehydration therapy
C. Antibiotic
D. Appropriate feeding
E. Chemotherapy

Potential intervention for reducing diarrhea

morbidity and mortality by increasing host
resistance to infection, illness and death


Child nutrition
Maternal nutrition
Personal and domestic hygiene

5. Potential intervention for reducing diarrhea

morbidity and mortality by reducing
transmission of pathogenic agent of diarrhea
A. personal & domestic hygiene
B. water supply & excreta disposal
C. control of zoonotic reservoirs
D. fly control
E. hand washing by educational campaigns

True or false
Chloroquine act on parasite on bowel lumen.
Metronidazole is a mixed type of amebicides
Iodoquinol act on amoeba in intestinal wall and
D. Diloxanide furoate act on parasite on bowel
E. Paramomycin act on parasite on bowel lumen
2. Mechanism of action of Metronidazole
a. It requires reductive activation of the nitro
group by anaerobic or microaerophilic
b. Low or negative redox potential is
required to donate electrons to the drug
for its activation
c. Ferrodoxin donates electrons accepted by
metronidazole or a biological electron
d. Metronidazole serves as an electron
e. Protozoan parasite has low redox
potential electron transport proteins which
participate in metabolic reactions
3. True or False
a) Cemetidine will shorter the half life of
b) Unpleasant metallic taste is one of the
adverse effect of Metronidazole.

c) Long term use of Idoquinol is associated

with myelo-opticm neuropathy, optic
neuritis & permanent loss of vision
d) Diloxanide furoate can be use in pregnant
e) Paramomycin gives an amebicidal effect.
4. Adverse effect of mesoprolol..
a. Encephalopathy may be appear soon
after the first course of
b. Hypersensitivity reactions
c. Contraindicated in patients with influenza
d. Haemolytic jaundice can occur in patients
with G6PD deficiency
e. No GIT problem was report.
5. True or False
a) Pentamidine will binds to parasites DNA
and interfere with synthesis of DNA, RNA,
phospholipids and proteins.
b) Pentamidine is effective against
meningoencephalitic stage
c) Nifurtimox used only in Chagas disease
d) Suramin binds to protein plasma and it
remains in plasma for a long time
e) Treatment of Suramin should be stopped
when cylindriuria or hematuria occurs.
1. Regarding enteric Fever
a. S. paratyphi C only can be found in Latin
b. Antigenic structure O referred to flagellar
c. Widal test need a 2nd sera taken 2 weeks
after the 1st sera is taken
d. Oral Vaccine (vivotif) had an efficacy of
e. Typhoid outbreak is the 2nd after Malaria
outbreak in Malaysia
2. Investigations of Typhoid Fever in typhoid
a. IgM positive in typhidot test means
relapsed infection
b. IgM negative in Typhidot-M means not


There will be decrease in WBC with

d. Urine culture will show negative result in
3rd week
e. Salmonella is lactose fermenter on
3. Typhoid in Malaysia
a. Prevalent areas of typhoid include
Kelantan, Pahang, Sabah and
a. Sarawak.
b. Incidence rate in Malaysia only about
4000 cases/year
c. About 75% of the cases occur among
school children and young adults.
d. S. paratyphi A is multi-resistance antibiotic
in Malaysia.
e. Screening is done only among patients
1. Regarding Cryptosporodium parvum
A. Oocyst present in the
environment and contaminated
food and water
B. Human and animal are the host
C. Incubation period is 1 week
D. Mode of transmission is from
person to person contact
E. Thin walled oocyst can survive in
the environment
2. Symptoms of Cryptosporidium parvum
infection is/are
A. Profuse watery diarrhea
B. Abdominal pain
C. Vomiting
D. Weight loss
E. Loss of appetite
F. Fever
3. Regarding Cyclospora cayetanensis
A. It is multicellular protozoan
B. Oocyst contain 4 sporocyts
C. Incubation period is 1 week
D. Infect small intestinal epithelial

E. All infected person are

4. Symptoms of Cyclospora cayetanensis
A. Watery diarrhea
B. Loss of appetite
C. Reduced flatus
D. Nausea
E. Vomiting
F. fever
5. Regarding Isosporiasis
A. Infection is acute
B. Bloody diarrhea
C. Patient experience crampy
abdominal pain
D. Last for months
E. Causes malabsorption and weight
F. Infect infants and children
1) Dysentery is
a. A an illness involving severe diarrhea that
is often associated with blood in feces
b. B caused by arbovirus
c. C have 2 major types which are by
bacillary dysentery and amoebic
d. D also caused by Campylobacter
jejuni,E.coli,some strain of salmonella
and yersinia enterocolitica.
e. E Caused by ingestion of food containing
microoraganism causing a disease in
which inflammation of the intestine.
2) Bacillary dysentery
a. A caused by 4 major species of
b. B not major public health problem in
developing and underdeveloped
c. C GIT of human and primates are its
natural hosts
d. D gram positive rod and non motile .
e. E Is lactose fermenter

