1. Diseases characterized by abnormal accumulation of tau in neurons include all EXCEPT A. Progressive supranucleat palsy B. Alzheimer's Disease 6. Porc Daeg 2.39 year-old woman developed frontal headaches fever and malaise. Computerized tomography (CT) of head showed a single cavitary lesion suggestive of an abscess in right frontal lobe. The ‘most likely source of an infection is: A. Congenital heart disease t ceeecem cea maa” 1D. Marantic endocarditis E. Otitis media 3. Allof the following are true in regard to ocular toxoplasmosis except: “The domestic dows reeaded a the definite Ros 8. ‘Yansplaceatal transmission ofthe protozoa can resi in both ENS and ocular infection E hitaveccren wlpsigetoal Wacom nancy” 1. Most adult cases show high serologic titers which suggest eudence of recent infection 4. Associated with cyanotic congenital heart disease, chronic pulmonary sepsis and acute bacterial endocarditis Ww B._ Suppurative leptomeningttis ©. Both D. Neither Newborn with acute leptomeningii Poliomyelitis Eastern equine encephalitis 5 ‘ e frontal Is ©. Brain abscessin ronal ibe 16 tones ce wl eas. Nisseria meningftides Phagocytic (microglia) nodules and neuronophagia in the central nervous syster Bacterial infection Parasic infection * id iforct ‘Autoimmune reaction |A young man is severely beaten. He develops coma and.a dilated right pupil in likely diagnosis is SS ral hematoma on the eft abel ‘Acute subdural hematoma on the left Epidural hematoma on the left Hemorrhage in the left corpus striatum ee eee Ses i 1 sane oY = Se CeeCongenital or "berry" aneurysms tesult from Trouma Polyarteritis nodosa Atherosclerasis Septic embol 10 The mos irequent 1. RS 8. Ruptured arte C._ Vascular malformation D. Amyloid angiopathy E. Blood dyscrasias, 4 laceration fiddle eninge! ay a ea B. Hemorrhagic irontal parictal lobe infarct C. Intracerebral hemorrhage D. All ofthe above E._ None of the above mMonere ‘of intracerebral hemorshage listed below is: > Fires SAH . 12, Which of the following statements if FALSE? oe A fypetenion amr acer nerpailog charges in ibe Boose con cont tact occas enc tc, < ea ao 110. Borderzone infarcts occur at IN¢EBarder between grey and white matter during episodes of carbone monoxide injury E Compression ofthe nudbrain gf 13. Prolonged repetitive low velocity blunt force injury t0 the frontal lobes is most associated with A. Subdural hemorrhages . 18. Seperiial conical Conusions-# c D. Epidural hemorthages| E. Diffuse axonal damage 14, A hammer blow to the lel frontal temporal region is most likely t result in: A. Contusions To The Left Frontal Cortex And Right Temporal Cortex B. Just Contusions To The Right Temporal Comtex, IC. Epidural Hemorrhage On The Letty 1 3 E. Subdural Hemorthage On The Lett 8 15. Subacute Combinéd Degeneration of vitamin 812 deficiency refers to: A. Lesions in both the putamen and substantia nig. eae 18 Lose yin don crcl nl a and ascending poset oli CC. Loss of upper motor neurons in the precentral gyrus and lower motor neurons in the anerior horn ‘of the spinal covd. 1D. Lesions of both the substantia nigea and locus ceruleus E. Lesions ofthe ascending spino-cerebellac tract and cerebellar purkinje neurons. Page 3 of 15, v216, The most common cause of CNS death in severe acute hepatic failure is A. ifluse neuronal excitotoxicity Senne eee Sere NA» iam 77 f, Glande Bilateral basal ganglia necrosis 17. Aman falls backwards off a5 foot ladder and strikes the ground in the occipital region of hi head top te mt ly pen ately ban A. idan arson mocepal a B. Massive contusions in occipital poles 0 ‘aamiiial iia 7 0 f ke i a 16, Which ofthe following may obstruct the cerebellar exit foramina: A. Aneurysm Of The Great Vein Of Galen E.AAnd B 19. The foramen of Monroe: Ais located in the lateral recess ofthe ath ver B. spans the length ofthe midbrain re Ds located in the subarachnoid space next to the sagittal sinus Eis located in the base ofthe 3rd ventricle 20. Hemorrhagic necrosis of temparal lobes and intranuclear inclusions in neurons and glial cells A Cres lakob disease 18 . Cryptococeal meningitis D_ Acute pneumococcal meningitis E._ Progressive multifocal leukoencephalopathy 21, Which of the following is NOT true regarding Progressive Multifocal Leukoencephalopathy: A. Associated with immunocempromised host B._Etiologic agent is ubiquitous C. Mediates white matter disease 10. E. Clinical symptoms res 22. intracytoplasmic eosinophilic inclufions, in pyramidal neurons of Ammon's horn, Caper mene c (ssro 7 1.C. Subacute sclerosing panencephalt D. Poliomyelitis E._ Progressive multiocal leukoencephalopathy 23, Encephalitis with eyfoplasmic inclusions in Purkinje cells of cerebellum. A. Herpes simplex * eae - D. Papova viruses E. Influenza virus ve Page 4 of 1524, Mud traumatic brain injury is consistent with a Glasgow Coma Scale score of ‘A_ 15 and aboyg ae © 13-20 D 9-12 £ 1-8 25. Me delnng races ope ead iy 1A. aceration ofthe salp Feature ot the sll ¢ D. Laceration of the ventricle E. Depressed skull fracture 26. Raccoon eyes is associated with what fractures of the skull. A. Fractures of the maxillary bones B. Fractures of the middle cranial fossa Ic. 1. Fractures of the posterior cranial fossa Fractures oF the squamous frontal bone 27 The following statements about epidural hemorrhages are true except A. Toccurs in 10-15% of severe traumatic brain itry 18 > C. Tes associated with fractures ofthe cranium D. tis not associated with bridging veins E._ttmay be caused by laceration of the middle meningeal artery 28, Subdural hemorehages are associated with the {plowing except 1A. Acceleration’deceleration shearing forces, 8. Cortical atropl in the elderly C. Cortical atrophy in chronic alcoholics . Subdusal membanes 1 ira 29. The follwing may be types of difuse brain injury excopt A. Diffuse traumatic axonal injury B._ Diffuse cerebral vascular injury C. Diffuse cerebral fat embolism ig Li ana ic neoplasm may produce coma hecause of 30. A cerebral hemisph 16. E. Compression of pituitary and endocrine insufficiency 31. Which ofthe following is true of papillary ‘carcinoma? 4A Sho twp hal B._ The least common kind of thyrotd carcinoma YX C. The type of thyroid carcinoma with the worst prognosis X -—» , 1B. Occurs in patients with MEN I E_ Most common in elderly patient y v2 Page 5 of 1532. A patient with Cushing syndrome might present with any ofthe follow A. Obesity a ¥ of the following EXCEPT: BA butt hump gon facies 1D E. Glucose inolerance * 33. Patients with diabetes have an increased risk ofall of the following EXCEPT: A. Cataracts B, Inlecons Increased atherosclerosis b ii ‘neuropathy “ 34, Which ofthe following is true regarding, pheochromocytoma? B._ tt usually an aggressive, malignant tumor ©. only occurs in the adrenal gland 1D. tis derwed from neural crest cells E. Many tumors have a Tp deletion 35 Which of he flowig i ue ceprdingAdison dest Ivis characterized by an overproduction of catecholamines Most cases are due to infection 1D. The onset is sudden E, Patients are often hypertensive 36, You are seeing a 41-year old male who is very tall and has a large jaw. You wonder if he might hhave acromegaly due to a pituitary adenoma. What laboratory test would be best for making this 1 B._ Random serum growth hormone evel C. Prolactin level D. Hemoglobin £. Lactate dehydrogenase 37. Common complications of VP or VA shunt malfunction include the following A. Allergy o the material shunts are made off (Silastic) 8. Hypovolemic shock Cpeomer : 11, Blockage and infection yo 3B. Eighty percent ofthe CSF is produced by? AY ial surface vessels B. Ependymal cells Limi 39 rdrocephals may eu fom Aneurysm’ (varix) of great vein of Galen Arnold-Chiari malformation Chronic leptomeningitis A 7 eer 12 mney” v2 Page 6 of 1540, The most conmon cause of nop.commmunicating hydrocephalus ie AA Mecingealtberculss ga osng cmd ago "0 C_Choraid plexus papilloma 1D Choraid plexus carcinoma 41. What does the term communicating hydrocephalus mean? A. Patients are able to communi il they have increased intracranial pressure ‘ 18 _ Tere canmuncagn een he el verres ae pal iba pe ¢, ‘Frdrécephalus is dutto blockage at the level ofthe aqueduct D. None of the above 42, What is the etiology of aqueductal stenosis? A. Aqueductal septum B._ Forking of the aqueduct CC. Gliosis of the aqueduct — D. Stonosis of the aqueducts E 43. What is the most common causeal ebmmunicating hydrocephalus? a B. Previous open brain surgery CC Herpes virus encephalits D. Polis 44, What isthe normal wyygeranial pressure CP) in an adult mbt TA. V6t0 18 mmbig a B._200 mH ai cong ree D. 40:50 mmitg é te 45. What statement beter describes Normal Pressure Hye aus (NPHN 7 A. NPHus a common condition of newborns 12. rormatrange D. NPHisa hlesthreatening condition and should be teated as an emergency E__NPH never occurs ia teenagers 46, Which answer better describes the route of flow of CSE 1A > 8. “Lateral ventricles, perispinal subarachnoid spaces, foramina of Magendie and Luschka CC. Cisterna magna, lateral venticles, perimedullary subscaclnovd space D. Perimedullary space subarachnoid space, cisterna magn, lateral ventricles ‘ 5 47. Macrocephaly is found wf which ofthe following contexts ; ‘A. Megalencephaly 8. Hydrocephalus €.A Small Brain Wat Expanded CSF Spaces D.A Normal Sized Brain Page 7 of 15 v248. The following is/are NOT considered a feature of anencephaly A. Prominen’ Eyes ge Ne 8. Hindbrain Crowding ———> C’Area Cerebrovasculosa, go i D. tmcact Anterior Pituitary EAand 8x +49. Etiologic factors implicated in holoprosencephaly include A. Cholesterol Biosynthesis 8. Ethanol JC. Deiects OF The Sonic Hedgehog Signaling Pathway ~~ ‘D_ Maternal Diabetes 50. The following is NOT astocited with Dandy-Walker maliormaton A. Enlargement OF The Posterior Fossa = 8. Agenesis OF The Poterie Cerebellar Vermis 1. Displacement OF The Cerebellar Tonsils Below The Foramen mH ( 7 A o i" 51 A.common suprasellar tumor in children is: A. Meningioma ; 1D Ependymoma—_-, 52_All the following associated pairs are correct, EXCEPT L, ——— Penivascular Pseudoroseties CC. Craniopharyngioma - Wet Keratin 18. Canghoghoms - Psammgr Bodies ae 53. MOST pediatic brain tumors Sie foe AN Above fhe Tetoram 8 tn The Cerebral Hemispheres Inthe Spinal Cord Z i 54 Creutzfeldt Jakob Disease |A. Often Shows Severe Cortical Atrophy © Neatly Alwape Hos Prin Plagues rhe Cerebellum fas Spongfoen Changes In The Gry Mater Has Spongiform Changes in The White Matter 55. The most important pathogenic mechanisin of GDM is TA. Ineremed dibeogenie orvones, Increased maternal weight Failure of beta cells mass to increase — ve Page 8 of 1556 A.65 years old female has following thyroid profile:* Serum (73 2.16 payin! (1.60-4.20)* Serum iT 1.34 nginl (0 70-1,68) Serum TSH §,62 mMU/L (0 304.0, The most probable diagnosis inthis patient is A. Non.thyroidal illness syndrome B__ Normal thyroid profile for the age C_Pamary hypothyroidism D. Secandary hypothyroidism A.34 years old female suspected of acromegaly has been referred to you to rule out the disease ‘Which of the following isthe single most important first test or screening test to rule out acromegaly inthis patient A. CT scan Bo MRI Snisceiiaiilil ra E._ Serum IGF-1-binding protein (IGF8P-3) 58. A55 years old male, presented in semi-conscious tate, His biochemical profil is sfllowing + pH:7.38 (735-745) + HCO3: 24 mmolt 23 ~28) $E23 (c3--3) + PO2: 102 mm 80 - 110) + 8CO2: 39 mmHg (35-45) Na: 153 mmol (135-150) 24S mmol 3.3 —50) eee Des HHS - + Urea: 15.2 mmobt (3.36.6) —> ee + Osmolaliy. 347 mimolkg 275 — 295-9 * Glucose (R39 mmol 35-11) Urine * Ketones: Trace What ithe most likly diagnosis? A Accidental ingestion of sea water 8. Delydration due to severe darthoea C_Diabetic ketoacidosis - E. Primary byperaldosteronism 59. FPG of a 48 years old senior male officer during his “Annual Check-up” was found to be 7.9 mmol/. (142 mg/dl, He was advised re-testing for DM by Glycosylated Haemoglobin (Ac), The result of ATC was found to be 6 8%. Now he wants your opinion. Keeping in view the latest | recommendations by international bodies, which of the following you think is the best option for 3 thspalint 2 5 B. Requires repeating of FPG. Requires repeating of AIC D. Requires OGTT E. Requires urinalysis 60. A diagnosis of meningitis is made through the analysis of CSF. Which of the following results would be expected with a diagnosis of bacterial meningitis? / a B. Clear CSF, decreased WBC, eledated protein and elevated glucose C. Cloudy CSF, decreased WEC. decreased protein and elevated glucese D. Clear CSF, elevated WAC, decreased protein and decreased glucose ve Page 9 of 1561. Which of the following statements regarding viral (aseptic) meningitis is TRUE® A. Viral meningitis is often caused by the pathogens meningococcus (Neisseria meningitidis) and pneumacoccus (Streptococcus pneumoniae, 8. Viral meningitis is limited to the meninges and the CSF will not have an identifiable pathogen, Viral meningitis i a rare form of meningitis and is caused by inhalation of fungal spores. 1D. Viral meningitis is spread through contaminated saliva, respiratory tract secretions and respiratory droplets thereby requiring droplet isolati 62. A patient is admitted into the emergency department following a head injury at work. He resuscitated and stabilized, but a computed tomography scan shows significant brain contusion. He 's intubated and cared for on the intensive care unit, You attempt to evaluate his Glasgow Coma Scale score; there is no response to voice, but pressing a pen into his fingernail causes the patient to ‘open his eyes and attempt to withdraw his hand from you, His Glasgow Coma Seale score therefore: A sto indie na he Ae. 63. A patient is admitted o the emergency department with a reduced level of consciousness, smelling of alcohol. A boggy haematoma is noted on the posterior aspect of his skull. The patient's eyes open to voice, but he makes no attempt to vocalize.A sternal rub causes the patient to open his fees, moan and extend his arms and legs. His Glasgow Coma Seale score fs: A ans ae = Th se E ans 64. \27-yearold man is brought to the emergency department after being injured in a ‘motor vehicle collision. He is noted to speak using inappropriate words, He withdraws and ‘opens his eyes to pain only. This patients Glasgow Coma Scale score is: ae ‘35H 3 Ae 65. All of the following CSF findings are present in tuberculous meningitis, except: A. Raised protein levels B. Low chloride levels, C_ Cob wel formations 1 SEREASSHERTERLEX > f, a 66. Which one of the following isthe rmost common cause of congenital hydrocephalus? moo . Mallormations of great vein of Galen 67. Which ofthe following congenital malformations can be diagnosed in the first imester? A. Microcephal Meningocele ncepralocele D, trees ona, FPaeve Hwee, Page 10 of 15.68. Release of Anterior Pituitary hormones is regulated by the hormones secreted from the hypothalamus. Which of the following hormone is not released from the hypothalanus? A. Growth houmone seleasing hosmgne 1 yo Stang oem oe . Ganadotropin-reteasing hormone D. Conticotrophin-eleasing hormone 69. 0-year old man spl kin and tag Hs pla TSH ee wand incensed matey ene ghen My opreresing hme Wha he ly ate (0) Hyped dd an noma in tepals? ee 5. Hypotreum daetan romaine Mts 70. Which oi the following hormones is synthesized by the posterior pituitary gland? A. LH & FSH 8 tsH 1.C. Antidiuretic hormone and Oxvtocing <2 — ©. Growth hormone and Prolactin ive agent of primary amoebic meningoencephalitis? B. Eniameba histolyticum Amoeba proteus D. Acanthamoeha polyphaga 72. How do humans usually contract neurocysticercosis? A. The Bite Oi An Infected Anhropod 8. Exposure To Contaminated Cat Feces + einai; 73. Your sister is complaining that she is always tired, despite getting enough sleep. You notice that she seems pale, and when you feel her pulse it is quite slow. She alsa mentions that she can't stand the cold these days, What two lab tests would be most helpiu! in diagnosing her condition? A. FSH and Li levels 18, C. Calcium, phosphate, and parathyroid hormone levels 1D. Insulin-like growth factor and profactin levels E. Comtisol and ACTH levels Which of the following lists the most common cause of hypopituitarism? 6 il . Malignant Tumour D. Lesions In The Fypothalamas” 75. Which ot te following hormones are impacted by hypopi ‘A. Luteinizing Hormone B. Thyroid Stimulating Hormone C_ Growth Hormony , Page 11 of 15 veSECTION B MATCH THE TEN STATEMENTS WITH THEIR APPROPRIATE DIAGNOSES IN THE LARGE TABLES, WRITE YOUR RESPONSES IN THE SMALLER TABLES THAT FOLLOW. 1. An 6-year-old boy has had persistent headaches far 8 weeks. He also exhibits difficulty walking with ataxia. A CT scan demonstrates lateral ventricular enlargement along with a 3 em circumscribed mass snvolving the vermis ofthe cerebellum, A lumbar puncture is periormed. CSF protein is elevated, with normal glucose, 3 lymphocytes, 1 neutrophil, and several large E atypical cells: Jreyrwite junction nthe ght and fet area lobe 2 4. A 60-year-old man with a history of untreated bygertension suddenly becomes unable to move his right arm and leg, ‘8 90-year-old man had » history of progressive cognitive decline over the past 7 years. He had no rent disorder. At autopsy, microscopic sections of his cerebral cortex reveal many neuritic - plaques with amyloid cores re Ftapoana palm” Pe tpaal homage caeye Tr fone hoon | iva gn © Clone her ae rome > Medsiobonone Scrooaaraton ae honoree Emaar ati v2. Page 14 of 15,6 25-year-old male with fatigue, dizziness, weight loss. Has postural hypotensiog, buccal pigmentation, and has a sodium-128, potassium-5.6, and low cortisol . 7. 26.year-ldtemale with angue and weight goin Farily history of goiter wih ree 746.8, CQ, TSAC1B, ant-TPO anibodesct0 9. 65-year-old female complains of fatigue, aches and pains, constipation. She has a history of renal stones, ‘ — 10. A 32-year-old female 2 months post-partum is unable to breastfeed due to failure to lactate and, feels fatigued with weight gain of 3kg, Delivery was complicated by significant blood loss and low biood pressure. Bloods show an LH<0.5, FSH-0.8, Oestradiol-102, (74.9.0, TSH.0.6. ‘A: Secondary F- Pituitary adenoma | K-Graves disease - Nelson’ syndrome hyperthyroidism © Addison’ disease | H-Mulipl endocrine | M-Primary R-Cushings disease neoplasia type 1 byperparathyroism D- Ternary Sheehan's syadrome | N-Diabetes insipidus J S-Creutzield-Jakob hyperparathyroidism disease Primary hypothyrondin EMuliple endocrine! | Avaterhouse ‘O-Prelactinams neoplosia type 23 | Fredhichion syndrome 1. FPG. Fasting Plasma Glucose 2. GDM. Gestational Diabetes Mellitus 3. IGE Impaired Glucose Tolerance 4. MODY. Mature Onset Diabetes of the Young, Page 15 of 15 ve