Multiple Choice Questions

NEUROSCIENCE
FK UPH 2014
Friday, 07 Oct. 16
08.10 – selesai
[Missed questions : 1-3 numbers]

1. 1 year old boy dibawa ibunya karena delayed mental development dan kepala
membesar. Di diagnosis kena hydrocephalus. CSF mengalur dri ventricle tiga ke
ventricle empat melalui?
A. Foramen luschka
B. Foramen magendi
C. Foramen monro
D. Cisterna magna
E. Aquaductus cerebri sylvi

2. 1. Neural crest
2. Notochord
3. Neural plate
4. Neural tube
5. Neural groove
Urutan yg bener gimana?
E. 2-3-5-1-4

3. Male new infant , normal vital sign, have a bulging cyst like diameter 4cm in his back.
Limited low extremities ability to move. Closure bagian mana yg bermasalah?
A. Neural tube
B. Anterior neuropore
C. Posterior neuropore
D. Neural plate
E. Mesenchyme


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4. 3 main function of csf :
A. Homeostasis, immunologis, blood brain barrier
B. Homeostasis, immunologis, mechanical function
C. Homeostasis, immunologis, circulation of nutrient
D. Homeostasis, circulation of nutrient, mechanical function
E. Homeostasis, circulation of nutrient, blood brain barrier

5. Which of the items listed below best characterizes the following statement: A graded,
fast potential, lasting from several milliseconds to seconds, resulting from a chemical
transmitter binding to a receptor to produce either an excitatory postsynaptic potential
(EPSP) that depends upon a single class of channels for sodium and potassium or an
inhibitory postsynaptic potential (IPSP) that is dependent upon chloride or potassium
conductance. (ini ngomongin temporal summation kan ya?)
A. Receptor potentials
B. Electrical postsynaptic potentials
C. Increased-conductance postsynaptic potentials (USMLE)
D. Decreased-conductance postsynaptic potentials
E. Decreased-conductance postsynaptic potentials

6. Which of the following characterizes a principal feature of axosomatic synapses?

A. It is referred to as a type I synapse
B. They have an electrical continuity linking the pre- and postsynaptic cells
C. They are typically inhibitory (USMLE)
D. Synaptic transmission is mediated by glutamate
E. They form the predominant synapse of cortical projections to the neostriatum

7. A 65-year-old man is diagnosed with a form of a peripheral neuropathy. This individual

will likely display which of the following:
A. A loss in motor function, but sensory functions will remain largely intact
B. A reduction in conduction velocity of the affected nerve (USMLE)
C. An increase in the number of Ranvier's nodes

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 D. Degeneration of myelin but the axon will typically remain intact
E. Signs of an upper motor neuron (UMN) paralysis

8. 25 years old female comes with paralysis and sensory loss. Oligoclonal igG band was
found in the laboratorium examination. Multiple sclerosis was diagnosed by the doctor,
based on MS McDonald’s criteria. What is the cause of paralysis and sensory loss?
karena ngga bisa repolarization
A. Activate Voltage-dependent Na
B. Increase Ca efflux
C. Increase Na efflux
D. Increase Velocity conduction
E. Increase K efflux ( karena part yang demyelinate jadi hyperpolarized, dibawah
myelin sheath itu bnyk k channel)

9. Neurodegenerative dx dapat menganggu astrosit. Pertubration astrocyte can disrupt

triptate something. Karakteristik yang berhubungan dengan LTP? ( ini slide si dr Robert
nih, yang isinya sbnrnya cuman ca 2+, tpi setau gue gak berhunungan sam LTP, hrusnya
lewat si NMDA sama AMPA)
A. Habituasi -> Terlalu sering sampe ngerasa cuek / biasa aja
B.
C. Astrosit Ca2+ ( ini jawaban slide dr Robert)
D.
e. Increase of AMPA receptor. ( ini jawaaban LTP tapi HAHA)

10. What is the most conspicuous stimulate area that responsible for almost natural sleep?
A. Hypothalamus
B. Locus cerelous -> NE
C. Raphe nucleus -> sleep
D. RAS -> Consciousness
E. Pontomesencephalon -> Bia buat tidur & arousal

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11. 4 years old dibawa ortunya ke RS. Woke up in the middle of the night. Kadang ada di
suatu tempat di rumahnya, crying, screaming. Pas paginya dia bangun seperti biasa
dengan happy mood dan ga inget kejadian malamnya. Dokternya bilang kalau dia
experience nightmare or night terror. Kejadian ini ada di fase mana? Baca di
Sherwood / slide dr. Hermann ttg Sleep Physiology & Somnabulism
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
E. REM -> Atonia, biasa mimpi indah

12. A 2 y.o baby girl is brought to hospital by her mother because an ulcerative mass in her
spine around T12-L1. An examination by CT- scan across abdomen showed an abcess.
A curretage biopsy is performed and its hystopathologic showed necrous caseous, giant
cell of langhan, (satu laginya lupa )
What is your diagnosis that most likely you may describe for this condition?
A. Spina Bifida
B. TB spondylitis
C. Synovitis non specific
D. HNP
E. Poliomyelitis

13. A 32-years old women come to clinic with bilateral weakness of lower limb. The
neurological examination: no neck stiffness (buat singkirin meningitis, subarachnoid
hemorrhage); increased tone, hyperactive tendon reflexes, extensor plantar response on
right foot. What type of cells that provide this mechanism? Protein naik, cell count
normal (soalnya aneh nih kalo bgini, kalo mau jawab UMN cells yang astrocyte juga
bener, anggep ini aja ini MS)
Lab show GBS, Symptoms show MS
Ependymal cell buat hasilkan CSF, Microglia buat makrofag otak, Oligodendroglia adlh
schwann cells di central , Astrocytes buat nutrisi ke neuron