3) Pathogenesis at shigellosis
a. A it caused tissue destruction by
secretion toxin
b. B presenting symptoms include
abdominal cramps,diarrhea with blood,pus
or mucus due to penetration and
destruction of colonic epithelium.
c. C Bloodstream invasion is common
d. D Produces endotoxin that irritate the
bowel wall
e. E severity of clinical illness depend on
type of species
4) Possible complication
A stress ulcer
B rectal prolapse
C Reiters syndrome
D Hemolytic uraemic syndrome(HUS)
E Intestinal obstruction and toxic megacolon
5) Treatment and control
a. A Adults give oral ciprofloxacin
b. B No need oral rehydration
c. C Agents decreasing intestinal motility
should not be used
d. D Control by chlorinated water and
waterborne sewage
e. E Eat well cooked food and rigorous hand
1. Measles
A. is caused by a virus from the Togaviridae
B. in pregnant women results in congenital
C. usually shows rash spreading the same
way as rubella
D. can cause Subacute sclerosing
panencephalitis (SSPE) in the first week
after the onset of rash
E. rash can coalesce to form blotches
2. Chickenpox
A. can spread by fomites like measles
B. is caused by human parvovirus B19
C. is more likely to be more severe in

D. has initial red papules that evolve into

vesicles on the stomach, back and face
E. can cause bacterial superinfection
3. Human parvovirus B19
A. commonly causes subclinical infection
B. is possibly transmitted via respiratory
C. is infectious when rash appears
D. causes anemia in immunocompromised
E. is diagnosed by antibody assay
4. Rubella virus
A. causes a mild, self-limited illness that
usually has few or no signs or symptoms
B. causes rubeola
C. can be isolated and identified from throat
D. can be prevented by MMR vaccination
given at the age of 2 months
E. can cause developmental abnormalities
5. Exanthem
A. can only be caused by infection
B. precedes fever in infection caused by
human herpesvirus 6
C. coalesces in rubella
D. is widespread rash
E. is usually associated with fever, malaise
and headache


1. Regarding Arboviruses
a) maintained in the nature through
mechanical transmission between
susceptible vertebrate hosts
by blood feeding arthropod
b) can cause JE, Chikungunya, and Yellow
2. Regarding Dengue Viral Infection
a) 5 virus serotypes DEN !-DEN 5
b) has cross protection
c) epidemics caused by single serotype Hyperendemicity
d) 3 types, dengue fever, dengue

haemorrhagic fever and dengue

intestinal fever
e) patient with sypmtomatic presentation
3. Clinical manifestation of Dengue fever
a) acute fever
b) thrombocytosis
c) rash
d) circulatory failure
e) hepatomegaly
4.Clinical manifestation of Dengue Haemorrhagic
a. bone and joint pain
b. high fever
c. haemorrhagic phenomenon
d. leakage of plasma: effusion,
hypoproteinaemia, decrease haematocrite
e. vomiting
5. Dengue Shock Syndrome
a. occurs 1 week after fever
b. narrowing pulse pressure (<20 mmHg)
c. hypertension
d. metabolic alkalosis
e. oliguria
f. fatal
6.Regarding Japanese Enchephalitis (JE)
a) endemic in Malaysia
b) DNA with capsid & envelope
c) maintained the cycle by involving
culicine ,mosquitoes and waterbirds
d) pigs are the main amplifying hosts
e) incubation period about 1 month
f) sudden fever, headache and vomiting
7. Severe infection of JE
a) neck stiffness
b) tremors
c) high fever
d) stupor
e) sequele with mental retardation, deafness
and emotional lability
1) Regarding penicillin
a. it is one of the B-Lactam antibiotics

b. the excretion of this drug is inhibited by

c. syiphilis is best treated by Penicilin G
d. can lead to superinfection
e. can cross react with cephalosporin
2) Choose the correct adverse effect
a. cephalosporin superinfection
b. glycopeptide Red Man Syndrome
c. sulfonamide Steven Johnson Syndrome
d. penicilin G crystalluria
e. fluoroquinolone megaloblastic anaemia
3. In combination of sulfonamide..
a. Fansidar is a combination between sulfadoxin
& pyrimethamine
b. Fansidar is the 1st line drug for acute
c. Co-trimoxazole is bactericidal
d. Sulfamethoxazole synergist the action of
e. combination of sulfonamide with other drug
can prevent Steven Johnson Syndrome
4) Regarding Co-Trimoxazole
a. is a combination between
sulfamethoxazole with Trimethoprim
b. this drug prevent transportation of Vit B12
into cell
c. can be use parentarally only
d. drug of choice in prostitis because able to
penetrate well into prostate
e. not effective against Shigella
5) Regarding Fluoroquinolone..
a. inhibit bacteria cell wall
b. prevent separation of replicated DNA by
inhibit Topoisomerase IV
c. contraindicated in meningococci carrier
d. it is a synthetic fluorinated analogs of
nalidixic acid
e. may lead to damage growing cartilage
1. Aminoglycosides
A. Use against Gram ve infection
B. Streptomycin is mainly use in the treatment
of TB

