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SMOLENSK STATE MEDICAL UNIVERSITY
NEUROLOGY AND NEUROSURGERY DEPARTMENT
Multiple choice questions
on neurology and neurosurgery
for overseas students
Smolensk, 2016
SMOLENSK STATE MEDICAL UNIVERSITY
NEUROLOGY AND NEUROSURGERY DEPARTMENT
Multiple choice questions on neurology and neurosurgery for
overseas students
Compiled by N. N. Maslova, Ph.D., Assistant Professor, Head of the
Neurology and Neurosurgery Department, V. V. Sergeev, Ph. D., Assistant
Professor, N. A. Ivanova, Ph. D., Assistant Professor.
The multiple choice questions for overseas students of fourth year cover
selected issues of neurology and neurosurgery and intended for final exam
on neurology. The book is divided into three sections concerning general and
clinical neurology and neurosurgery. The majority of questions require one
answer. The letter below the question designates correct choice. Several
items appear as clinical cases.
Smolensk, 2016
1. General neurology
1. Which IS NOT characteristic of the upper motor neuron lesion?
a. global atrophy
b. hyperreflexia
c. individual atrophy
d. central palsy signs (i.e. pyramidal signs)
e. diminished superficial abdominal reflexes
f. increased tone in the antigravity muscles
c
2. Which IS NOT a feature of upper motor neuron disease?
a. exaggerated reflexes
b. Babinski sign
c. ophthalmoplegia
d. fasciculations
c
3. Which of the following IS NOT characteristic of a lesion of the lower motor neuron?
a. individual paresis
b. individual atrophy
c. diminished deep tendon reflexes
d. Achilles clonus
e. fasciculation
f. extensor plantar reflex
d
4. Muscle hypotonia would be expected in a damage to all of the following structures
EXCEPT:
a. peripheral nerve
b. cerebellum
c. thalamus
d. lower motoneuron
с
5. Characteristic features of spasticity – the muscle tone is increased:
a. in flexors of the arms and in extensors of the legs
b. in flexors of the arms and legs
c. in extensors of the arms and legs
d. in all muscle groups
a
6. Cog-wheel rigidity can be found in:
a. Foster Kennedy syndrome
b. Parkinson's disease
c. Wernicke encephalopathy
d. multiple sclerosis
b
7. Which of the following IS NOT indicative of a damage to the pyramidal tract?
a. spasticity
b. hyperreflexia
c. Babinski sign
d. muscle fasciculation
d
8. Which of the following signs IS NOT indicative of a damage to the pyramidal tract?
a. Babinski
b. Brudzinski
c. Rossolimo
d. Chaddock
b
9. Which of the following DOES NOT participate in regulation of the muscle tone?
a. muscle spindle
b. motor neuron in the ventral horn of the spinal cord
c. cerebellum
d. spinothalamic tract
d
10. The decussation of the corticospinal tracts occurs:
a. in the internal capsule
b. near the caudal extremity of the medulla oblongata
c. above the sensory decussation
d. in the ventral pons
e. in the ventral funiculus of the spinal cord
b
11. In the pathway of the pyramidal tract, the axons project through all of the following
EXCEPT:
a. corona radiata
b. posterior limb of the internal capsule
c. pedunculus cerebri
d. pontine tegmentum
e. lateral funiculus of the spinal cord
f. anterior funiculus of the spinal cord
d
12. Which of the following tracts DOES NOT decussate along their course?
a. dorsal spinocerebellar
b. ventral spinocerebellar
c. spinothalamic
d. medial lemniscus
e. spinotectal
f. rubrospinal
a
13. Where is the primary motor cortex located?
a. in the parietal lobe
b. in the postcentral gyrus
c. in the precentral gyrus
d. in the temporal lobe
e. in the operculum
f. in the prefrontal area
c
14. All of the following are superficial reflexes EXCEPT:
a. flexor plantar reflex
b. abdominal reflexes
c. conjunctival reflex
d. cremasteric reflex
e. masseter reflex
e
15. Which IS NOT a deep tendon reflex?
a. corneal reflex
b. masseter reflex
c. triceps reflex
d. biceps reflex
e. Achilles reflex
f. patella reflex
a
16. The myelin sheath in the peripheral nervous system is produced by:
a. oligodendroglia
b. astrocytes
c. fibroblasts
d. Schwann cells
e. microglia
f. choroid plexus
a
17. Where is the primary sensory cortex located?
a. in the frontal lobe
b. in the temporal lobe
c. in the parietal lobe
d. in the prefrontal area
e. in the cingulate gyrus
f. in the angular gyrus
c
18. All of the following structures are sensitive to pain EXCEPT:
a. periosteum
b. meninges
c. majority of blood vessels
d. brain parenchyma
d
19. All of the following are sensory receptors EXCEPT:
a. Merkel's disks
b. Hassall corpuscles
c. Meissner's corpuscles
d. Paccinian corpuscles
e. Ruffini endings
f. Krause end bulbs
b
20. Impairment of position sense could be caused by a lesion in which of the following
structures:
a. ventral root
b. central part of the spinal cord
c. ventral horn of the spinal cord
d. posterior funiculus of the spinal cord
e. lateral funiculus
f. ventral funiculus
d
21. The total number of spinal nerves are
a. 30 pairs
b. 31 pairs
c. 29 pairs
d. none of the above
b
22. The spinal cord ends at the level of
a. T12 vertebra
b. L1 vertebra
c. L3 vertebra
d. S1 vertebra
b
23. Sacral sparing is a feature of
a. intramedullary lesion
b. extramedullary lesion
c. extradural abscess
d. transverse myelitis (i. e. complete spinal cord transection)
a
24. Horner's syndrome occurs in spinal cord lesions above
a. T6
b. T2
c. C6
d. C4
b
25. Which of the following segment is involved in the knee jerk?
a. L1
b. L4
c. L5
d. S1
b
26. Loss of the Achilles reflex results from the lesion to the:
a. L4 segmentum
b. L3 segmentum
c. S1 segmentum
d. L2 segmentum
e. Th12 segmentum
f. none of the above
c
27. Characteristic signs of conus medullaris syndrome include EXCEPT:
a. central palsy signs (i.e. pyramidal signs)
b. sphincter dysfunction
c. perineal sensory deficit
d. symmetric neurological signs
e. loss of anal reflex
f. sexual dysfunction
a
28. Which of the following IS NOT a feature of the cauda equina syndrome?
a. flaccid paresis
b. hyporeflexia
c. central palsy signs (i.e. pyramidal signs)
d. asymmetric neurological signs
e. symmetric neurological signs
f. muscle atrophy
c
29. All of the following may be the anatomical basis of spastic paraparesis involving legs
EXCEPT:
a. parasagittal processes
b. lesion in the pontine base
c. damage to the thoracical spinal cord
d. lesion to the ventral tegmental area
d
30. Which of the following is indicative of a complete unilateral lesion of the dorsal
column?
a. intact vibratory sensation ipsilaterally below the level of the lesion
b. ipsilateral loss of conscious proprioception below the level of the lesion
c. contralateral loss of discriminative touch starting at 1-2 segments below the level of the lesion
d. contralateral loss of conscious proprioception below the level of the lesion
e. loss of pain and temperature sensations ipsilaterally below the level of the lesion
f. none of the above
b
31. The cell bodies of the preganglionic sympathetic neurons are located in the:
a. ventral horn horn of the spinal cord
b. dorsal horn of the spinal cord
c. nucleus proprius
d. sacral level of the spinal cord
e. none of the above
f. all of the above
e
32. Which IS NOT characteristic of radial nerve lesion?
a. ape hand
b. weakness of finger extension
c. the forearm is a prone position
d. wrist drop
e. weakness of wrist extension
f. all of the above
a
33. Which of the following statement IS NOT TRUE regarding the upper plexus brachialis
lesion (Erb-Duchenne)?
a. Horner's syndrome is present
b. the patients are unable to abduct their shoulder
c. the patients are unable to laterally rotate their upper arm
d. the affected upper extremity is in internal rotation and pronation
e. the patients present in a “waiter’s tip” position
f. the affected roots are: C5 and C6
a
34. “Steppage gait” may associate with the injury of the:
a. tibial nerve
b. peroneal nerve
c. femoral nerve
d. sural nerve
e. cervical spinal cord
f. superficial femoral nerve
b
35. Visual pathway includes all of the following EXCEPT:
a. lateral geniculate body
b. area striata
c. medial geniculate body
d. superior colliculus
e. area peristriata
c
36. An upper homonymous quadrantanopsia can arise from:
a. area striata
b. ipsilateral occipital lobe
c. contralateral parietal lobe
d. contralateral temporal lobe
e. optic chiasm
f. optic tract
d
37. Foster-Kennedy syndrome is characterized by all of the following EXCEPT:
a. ipsilateral anosmia
b. contralateral papilledema
c. ipsilateral papilledema
d. ipsilateral optic atrophy
e. raised intracranial pressure
f. headache
c
38. Edinger Westphal nucleus lies
a. in the pontine tegmentum
b. between the red nuclei
c. in the floor of the fourth ventricle
d. between the inferior olives
e. in periaquaductal grey at level of superior colliculus
f. in periaquaductal grey at level of inferior colliculus
e
39. Miosis is associated to:
a. Horner syndrome
b. pontine bleeding
c. cholinergic toxicity
d. opiate overdose
e. all of the above
f. none of the above
e
40. Which of the following muscle is supplied by the trochlear nerve?
a. rectus superior
b. sphincter pupillae
c. levator palpebrae superior
d. obliquus superior
e. rectus inferior
f. obliquus inferior
d
41. The contents of the superior orbital fissure include EXCEPT:
a. oculomotor nerve
b. abducent nerve
c. facial nerve
d. trochlear nerve
e. ophthalmic nerve
c
42. The pathway for the pupillary light reflex DOES NOT involve:
a. pretectal nuclei
b. optic tract
c. optic radiation
d. brachium of superior colliculus
e. optic chiasm
f. third cranial nerve
c
43. The motor nucleus and the chief sensory nucleus of the trigeminal nerve are located in
the:
a. lower pons
b. middle pons
c. upper pons
d. lower midbrain
e. lower medulla oblongata
f. upper midbrain
b
44. Which of the following passes foramen ovale?
a. maxillary nerve
b. mandibular nerve
c. oculomotor nerve
d. trochlear nerve
e. abducent nerve
f. facial nerve
b
45. Which of the following is true of the nuclei of the facial nerve?
a. shares nucleus ambiguus with cranial nerves IX and X
b. motor nucleus is located in the upper pons
c. parasympathetic nucleus is the inferior salivatory nucleus
d. sensory nucleus is represented by the spinal trigeminal nucleus
e. none of the above
f. all of the above
e
46. All of the following deficits might occur with facial nerve palsy EXCEPT:
a. dry eyes
b. weakness of the muscles of facial expression
c. loss of taste to anterior 2/3rds of tongue
d. hyperacusis
e. weakness of the temporal muscle
e
47. Which of the following nerves carry parasympathetic fibers?
a. oculomotor
b. facial
c. vagus
d. glossopharyngeal
e. all of the above
f. none of the above
e
48. Signs of bulbar syndrome are (more than one answer is suggested):
a. absence of pharyngeal reflex
b. snout reflex
c. dysphagia
d. dysarthria
a, b, c
49. Pseudobulbar paresis may result from a damage to the:
a. cranial nerve nuclei located in the medulla oblongata ipsilaterally
b. cranial nerve nuclei located in the medulla oblongata bilaterally
c. corticobulbar fibers bilaterally
d. corticobulbar fibers ipsilaterally
с
50. Frontal release signs include all of the following EXCEPT:
a. sucking reflex
b. pronator drift
c. palmar grasp reflex
d. glabellar reflex
e. snout reflex
b
51. Signs of pseudobulbar palsy are (more than one answer is suggested):
a. compulsive laughter and weeping
b. dysphagia
c. dysarthria
d. aphasia
a, b, c
52. Alternating syndromes may associate with a lesion to the:
a. cerebellum
b. extrapyramidal system
c. brainstem
d. frontal lobes
e. thalamus
f. red nucleus
c
53. Which of the following is damaged in a case of left sided hemiparesis associated with a
gaze paralysis to the right?
a. right frontal lobe
b. the pons on the right side
c. the pons on the left side
d. left frontal lobe
e. medulla oblongata on the left side
f. medulla oblongata on the right side
b
54. Ophthalmoplegia is a characteristic feature in all of the following EXCEPT:
a. Gradenigo syndrome
b. Nothnagel syndrome
c. Millard-Gubler syndrome
d. Benedikt syndrome
e. Weber syndrome
f. Foville syndrome
c
55. A lateral medullary syndrome (Wallenberg) might result from occlusion of the:
a. posterior inferior cerebellar artery
b. posterior choroidal artery
c. vertebral artery
d. posterior cerebral artery
e. basilar artery
f. anterior inferior cerebellar artery
a
56. Which of the following statement IS NOT TRUE regarding oculo-cephalic reflex (doll's
eyes)?
a. it is tested in comatose patients
b. when brainstem is intact:eyes follow direction of head rotation
c. the conscious patient will usually suppress this reflex
d. in cases of brainstem injury:eyes follow direction of head rotation
e. when brainstem is intact:eyes continue to gaze straight ahead (deviate contralaterally)
f. the lack of this response in both eyes is part of the picture of brain death
b
57. Bilateral pinpoints pupils suggest:
a. pontine lesion
b. tectal lesion
c. midbrain lesion
d. bilateral oculomotor lesions
e. bilateral uncal herniation
f. none of the above
a
58. Parinaud's syndrome (upward gaze paralysis plus vertical nystagmus) results from a
lesion to the:
a. cerebellum
b. corpora quadrigemina
c. pontine tegmentum
d. medulla oblongata
e. anterior nucleus of thalamus
f. inferior colliculus
b
59. Which IS NOT a part of the extrapyramidal system?
a. pallidum
b. amygdala
c. caudatum
d. substantia nigra
e. corpus subthalamicum
f. putamen
b
60. Which of the following are collectively referred to as the lentiform nucleus?
a. pallidum and caudatum
b. putamen and globus pallidus
c. putamen and caudate nucleus
d. striatum and subthalamic nucleus
e. red nucleus and subthalamic nucleus
f. hippocampus and subthalamic nucleus
b
61. Lesion to the extrapyramidal system results in all of the following EXCEPT:
a. ballism
b. athetosis
c. chorea
d. lockjaw (trismus)
e. torsion dystonia
f. tremor
d
62. Hypotonic hyperkinetic syndromes include EXCEPT:
a. ballism
b. intention tremor
c. chorea
d. athetosis
e. myoclonus
b
63. Hypertonic-hypokinetic syndrome includes EXCEPT:
a. rigidity
b. tremor
c. akinesis
d. chorea
d
64. Which structure is affected in Huntington's chorea?
a. pallidum
b. amygdala
c. archistriatum
d. neostriatum
e. hippocampus
f. thalamus
d
65. The damage to which of the following structure induces hemiballism?
a. striatum
b. cerebellum
c. corpus subthalamicum
d. putamen
e. pallidum
f. amygdale
c
66. Adiadochokinesis refers to:
a. the inability to correctly judge distances
b. the tendency to fall, particularly with closed eyes
c. a specific form of gait disturbances
d. the inability to perform rapid alternating movements
d
67. Which area is involved in Parkinson's is disease?
a. neostriatum
b. substantia nigra
c. pallidum
d. putamen
e. amygdala
f. claustrum
b
68. All of the following may result from damage to the thalamus EXCEPT:
a. dementia
b. epileptic seizures
c. thalamic hand
d. hyperkinesis
e. pain
f. apathy
b
69. Which of the following IS NOT a part of cerebellum?
a. declive
b. folium
c. operculum
d. uvula
e. flocculus
c
70. All of the following nuclei are located in the cerebellum EXCEPT:
a. dentate nucleus
b. emboliform nucleus
c. nucleus fastigii
d. nucleus ambiguus
e. globose nucleus
d
71. Cerebellum receives inputs from all of the following EXCEPT:
a. oliva inferior
b. vestibular nuclei
c. cerebral cortex
d. Goll, Burdach nuclei
e. nucleus rubber
e
72. The most important efferent projection of the cerebellum is to the:
a. red nucleus
b. corpus subthalamicum
c. caudatum
d. striatum
e. thalamus
f. frontal lobe
a
73. Muscle tonus results from cerebellar disease
a. hypertonic
b. hypotonic
c. distonic
b
74. Which of the following speech disturbance would be expected in a damage to the
cerebellum:
a. dysarthria
b. scanning speech
c. aphasia
d. monotone speech
b
75. What causes intention tremor?
a. a damage to the cerebellum
b. a lesion within the extrapyramidal system
c. anxiety
d. muscle weakness
a
76. Which of the following DOES NOT result from a lesion of the cerebellum?
a. dysdiadochokinesis
b. muscle hypotonia
c. dysmetria
d. tremor at rest
e. intention tremor
f. trunk ataxia
d
77. Which of the following CANNOT be expected in a damage to the cerebellum?
a. muscle hypotonia
b. dysdiadochokinesis
c. nystagmus
d. agraphia
e. intention tremor
d
78. Which of the following IS NOT a clinical symptom of cerebellar damage?
a. intention tremor
b. scanning speech
c. aphasia
d. dysmetria
c
79. The capsulae internae include the following parts:
a. the anterior limb
b. the posterior limb
c. the genu capsulae internae
d. the body capsulae internae
a, b, c
80. All of the following results from a damage to the frontal lobe EXCEPT:
a. upper motor neuron lesion
b. expressive aphasia
c. receptive aphasia
d. disturbance of initiative and judgment
e. gaze paralyis
f. frontal release signs
c
81. Damage to the right frontal eye field results in which of the following:
a. the patient cannot look upward
b. the patient cannot voluntarily look to the right
c. both eyes are deviated to the left at rest
d. both eyes are deviated to the right at rest
e. double vision occurs
f. none of the above
d
82. A lesion of the right frontal lobe will result in all of the following EXCEPT:
a. left sided hemiparesis
b. signs of central palsy on the left side
c. gaze paralysis to the right
d. eyes will look away from the paralyzed left limbs
e. gaze paralysis to the left
f. adversion of the head to the right
c
83. A lesion to the following structures results in hemiparesis EXCEPT:
a. frontal lobe
b. parietal lobe
c. internal capsule
d. cervical spinal cord
e. precentral gyrus
b
84. Disturbances of body schema include all EXCEPT:
a. astereognosia
b. hemineglect
c. anosognosia
d. autotopagnosia
e. finger agnosia
a
85. Damage to paracentral lobulus may cause:
a. hemihypaesthesia
b. polydipsia
c. retentio urinae
d. impotentia generandi
e. ipsilateral hemiparesis
f. contralateral quadrantanopsia
c
86. Damage to the temporal lobe would result in EXCEPT:
a. psychomotor seizures
b. contralateral upper quadrant anopia
c. uncinate fits
d. anomic aphasia
e. Wernicke aphasia
d
87. Signs of sensory (Wernicke’s aphasia) are (more than one answer is suggested)
a. non-fluent, hesitant speech
b. speech nonsensical but fluent
c. nonexistent words
d. good comprehension
b, c
88. Astereognosis results from a damage to which lobe?
a. frontal
b. temporal
c. parietal
d. occipital
c
89. Which statement IS NOT true regarding anosognosia?
a. it was first described by the French neurologist Babinski in 1914
b. it results from a damage within the dominant hemisphere
c. it results from a damage within the subdominant hemisphere
d. it usually occurs among people who have suffered a stroke
e. the patients insist that their paralyzed limbs are functioning normally
f. it belongs to the neglect syndromes
b
90. CSF is produced by which of the following structures:
a. choroid plexus
b. Pacchioni granulation
c. astrocytes
d. oligodendroglia
e. microglia
f. pineal gland
a
91. The greatest amount CSF is produced in the:
a. spinal subarachnoid space
b. lateral ventricles
c. cisterns of the cerebrum
d. fourth ventricle
b
92. Indications for lumbar puncture include all EXCEPT
a. to get CSF sample
b. to inject air
c. to reduce ICT
d. to give drugs
c
93. Contraindications for lumbar puncture include EXCEPT:
a. papilledema
b. papillitis
c. skin infection near the puncture site
d. severe bleeding disorders
e. suspicion of increased intracranial pressure
f. acute spinal cord trauma
b
94. CSF (lumbar) normal findings (more than one answer is suggested):
a. clear
b. no red blood cell
c. 0-10 neutrophils
d. protein content: 0.15-0.45 g/L
e. glucose: 60-70% of plasma levels
a, b, c
95. Under normal condition, lumbar puncture usually reveals a CSF pressure of:
a. 120-180 mm of water
b. 0 mm of water
c. 300-600 mm of water
d. 10-20 mm of water
e. 200-300 mm of water
a
96. Cell count in CSF under normal condition on lumbar puncture:
a. 20-30/3
b. 30-40/3
c. 40-50/3
d. 8-10/3
d
97. Elevated CSF protein content can be found in all of the following EXCEPT:
a. polyneuropathy
b. cerebral tumors
c. tumors of the spinal cord
d. radiculopathies
e. meningitis
f. toxic encephalopathy
a
98. The contrast medium used in MRI is
a. TDA
b. Gd-DTPA
c. renograffin
d. myodil
b
99. Posterior cranial fossa is best visualized by
a. CT
b. MRI
c. PET scan
d. tomography
b
100. Which IS NOT TRUE of MRI?
a. low radiation exposure
b. no bone interference
c. delineates grey and white matter
d. visualizes spinal cord
a
101. Which one of the following delineates viable from nonviable tissue?
a. digital angiographv
b. PET scan
c. contrast CT
d. MRI
b
102. All of the following may be detected on CT scans EXCEPT:
a. cerebral ischemia within the first 6 hours
b. hydrocephalus
c. abscess
d. parenchymal hemorrhage
e. subarachnoid hemorrhage
f. old infarct
a
103. The risks of angiography include EXCEPT:
a. thromboembolic occlusion of the vessels investigated
b. bleeding at the puncture site
c. there are no risks
d. dissection of the vessel wall
e. infection
f. allergic reaction to contrast media
c
104. Following are disadvantages of digital subtraction angiography EXCEPT
a. collateral blood flow not visualized
b. requires low cardiac output
c. large volume of contrast
d. degree of stenosis is uncertain
b
105. Which of the following will confirm the diagnosis of the cerebral neoplasm?
a. CT
b. Visual Evoked Potentials (VEP)
c. myelography
d. electromyography
e. ultrasonography
f. Brainstem Auditory Evoked Response (BAEP)
a
2. Clinical neurology
1. Medulla oblongata are supplied by the (more than one answer is suggested):
a. posterior inferior cerebellar artery
b. anterior inferior cerebellar artery
c. anterior spinal artery
d. posterior cerebral artery
a, b, c
2. Pons is supplied by the:
a. posterior cerebral artery
b. anterior spinal artery
c. posterior choroidal artery
d. basilar artery
d
3. Midbrain is supplied by the:
a. superior cerebellar artery
b. posterior cerebral artery
c. rami interpedunculares
d. posterior choroidal artery
e. all of the above
e
4. Which of the following is a branch of the vertebral artery?
a. posterior cerebral artery
b. superior cerebellar artery
c. posterior inferior cerebellar artery
d. anterior inferior cerebellar artery
e. anterior choroidal artery
f. posterior choroidal artery
c
5. Most common cause of stroke is
a. thrombotic
b. embolic
c. haemorrhagic
d. infective
a
6. Risk factors of ischemic stroke are:
a. hypertension
b. atherosclerosis
c. atrial fibrillation
d. systemic diseases
e. all of the above
e
7. Modifiable risk factors for stroke include EXCEPT:
a. diabetes
b. hypothyreosis
c. hypertension
d. smoking
e. asymptomatic carotid stenosis
f. atrial fibrillation
b
8. Which IS NOT a feature of temporal arteritis?
a. Leukocytosis
b. Steroids do not prevent blindness
c. Thrombosed temporal artery
d. Severe headache
b
9. Risk factors for intracranial hemorrhage are (more than one answer is suggested):
a. hypertension
b. arterial-venous malformations
c. stenosis of intracranial arteries
d. systemic diseases
a, b, d
10. Which of the following DOES NOT cause an increase in cerebral blood flow under
normal condition?
a. an increase in blood pressure
b. an elevation of PaCO2
c. a decrease of PaO2
d. a release of EDRF (endothelium derived relaxing factor)
e. a release of acetylcholine
f. a release of adenosine
a
11. Which of the following statements are true concerning “ischemic penumbra” (more
than one answer is suggested)?
a. it occurs in the area surrounding the ischemic core
b. in the area of penumbra, the nerve cells undergo necrosis
c. it is a term which refers to the reversible loss of neuronal cell function related to cerebral
hypoperfusion
d. after restoration of circulations, the cells DOES NOT regain their functionality
a, c
12. What is the role of glutamate in cerebral infarction?
a. it protects the neurons
b. it protects the glial cells
c. it increases calcium influx
d. it induces membrane hyperpolarization
e. it prevents the formation of edema
f. it prevents lactic acidosis
c
13. Infarcted area in the brain is replaced by
a. astroglia
b. fibrosis
c. neurons
d. vascular endothelium
a
14. The neurological deficit in transient ischemic attack DOES NOT last beyond
a. 1 hour
b. 6 hours
c. 12 hours
d. 24 hours
d
15. Convulsions in an individual above 50 years is most likely due to
a. meningitis
b. tumors
c. stroke
d. trauma
c
16. Most common site of cerebral hemorrhage is
a. cortex
b. putamen
c. thalamus
d. pons
b
17. Clinical signs of intracranial hemorrhage are:
a. rapid onset of headache, seizures, nausea, vomiting, disturbed consciousness with focal and
meningeal symptoms
b. sensory disorders in the distribution of nerve roots
c. gradual development of symptoms
d. preceding transient symptoms
a
18. Which IS NOT a feature of hypertensive cerebral hemorrhage?
a. occurs when patient is awake
b. deep coma
c. rebleeding is common
d. evolves over minutes
c
19. Which IS NOT a feature of pontine hemorrhage?
a. hypertension
b. hyperpnea
c. hyperhidrosis
d. flaccidity
d
20. Thrombotic cerebrovascular disease most commonly affects
a. anterior cerebral artery
b. middle cerebral artery
c. posterior cerebral artery
d. basilar artery
b
21. The facial nerve may be involved in all of the following disorders EXCEPT:
a. Bell's palsy
b. Weber syndrome
c. Ramsay-Hunt syndrome
d. Melkersson-Rosenthal syndrome
e. Foville syndrome
f. Millard-Gubler syndrome
b
22. Signs of ischemic stroke of non-embolic origin are (more than one answer is suggested):
a. acute onset
b. gradual development of symptoms
c. onset of symptoms in the morning
d. onset after physical exertion
b, c
23. Clinical signs of the anterior cerebral artery occlusion are:
a. Wallenberg alternating syndrome
b. thalamic syndrome
c. bulbar syndrome
d. spastic palsy of leg
d
24. Clinical signs of the medial cerebral artery occlusion are:
a. Wallenberg alternating syndrome
b. motor (Broca’s) aphasia, hemiplegia, hemihypesthesia)
c. bulbar syndrome
d. ataxia, decreased muscle tone, nystagmus
b
25. Clinical signs of the posterior cerebral artery occlusion are:
a. Wallenberg alternating syndrome
b. motor (Broca’s aphasia, hemiplegia, hemihypesthesia)
c. bulbar syndrome
d. homonymous hemianopia, visual agnosia
d
26. The signs and symptoms of vertebrobasilar stroke may include:
a. dizziness
b. numbness around the mouth
c. drop attacks
d. unsteadiness
e. all of the above
e
27. Bilateral pyramidal signs is suggestive of
a. anterior cerebral artery
b. middle cerebral artery
c. posterior cerebral artery
d. anterior choroidal artery
a
28. Sudden weakness of one leg may results from the occlusion of the:
a. contralateral anterior cerebral artery
b. ipsilateral anterior cerebral artery
c. contralateral middle cerebral artery
d. ipsilateral middle cerebral artery
e. contralateral posterior cerebral artery
f. ipsilateral posterior cerebral artery
a
29. Transient uniocular blindness indicates occlusion of
a. internal carotid artery
b. external carotid artery
c. posterior cerebral artery
d. any of the above
a
30. Hemiparesis with aphasia suggests a lesion in
a. anterior cerebral artery
b. middle cerebral artery
c. posterior cerebral artery
d. posterior cerebellar artery
b
31. All of the following are referred to as early ischemic signs on CT scans EXCEPT:
a. hypodensity
b. hyperdense MCA sign
c. loss of gray-white matter differentiation
d. sulcal asymmetry
e. obscuration of the lentiform nucleus
f. insular ribbon sign
a
32. Most common cause of subarachnoid hemorrhage is
a. hypertension
b. berry aneurysm rupture
c. arterioveous malformations
d. trauma
b
33. Indicate investigations required for subarachnoid hemorrhage diagnosis (more than
one answer is suggested):
a. CT of the scull
b. EEG
c. spinal tap
d. electromyogram
a, c
34. Subarachnoid hemorrhage may bring about the following symptoms:
a. headache, dizziness
b. impaired consciousness
c. meningeal signs
d. blood in CSF
a, b, c, d
35. Which IS NOT a feature of subarachnoid hemorrhage?
a. sudden severe headache
b. unconsciousness
c. vomiting
d. focal neurological deficit
d
36. Following are complications of subarachnoid hemorrhage EXCEPT
a. sudden severe headache
b. duodenal ulcer
c. pulmonary embolism
d. cardiac arrhythmias
a
37. The most common complications of subarachnoid hemorrhage are (more than one
answer is suggested):
a. vasospasm
b. rebleeding
c. hydrocephalus
d. meningitis
a, b, c
38. Which structures are affected in multiple sclerosis?
a. optic nerves and pyramid pathways
b. optic nerves and posterior funiculi
c. pyramid and spino-thalamic pathways
d. basal ganglia
a
39. Plaques in multiple sclerosis are most numerous in
a. cerebellum
b. hippocampus
c. paraventricular area
d. motor cortex
c
40. Most common early symptom of multiple sclerosis is
a. loss of vision
b. ataxia
c. paresthesia
d. motor weakness
a
41. Which IS NOT a common feature of multiple sclerosis?
a. age of onset 10 years
b. waxing and waning signs
c. oligoclonal bands in CSF
d. more common in females
a
42. The most characteristic changes on the eye fundus in multiple sclerorsis is:
a. disc edema
b. venous hyperemia
c. arterial spasm
d. pale temporal portions of the discs
d
43. Which of the following drugs are used for treatment of multiple sclerosis (more than
one answer is suggested)?
a. Interferon Beta-1b (Betaseron)
b. Pramipexole (Mirapex)
c. Glatiramer Acetate (Copaxone)
d. Ticlopidine hydrochloride (Ticlid)
a, c
44. Hungington's chorea is characterized by:
a. choreoid hyperkynesis
b. increasing muscle rigidity
c. dementia
d. all of the above
d
45. Hungington's chorea is characterized by degeneration of
a. caudate nucelus
b. putamen
c. globuspallidus
d. amygdala
a
46 Huntington's chorea is inherited as
a. autosomal dominant
b. autosomal recessive
c. x-linked
d. polygenic
a
47. Which of the following poisonings leads to Parkinsonism?
a. arsenic
b. lead
c. carbon monoxide
d. phosgene
c
48. Neurotransmitter changes in basal ganglia in Parkinson disease:
a. dopamine decrease
b. acetylcholine increase
c. noradrenaline decrease
d. all of the above
d
49. Symptoms of Parkinson’s disease are (more than one answer is suggested):
a. expressionless face
b. decrease of muscle tone
c. cogwheel-like muscle rigidity
d. bradykinesia
a, c, d
50. Parkinson's disease is characterized by all EXCEPT
a. dementia
b. exaggerated deep reflexes
c. rigidity
d. resting tremors
b
51. The frequency of tremors in Parkinsonism is
a. 2 / second
b. 4 / second
c. 8 / second
d. 14 / second
b
52. Punch Drunk syndrome refers to Parkinsonism in
a. chonic alcoholics
b. drug addicts
c. boxers
d. coal miners
c
53. Which of the following drugs IS NOT used for the treatment of Parkinson disease?
a. levodopa
b. pramipexole
c. ethosuximide
d. ropinirole
e. pergolide
f. bromocriptine
c
54. The feature of Parkinsonism best corrected by levodopa is
a. tremors
b. akinesia
c. rigidity
d. dementia
b
55. Amantadine acts by
a. releasing dopamine
b. increasing receptors
c. direct stimulation
d. all of the above
a
56. The muscles most commonly involved in myasthenia gravis are
a. ocular muscles
b. diaphragm
c. intrinsic muscles of hand
d. pelvic muscles
a
57. Indicate investigations used in myasthenia diagnosis (more than one answer is
suggested):
a. muscle biopsy
b. ECG
c. test with proserine
d. CT of the scull
e. electromyogram
a, c, e
58. Drug that may exacerbate weakness in myasthenia gravis are (more than one answer is
suggested):
a. beta blockers
b. aminoglycosides
c. procainamide hydrochloride
d. dopamine agonists
a, b, c
59. Which of the followings are characteristic of the myasthenic crisis (more than one
answer is suggested)?
a. miosis
b. mydriasis
c. bradycardia
d. tachycardia
b, d
60. Which of the following is recommended for the treatment of the cholinergic crisis?
a. neostigmine methylsulfate
b. pyridostigmine bromide
c. edrophonium chloride
d. atropine
d
61. Which IS NOT TRUE of Eaton-Lambert myasthenic syndrome?
a. mostly found with bronchogenic carcinoma
b. ocular muscles weak
c. Normal acetylcholine (Ach) receptors
d. autonomic dysfunction
b
62. Treatment of Eaton-Lambert syndrome is with
a. atropine
b. neostigmine
c. edrophonium
d. guanidine
d
63. Which of the following statements IS NOT true regarding Wilson's disease?
a. copper accumulates in the liver, CNS, and eyes
b. it is an inherited disease
c. an autosomal dominant inheritance is characteristic
d. the serum copper level is elevated
e. in most of the cases Kayser-Fleischer ring is present
f. the serum ceruloplasmin level is low
c
64. Treatment of Wilson disease (more than one answer is suggested):
a. use of D-Penicillinamin
b. low-copper diet
c. use of zinc acetate
d. copper-rich diet
a, b, c
65. Indicate the structures involved in syringomyelia:
a. cauda equina
b. posterior horn
c. medulla
d. posterior root
b, c
66. Symptoms of syringomyelia include (more than one answer is suggested):
a. dissotiated sensory loss in the trunk
b. flaccid palsy of arms
c. spastic palsy of legs
d. choreoid hyperkinesis
a, b, c
67. Which IS NOT a feature of syringomyelia?
a. wasting of muscles
b. loss of vibration sense
c. kyphoscoliosis
d. charcot joints
b
68. The investigation of choice in syringomyelia is
a. CT scan
b. MRI
c. myelography
d. pneumomyelogram
b
69. Bulbar syndrome is seen in following diseases (more than one answer is suggested):
a. lateral amyotrophic sclerosis
b. myasthenia
c. diphteria
d. occlusion of internal carotid artery
a, b, c
70. Clinical features of amyotrophic lateral sclerosis are the following (more than one
answer is suggested):
a. atrophies and fasciculation in the muscles of the limbs
b. exaggeration of muscle stretch reflexes
c. bulbar signs
d. aphasia
a, b, c
71. Pathological hallmarks of Alzheimer's diseases include all of the following EXCEPT:
a. amyloid deposition in neuritic plaques
b. parieto-temporal atrophy
c. Lewy body
d. neurofibrillary tangles
e. senile plaques
f. neuronal loss
c
72. The basic deficiency in Alzheimer's disease is of
a. GABA
b. dopamine
c. acetylcholine
d. glutamine
c
73. Which of the following diseases are muscular in origin (more than one answer is
suggested)?
a. progressive muscular dystrophy
b. Werdnig-Hoffmann disease
c. myotonia congenita
d. amyotrophic lateral sclerosis
a, c
74. Common signs of myotonic dystrophy are:
a. alopecia
b. weakness and wasting in the distal limb muscles
c. cataracts
d. testicular atrophy
e. all of the above
e
75. Intake of which drug by the mother leads to spina bifida in infant
a. tetracycline
b. ethambutol
c. cyclophosphamide
d. sodium valproate
d
76. Which IS NOT TRUE of neurofibromatosis?
a. autosomal recessive
b. Schwann cell neoplasms
c. 10% malignant transformation
d. axillary freckles
a
77. Adenoma sebaceum in tuberous sclerosis are
a. Uncommon over the face
b. