MCQ NEURO ANGKATAN 2018, compiled by Joey

1. A 58 year old woman suddenly had difficulty to raise her right arm and leg, an also
slurred speech. She brought to ER, her blood pressure 180/100 mmHg, pulse
80x/minute, RR 16x/minute, temperature 36,6 C. She was still alert and could
communicate. Previously she had uncontrolled hypertension. Twelve hours later she
had improvement, her complains resolved, she can raise her right arm and leg, also
could speak normally. What is the most possible diagnosis for this patient?

a. Transient Ischemic Attack (TIA)

b. Reversible Ischemic Neurologic Deficit (RIND)
c. Hemorrhagic Stroke
d. Ischemic Stroke
e. Complete stroke

2. Mrs N, 32 years old, is complaining about lack of energy, depressed mood,

insomnia, lack of motivation, and loss of weight for about 1 month. Which
neurotransmitter is primarily responsible for the symptoms in Mrs N?

a. GABA
b. Norepinephrine
c. Serotonin
d. Adrenaline
e. Glutamate

3. 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 occurs whenever she goes to bed or wakes up. She denies any hearing loss of
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. Vestibular migraine
c. Viral vestibular neuronitis
d. Benign paroxysmal positional vertigo
e. Meniere disease

4. Following Mita’s near fatal car accident, her doctor noticed that the pupillary reflex
of the eyes was abnormal. Which of the following indicates the damage because the
accident?

a. Autonomic nervous system

b. Left temporal lobe
c. Right frontal lobe
d. Left occipital cortex
e. Cerebellum

5. The drugs donepezil, rivastigmine, and galanthamine are used in Alzheimer’s

disease to try to raise the availability of what transmitter in the brain?
a. Glutamate
b. GABA
c. Norepinephrine
d. Acetylcholine
e. Dopamine

6. Glial-appearing cells, called pituicytes, are found within which region of the
pituitary gland?

a. Infundibular stalk
b. Pars distalis
c. Pars intermedia
d. Pars nervosa
e. Pars tuberalis

7. Mrs. Pamela, 78 years old, was brought to the neurology clinic by her son
because he noticed that patient had problems with her memory, particularly short
term memory loss, with patient not being able to remember the task she was doing
at a time since 1 year ago. She forgot where she kept her purse and eyeglasses.
Sometimes she also found difficulty to remember way back home from market that
she regularly visited every week. She could not do her daily activities on her own,
such as eating, taking bath, and dressing. The patient had no history of
hypertension, diabetes mellitus, or previous stroke event. She is diagnosed with
Alzheimer’s disease. Classical conditioning is an example of

a. Nonassociative memory
b. Semantic memory
c. Declarative memory
d. Episodic memory
e. Implicit memory

8. A 1 year old child has delayed mental development and enlarged head diameter
after being diagnosed with encephalitis 6 months ago. His mother brought him to the
hospital and later was diagnosed with hydrocephalus. Cerebrospinal fluid is mostly
produced by?

a. Plexusc chorioideus ventriculus lateralis

b. Plexusc chorioideus systema ventriculare cerebri
c. Plexusc chorioideus ventriculi lateraies
d. Plexusc chorioideus ventriculus quartus
e. Plexusc chorioideuv ventriculus tertrius

9. A 56 year old female patient came to the clinic with chief complaint of having the
first seizure in her life. Her family described her seizures as head and eye turning to
the left side accompanied by stiffness and twitching of the left extremities and
followed by the right extremities. She was unconscious while seizing and the seizure
duration was 2 minutes. After the seizure, she was fully alert. She had a history of
brain tumor removal over the right temporal area 1 year ago. According to your
diagnosis above, what is the best treatment to be given to this patient?
a. Diazepam
b. Dexamethasone
c. Midzolam
d. Lidocaine
e. Phenytoin

10. A person is suffering from typhoid fever with high temperature of 40 C 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. Delirium
c. Dementia
d. Affective manic state
e. Schizophrenic reaction

11. A 59 year old male suffered a stroke and later presented with a spastic paralysis.
Which of the following was affected by the stroke that accounts for the spasticity?

a. Postcentral gyrus
b. Ventral horn cells
c. Internal capsule
d. Substansia nigra
e. Corpus callosum

12. A person has such a character that he is very quiet, will not, and cannot make
any friends what he had is only one friend in this world. He talks very little, tendency
to withdraw from group of people 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. Paranoid  Pervasive distrust and suspicion

b. Narcissistic  Grandiosity, sense of entitlement, lack of empathy
c. Antisocial  Disregard for others, lack of remorse, criminality, impulsivity
d. Schizoid  Voluntary social withdrawal, content with social isolation
e. Histrionic  Excessive emotionality, attention seeking, sexually provocative

13. A 58 year old woman suddenly had difficulty to raise her right arm and leg, an
also slurred speech. She brought to ER, her blood pressure 180/100 mmHg, pulse
80x/minute, RR 16x/minute, temperature 36,6 C. She was still alert and could
communicate. Previously she had uncontrolled hypertension. Twelve hours later she
had improvement, her complains resolved, she can raise her right arm and leg, also
could speak normally. Which of the following tract make her could not move her right
arm and leg?

a. Lateral spinothalamic
b. Extrapyramidal
c. Anterior cerebellar
d. Pyramidal
e. Anterior spinothalamic

14. A 67 year old man has history of progressive memory loss for 2 years. His
examination is otherwise normal. A diagnosis of Alzheimer disease is made. Which
of the following medications may result in some cognitive impairment?