C. Macrolides works as an inhibitor for

elongation of the protein
D. Tetracyclines is used in combination to treat
gastric or duodenal ulcer
E. Efficiently cross biological barrier
1. Regarding snake bite
a) viper bites are more common than elapidae
b) extent of tissue damage proportionate to
the amount of venom produced by land
c) snake venom contains high proportion of
protein component
d) elapidae produce haemotoxin type of
e) neurotoxin venom can cause toxin to heart
2. Symptoms of haemotoxin
a) very painful
b) wet gangrene
c) vascular collapse
d) bledding from mucous membrane and
internal organ
e) changes of urine color
3. Viperidae
a) has elliptical and vertical eyes
b) hissing
c) triangular head
d) hood when aroused
e) not real aggressive
4. Pre-hospital management of snake bite
a) immobilization and positioned limb slightly
below the heart
b) excision and bleed out the venom
c) arterial tourniquets and constriction band
d) vital sign monitoring
e) fluid ressusitation
5. True or false
a) recurrence phenomena d/t late onset of
venom effects
b) tetanus yoxoid must be given to snake bite

c) use antivenom crostalide polyvalent for

elapidae bite
d) monovalent antivenom has better
advantage than polyvalent
e) venom enzyme can cause RBC and
platelets destruction
1. Clinical features of poliomyelitis
a) In abortive poliomyelitis, marked
neurological deficit is seen
b) There are signs of meningitis in non
paralytic poliomyelitis
c) Severe systemic manifestation seen in
nonparalytic poliomyelitis
d) Abortive poliomyelitis is easily to be
suspected clinically
e) fever in abortive poliomyelitis
2. Polio-like syndrome
a) cause be West Nile virus
b) the vector for transmission is Culex spp
c) can cause severe meningoencephalitis
d) found in cold climate region
e) can cause neuroinvasive diseases
3. Acute flaccid paralysis
a) symmetrical weakness
b) infected neurons in the spinal cord
c) hyperreflexia
d) objective sensory loss is common
e) loss of bladder and bowel function
4. Gullian Barre syndrome
a) commonly has antecedent event
b) autoimmune disease
c) presented with weakness and assymetrical
d) can cause acute respiratory distress
e) chronic inflammatory demyelinating
1. Increase risk of HIV transmission in
a) circumcised men
b) oral contraceptive users

c) pregnant women
d) concomitant infection with other STDs
e) through vaginal sexual contact ; highest
chances of transmission
2. Neoplastic diseases in AIDS patient
a) Burkitts lymphoma
b) paraneoplastic syndrome
c) Kaposis sarcoma
d) Non Hodgkin lymphoma
e) invasive cervical cancer
3. HIV cases in Malaysia
a) the highest proportion of transmission is
through IDU
b) predominantly among homosexual men
c) majority are Malay
d) heterosexual transmission is increasing in
e) concentrated epidemic
4. HIV prevention & control programs in Malaysia
a) anonymous voluntary HIV testing
c) pre-marital HIV screening done 1 months
before marriage
d) subsidization by government for HIV
e) post exposure prophylaxis for health
workers who have been expose
to HIV
1. Regarding systemic fungal infection
A. High incidence in AIDS patient
B. Also known as opportunistic fungal
C. There is deficit in humoral immunity
D. Candidiasis is most common disease
of opportunistic infection
2. True or false statement
A. Candida albicans is the only causative
agent for candidiasis
B. Candida are members of normal flora
of the skin, mucous membranes and
gastrointestinal tract
C. cryptococcal metabolic products
melanin and mannitol function as

antioxidants that can protect the yeast

against oxidative attacks of
D. A. fumigatus is the most common
human pathogen and ubiquitous
saprophytes in nature
3. Risk factor for candidiasis
A. Indwelling catheters
B. Surgery
C. Intravenous drug abuse
D. Aspiration
E. Damage to the skin of gastrointestinal
4. All of statement are false except
A. Cryptococcus neoformans is yeast
characterized by a thin polysaccharide
B. Disseminated fusariosis transmission
is airborne or inoculated through
breakdown of the skin barrier
C. Disseminated fusariosis mimics
D. Dimorphic systemic mycoses occurs
in immunocompetent individuals
E. Clinical presentation of histoplasmosis
may mimic tuberculosis
5. Host defense mechanisms deficit
A. neutropenia
B. quantitative deficits in phagocyte
C. deficits in cell-mediated immunity
D. deficits in mucosal immunity
E. leukocytosis
6. Main fungal virulence factors
A. polysaccharide capsule
B. production of melanin and mannitol
C. beta mating type
D. mannoprotein-4
E. alpha mating type
1) Regarding the acanthamoeba:
a. have 2 life cycle which is cyst and

b. have single nucleus with large karyosome

c. infection through lower respiratory tract
and ulcerated skin
d. incubation period is 2 days
e. low mortality course

E. May result hemorrhagic CSF


2) Following diseases are associated with

acanthamoeba infection:
a. chronic granulomatous amebic
encephalitis (GAE)
b. primary amebic meningoencephalitis
c. amebic keratitis
d. skin lesions
e. sinusitis

1. Regarding Pneumocystis Pneumonia:

A. Seen in patient with CD4 count below 200
B. Presented with fever, productive cough,
chest tightness
C. Diagnosis by detection of organism in
induced sputum or bronchial lavage
D. The trophozoites is diagnostic form
E. Bactrim is drug of choice
F. Alternative drug- IV pentamidine

3) About Amebic keratitis:

a. affect soft contact lenses wearer
b. TB is differential diagnosis
c. cataract is its complication
d. with history of swimming and bathing
e. cause redness, corneal epithelial defect
and subepithelial opacities.

2. Diagnosis of oral candida (thrush)

A. Painful white oral lesion
B. Can be easily scraped off
C. Lab confirmation- KOH or culture
D. Gram staining appearance of yeast cell
E. Candida albicans is round shape budding
gram +ve organism

4. Naegleria fowleri
A. One of free living ameba
B. Infect immunocompetent children and
C. Has 2 stages: cysts and trophozoite
D. Route of infection through olfactory
E. Cause Granulomatous amebic
encephalalitis (GAM)

3. Regarding atypical mycobacteriosis

a. A Mycobacterium avium complex is the
most common of infection by
ontuberculous mycobacteria in AIDS patient
b. B MAC is non-ubiquitous
c. C Produce characteristic intranuclear owls
eye inclusions ininfected tissues
d. D Commonly treated with a combination of
clarithromycin and ethambutol
e. E Cause lymphadenitis especially in

5. Ameboid form of Naegleria fowleri

A. Only recognize in human
B. Have a thorn-spike like pseudopodia
C. Elongated with narrow anterior and
tapered posterior end
D. Large and central karyosome
E. Change to flagellate form when they are
transferred from culture or teased from
tissue into water and maintain
temperature of 27 to 320C
6. Regarding Primary amebic encephalitis (PAM)
A. Incubation period within 2-15 days
B. Cysts in CSF is a diagnostic finding
C. The clinical course is acute and fulminant
D. Differential diagnostic are TB, viral, fungal
encephalitis, brain tumour/abscess

4. Cytomegalovirus infection
a. A Transmitted person-to-person by close
contact with virus-bearing
material via oral and respiratory spread
b. B Able to replicate in multiple tissue in-vivo
c. C risk factors are neonate, solid organ
transplant, bone marrow
transplant and AIDS
d. D AIDS patient may develop retinitis that
may lead to blind
e. E direct effects are fever, leucopenia and

1. Regarding Cryptosporadium parvum..

A. active at high temperature
B. life cycle complete in one host
C. detectable by routine saline and
iodine staining
D. has trophozoite and cyst stages
E. chorine resistant
2. Regarding Cyclospora cayetanensis..
A. is a dimorphic fungi
B. symptoms prolonged in
immunocompromised patient
C. ubiquitos in environment
D. oocyst detectable by
E. can infect host by autoinfection
3. Intestinal coccidian
A. Is a air borne parasite
B. Symptoms are self limited in
immunocompetent patient
C. Transmitted by ingestion
contaminated water
D. Need intermediate host to
complete the life cycle
E. Oocyst is the diagnostic stage
4. Regarding Isospora belli
A. is transmitted sexually
B. gametogony occur in animal
C. trophozoite is diagnostic stage
D. is identified using wet mount
E. has both asexual multiplication
and sexual development
5. True or False..
A. Intestinal coccidian infection is a
possible cause of travelers
B. Isospora belli oocyst is bigger and
circular in shape
C. All Cryptosporadium, Cyclospora,
and Isospora detactable by
modified acis fast staining.
D. Auramine-rhodamine staining is
another diagnostic method for
E. Intestinal coccidian infections
cause non bloody diarrhoea


1. Those are in group of Herpes virus
a) Herpes simplex virus 1
b) Herpes simplex virus 2
c) Epstein-Barr virus
d) Varicella-zoster virus
e) Cytomegalovirus
2. Regarding acyclovir
a) It is an antiviral agent
b) It is a prodrug
c) Active against cytomegalovirus
d) Not indicated for mucocutaneous
e) Rashes is one of its adverse effects
3. True or false
a) Ribavirin - inhibits synthesis of
guanosine triphosphate
b) Saquinavir, Indinavir - fusion inhibitor
c) Amantadine, rimantadine - Stops
lengthening of DNA strands
d) Zidovudine (AZT) - inhibits
transcription of viral RNA into DNA
e) Oseltamavir & Zanamivir - inhibit
4. Example of antifungal drug
a) Nystatin
b) Amphotericin B
c) Fluconazole
d) Albendazole
e) Flucytosine
5. Regarding polyene
a) Interact with ergosterol which is component
of cell membrane
b) Lead to leakage of cell contents and
c) Use mainly for systemic fungal infection
d) Inactive against candida, cryptococcus and
e) Available in IV


Flucytosine has anticancer property

Amphotericin B is poor protein bound
Azoles is more toxic than amphotericin B
Griseofulvin will bound to keratin in newly
form epidermis and protect the skin

1. State true of false
a) Trypanosoma cruzi responsible for
end stage renal failure in South
b) Giardiasis can cause severe diarrhea
to immunocompromised patient
c) Ascariasis can cause bile duct
d) Chagas disease caused by
Trypanosoma cruzi
e) Cutaneus Leishmaniasis have no
significant infection in organ transplant
2. Regarding acquired immune deficiency
a) Chemotherapy cause immune
b) DMARDs are used to suppress
immune activity in autoimmune
c) Organ transplant of recipient is not
given immunosuppressive drugs
d) Drug that cause neutropenia cannot
cause immune suppression
e) AIDS is one of the immune deficiency
3. Parasites that may be REACTIVATED in
immunocompromised host includes
a) Giardiasis
b) Amebiasis
c) Visceral leishmaniasis
d) Capillariasis
e) South American trypanosomiasis
1. Regarding the Malaria infection

6. Regarding antifungal drug

a) Amphotericin B is narrow spectrum

a) clinical symptoms and signs of

malaria are produced by the asexual
forms of
the parasite
b) cytokines involved to produce fever
are TNF- and IFN-
c) in P. vivax infection, the red cell Duffy
antigen on the uninfected red cell is
involved in the process of invasion of
d) in cytoadherence, mature infected
cells specifically bind to endothelial
cells in postcapillary venules
e) In rosetting, red cells containing the
more mature stages of parasite bind
to uninfected red cells surface
2. Production and release of TNF- account for
a) Leukocytosis
b) enhanced sequestration
c) hyperglycemia
d) alkalosis
e) dyserythropoiesis

3. Causes of renal failure in Palmodium falcifarom

a) Hemolysis
b) Hypertension
c) microvascular obstruction of the
cortex by parasitized RBC
d) free malaria pigment or heme that are
released following hemolysis
e) quinine or quinidine treatment
4. According to genetic and immunologic factor in
Malaria infection
a) absence of Duffy antigen in red blood
cells, prevent P.vivax malaria
b) in patient of sickle cell disease, the
incidence of malaria is lower than
expected for the general population of
a given area
c) in patient of glycophorin C deficiency,
there is high incidence of malaria
d) G6PD deficiency patient is protected
from malaria
e) Patient of hereditary elliptocytosis
prone to get malaria

5. True or false
a) The infectious stage of malaria
parasite is the schizonts
b) MSP-1 and MSP-2 are surface protein
appear on red blood cell after infected
by malaria parasite
c) Cytokine is released in falciparum
d) EBA 175 interacts with red blood cells
e) Hemozoin is responsible to excite
cytokine released (others such as
phospholipids and GPI)
6. Plasmodium falciparum will cause
a) Microvascular sequestration
b) Renal failure due to antimalarial drugs
that use rapidly
c) Black color urine on day 4
d) Anaemia due to DIC is commonly
e) Sequeatration of parasitized RBC in
the lungs is common
7. Regarding malaria
a) P. Vivax attack only young red blood
cells that have Duffy antigen
b) Cytoadherence occur in P.Falciparum
but not in P.Vivax
c) P.malariae had knob on the
parasitized RBC
d) P.Malariae produce immune complex
e) Severe anaemia is seen in
P.Falciparum infection
1. Definitive diagnosis combines
a) Full history including travel
b) Results of blood film or other diagnostic
c) Results of antimalarial drug therapy
d) Clinical examination
e) Clinical features
2. Diagnostic test for malaria


blood smear
Knotts concentration method
Membrane filtration method
Quantitative Buffy coat

3. Quantitative Buffy Coat

The components of the buffy coat
separate according to their
stain DNA in parasite
uses a glass capillary coated with
acridine violet
a test for malaria
4. Plasmodium falciparum
a) its ring form is very thin
b) mature schizont has 8-24 merozoites
c) trophozoite has band form chromatin
d) it usually affect old RBC
e) macrogametocyte has compact
chromatin masses near center
5. Differentiate between P.vivax and P. malariae
a) p.vivax has thick and compact ring
form of trophozoites
b) p.malariae has band form chromatin
whereas p.vivax has ameboid shape
c) infected RBC by p.malariae usually
d) p.vivax has 12-24 merozoites
whereas p.malariae has 6-12
e) both have schuffers stippling
6. Regarding plasmodium spp. life cycles :
a. Human is the only host
b. Plasmodium vivax and Plasmodium ovale
have dormant stage
c. Plasmodium parasite was transmitted by
Anopheles mosquito
d. Fusion of microgamete and macrogamete
occurs in human
e. Erythrocytic stage is responsible for
causing fever
7. Features of Plasmodium spp. :
A. P. vivax infections causing RBC

B. Schuffners stippling was seen in P.

vivax and P. ovale infections
C. P. malariae has ameboid cytoplasm
D. P. malariae has band and basket form
E. Mature schizont of P. ovale consist 12
1. For diagnosis filariasis
a) take blood smear.
b) membrane filtrations 3-5 filter
c) immunochromatography test for detect
d) ELISA test for detect antibody IgG4
e) PCR also can detect filariasis
2. For treatment filariasis
a) diethylcarbamazine (DEC)
b) DEC side effects is nausea
c) Ivermectin
d) Albendazole
e) Headache, joint pain, and fever are DEC
side effects.

c) Will cause cinchonism - syndrome

d) Reduce digoxin levels
e) Interferes in heme polymerization
4. True or false
a) Nematodes causes infection in respiratory
b) Mebendazole which is an antifilarial drug is
soluble in aqueous solution
c) Thiabendazole have same MOA with
d) Mebendazole have many side effects
e) Mebendazole is courage for pregnant
5. Regarding antifilariasis
a) Pyrantel pamoate exerts effects in GI tract
b) Ivermectin does not cross blood brain
c) Thiabendazole give a mazotti-like reaction
when killing the microfilaria
d) Diethylcarbamazine cause immobility of the
e) Mebendazole prevents glucose uptake of
the filaria


1. The following are erythrocytic phase type of
antimalarial drugs
a) Artemisinin
b) Chloroquine
c) Mefloquine
d) Pyrimethamine
e) Primaquine