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GBS : Polyradiculopathy, demyelinisasi di perifer, biasanya abis infeksi, ada ascending
weakness, cytoalbumin dissociation,
A. Astrocyte -> Ada di BBB
B. Oligodendroglia -> Disease : MS
C. Schwann Cell -> Disease GBS

14. 65 yo man brought to emergency room with gradually unconsciousness since 3 days
ago after his head against the floor when he fell down from stairs. The neurosurgeon
did an urgent craniotomy and evacuate blood from space between dura-mater and
arachnoid-mater. What is the diagnosis?
A. Pontine hemorrhage
B. Subarachnoid hemorrhage
C. Epidural hematoma
D. Subdural hematoma
E. Basal ganglia hemorrhage

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15. 45 y.o man previously healthy develop headaches over past month. No remarkable
finding d PE, Cerebral angiogram shows 7 mm saccular aneurysm di trifurcatio right
MCA. Komplikasi:
SDH : Sumber dari bridging vein, biasa di orang tua yg komplain headache, CT: Cresent
shape
SAH : Sumber dari aneurysm / AVM, biasa karena trauma / HT, “Worst headache, kaku
kuduk +, CT : Mengisi sulcus / gyrus
EDH : Sumber dari middle meningeal artery, biasa unconscious 2 kali
A.subdural hematoma -> Bridging vein
B. Subarachnoid hemorrhage
C.epidural hematoma
D.cerebellar parotid herniation (kalo ga salah )
E.hydrocephalus

16. 80 years old was admitted to hospital because of recent onset fluctuating level of
consciousness. Ct scan of head show collecting blood between dura mater and skull of
right. What most like produce symptoms findings?
A. Tear of bridging veins
B. Ruptured saccular aneurysm
C. Blood from AVM
D. Ruptured of middle meningeal artery
E. Thrombosis of middle cerebral artery

17. What is the origin of the anterior communicating artery?

A. Internal carotid artery
B. Anterior Cerebral artery
C. Medial Cerebral artery
D. Posterior Cerebral artery
E. Basillar artery

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18. An 18 year old college student presented with the following signs after having a
midthoracic spinal injury. With eyes closed he could not tell whether his toe was
dorsiflexed or plantarflexed. In addition, there is loss of tactile discrimination and
vibration sense. The lesion is involved in which of the following tracts?
A. Corticobulbar
B. Spinocerebellar
C. Spinothalamic
D. Cortiocspinal
E. Dorsal column
19. A 40 year old woman felt uncomfortable going with the car especially during
acceleration and deceleration. What kind of vestibular receptor will be stimulated
during acceleration and deceleration (horizontal)?
Otolith organs : utricle & saccule buat gravitasi & posisi tubuh
A. Utricle -> Buat yg horizontal
B. Saccule -> Buat yg vertical
C. Canal semilunaris horizontal -> Gerakan nengok kanan kiri
D. Canal semilunaris anterior -> Dalam gerakan ngangguk
E. Canal semilunaris posterior -> gerakan kepala tempel kuping

20. In testing for motor neuron, a neurologist nemuin An upwards movement of the patient
toe when the plantar surface of his foot was stretch (Babinski +). This response is
indicative of a lesion of a part of the nervous system. Which is the following that cause
that response
UMN : CORTEX - before cornu anterior spinal cord
LMN : Cornu anterior - muscle fiber
A. Dorsal collom
B. Sensor neurons
C. UMN
D. Corticospinal tract
E. LMN

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21. Left weakness of limb, left vibration, loss sensation of pain temp which injury? Injury
in medulla spinalis
A. Anterior cord syndrome
B. Central canal syndrome
C. Left hemisection syndrome -> Brown Sequard Syndrome (kena motoric & sensoric)
DAN HARUS PAIN & TEMP harus Contralateral
D. Right hemisection syndrome

22. Kakek2 dateng hemiparesis, buat exclude hemorrhage pake apa?

A. Angiogram. -> For occlusion // ischemic stroke
B. CT Scan
(pilihan lain lupa)
CT with contrast for infection & tumor
23. 24 years old female complex partial seizure. Automaticism di complex partial seizure?
Complex seizure : Unconscious
A. Lip smacking, chewing, gesturing (orobuccolingual movement, head, neck & hand
movement)
B. Singing and coughing
C. Choreiform dance like movement -> Huntington
D. Rigid arm motion directed laterally
E. Jerking in extremity

24. 9 years old boy has absance seizure. Which is the best describe absance?
A. Right arm tremulous
B. Stop kegiatan , pandangan kosong, daydreaming
C. Flexion extension of arm leg
D. Loss of tonus and fall to ground

25. The drugs donepezil, rivastigmine, and galanthamine are used in AD to try to raise the
availability of what transmitter in the brain? Obatnya memperlambat penurunan NT

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 A. Dopamine D. Acetylcholine
B. Norepinephrine
C. Glutamate
*Alzheimer : Ach > dopamine
*Parkinson : Ach > dopamine
*Seizure : Glutamate > GABA
*Schizophrenia : Dopamine tinggi

26. Abnormal processing of which of these proteins is felt to be particularly important in

the pathophysiology of Alzheimer’s disease?
A. Acetylcholinesterase
B. Alpha-synuclein -> For Parkinson
C. Huntingtin
D. Amyloid precursor protein / TAU Protein
E. A right spinal cord hemisection syndrome

27. A 61-year-old man is brought into the doctor’s office for memory loss and confusion.
Which of the following symptoms are most suggestive of Alzheimer disease as opposed
to dementia with Lewy bodies?
A. Visual hallucinations ( ini common di LEWY)
B. Dramatic fluctuations in clinical condition (Ini lewy, dementianya ilg timbul)
C. Early anterograde memory loss -> *Short-term Memory
D. Early shuffling gait (Parkinson)
*Alzheimer : Memoy loss, capgras syndrome (late stage of Alzheimer, delusion that the
caregiver has been replaced by an imposter)
*FTD : Apathy, poor judgement
*DLB : Visual Hallucinations & capgras syndrome (early stage of DLB, delusion that the
caregiver has been replaced by an imposter)
28. College student, injured karna kena tackle pas football game, dibawa ke rmh sakit
ditemukan bahwa:
- unable to abduct and rotate left arm at shoulder
- ga bisa flex elbow kiri

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 - ga bisa angkat wrist kiri
Pas PF: decreased biceps reflex di limb itu, di limb lainnya normal
Kemungkinan lesinya dmn: *Hafalin brachial plexus & dermatomes*
A. Pre central gyrus -> Hancurkan semua motor
B. Basilar pons
C. Ventral horn at C1
D. Nerve root C5-6 -> Kena di brachial plexus
E. Triceps muscle

29. What is the most common cause of Bell’s Palsy in an adult?

A. Lyme disease -> DD Bell’s Palsy yg bisa dipikirkan ketika terjadi di daerah
epidemik & disebabkan oleh infeksi bakteri.
B. Varicella zoster reactivation
C. Acoustic neuroma
D. Herpes simplex virus reactivation -> HSV 1 (lebih sering)
E. Noncaseating granulomas
* Bell’s Palsy bisa sembuh dlm 3 bulan
* Synkinesis : kedip & senyum berbarengan
* Obat : Corticosteroid & anti-viral
30. A 45-year-old woman complains of recurring episodes of vertigo that began after she
bumped her head rather forcefully 2 weeks ago. Her spells last 10 to 15 seconds and
occur whenever she goes to bed or wakes up. She denies any hearing loss or tinnitus.
Her physical examination is normal except for a latent, rotatory nystagmus when she is
lying with the right ear down. What is the most likely diagnosis?
A. Acute serous labyrinthitis -> Inflammation of inner ear
B. Benign paroxysmal positional vertigo -> Karena ada perubahan posisi
C. Vestibular migraine
D. Ménière disease due to change of fluid volume in labyrinth -> Triad : Tinitus,
hearing loss, vertigo
E. Viral vestibular neuronitis
*Acoustic Neuroma -> Neurinoma di CN 8

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 31. 10 year old girl come with his father to your clinic BECAUSE of weakness on
both lower extremities when she woke up in the morning and it was so hard for
her to get off from her bed. In the afternoon, she had difficulty to rise up her both
arm when she try to comb her hair. She also had a shortness of breath and sore
throat for 3 weeks ago. She underwent lumbar puncture, and analysis of CSF
showed following result:
• None (-) pandy (++)
• Cell count 4/ul
• PMN -
• Protein 300 mg/dl
• Glucose 98 mg/dl
Diagnosis nya apa?
A. GBS ( cell normal protein naik) -> didahului oleh infeksi respiratory & GI tract
(CMV, EBV & Campylobacter jejuni), merupakan penyakit autoimmune,
CSF: protein >50 mg & without pleiocytosis
B. Acute stroke
C. Myasthenia gravis -> Khas : Gampang capek, harus ada jeda istirahat, penyakit
autoimmune
D. Inflammatory myopathy
E. Tick paralysis

32. A 62-year-old man with hypertension and diabetes presents with acute right face, arm,
leg weakness, slurred speech, and right-sided hyperreflexia. *Hyperreflex : UMN
Lesion*
A. GBS
B. Acute stroke
C. Myasthenia gravis
D. Inflammatory myopathy
E. Tick paralysis -> Kutu rambut yg sebabkan paralysis

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33. A 34-year-old woman presents with fatigueable muscle weakness with climbing stairs
or blow drying her hair. This is associated with some shortness of breath, which
improves with rest. What neurotransmitter plays a role? (myasthenia gravis makin
dipake makin bego)
a. NE
b. Dopamine
c. GABA
d. Serotonin
e. ACH (bisa ngomongin MG ato Muscarinic & nicotinic receptor)

Soal 34-36
A 35 years old male got a motor vehicle accident, he was unconscious for 15 minutes, forgot
all memory around the accident time frame. He was conscious when he admitted the
emergency unit. BP 130/80 mmHg, HR 88 x/minute. During clinical investigation in
emergency unit, he became unconscious. He also developed right pupil dilatation, and left
side weakness. *Diagnosis : Epidural Hematoma * CN 2: Sensorik CN 3: Motorik
*Uncus : Bagian dari midbrain
* Midbrain : Medium size eye
34. Why does he develops right pupil dilatation? *Dilatation Ipsilateral : CN 3
A. Direct uncal compression at the pons level -> Pin point eye
B. Direct uncal compression at the medulla oblongata
C. The uncus cause stretching of the third nerve
D. The uncus cause stretching of the sixth nerve
E. The uncus cause stretching of the forth nerve

35. The physician did a CT Scan, according to the clinical findings, what would you
expected to find?
a. Intraventricular hemorrhage
b. Epidural hemorrhage at posterior fossa
c. Subdural hemorrhage at interhemispheric
d. Epidural hemorrhage at occipital region

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 e. Epidural hemorrhage at temporal region -> Karena kena 1 sisi

36. He got a lucid interval, means conscious interval between two episodes of
unconsciousness. What is the most probable cause of second episode of unconscious?
Lucid :
Lucid interval di anatomi adlh SDH
Lucid interval aslinya itu di EDH
Consciousness center : 1/3 thalamus, midbrain, 2/3 pons
Baca CN
A. Direct uncal compression at the pons level
B. Direct uncal compression at the medulla oblongata
C. Direct uncal (uncus di daerah temporal) compression at midbrain
D. Direct uncal compression at cingulate gyrus
E. Direct uncal compression at corpus callosum

37. 25 years old man feel weakness 9n both lower limb after fall from 4th floor building.
Physical examination reveals Babinski reflex positive (UMN). What structure involve?
* Anterior Corticospinal : Buat otot badan
A. lateral spinothalamic
B. Gracilis and cunateus fasciculus
C. Lateral corticospinal -> Deccusate at medulla spinalis
D. Dorsal column
E. Spinal nerve

38. Cowo umurnya lupa, udah 1 minggu pusing kepala dan demam. Pada pemeriksaan fisik
ditemukan plantar reflex positive, ada nuchal rigidity. Tidak ada papilledema. Sebelum
pemeriksaan lbh lanjut, diagnosis yg paling mungkin..
A. Meningitis
B. Cerebral hemorrhage
C. Subdural hemorrhage
D. Lupa

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 E. Obstructive hydrocephalus

39. A 56 years old man came to ER with sudden weakness of his left extremities.
He had history of hypertension and diabetes. On examination his strength on left
extremities was grade 2. His rest examination was normal. Brain MRI showed
infarct on right internal capsule. The fiber tract affected by this syndrome
decussates at what level? Kena tractus lateral (decussate at medulla oblongata) &
anterior (decussate at spinal cord) corticospinal
A. At the anterior thalamus
B. At the junction of the medulla ob. and the spinal cord -> Setinggi foramen
magnum
C. At the junction of the midbrain and the medulla ob.
D. At the junction of the pons and the medulla ob.
E. Within one to two levels after entering the spinal cord

40. Cewe 56 yo tiba2 menjatuhkan cangkirnya ketika sedang minum kopi. Dia gak bisa
bangun, gak bisa jalan. Physical examination ada weakness di sebelah kiri. BP: 150/110
RR dan pulse rate normal. Pas di neurologic exam, kekuatan face dan motoric upper
extremities 4, sedangkan lower extremities 0. Kenanya dmn?
A. Arterior cerebral artey ( liat homunculus) (Buat lower limb)
B. middle cerebral artery -> Tangan, truncus (Buat uppe limb)
C. Posterior cerebral artery -> Ke penglihatan
D. Basilar artery -> Mati
E. Lenticulostriate artery -> Kena medial temporal region (Kena semua tapi biasanya
pure motor / pure sensoric) ( deket internal capsule, yaa gasalah sih )

41. A 21 year old man got his left elbow injured after motorcycle accident. The Xray showed
fracture at epycondyle of left humerus. After the surgeon doing fixation and reposition
procedure, he can't move his left thumb. Which of the following nerve is impaired? (ni
soal sbnrnya rada aneh, trauma nya ulnaris, tp jempol mostly medianus)
A. n. Musculocutaneous

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 B. N. axillaris
C. N. medianus -> Hand of Benedict / Preacher’s hand
D. N. radialis -> Wrist drop
E. N. ulnaris -> Claw hand

42. A man went to the doctor given the injection in right buttock. After the injection he
experienced weakness in the right leg, he cant stand up or squat. Which of the
following nerve is affected ?
A. Inferior gluteal nerve
B. Superior gluteal nerve
C. Pudendus nerve
D. Sciatic nerve
E. Inferior cluneal nerve

43. When somebody exposed to a sharp objects then initially the body will perform reflex.
Which of the following is the sequence of reflex?
A. Impuls > Sensory neuron > Receptor > Spinal cord > Motor neuron > Effector
B. Impuls > Motor neuron > Receptor > Spinal cord > Sensory neuron > Effector
C. Impulse > Receptor > Sensory neuron > Spinal cord > Motor neuron > Effector

44. laki" 54 tahun terdapat tremor ditangan kanan yg semakin parah sejak 6 bulan. serta
sulit untuk menggerakkan tubuh terutama untuk jalan. PF : tremor tangan kanan pada
saat istirahat, mask face, slow and deliberate gait, tonus tangan dan kaki kanan naik.
treatmentnya apa? Diagnosis : Parkinson
A. amantadine
B. anticholinergik
C. dopamine
D. levodopa -> Ini bisa tembus BBB
E. SSRI

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45. A 62 year old man complain double vision when he looks to his left. On examination,
he experience double vision when pursuing object and being worst when he looking to
his left. When he covers his left eye, the outermost image disappear. Which of the
following cranial nerves is most likely to be affected? *Double vision Right
occulomotor / left abducens
Yakin paten

A. Left oculomotor D. Left trochlear
B. Right oculomotor E. Left abducens
C. Left optic

46. Cewe 70an tahun came to emergency because of paralysis in hand and feet, CT found
out there is infraction in left middle cerebral artery.
What is the best drug to prevent the 2nd time relapse?
A. Streptokinase
B. rTPA -> Hafalin indikasi rTPA (For acute treatment, Golden period : 3-4,5 jam)
C. Acetylcholie esterade
D. Clopidogrel -> Anti platelet
Aspirin : Antiplatelet
Heparin : Anticoagulant
Antiplatelet buat artery
Anticoagulant buat vein (ex. DVT)
47. 35 y.o brought to ER after traffic accident. Neurologic examination: corneal reflex
absent on both eyes. Which is the abnormal Cranial nerves? Corneal Reflex itu pake
CN 5
A. Optic nerve
B. Oculomotor nerve
C. Trigeminal nerve
D. Vagus nerve
E. Accesorius nerve

48. 25 years old male with tingling and numbness over the little finger and ring finger,
wasting of the dorsal interossei and abductor digiti minimis, and sensory disturbance

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 over the little finger and ring finger. Where is the location of the peripheral nerve
lesion?
A. Median nerve
B. Ulnar nerve
C. Radial nerve
D. Peroneus communis nerve -> achilles reflex
E. Brachial Plexus

49. 45 year old woman presented with blurred vision gradually since 3 months ago. The
neurological examination revealed visual deficit with pattern below:

Which of the following site lesion for her symptom? Diagnosis : Bitemporal
hemianopsia due to pituitary tumor
A. Temporal lobe
B. Occipital lobe
C. Parietal lobe
D. Optic chiasm
E. Retina

50. 40 yo woman complains headache that is getting worse, she also complains of difficulty
in smelling perfume, Ct shows brain tumor, which lobe is the probable location of the
tumor?
A. Occipital
B. Temporal
C. Frontal -> Olfactory bulb
D. Optic chiasm
E. Brainstem

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 * Area 1,2,3 : Primary Somatosensory
* Area 5 & 7 : Somatosensory ass cortex
* Area 4 : Primary motor cortex
* Area 17 : Primary visual cortex
* Area 18 & 19 : Secondary visual cortex
* Area 22 : Primary Wernicke
* Area 41 : Primary auditory cortex
* Area 42 : Secondary auditory cortex
* Area 44 : Primary Broca

51. A 37 years old man fell down when fix the roof of his house. His back hit big stone on
the ground then suddenly he feel sensory deficit for temperature and pain. Which tract
of the spinal cord is the mostly affected?
A. Fascicullus gracilis -> Proprioceptive di kaki
B. Fascicullus cuneatus -> Proprioceptive di tangan
C. Spinothalamic anterior
D. Spinothalamic lateral
E. spinocerebellar -> For gait & balance

52. A 30-year-old man was crashed by motorcycle and felt down at his sacrum. The
imaging showed fracture of his sacrum. Afterwards he has problem of micturia and
dysfunction of erection. What nervous system is the most likely injured:
A. parasymphatetic nervous system -> For erection
B. symphatetic nervous system -> For ejaculation
C. sensoric nervous system
D. motoric nervous system
E. central motor neuron

53. An 18 year old college student presented with the following signs after having a
midthoracic spinal injury. With eyes closed he could not tell whether his toe was

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 dorsiflexed or plantarflexed. In addition, there is loss of tactile discrimination and
vibration sense. The lesion is involved in which of the following tracts?
A. Corticobulbar
B. Spinocerebellar
C. Spinothalamic
D. Cortiocspinal
E. Dorsal column

54. When hiring a new employee, the doctor examines several reflexes including the
patellar reflex. What is the receptor most related to the reflex above?
A. Corpus Paccini receptor in the joint
B. Touch receptor in the patella
C. Receptors in Muscle spindle (Muscle stretch reflex)
D. Golgi tendon apparatus
* Reflexes : Muscle stretch reflex, golgi tendon organ reflex, flexor reflex & withdrawal
reflex
56. Eosinophilic cystoplasmic inclusions in the brain cells of patients with parkinson's
disease is :
A. Tau protein -> Alzheimer
B. Amyloid plaques -> Alzheimer
C. Golgi bodies
D. Pachusen bodies
E. Lewy bodies

57. 40 year old male construction worker dtg dengan keluhan stiffness pada leher, jaw,&
back. Previously he had nail wound. What is the bacteria responsible for it?
A. Clostridium perfringens
B. Clostridium botulism -> Respiratory depression
C. Clostridium ...
D. Clostridium tetani -> Trismus & ophistotonus
E. Clostridium s...

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Mysthenia Gravis : block di receptor ach
Botulinum : can’t release ach
58. A young woman present with sudden onset of double vision, dry mouth, and weakness.
No previous history of episodic weakness or dog/tick bite. Last night she ate som
canned-food. Physical examination show she alert and no fever. Doctor notice
ptosis:bilateral third and tenth cranial nerve, symmetric flaccid of all four extremities,
decrease deep tendon reflex, decrease bowel sound, no sensory loss. Mechanism?
botulism
*Tetanus : Tetanospasmin
A. Close contact with infected animal
B. Stop___ (?) Elongation factor 2(EF-2)
C. Inhibiton release of acethylcholine
D. Contagious of ___ infectiouse
E. Lupa maaf

59. A 18 years old girl was brought to emergency department with 12 hour history of high
fever, chills, and severe headache. Soon after arriving at ED, she vomited twice. She
looked confused and was highly agitated. The patient was unable to answer question of
follow command. Neck stiffness was present (meningitis), a purpuric rash (hemorrhagic
rash) , mainly on her extremities was noted. Which of the following transmission is
more likely to cause her illness?
Neisseria meningitidis ada purpuric rash
A. Fecal oral
B. Droplet
C. Close contact
D. Mosquito bite
E. Intravenous

60. A 62 years old male came to neurology clinic with a history of seizure 5 times in the
last week. Previously he had seizure 3 times in a month. His seizure starts with face and
eyes turning to left, tonic-clonic of the left extremities, and then spreads to the right

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 extremities with loss of consciousness. His seizure last for 2 minutes and then stopped
and he regained consciousness. What is the diagnosis:
*Diagnosis : Generalized seizure
A. Acute symptomatic seizure
B. Chronic symptomatic seizure
C. Epilepsy
D. Status epilepticus -> No regain consciousness
E. Non psychogenic epileptic seizure

61. What is the basic mechanism of the seizure above?

A. Increase Glutamate
B. Increase GABA -> HARUSNYA GABA TURUN!
C. Increase dopamine
D. Increase acethylcholine
E. Increase cholinergic

62. Ibu 35 th kejang sekali 3 menit. Normal blood glucose ada dm 2. Penyakitmya apa:
A. Acute symptomatic seizure
B. Chronic symptomatic seizure -> NGGA ADA!!
C. Epilepsy
D. Status epilepticus
E. Non psychogenic epileptic seizure

63. A 29 years old woman presented with right facial pain a while ago. The pain was hot
and electric pain lasting for 1-2 seconds and the dissapear itself. Pain occured while she
is chewing or brushing teeth. What is the most probable cause of this symptoms?
A. Cluster headache
B. Tension type headache
C. Migraine
D. Trigeminal neuralgia
E. Temporal arteritis

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64. A 45-year-old woman complains of recurring episodes of vertigo that began after she
bumped her head rather forcefully 2 weeks ago. Her spells last 10 to 15 seconds and
occur whenever she goes to bed or wakes up. She denies any hearing loss or tinnitus.
Her physical examination is normal except for a latent, rotatory nystagmus when she is
lying with the right ear down. What is the most likely diagnosis?
A. Acute serous labyrinthitis
B. Benign paroxysmal positional vertigo
C. Vestibular migraine
D. Ménière disease
E. Viral vestibular neuronitis

65. Ada orang berdiri ga bisa seimbang. Di PF, dia gabisa bedain jari-jari kakinya sedang
ke arah atas atau bawah oleh dokter. Lesi di? *Kalo ngga seimbang berarti kena di
spinocerebellar*
A. Lateral Spinothalamic
B. Lateral Corticospinal
C. Spinocerebellar & dorsal collum buat proprioceptive
D. Corticobulbar
*Kalo ada dorsal collum, pilih dorsal collum
66. Café au lait (Lesi di kulit yg kayak kopi susu / multiple nodule) Jawaban :
Neurofibromatosis Von Recklinghausen’s (Penyakit) l kalo diagnosis patologis
berdasarkan mikroskop adlh neurofibroma ( ada fibroma & schwanoma)
67. A 40 year old female complained headaches . She fell and hit her head. A CT scan
showed a 3 cm mass beneath dura that compresses the underlying left lateral parietal
lobe. She is taken to surgery and after removal by her neurosurgeon, the mass send to
Pathology laboratorium. Microscopic showed elongated cells, oblong nuclei and pink
cytoplasm with psammoma bodies (Whorlling calcification). Which of the following
lesions has probably occured ?
A. Meningioma
B. Schwannoma

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 C. Astricytoma
D. Ependymoma
E. Glioma

68. (kalo ga salah) Ada orang ngomongnya fluent, tapi ga bisa ngerti kita ngomong apa,
repetitif nya juga ga bagus. Kelainan = Wernicke

69. Can't move her left side of the face. She can't wrinkle her left forehead, can't show her
teeth nor can't purse her left lips. Diagnosed as Bell's Palsy. Another symptoms?
A.Lidah deviasi ke kanan
B. Lidah deviasi ke kiri
C. Abnormal taste 2/3 left anterior tongue
D. left parotid gland ga fungsi
E. Gak bisa nelen
Parotid gland innervated by CN 9 & 10
Bell’s Palsy -> di soal penyebabnya adlh HSV 1
Di ospe anat penyebabnya adlh mukosa bengkak karena kena dingin

70. A 50 year old woman had shaking her right arm since last month. The episode last 5-10
minutes (or seconds gue lupa lol), occur several times a day and became more frequent
recently. No other symptoms and there is no changes in level of consciousness. Type of
seizure?
A. Simple partial seizure
B. Complex partial seizure
C. Tonic clonic seizure
D. Myoclonic seizure
E. Absence seizure
71. You are a doctor called to the emergency unit to interpret a ct scan of a person with a
stroke. The ct scan:

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 ! LEFT
What is the clinical manifestation?
A. Sensoric aphasia, right side weakness
B. Motoric aphasia, right side weakness
C. Motoric and sensoric aphasia, right side weakness
D. Motoric and sensoric aphasia, coordination imbalance
*Baca lecture Radiology!!!
* Fasciculus arcuata : connects broca & wernicke
72. Orang 45 thn, trouble walking, wife gait, susah jalan di malam, bisa balance misalnya
tutup mata. NE : loss of fine touch, vibration, proprioception, both lower limb. Other
sensory and motoric are normal. Which spinal cord is affected?
A. Fasciculus grasilis
B. Fasciculus cuneatus -> Buat upper limbs
C. lateral spinothalamic
D. ventral spinothalamic
E. spinocerebellar

73. 19 years old woman is admitted to psychiatric by her parents after a week before stating
that she want to drop off college to find paradise. Her roommate told she insist trash in
dormitory consist dinosaurus bone. On the evaluation, she is very quite, put her hands
together as praying, giggling when she look to the ceiling. Her parents say that the
symptoms already persist for 3 months, what is the diagnosis?
A. Schizophrenia paranoid type
B. Schizotypal personality disorder
C. Schizophreniform disorder -> Kena selama 1-6 bulan (< 6 bulan)
D. Avoidant personality disorder

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 E. Brief Psychotic disorder

74. Battey, often remarks that she is extraordinarily wealthy, despite her being in a
psychiatry hospital and have an empty bank account. When asked about this apparent
contradiction, she said that the hospital keeps all her money because the administrators
fear of her power if she's not hospitalized. Her symptoms first began when she
graduated from highschool. This symptoms can be referred as...
A. Grandiose delusion
B. Jealousy delusion
C. Reference idea
D. Thought insertion
E. Thought withdrawal

75. A 19-year old man was brought by his family to Psychiatrist. Patient says: The voices
told me to do “bad things”, there are often two or three voices talking, and they often
comment to each other on his behavior. He believes that someone want to kill him. He
has ideation of killing his father occasionally. Which pathway is predominantly
disturbed in this case? *Gejala + symptoms*
A. Nigrostriatal
B. Tuberoinfundibular
C. Mesolimbic
D. Mesocortical ( negative symptoms)
E. Tuberostriatal

76. X 35 years old woman is suffering from sleep difficulties, easily getting tired, lack of
motivation, lack of desire to cope with daily activities, she lose weight for almost 5 kg
within the last 2 months, with suicidal thought. What is the medicine that will help Mrs.
X? The agent work specifically by: *Diagnosis : MDD
A. Inhibit the reuptake of serotonine -> SSRI
B. Blockade the monoamine oxidase -> MAOI (Anti-depressant & Parkinson)
C. Enhancing the reuptake of dopamine

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 D. Blockade the chloride channel
E. Inhibit the reuptake of GABA

77. A 23 year old man who has been receving treatment for substance addiction presents to
physiscians office with complaints weakness and anorexia. Assessment for vital signs :
pulse rate 107 beats per minute and respiratory rate 24 breaths per minute. Lacrimation,
rhinorrhea, and mydriasis (pupil dilatasi) are presents, and the patients yawns
repeatedly during interview. The clinical signs and and symptoms are most consistent
with withdrawal from:
A. Alcohol
B. Coccaine
C. Opiates -> Intox : lawan dari withdrawal amphetamines
-> Withdrawal : lawan dari intox amphetamines
D. Benzodiazepines
E. Amphetamines -> intoxication: Stimulus simpatetik ( badan panas, tachycardia)
-> withdrawal : Stimulus parasimpatetik (pupil mengecil, stress)

78. What test do you think most appropriate and practical ?

a. Blood test
b. Urine test
c. Saliva test
d. Breath test
e. Stool test

79. 55 yo man has been taking haloperidol for schizo since 20 years ago. On exam, he
displays continual facial movement which look as though he is chewing his own mouth.
Which of the following side effects is he suffering :
A. Acute dystonia
B. Akithisia
C. Parkinsonism
D. Serotonin syndrome

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 E. Tardive dyskinesia -> Side effect of Haloperidol
Pseudoparkinsonism, tardive dyskinesia, akathisia, acute dystonia (Extrapyramidal
Symptom)
80. Seseorang lelaki drug abuse. Dia minum abuse obat yang diduga dapat merusak
neuron-neuron yang berada di midbrain. Setelah sembuh, dia menjadi depresi.
Neurotransmitters apa yang loss ?
A. Enkhepalin -> opiate endogenous morphine
B. Dopamine -> Over dopamine : Schizo
C. Norepinephrine
D. Serotonin -> Lack of serotonin : Depression
E. GABA

81. S25 th cowo tidur sambil jalan bangun tidur pindah tempat. Sakit apa?

A. Insomnia D. Night teror
B. Hipersomnia E. Night mare
C. Somnabulism

82. A 22 year old woman with episodic, uncontrolled, compulsive, and rapid ingestion of
large amounts of food within a short period of time (binge eating) followed by self-
induced vomiting, use of laxative or diuretics, fasting, or vigorous exercise to prevent
weight gain. Which of the following disorder is the most appropriate with these
symptoms?
A. Anorexia nervosa
B. Bulimia nervosa
C. Obesity
D. Kleine-Levin syndrome
E. Major depressive disorder

83. Org 19 tahun, dia merasa mendengar suara-suara yang menyuruhnya do bad things.
Terus ada suara 3 org, ngomongin behaviour dia, terus dia merasa ada org mau bunuh
dia. Psycopathology?
Halusinasi : Benda ngga ada dibilang ada

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Delusi : Kepercayaan yg salah
Ilusi : Misinterpretation
A. Disorganized speech, halusinasi
B. Halusinasi, delusi
C. Derelasisasi, depersonalisasi
D. Depersonalisasi, ilusi
E. ilusi,delusi

84. Mr. X 27 years old, found vagabond (gelandangan) by his father after he ran from
house 1 month ago. Previously he always sleeps all day, and remain awake at night. He
have irregular sleeping pattern, decreased apetite, and feels angry when his father
wakes him up from his sleep. He likes being alone as much as possible, less talk with
other people. What is the probable diagnosis? *Either Schizo simple / residual*

A. Schizophrenia katatonik D. Schizophrenia paranoid -> ada

B. Schizophrenia simple
C. Schizophrenia residual -> Biasa
tdk ada + symptoms, yg sisa
adalah - symptoms (dr engel
jwb ini)
halu & delu yg kuat
E. Schizophrenia hebefrenik -> Kalo
behavior bener-bener salah
( gelandangan)

85. Ada orang merasa dirinya dari planet lain. Datang ke dunia untuk menyelamatkan
bumi. Mencurigai tetangganya. Psikopatologi:

A. Halusinasi D. Depersonalisasi
B. Delusi E. Derealisasi
C. Ilusi

86. Org 19 tahun, dia merasa mendengar suara-suara yang menyuruhnya do bad things.
Terus ada suara 3 org, ngomongin behaviour dia, terus dia merasa ada org mau bunuh
dia. Psycopathology?

A. Disorganized speech, halusinasi C. Derelasisasi, depersonalisasi
B. Halusinasi, delusi D. Depersonalisasi, ilusi

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 E. ilusi,delusi

87. A 24 year old man having a motorcycle accident where he banged his head on the
street floor and passed out for 7 minutes, and came round and complains of forgetting
what was happening to him. He remembered only until about a month before the
accident, but from that moment to the time of the accident he could not remember. Can
you indicate what happened to him from a month before the accident till the time of the
accident.
A. Anterogade amnesia
B. Delirium
C. Narcolepsy
D. Retrograde amnesia
E. Frontal lobe syndrome

88. A person is suffering from typhoid fever with high temperature of 40⁰C, and when in
this state he became very agitated, hallucinated shouting that so many people are
jeering at him, and would drive all visitors not to come near him stating that they are
robbers, this person is suffering from:
A. Paranoid reaction
B. Schizophrenic reaction
C. Delirium = Acute confusional state
D. Dementia
E. Affective manic state

89. A patient, male 18 years of age, is brought by his mother to a psychiatrist with a
complaints of always nagging to his mother stating that he is always having the thought
that his body is not masculine enough, he says that his hip is too big and according to
patient he feels like the hip of a female. His dissatisfaction is mounting until he could
not have good sleep for the last month. What do you think he has as diagnosis for his
illness?
A. disturbed body image -> bisa anorexia / bulimia
B. his sex hormone might be too much of estrogen

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 C. he has a dysmorphophobic condition
D. he is mentally retarded
E. he is having a mild depressive disorder

90. A 30 years old woman, married 6 years ago complained of having pain during sexual
intercourse with her husband. She did not enjoy having sex with him. She has got no
infection and abnomality in her vagina. What does she got?
a. Chronic pain disorder
b. Does not like her husband
c. Dyspareunia
d. Vaginismus
e. Lack of estrogen

91. A person has such a character that he is very quite, will not and cannot make many
friends what he had is only one friend in this world, he talks very little, tendency to
withdraw from group of people, a bit suspicious and can only work alone and prefer to
handle a non living object rather than human such as work with computer only, he is
having a personality disorder of type.
A. Narcisisitic
B. Paranoid
C. Schizoid
D. Anancastic
E. Avoidant -> Ngga suka terima kritik

92. People using drugs for many reasons, including non-medicinal indications. Some drugs
can give peaceful feelings, euphoria, increased self-confidence and stamina; and also
used for body slimming or reduce bodyweight.Which drugs do you think can provide
those effects?
A. Opiate.
B. Cannabis.
C. Cocaine.

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 D. Amphetamine
E. Benzodiazepine

93. Seorang perempuan, 24 tahun datang ke Emergency Room dengan laserasi di

pergelangan tangannya setelah berargumen dengan co-workernya. Sudah 7 kali dia
melakukan hal tersebut. Selain itu dia juga rapid mood swing, merasa sendiri terus.
Disebut apa?
A. Schizoid
B. Anti social
C. Bipolar Tipe 1
D. Bipolar Tipe 2
E. Borderline -> Biasanya bunuh diri

94. A 25 year old man suspected of abusing drugs. His parents find him comatose in his
room and taken by ambulance to the Siloam ER where he is noted to be in a stupor with
bilateral pinpoint pupils, cold and clammy skin, skeletal muscle flaccidity & respiratory
rate 6-8/min. Which of the following medication should be given for this situation?
*Diagnosis : Opium intox
A. Amphetamine
B. Caffein
C. Flumazenil buat intox benzo
D. Naloxone / Naltrexzone for treatment of amphetamine withdrawal
E. Neostigmine

95. A 42 year old woman comes to your private practice with chief complaint of insomnia
and difficulty falling asleep. She has no symptoms of anxiety and states that she tried
talking some triazolam from her previous doctor, but it made her drowsy and sluggish
the following workday. Which of the following drug is the preferred one, because of it
have a rapid onset of action and low risk of subsequent day time sedation, and can be
safely administered over days to weeks?
A. Diazepam for antianxiety & for panic disorder -> Bikin ngantuk siang hari

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 B. Luminal
C. Chlorpromazine
D. Haloperidol
E. Zolpidem -> Anti anxiety

96. Mr. A 26-year old, he is schizophrenic man, feels restless / walk round in room and
cannot sit still. The doctor of psychiatry said, that this behavior is caused by
medication. What's the name of this symptom?
A. Catatonic
B. Chorea -> In Huntington disease
C. Akathisia -> Hyperactive
D. Tardive Dyskinesia -> Gerakan ngga jelas
E. Parkinsonism -> Dopamine
Neuroleptic Malignant : Fever
97. A 37 year old man comes to the psychiatry clinic complaining of sudden shortness of breath,
palpitation, frequent of urination, numbness over his hands, sweating all over his body, and
neck rigidity. He is very afraid if his heart suddenly stopped. This condition appears since 2
months ago. What is the most likely diagnosis for this condition?
*Panic disorder = Recurrent >1 x in a month 

A. Post Traumatic Stress Disorder D. Obsessive-compulsive disorder
B. Panic disorder. -> Ada gejala E. Social phobia
C. General anxiety disorder

98. Laki laki, 38 thn married, hidupnya dependable, kerja sbg book keeper. Bbrp minggu terakhir
ngerasa sleepness, anxious, sulit konsentrasi. Trus dia merasa spt diracuni tetangganya jd
pandangannya kabur, dia dikasih newspaper sm bosnya trus tulisannya ada yg salah. Dia kira
newspaper yg salah itu bkn dia malu, trus dia dibawa oleh psikiater trus di jalan naik mobil dia
ngerasa di setiap mobil ada org yg lg mata-matain dia. Psycopathology apa yg bermasalah dlm
kasus ini? 

A. Neurotic D. (Lupa)
B. Reference delusions E. Erotomania delusions
C. Hallucination

99. 50 year old man has been feeling moody and irritable for the past 5 weeks. He lost desire for
sexual activity, susah tidur, decrease apetite, lost 2 kgs in a month. Diagnosis?

A. Cyclothymic B. Bipolar 1

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 C. Bipolar 2 E. Dysthymic -> At least 2 years
d. Major depressive disorder

100. A 78 years woman brought to the clinic by her daughters and reported to have difficulty in
sleeping for the last 3 months; she also started to be agitated when she was unable to sleep
during the night. She is also very emotional, angry at everybody, accusing them robbing her
money. She is very good at remembering her past experience. She is able to account very
clearly about her childhood, even the names of all her childhood friends; but she could not
recognize her grandchildren, her name, and her identity. What is the most appropriate
diagnosis? 

A. Mild cognitive impairment
B. Schizophrenia
C. Loss of consciousness
D. Organic delutional state
E. Dementia -> Hukum Birouth

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