a. Risperidone
b. Donepezil
c. Vitamin B12
d. L-Dopa
e. Prostigmin

15. A 9 month baby boy was taken to a GP because there was tuft of hair in his
lumbar region. After examination the GP explained to the parents that he suspected
a congenital malformation. Therefore the GP told the parents that he would consult a
Pediatric surgeon. Spinal cord develops from:

a. Anterior neuropore
b. Posterior neuropore
c. Mesencephalon
d. Diencephalon
e. Telencephalon

16. A 25 year old man came to emergency department, fully alert, no fever. He
complained sudden left sided weakness when he is working at home. He denied any
history of hypertension nor diabetes mellitus. No history of smoking. He works as
physical education teacher. In history taking, which component should be asked to
narrow down the differential diagnosis of the patient?

a. Chronic type headache to exclude intracranial tumor

b. Sign of vessel obstruction located in specific organ system, other than brain
vascularization
c. Dyspnea or chest pain to suspect the cardiac problems
d. Sign of increased intracranial pressure to exclude brain hemorrhage
e. Positive meningeal sign to rule out subarachnoid hemorrhage

17. A 55 year old man has been taking haloperidol for schizophrenia since his initial
diagnosis 20 years ago. On examination he displays continual facial movements
which look as though he is chewing his own mouth. These movements have been
present for some time. Which ONE of the following side-effects is he suffering?

a. Tardive dyskinesia  Stiff, jerky movements of face and body

b. Acute dystonia  Involuntary muscle contraction; twitching
c. Akathisia  Cannot stay still
d. Serotonin syndrome  Stimulation of the CNS (agitation), Reproductive
dysfunctions in males, Insomnia, Diarrhea, nausea, vomiting; Caused by SSRIs
e. Parkinsonism  tremor, slow movement, impaired speech, muscle stiffness
18. A man came to the doctor with history of run out of the oxygen reserve during
climbing the high mountain to the 24,000 ft altitude. After descent, he had suffered
memory deficient. The doctor suspected that he had a problem in his neuron cellular
signalling or conducting synapse transmission. What is the characteristic of electrical
synapse?

a. Connected by special channels called gap junctions

b. Neurotransmitter are released to gap junction
c. Neurotransmitter are released to synaptic cleft
d. Connected by special channels called synaptic gap
e. The neurotransmitter may initiate an electrical response

19. An 28 year old female is involved in a car accident in which her spinal cord is
damaged at the T6 level. Detailed testing of her sensory and motor systems reveal
that her motor system is intact and she has no loss in pain or temperature sensation.
However, she has lost fine touch, vibration, and proprioceptive sensation from the
left side of her body below the T6 level. Therefore, she has damaged her:

a. Anterior column on the left side

b. Posterior column on the left side
c. Lateral column on the left side
d. Posterior column on the right side
e. Lateral column on the right side

20. An infant has a head CT examination because of a large head and failure to
thrive. The diagnosis of hydrocephalus is made by the physician. Congenital
hydrocephalus may develop as a consequence of which of the following first-
semester maternal disorders?

a. Viral infection
b. Eclampsia
c. Placental dysfunction
d. Hyperemesis gravidarum
e. Chores gravidarum

21. Mrs. N, 32 years old, is complaining about lack of energy, depressed mood,
insomnia, lack of motivation, and loss of weight for about 1 month. Mrs. N was given
medication to improve her mood. Which of the following antidepressant belong to
SSRIs class?

a. Escitalopram
b. Vortioxetine
c. Buproprion
d. Moclobemide
e. Amitriptyline

22. A 35 year old male has had increasing difficulty with activities of daily living for
the past years which mainly because of choreiform movements. His families have
also observed that he has exhibited behavioural changes although his memory
remains intact. The most likely finding in the CNS changed you will get is?
a. Diffuse negri body cells in cerebral
b. The loss of motor neurons
c. Loss of neurons and gliosis in nucleus caudatus
d. Diffuse Lewy body in the cerebral
e. The loss of pigmented dopaminergic neuron

23. An 18 year old high school senior was brought to the emergency room by police
after being picked up wandering in traffic on the Benton Junction. He was angry,
agitated, and aggressive, and he talked various people who were deliberately trying
to confuse him by giving him misleading directions. His story was rambling and
disjointed, but he admitted to the police that he had been using speed. In the
emergency room, he had difficulty focusing his attention and had to ask that
questions be repeated. He was disoriented as to time and place and was unable to
repeat the names of three objects after five minutes. Which of the following would be
your diagnosis to this patient?

a. Cannabis intoxication
b. Amphetamine intoxication
c. Opioid withdrawal
d. Opioid intoxication
e. Cannabis withdrawal

24. A 62 year old male over a period of weeks begins to experience difficulty in
swallowing and hoarseness in speech. A thorough examination reveals the presence
of growing tumor. Which of the following loci best accounts for this deficit?

a. Facial foramen
b. Dorsal midbrain
c. Geniculate ganglion
d. Jugular foramen
e. Ventral aspect of pons

25. An elderly man has an expressionless face and has uncontrollable movements
caused by muscular rigidity. When in sitting, his hands have a pill-rolling tremor.
Which of the following pathologic conditions of his brain is the most likely happened?

a. Loss of pigmented neurons in substantia nigra

b. Loss of pigmented neurons in thalamus
c. Neurofibrillary tangles and neuronal degenerative in neurocortex
d. Neuronal degenerative and neuronal loss in caudate
e. Neuronal degenerative and neuronal loss in hippocampus

26. A 17 year old man visited the physician because he had severe headache and
seizure. He was suspected with brain tumor that originated from neuron or glial cell.
What is the function of glial cell?

a. Integrates the information

b. Conducting region of a neuron
c. Convey electrical signals
d. Insulate one neuron from another
e. Generates nerve impulses

27. A 25 year old woman was suddenly becoming aggressive, impulsive, after
having sleep disturbance, and sometimes speaking of giggling by herself. She told
everybody that she was a princess from outer space. Her mind and body were being
controlled from outer space. Her mission was to protect the earth from outer space
enemies, she was suspicious with the neighbours. The condition started seven
months ago. Her mind and her body were being controlled from outer space. What is
the interpretation of this statement?

a. Auditory hallucination
b. Visual hallucination
c. Derealization
d. Delusion
e. Illusions

28. A 20 year old man came to outpatient clinic and complaining that he is sexually
aroused by woman’s shoes, hair, and underwear. He felt uncomfortable and
ashamed of his condition. What is the most appropriate diagnosis?

a. Fetishism
b. Frotteurism
c. Transvestic fetishism
d. Exhibitionism
e. Voyeurism

29. A 50 year old male has been moody and irritable for five weeks. He has lost
interest in sex and his favourite leisure activities and nothing seems to cheer him up.
He has difficulty falling asleep at night and his appetite is decreased, although he
has lost 2 kg in one month. What is the most likely diagnosis?

a. Bipolar II disorder
b. Bipolar I disorder
c. Dystimic disorder
d. Major Depression Disorder
e. Cyclothymic Disorder

30. A 35 years old man 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 to emergency unit. BP was 130/80 mmHg and HR 88x/minute.
During clinical investigation in emergency unit, he became unconscious. He also
developed right pupil dilatation, and left side weakness. Why he develops right pupil
dilatation?

a. Direct uncal compression at the medulla oblongata

b. The uncus cause stretching of the sixth nerve
c. Direct uncal compression at the pons level
d. The uncus cause stretching of the third nerve
e. The uncus cause stretching of the fourth nerve
31. In testing for motor dysfunctions ,a neurologist identified an upward movement of
the patient toe when the plantar surface of his foot was scratched. This response is
indicative of a lesion of a part of the nervous system. Which of the following is linked
to this response?

a. Autonomic nerves
b. Lower Motor neurons
c. Upper Motor neurons
d. Sensory neuron
e. Column dorsal

32. A 23 year old man who has been receiving treatment for substance addiction
presents to the physician’s office with complaints of weakness and anorexia.
Assessment of vital signs shows a pulse rate of 107 beats per minute and a
respiratory rate of 24 breaths per minute. Lacrimation, rhinorrhoea, and mydriasis
are present, and the patient yawns repeatedly during the interview. These clinical
signs and symptoms are most consistent with withdrawal from:

a. Opiates
b. Marijuana
c. Alcohol
d. Cocaine
e. Benzodiazepines

33. A 36 year old male had a motor vehicle

accident. His head hit the road and
afterwards he could not move his right arm
and leg. The brain CT scan examination
showed an intracranial hemorrhage at the
left frontal lobe. Which Broadman area
number is the most probably injured?

a. Area 9,10
b. Area 2,3
c. Area 17,18
d. Area 7,8
e, Area 4,6

34. After a car accident which produced trauma to her skull, a 25-year old patient
complains of double vision (diplopia). Knowing which cranial nerves innervate the
muscles of the eye and their course from the brain stem to the orbit, the physician in
charge can determine the extent of the damage. The physician would need to
consider which of the following cranial nerves in his diagnosis?

a. Oculomotor (III), trigeminal (V), and abducens (VI)

b. Oculomotor (III), trigeminal (V), and facial (VII)
c. Optic (II), oculomotor (III), and trigeminal (V)
d. Oculomotor (III), trochlear (IV), and abducens (VI)
e. Oculomotor (III), trochlear (IV), and trigeminal (V)
35. A 19 year old man was brought by his family to emergency department. 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 wants to kill him. He repeated this statement of idea since one year ago.
His affect is congruent, although it is flat and his mood is good. He has loose
associations and ideation of killing his father occasionally. What psychopathologies
are found in the patient above?

a. Derealisasi, anti-social
b. Illusion, ambivalence
c. Depersonalization, abulia
d. Disorganized behavior, social phobia
e. Auditory hallucination, delusion

36. As a result of infection, a 50 year old woman experience a loss of taste affecting
the front of her tongue and the ability to smile. If the sensory loss involves damage of
cell bodies, which of the following would be so affected?

a. Gasseri ganglion
b. Geniculate ganglion
c. Pterygopalatine ganglion
d. Trigeminal ganglion
e. Otic ganglion

37. A 16 year old girl is doing well at school. She is told by a friend that some of the
boys think that she is too fat and this news, though apparently well-meant, upsets
her. She has not had many dates, though she would have liked them, and she
decides to diet. She does so with success, and loses weight. However she becomes
too thin and her parents, though somewhat reassured by the way she maintains her
school and sporting activities, are alarmed. Her mother finally takes her to a
gynecologist to determine the reason for the amenorrhea that ensues. What is the
girl most likely to be suffering from?

a. Primary amenorrhea
b. Adolescent adjustment disorder
c. Anorexia nervosa
d. Sexual adjustment problem
e. Anxiety state

38. A 25 year old man is suspecting of abusing drugs. His parents find him in
comatose state in his room and was taken to the emergency where he is assessed
to be in a stupor with bilateral pinpoint pupils, cold and clammy skin, skeletal muscle
flaccidity and his respiratory rate is 6-8/min. Which of the following medication should
be given for this situation?

a. Flumazenil
b. Naloxone  Counters opioid effects
c. Amphetamine
d. Neostigmine
e. Caffeine

39. The histopathologic of a curettage biopsy from an ulcerative mass around

Vertebra Thoracalis 12-L1 in a 2 year old baby girl showed necrosis caseousa,
granulomas and Langhan’s cells. The best diagnosis for hers is:

a. Multiple myeloma
b. Myelitis
c. Spina Bifida
d. Granuloma
e. Pott’s disease

40. A man came to the doctor with history of run out of the oxygen reserve during
climbing the high mountain to the 24,000 ft altitude. After descent, he had suffered
memory deficient. The doctor suspected that he had a problem in his neuron cellular
signalling or conducting synapse transmission. What is the characteristic of graded
potential?

a. An local current depolarizes the neighbouring region or axon membrane

b. Spreads as local currents change the membrane potential of adjacent regions
c. Long-lived, localized changes in membrane potential
d. Action potentials are triggered by membrane depolarization to threshold
e. An electrical current depolarizes the neighboring region of the axon membrane

41. A 34 years old woman came to the physician with depression and sleep
disorders problem. The doctors thinks she had a problem in some neurotransmitter.
What is the mechanism of action of glutamate?

a. Glutamate bind to NMDA receptor opening Na channel

b. Glutamate bind to AMPA receptor removing Mg blockage
c. Glutamate bind to AMPA receptor opening Na channel
d. Gluatamate bind to AMPA receptor opening calcium channel
e. Glutamate bind to NMDA receptor removing Mg blockade

42. A 68 year old man is found fall on the ground because he is suddenly unable to
move his right hand and leg. Which of the following region was most likely directly
affected?

a. Broca’s area
b. Primary somatosensory cortex
c. Wernicke’s area
d. Superior temporal gyrus
e. Primary motor cortex

43. A 13 year old girl has severe case of mastoiditis. Despite treatment she develops
fluent aphasia. Her aphasia is most likely the result of extension of the infection in to
which portion of the brain?

a. Occipital love
b. Cerebellum
c. Frontal lobe
d. Parietal lobe
e. Temporal lobe

44. A 72 year old woman falls down the stairs. About 36 hours later she develops a
headache and confusion and is taken to the emergency department. On physical
examination, she is unconscious and has a scalp contusion on the occipital. Brain
CT shows bleeding in space between duramater and arachnoid mater. Where is the
most likely location of an intracranial hemorrhage in this patient?

a. Subdural
b. Subcutaneous
c. Subarachnoid
d. Subgaleal
e. Epidural

45. A 28 year old male patient has a loss of voluntary motor control below the L2
spinal nerve on the right side of the body, with no sensory losses. Which of the
following demarcated regions indicates the site of the lesion? B (lateral corticospinal
tract  controls muscles of the body)

46. A 1 year old child has delayed mental development and enlarged head diameter
after being diagnosed with encephalitis 6 months ago. His mother brought him to the
hospital and later was diagnosed with hydrocephalus. Where is the obstruction
located if the lateral and third ventricles are dilated, while the fourth ventricle remains
relatively normal?
a. Foramen of Monro
b. Through ductus ventricular
c. Cerebral aqueduct of Sylvius
d. Foramen of Luschka
e. Foramen of Magendie

47. A 9 month baby boy was taken to a GP because there was tuft of hair in his
lumbar region. After examination the GP explained to the parents that he suspected
a congenital malformation. Therefore the GP told the parents that he would consult a
Pediatric surgeon. The organ that have the greatest possibility to be involved in case
above is:

a. Peripheral nervous system

b. Brain and cerebellum
c. Central nervous system
d. Nervous system
e. Spinal cord

48. A man went to the doctor given intramuscular injections in the right buttock. After
the injection the patient experienced weakness on the right leg and cannot stand or
squat. Which of the following nerve is affected?

a. Inferior cluneal nerve

b. Sciatic nerve
c. Pudendus nerve
d. Inferior gluteal nerve
e. Superior gluteal nerve

49. A scientist wishes to study the simplest brain mechanism underlying emotions
and memory. Which of the following you recommend to be studied?

a. Limbic system of a dog

b. Basal ganglia of a monkey
c. Brainstem of a frog
d. Cortex of a human
e. Cerebellum of a monkey

50. His wife noted that her husband had troubles with simple calculation and
remembering recent conversations. On one occasion, while staying at an unfamiliar
environment, he became confused, unclothed, and attempted to enter the hotel
rooms of other guests. These symptoms mostly refer to the impairment in domain:

a. Visuospasial
b. Language
c. Memory
d. Attention
e. Executive function
51. A college student received an injury as a result of being tackled in a football
game. After the game, the student was found to be unable to abduct and rotate the
left arm at the shoulder, flex the elbow, and extend the wrist of the left side. Further
examination revealed depression of the biceps reflex of this limb. But the reflex
involving the other limbs was normal. Which of the following is the most likely site of
the injury?

a. Basilar pons
b. Triceps muscles
c. Precentral gyrus
d. Ventral horn cells at C1
e. Nerve roots of C5-C6

52. An infant has a head CT examination because of a large head and failure to
thrive. The diagnosis of hydrocephalus is made by the physician. In the patient
above, uncorrected congenital hydrocephalus will produce which of the following?

a. Microcephaly
b. Dolicocephaly
c. Holoprosencephaly
d. Macrocephaly
e. Bracycephaly

53. A 30 year old male patient presents at Emergency and states that he was
discharged from a mental hospital three days ago. He complains of severe dysarthria
because he is unable to retract his tongue properly. On further questioning he states
that he stopped all medications when he left hospital but does not know which
medication he was being given. What is the most likely diagnosis?

a. Extrapyramidal syndrome
b. Tardive dyskinesia
c. Myoclonic epilepsy
d. Hysterical conversion
e. Catatonic schizophrenia

54. A 45 year old, previously healthy man has developed headaches over the past
month. There are no remarkable findings on physical examination. A cerebral MR
angiogram shows a 7 mm saccular aneurysm at the trifurcation of the right middle
cerebral artery. Which of the following is the most likely complication from this
lesion?

a. Subdural hematoma
b. Cerebellar tonsillar herniation
c. Hydrocephalus
d. Epidural hematoma
e. Subarachnoid hemorrhage

55. A patient came to a clinic with uneasy state preoccupied by the feeling that his
proportion of chest to waist and other parts of body do not satisfy him. He wished his
physical appearance should be more manly rather than his current proportion. He
feels that his body stature is so girlish. What condition is described above?

a. Somatization disorder
b. Somatoform disorder
c. Body Dysmorphic disorder
d. Hypochondrical disorder
e. Neurasthenia

56. A 50 year old patient with recent damage to the hippocampus from a stroke
would likely have cognitive deficits. Which cognitive ability is probably remain intact
in this patient?

a. Describing a recent event

b. Learning a new vocabulary word
c. Remembering a face
d. Learning new facts
e. Recalling a childhood memory

57. A 17 year old man visited the physician because he had severe headache and
seizure. He was suspected with brain tumor that originated from neuron or glial cell.
What is the characteristic of dendrit?

a. Convey electrical signals as graded potential

b. Numerous terminal branches
c. Carries information away from soma
d. Electrical signal within
e. Convey electrical signals as action potential

58. Female, 24 year old was brought to emergency department with loss of
consciousness since 3 days prior to admission. One week ago, she complained
headache and fever. She also had double vision and weakness of left arm and legs.
During examination, the patient had generalized seizure for 2 minutes, which was
stopped with injection of diazepam intravenously. On neurological examinations, the
nuchal rigidity and Brudzinski’s sign were positive. What is the triad sign and
symptoms of encephalitis?

a. Fever, headache, neck stillness

b. Fever, headache, loss of consciousness
c. Fever, loss of consciousness, neck stiffness  Meningitis
d. Fever, headache, seizure
e. Fever, loss of consciousness, seizure

59. A bodybuilder friend suddenly seems to have grown several centimetres in

height. You suspect that your friend’s growth spurt has occurred he had been using
drug that affects the:

a. Thalamus
b. Adrenal gland
c. Parathyroid gland
d. Pituitary gland
e. Thyroid gland
60. A 63 year old man presents to the emergency room with a right hemiparesis and
non-fluent aphasia that began acutely 45 minutes ago. Blood pressure is 160/90
mmHg, and there is no recent history of bleeding. A head CT scan shows no
evidence of intracranial hemorrhage. Which of the following is the most appropriate
therapy at this point?

a. Intravenous mannitol
b. Intravenous rTPA
c. Oral Aspirin
d. Intravenous heparin
e. Intravenous streptokinase

61. Male, 60 years old was brought to emergency department with history of
recurrent seizure since 2 days prior to admission. He also complained of visual
hallucination that he saw black shadow which chasing him. On physical examination,
blood pressure 110/60 mmHg, heart rate 89 bpm, respiratory rate 16x/minutes,
temperature 38 C. Meningeal sign was negative and no focal neurological deficit was
found. Which pathogen of CNS infections that frequently causes neurological
sequel?

a. Toxoplasma gondii
b. Mycobacterium tuberculosis
c. Herpes simplex virus
d. Neisseria meningitides
e. Cytomegalovirus

62. Mrs. Dora, 23 years old, came to neurology clinic with complaint of tingling
sensation on first to fourth fingers of both hands since 6 weeks ago. At first, the
tingling only appeared during night and resolved by shaking her hands. The tingling
was worsened and felt the whole day. Mrs. Dora had a hobby of playing badminton
routinely 3 times a week and riding a motorcycle for daily transportation. Which is the
most possible nerve injury mechanism that underlying the patient’s condition?

a. Axonotmesis
b. Neurotmesis
c. Wallerian degeneration
d. Neurapraxia  temporary loss of motor and sensory function due to blockage of
nerve conduction, caused by carpal tunnel syndrome
e. Neuroma formation

63. Mr. Hugo, 60 years old, presents with complaint of sleeping difficulty since 2
months ago. He feels easily awake during night sleep, but no complaint of any pain,
shortness of breath, or chest pain at night. He also has decreasing appetite and feel
that he could hardly smell any familiar scent. Previously, since one year ago, he was
diagnosed with Parkinson’s disease due to tremor in his hand during resting position
and stiffness in extremities. He routinely consumes medication which contained
Levodopa and could do his daily activities relatively normal as usual. The supportive
criteria for diagnosis of Parkinson’s disease?
a. Levodopa response for 7 years or more
b. Cerebellar signs
c. Clear and definite response to levodopa
d. Unilateral onset
e. Severe levodopa-induced rigidity

64. A 25 year old woman was suddenly becoming aggressive, impulsive, having
sleep disturbance, and sometimes speaking or giggling by herself. She told to
everybody that she was a princess from outer space. Her mind and body were being
controlled from outer space. Her mission was to protect the earth from outer space
enemies; she was suspicious with the neighbours. The condition started seven
months ago. Which dopaminergic pathways that responsible for positive symptoms
of schizophrenia?

a. Mesolimbic
b. Tuberoinfundibular
c. Mesocortical
d. Nigrostriatal
e. Tuberostriatal

65. A 29 year old male had a tumor that pressing on the base of the brain, where it
impinged upon the optic chiasm. His field of vision was seriously affected. Which of
the following defects was present in this patient?

a. Binasal hemianopsia
b. Right homonymous hemianopsia
c. Bitemporal hemianopsia
d. Total blindness of one eye
e. Total blindness of both eyes

66. A 27 year old patient gave birth to a dead on delivery (DOD) male baby. Upon
his examination, the doctor found that the baby has no calvaria (cranial vault), scalp,
and major portion of the brain. The baby’s eyes bulged forward. Embryological
structure that has the greater possibility as the cause of this congenital malformation
is failure of the?

a. Neural tube closure

b. Neural tube lateral folding
c. Neural tube cephalocaudal folding
d. Anterior neuropore closure
e. Posterior neuropore closure

67. The microscopic appearance of a mass from the left cerebellum of a 10 year old
boy showed a rosette structure from a blastemal cells. What is the most possible
diagnosis for his cerebellum mass?

a. Neuroblastoma
b. Astrocytoma
c. Ependymoma
d. Oligodendroglioma
e. Medulloblastoma

68. An 18 year old high school senior was brought to the emergency room by police
after being picked up wandering in traffic on the Benton Junction. He was angry,
agitated, and aggressive, and he talked various people who were deliberately trying
to confuse him by giving him misleading directions. His story was rambling and
disjointed, but he admitted to the police that he had been using speed. In the
emergency room, he had difficulty focusing his attention and had to ask that
questions be repeated. He was disoriented as to time and place and was unable to
repeat the names of three objects after five minutes. From the case above, you can
also make the same diagnosis if the patient uses:

a. Putau (heroin)
b. Bir (beer)
c. Cimeng (marijuana)
d. Crack (cocaine)
e. Shabu (methamphetamine)

69. A 25 year old mother develops an illness during pregnancy. A diagnosis of

cytomegalovirus (CMV) infection is made by serology, Prenatal CMV infection may
produce which retinal disturbance?

a. Chorioretinitis
b. Cherry red spot
c. Microaneurysm
d. Hemorrhage
e. Hypervascularity

70. Male, 36 years old came to the emergency department with headache after head
trauma due to motorcycle accident since one day prior to admission. On physical
examinations, there were open fracture of right temporal bone. No abnormal findings
on neurological examination. He was suggested to be hospitalized, but decided to go
home because of economical reason. Three days later, the patient had worsening
headache and fever. He was re-hospitalized and diagnosed with meningitis. Which
infection pathway or mechanism is most possibly happened in this patient?

a. Pathogens penetrated CNS through damaged tight junctions of blood-brain barrier

b. Pathogens penetrated CNS through blood-cerebrospinal fluid barrier
c. Pathogens penetrated CNS through direct trauma of adjacent bone structure of
brain
d. Pathogens penetrated CNS through infected olfactory nerve as portal to brain
e. Pathogens penetrated CNS through damaged adherents junction of blood-brain
barrier

71. Mrs. Dora, 23 years old, came to neurology clinic with complaint of tingling
sensation on first to fourth fingers of both hands since 6 weeks ago. At first, the
tingling only appeared during night and resolved by shaking her hands. The tingling
was worsened and felt the whole day. Mrs. Dora had a hobby of playing badminton
routinely 3 times a week and riding a motorcycle for daily transportation. What is the
most possible diagnosis for this patient?

a. Guyon Canal Syndrome

b. Erb Syndrome
c. Radial Sulcus Syndrome
d. Carpal Tunnel Syndrome
e. Cubital Tunnel Syndrome

72. A 45 year old woman complains of imbalance and unsteadiness while standing
up or walking. On neurological examination, she could not distinguish the position
and direction of her toes directed by the examiner while she closes her eyes. The
neurologic tract that may be involved is?

a. Anterior corticospinal tract  innervates muscles of the body

b. Corticobulbar tract  innervates muscles of the face and neck
c. Lateral spinothalamic tract  pain and temperature
d. Spinocerebellar tract  unconscious propioception
e. Lateral corticospinal tract  innervates muscles of the body

73. A 27 year old male patient is in a car accident in which he is thrown from the
vehicle because he was not wearing a seat belt. He has sustained several fractures,
including a fracture on the base of his skull. Upon regaining consciousness in the
hospital, he notices that he cannot move the muscles on the right side of the face,
leading to drooling and a dry eye on that side. Further testing by his neurologist
indicates that the motor component of the facial nerve (VII) on his right side is not
functional (although lacrimal secretion, submandibular secretion, and taste are all
intact). This suggests that the nerve was severed as it passed through the?

a. Foramen spinosum
b. Internal acoustic meatus
c. Petrotympanic fissure
d. Stylomastoid foramen
e. Foramen rotundum

74. A patient is brough to the ER following a motor vehicle accident. On examination

he has weakness on his left arm and leg; loss of fine touches on the left; with loss of
pain and temperature sensation on the right. This clinical picture is most consistent
with?

a. A complete cord syndrome

b. A left spinal cord hemisection syndrome
c. An anterior spinal cord syndrome
d. A central cord syndrome
e. A right spinal cord hemisection syndrome

75. A 22 year old woman is involved in. car accident. She was not wearing a seatbelt
and she received a skull fracture when her head hit the windshield. By what
mechanism would this patient develop anosmia (loss of sense of smell)?
a. Subarachnoid blood causes pial adhesion on the olfactory nerve
b. Torsion on the brainstem inures trigeminal tracts
c. Traction on the chorda tympani damages fibers as they course through the skull
d. Shearing force sever filaments of the receptor cells as they cross the cribiform
plate
e. Injury to the temporal tip injures the olfactory cortex

76. A 25 year old girl came to her physician consulting her multiple nodules around
1,1 to 2,0 cm scattered dominantly in the extremities and torso. The physical
examination found café-au-lait (brown, coffee-like stain), irregular borders in her skin
beside multiple nodules. The biopsy from one of her nodules showed a benign
neoplasm. What is the best diagnosis for her?

a. Angiofibrolipoma
b. Benign Low grade Perineural sheath tumor
c. Neurofibromatosis Von Reckling-Haussen
d. Neurilemmoma
e. Dermafibroma

77. Betty remarks frequently that she is extraordinarily wealthy, despite being
housed in a psychiatric hospital and having an empty bank account. When asked to
explain this apparent contradiction, she indicated that the hospital is keeping her
money, but that it is part of a vast conspiracy because the administrators fear her
great power when she is not hospitalized. She has experienced symptoms such as
these since she graduated high school. These symptoms are sometimes collectively
referred to as?

a. Grandiose delusions
b. Ideas of reference
c. Thought insertion
d. Delusional jealousy
e. Thought withdrawal

78. A 25 year old man with numbness and tingling of the little and ring finger,
weakness, and wasting of the dorsal interossei and abductor digiti minimi, sensory
disturbance over the little and ring finger. Which of the following site of peripheral
nerve lesion for this condition?

a. Common peroneal nerve

b. Radial nerve
c. Ulnar nerve
d. Brachial plexus
e. Median nerve

79. 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 to emergency unit. BP was 130/80 mmHg and HR 88 x/minute. During
clinical investigation in emergency unit, he became unconscious. He also developed
right pupil dilatation, and left side weakness. The physician did a CT scan, according
to the clinical findings, what would you expected to find?
a. Intraventricular hemorrhage
b. Epidural hemorrhage at occipital region
c. Subdural hemorrhage at interhemispheric
d. Epidural hemorrhage at posterior fossa
e. Epidural hemorrhage at temporal region
80. Where is the most conspicuous stimulation area for causing almost natural
sleep?

a. The locus coeruleus

b. The hypothalamus
c. The pontomesencephalon
d. Reticular Activating System (RAS)
e. The raphe nuclei

81. A 37 year old man comes to a clinic complaining sudden shortness of breath,
palpitation, frequent urination, numbness over his hands, sweating all over his body,
and neck rigidity. He is very afraid that his heart would suddenly stopped. This
condition appeared since 2 months ago. What is the most likely diagnosis for this
condition?

a. Social phobia
b. General anxiety disorder
c. Panic disorder
d. Agoraphobia
e. Acute stress disorder

82. A 56 year old female patient came to the clinic with chief complaint of having the
first seizure in her life. Her family described her seizures as head and eye turning to
the left side accompanied by stiffness and twitching of the left extremities and
followed by the right extremities. She was unconscious while seizing and the seizure
duration was 2 minutes. After the seizure, she was fully alert. She had a history of
brain tumor removal over the right temporal area 1 year ago. According to ILAE
(International League Against Epilepsy) classification, what is the best diagnosis of
this patient?

a. Chronic symptomatic seizure

b. Brain tumor
c. Status epilepticus
d. Epilepsy
e. Acute symptomatic seizure

83. A 17 year old male patient came to the Emergency Department of Siloam
Hospitals with chief complaint having seizures for 1 minute. While having seizures,
patient was unconsciousness, both legs and arms were stiff and twitched, his head
and eyes were faced upwards. After the seizure, he regained conscious again. This
was his first seizure in his life. He had no remarkable previous history. What is the
type of seizure mentioned above?

a. Focal onset impaired awareness motor onset seizure

b. Generalized onset tonic seizure
c. Generalized onset tonic clonic seizure
d. Focal onset to bilateral tonic clonic seizure
e. Generalized onset clonic seizure seizure

84. A 72 year old man complains that he frequently forgot what he was just doing.
He went to the doctor and was suspected as having a neurotransmitter problem
which probably caused a neurodegenerative disease. What is the characteristic of
GABA?

a. Predominant excitatory neurotransmitter which increase the activation of calcium

channel
b. Predominant inhibitory neurotransmitter which decrease the activation of calcium
channel
c. GABAB acts via ionotropic receptor controlling potassium channel
d. GABAA acts via ionotropic receptor controlling sodium channel
e. GABAA acts via metaboreceptor controlling potassium channel

85. A 28 year old woman presented with right sided, pulsating, headache, VAS 6-7
since 1 day prior to admission. She also complained for nausea and vomiting.
Several minutes before the episode of headache, she felt blurred vision that diminish
when the headache appeared. In physical examination, there were no significant
findings. What is the most probably cause of visual problems.

a. Cortical spreading depression

b. Peripheral sensitization
c. Central sensitization
d. Conjunctival injection
e. Trigeminovascular activation

86. A 25 year old man had walking while he was asleep, He also suddenly woke up
in the middle of his sleep due to nightmare. Which of the following disorder is the
most appropriate with this condition?

a. Substance-induced sleep disorder

b. Somnabulisme (sleep walking)
c. Sleep wake sleep disturbance
d. Insomnia
e. Circadian rhythm sleep disorder

87. A woman, 37 years old, came to the emergency room with a spinning sensation
since 1 day ago. She instantly felt dizzy and nauseated and had been vomiting many
times. The spinning sensation was felt continuously, accompanied by hearing loss of
the left ear and fever. The problem is probably caused by disorder in which site?

a. Superior olivary nucleus

b. Incus and stapedius
c. Vestibular nerve
d. Semicircular canal
e. Labyrinth
88. A 32 year old female came to clinic with difficulty walking since a month ago after
accident which broke her left leg. The doctor said she had nerve injured and cause
lower motor neuron lesion of the left leg. Which of the following signs could present
in this patient?

a. Prominent patellar reflex

b. Positive Babinski sign
c. Spasticity
d. Increased in muscle tonus
e. Loss of tendon reflex

89. You are able to pull your hand quickly away from hot water before pain is felt
because?
a. Movement of the hand does not require intervention by the central nervous system
b. The brain reacts quickly to the prevent severe injury
c. Movement of the hand is a reflex that involves intervention of the spinal cord only
d. The autonomic division of the peripheral nervous system intervenes to speed
contraction of the muscles of the hand
e. Movement of the hand does not require intervention by the peripheral nervous
system

90. Following a head injury, a patient has ongoing difficulties to stay awake. Which of
the following is the most likely structure to be injured?

a. Cerebellum
b. Basal ganglia
c. Reticular formation
d. Corpus callosum
e. Thalamus

91. Female, 24 years old was brought to emergency department with loss of
consciousness since 3 days prior to admission. One week ago, she complained
headache and fever. She also had double vision and weakness of left arm and legs.
During examination, the patient had generalized seizure for 2 minutes, which was
stopped with injection of diazepam intravenously. On neurological examinations, the
nuchal rigidity and Brudzinski’s sign were positive. Which components do not
comprise the blood brain barrier?

a. Astrocytes
b. Basement membrane
c. Endothelial cells of blood vessels
d. Macrophage
e. Pericytes/Rouget cells

92. A 25 year old man is brought to the emergency unit with a high fever, lethargy,
and stiff neck. Based on the history taking, physical examination, lumbar puncture,
and laboratory analysis that indicated bacterial growth in the cerebrospinal fluid, the
attending physician suspect infection of central nervous system. Embryological
structure that has the greater possibility involved in the above case is the derivative
of mesenchyme surrounding?

a. Rhombencephalon
b. Neural tube (tubulus neuralis)
c. Mesencephalon
d. The brain vesicles (vesiculae cerebri)
e. Anterior neuropore (neuroporus anterior)

93. A 17 year old male patient came to the Emergency Department of Siloam
Hospitals with chief complaint having seizures for 1 minute. While having seizures,
patient was unconscious, both legs and arms were stiff and twitched, his head and
eyes faced upwards. After the seizure, he regained consciousness again. This was
his first seizure in his life. He had no remarkable previous history. What is the basic
pathophysiology of a seizure to happen?

a. Too many dopamine neurotransmitter in the brain

b. Too few excitatory neurotransmitter in the brain
c. Too few GABA neurotransmitter in the brain
d. Too many GABA neurotransmitter in the brain
e. Too few dopamine neurotransmitter in the brain

94. A 30 year old woman, married 6 years ago, is complaining of having pain during
sexual intercourse with her husband. She did not enjoy having sex with him, and she
has got no infection or abnormality in her vagina. What is the diagnosis of the case
above?

a. Dyspareunia
b. Lack of estrogen
c. Vaginismus
d. Does not like her husband
e. Chronic pain disorder

95. One of the tasks of participants of the Students Dissecting Program is to remove
cadaver’s visceral organs. After having removed cadaver’s brain the students found
the cerebellum still remain at the posterior cranial fossa because the student forgot
to dissect reflexion of meninges that covers cerebellum. Reflexion of meninges that
the student forgot to dissect is?

a. Falx cerebri
b. Falx cerebelli
c. Diaphragma sellae
d. Tentorium cerebelli
e. Reflexion of duramater

96. Mr. X, 27 years old, was brought to the mental hospital by his father because he
was found on the street as a vagabond (gelandangan) after he left his house 3
months ago. Previously, he often sat up all night, slept all day, and became very
angry when his father tried to get him out of bed. He did not shave or took a bath for
weeks. He smoked continuously, and ate very irregularly. He kept to himself (likes
being alone) as much as possible and rarely speaks with other people. What is your
diagnosis?

a. Residual schizophrenia
b. Schizophrenia paranoid
c. Simple Schizophrenia
d. Schizophrenia Katatonia
e. Schizophrenia Hebefrenic

97. A 35 years old man 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 to emergency unit. BP was 130/80 mmHg and HR 88x/minute.
During clinical investigation in emergency unit, he became unconscious. He also
developed right pupil dilatation, and left side weakness. He got a lucid interval,
means conscious interval between two episodes on unconsciousness. What is the
most probably cause of second episode of unconscious?

a. Direct uncal compression at cingulate gyrus

b. Direct uncal compression at the medulla oblongata
c. Direct uncal compression at the pons level
d. Direct uncal compression at midbrain
e. Direct uncal compression at corpus callosum

98. Mr. Vinson, 34 years old, came to neurology clinic with low back pain that
radiated to right legs since 1 week ago. No numbness or tingling sensation in the leg
and no weakness of both legs. Before the complaint, he had history of lifting heavy
objects. Which nerve fibers that responsible for causing symptoms of this patient?

a. C and A delta
b. A beta and A delta
c. A alpha and A beta
d. A alpha and A delta
e. A beta and C

99. A 54 year old woman was brought to the clinic and the daughter said that this
morning she couldn’t sleep, became agitated and ran out to the street naked. She
shouted, “My son is still alive! I want to give food to my son!”. Later on she became
more agitated and was not cooperative. She had never had any education of formal
occupation. She is a widow and her husband died 2 years ago because of cancer.
What is the type for this condition?

a. Catatonic type
b. Residual type
c. Disorganized type
d. Undifferentiated type
e. Paranoid type

100. Mr. X, 27 years old, was brought to the mental hospital by his father because he
was found on the street as a vagabond (gelandangan) after he left his house 3
months ago. Previously, he often sat up all night, slept all day, and became very
angry when his father tried to get him out of bed. He did not shave or took a bath for
weeks. He smoked continuously, and ate very irregularly. He kept to himself (likes
being alone) as much as possible and rarely speaks with other people. This patient
could not be treated by conventional antipsychotics. What is the principles of the
drugs?

a. Cholinergic receptors
b. Serotonin receptors
c. Histamine receptors
d. Dopamine receptor antagonists
e. Serotonin dopamine antagonists