1. Leishmania spp
a) is intestinal protozoa
b) sandfly is the vector
in the body, amastigote multiplication can
cause rupture of macrophage
c) Leishmania donovani causing Kala Azar
d) weight loss is one of the symptom

2. Regarding Primaquine
a) Only agent for radical cure of P. vivax &
b) Cannot be excreted in the urine
c) Destroys gametocytic forms or prevents
d) Responsible for adverse effects such as
hemolysis & Methemoglobinemia
e) Slowly oxidized to many compounds

2. Trypanosoma spp
a) T. Brucei in Africa
b) American trypanosomiasis causing
sleeping sickness
c) African trypanosomiasis causing Chagas
d) Tsetse fly is the vector
e) Winterbottom sign can be seen in Chagas

3. Regarding Quinine & quinidine

a) Well distributed in body after oral intake
b) Absorption stimulated when taken with

3. Babesia spp
a) zoonotic infection
b) infection in human is by B. microti and B.

c) infection by B. divergens is severe

d) tick is the vector
e) tetrad form seen in blood smear of infected
4. Regarding toxoplasma gondii
a) Obligate intracellular protozoa that infected
all cell
b) Its oocyst found in the human
c) Bradyzoites invade human skeletal muscle,
myocardium and brain
d) Hydrocephalus is one of the classical triad
of congenital
a) toxoplasmosis
e) PCR is a routine method of diagnosis
5. Trichomonas vaginalis
a) Reside only in female reproductive tract
b) has trophozoite and cyst form
c) prominenet symptom is vaginitis with
purulent discharge
d) Human is the only known host
e) Organism moves with characteristic
wobbling and rotating motion
1. Those are vectors that commonly transmit
disease to human
a) mosquitoes
b) ants
c) rodents
d) fleas
e) coakcroaches
2. The correct match between vectors and
a) Culex spp Malaria
b) Anopheles spp Japanese Encephalitis
c) Flies Leptospirosis
d) Rodents Dysentry
e) Cockroach Salmonellosis
3. Principles of VBDCP include
a) prioritize or stratify the vector borne
disease area
b) do case detection actively and passively
c) register the death cases only
d) treat severe cases

e) follow up the cases

4. Regarding VBDCP
a) the aim is to reduced morbidity and
b) it deals with unspecific disease
c) it is an area specific
d) it involves the current knowledge regarding
disease and procedures

MCQ Selanjar3 0809 (soalan 20-80),

1. Vagina is derived from
A. Paramesonephric duct
B. Urogenital fold
C. Genital tubercle
D. Mesonephric tubules
E. Sinovaginal bulb
2. Development of female external
A. Urogenital fold develop to labia
B. Urogenital sinus remain as open
as vestibule
C. labioscrotal swelling develop to
labia minora
D. Genital tubercle develop into
E. Development depends on DHT
3. Menopause
A. lose of ovarian follicular activity.
B. increase serum FSH.
C. conjugated estrogen stimulated

4. Regarding puberty
A. it begin 8-14 year old in girls
B. LH stimulates testosterone by leydig
C. Puberty milestone influent by
D. underweight girl early menarche
E. thelarche is development of testis.
5. Regarding ectopic pregnancy
A. Abdominal cavity is the commonest
B. Chronic salphingitis is the
predisposing factor
C. Leimyoma is a risk factor
D. Tubal pregnancy progress to full term
E. Endometrial biopsy shows chorionic
6. Causes of primary amenorrhea :
A double uterus
B impeforated hymen
C anorexia verosa
D swyers syndrome
E androgen insensitivity syndrome

7. Drug use in pregnancy

A. Dysmorphogenesis- severe if given
on 3rd pregnancy.
B. alcohol- intellectual impairment
C. hydrophilic drug cross placenta
D. benzodiazepine withdrawal in
E. vit B12- prevent neuro tube defect.
8. In pregnancy,
A. elevated ESR
B. elevated serum creatinine
C. elevated serum urea
D. elevated serum alakaline

E. raised white blood cells

9. endometriosis.
A. endometrial tissue develop outside
B. .adenomyosis uteri
C. Retrograde menstruation probably
explain endometriosis.
D. Dysmennorhea is aone of the
E. Can develop into cancer.
11.. Regarding Depo-Provera
A. also known as DMPA
B. administer throungh cutaneous
C. secondary action is to prevent
D. can prevent sexual transmitted
E. delayed infertility after removal
12. Regarding normal labour
A. Head is delivered in natural position
relative to the shoulder.
B. In internal rotation, the shoulder
rotates to bring the bisacromial
diameter into the AP diameter of the
pelvic outlet.
C. Normal duration of 3rd stage if
actively managed is between 20-30
D. Average blood loss= 5000 ml
E. Episiotomy is routinely done for
13. . criteria for baby friendly hospital
A. Having written breastfeeding policy
and routinely communicated to all
health care staff.
B. Helping mother to breastfeed within
2 hours of delivery.

C. giving infant no food or milk, unless

medically indicated.
E. Giving pacifier to infant.

14. Regarding pregnancy

A. perception of fetal movement by
mother is one of diagnostics feature.
B. Skin hypopigmentation is a sign
C. UPT is positive when 5 days
D. On ultrasound examination,
earlist detectable fetal heart activity is
9 weeks
of amenorrhea.
E. post term is when pregnancy has
passed 40 weeks of period of
16. this is the organisms which causes
intrauterine infection
A. herpes simplex virus type 1
B, candida albicans
C. cytomegalovirus.
D. toxoplasma Gondii
E. Rubella
17. Surface epithelium of ovary
B. Presence of psammo body
18. Type I msuscle fibre consist of
A. Adenosine triphoshate
B. Oxidative enzyme
C. lipid
D. Glycogen
E. phosphorylase

20) Drug used to relaxed gravid ,uterus
A- Calcium lactate
B- Ritodrine
C- Bromocriptine
D- Prostaglandin F2-
E- Halothane
21) Attending skills in interview
A- Good eye contact
B- Awareness of body image
C- Parroting
D- Make interviewer feel comfortable
E- Posture
22) Classical conditioning
A- Timing of association between 2
stimuli is important
B- New behaviour acquired
C- Conditioned stimulus precedes
unconditioned stimulus
D- Also known as Pavlovian
E- Require reinforcement
23) Disoredr of thought content
A- Delusion
B- Obsession
C- .
D- Pressure of speech
E- Thought broadcast
24) Shizophrenia
A- Male have better prognosis
B- Inherited as abnormal recessive
C- Higher prevalence in mentallyretarded people
D- Negative symptoms are better
treated with conventional
E- Amphetamine precipitate relapse
in stable patient

25) Characteristics of client-centered

A- Non-judgemental
B- Euplastic
C- Directive
D- Interpretative
E- Genuine

26. Behavioral technique include

A. Aversion therapy
B. Electroconvulsive therapy
C. Systemic desensitization
D. Free association
E. Resistance
27. Defense mechanism associated with
A. undoing
B. splitting
C. projection
D. displacement
E. reaction formation
29. DSM IV criteria for manic
A. irritability
B. hypersomnia
C. suicidal idea
D. spend speere
E. increase goal directed activity
30. Abnormal behaviour
A. deviate from social norm
B. fail to function adequately
C. behavior that is statistically
D. poor interpersonal relationship
E. personal distress is present

31. Impaired reality testing are seen in ?

A. Mania
B. Dellusional disorder
C. Neurasthesia
D. Anorexia nervosa
E. Hypochondriasis
32. Personality disorder
A. Ego dystonic
B. Borderline personality in
cluster D
C. Slow pursuit movement
associated in schizoid type personality
D. Antisocial personality disorder
in cluster A disorder.

33. Punishment centres in limbic system

A. are stimulated by
B. include hippocampus
C. are presented in
periventricular zone of hypothalamus
D. if stimulated give rise to rage
E. are inhibited by reward centres
34. Symptoms of lithium toxicity include
A. polyuria
B. coarse tremor
C. vomiting
D. hypertension
E. coma
35. Vascular dementia
A. commonest type of dementia
B. has slow chronic onset
C. associated with focal
neurological deficit
D. characterized by
neurofibrillary tangles

E. has atherosclerotic plaque in

vessel of brain
36. Regarding antipsychotics
A. Atypical antipsychotic act both
at D2 and 5H2A receptors
B. Haloperidol is a low potential
C. Low potency drugs is more
prone to cause extrapyramidal
D. High potency drugs are more
suitable for elderly
E. Clozapine is a phenothiazines.
37. Short term memory
A. include iconic memory
B. last for 15-30 minutes
C. involve in retrograde amnesia
D. storage involve 7 chunks of
E. store in long term memory by
38. DSM IV multiaxial involve
A. it has 4 axis
B. axis I is about primary
psychiatric illness
C. axis II include mental
D. axis III is about psychosocial
factor related to psychiatric illness
E. axis IV is about the grading
given by clinician regarding individual
level of functioning

39. Regarding conversion disorder

A. The classification under
somatoform disorder in ICD 10

B. Characterized by presence of
neurological disorder
C. Symptoms intentionally
D. Also known as factitious
E. Pharmacotherapy is the most
important treatment.
41. Regarding blood brain barrier
A. It is a barrier between blood
and cerebrospinal fluid
B. Impermeable to cytokines
C. Astrocytes involved in its
D. Protect brain from harmful
E. Tight junction is one of the
44. Microscopic features of cerebral
infarction after 3 weeks include
A. red neurons
B. neutrophilics infiltration
C. macrophages infiltration
D. cystic space formation
E. surrounding gliosis
46. Regarding Myasthenia Gravis,
A. it is due to impaired
neuromuscular junction transmission
B. characterized by weakness of
smooth muscle
C. associated with presence of
anti- acethylcholine receptor antibodies
D. present with ptosis
E. common in elderly

47. Features of grey matters disease

A. spasticity
B. deafness
C. weakness of muscles
D. seizure

48. Regarding Duchenne Muscular

A. it is an X-linked recessive
B. male is an asymptomatic
C. can cause calf muscle
D. atrophy of muscle group
E. Dystropin is absent in muscle
50. Extensor plantar reflex present in
A. infant
B. post generalized convulsion
C. spastic diplegia
D. lower motor neuron lesion
E. coma
51. Regarding CNS infection
Herpes encephalitis cause increase red
blood cell level in CSF
Hemophilus influenza cause subdural
E. coli one of its pathogenic factor is P
Enterovirus always result in fatal
Alcohol ingestion is a risk factor for
Pneumococcal meningitis

52. Hypertrophic form of Charcot Tooth

Mary Disease
A. Early death
B. Pes cavus
C. Hypertrophy of calf
D.Onion bulb around nerve

B. are preceded by aura

C. present with dj vu
D. manifest with generalized
tonic clonic movement
E. indication for treatment with


61. Free living amoeba

Naegleria gowleri
Triponosoma spp.
Leishmania spp.
Babesia microti

54. Regarding HIV infection in CNS

A. Later phase is associated with
B. Dementia occur in early stage
of infection
C. Progressively worsen in
majority of cases
D. Cognitive function is impaired
in majority of cases
E. Cranial neuropathies is usually
late signs.

58. Increase intracranial pressure

associated with
A. hypocapnea
B. traumatic subdural hematoma
C. bradycardia
D. dural sinus thrombosis
E. hypotension

62. Infection transmitted by aerosol:

Pneumonic plague
Toxic shock syndrome
63. Regarding dengue fever
A. It has 4 serotypes
B. Different serotype has different
C. Can diagnosed by 3D
D. It is caused by RNA virus
E. It is due to Anopheles species
64. Pneumocysti jirovecii
A. It is a protozoa
B. It is an intracellular pathogen
C. Ground glass appearance in
chest x-ray features of lung infection
D. Transmission mode is via
direct contact
E. Prevented by cotrimoxazole.

60. Complex partial seizure of temporal
lobe epilepsy
A. associated with alteration of

65. Gastroenteritis
A. Coronavirus cause diarrhea in

B. Rotavirus cause bloody

C. Norvovirus cause major
D. Astrovirus occur in
immunocompromised people
E. Adenovirus cause prolong
66. Regarding gastroenteritis,
A. Incubation period for
Staphylococcus aureus is less than 12
B. Bacterial gastroenteritis is
more common than viral gastroenteritis
in children.
C. Shigellosis can cause
hemolytic uremic syndrome
D. Pseudomembranous colitis is
caused by Campylobacter jejuni.
E. Salmonellosis is caused by
eating half-cooked chicken egg.
67. Regarding drugs used in
communicable disease
A. Chloramphenicol is used as
protein synthesis inhibitor
B. Sulfonamide is used to inhibit
folate reductase
C. Gentamicin is used only for
Gram positive bacteria infection
D. Fluconazole is used for fungal
68. Regarding malaria,
A. it is a protozoa infection
B. the causative agent is male
Anophelus mosquito
C. more severe infection caused
by Plasmodium ovale
D. Plasmodium falciparum can
cause glomerulonephritis
E. relapse can occur in
Plasmodium vivax

70. Transmission of communicable
A. Direct transmission via droplet
air through coughing
B. Bacterial enter scalp causing
C. Vertical transmission is a direct
D. Air borne with size more than
5 micrometre in air can be deposited in
E. Direct contact with TB patient
71) Notifiable disease
A- Gonococcal infections
B- Relapsing fever
C- Leptospirosis
D- Viral encephalitis

72) Soil-transmitted helminths

A- Trichinella spiralis
B- Ascaris lumbricoides
C- Ancylostoma duodenale
D- Strongyloides stercoralis
E- Enterobius vermicularis
73) Acanthamoeba
A- Free-living organism
B- Dx made detecting cyst in the
C- Cogwheel morphology of cyst is
D- Cause keratitis
E- Cause amoebic
74) Measles virus

A- Infection is associated with

B- Animal reservoir
C- Majority infection is symptomatic
D- Pneumonia is the manifestation of
the disease
E- Subacute sclerosing
panencephalitis is the delayed
75) Lab Dx of HIV infection
A- Western blot is a screening
B- Simultaneous detect antigen &
antibodies enables early detection of
C- Quantitative nucleic acid test to
monitor antiretroviral treatment
D- Antibody detection are of limited
role in late course of the disease
E- Influenza immunization known to
cause false +ve in ELISA
76) Correctly matched zoonotic disease
and their animal reservoir
A- Japanese encephalitis - swine
B- Leptospirosis - rat
C- Variant Creutzfeldt-Jakob disease
D- Brucellosis - Cattle
E- Nipah virus bat
77. Match the zoonotic disease with its
causative animal
A. Japanese encephalitis swine
B. Leptospirosis rat
C. Variant Creutzfeldt-Jakob
encephalitis cat
D. Brucellosis cattle
E. Nipah bat

78) Antimicrobial
A- Chloramphenicol is protein
synthesis inhibitor
B- Sulfamethoxazole inhibit
dihydrofolate reductase
C- Cloxacillin is effective for treating
cellulitis caused by Staphylococcus

D- Gentamycin is used to treat Gram

+ve infection
E- Imipenam is a narrow-spectrum
79. Trematodes that used 2
intermediate hosts include
A. Fasciolopsis buski
B. Fasciola hepatica
C. Paragonimus westermani
D. Chlonorcis sinensis

E. Schistosoma hematobium
80. Elapidae (cobra) cause
A. respiratory diaphgram
B. haematuria
C. cardiotoxic effect
D. myoglobunuria
E. no envenomisation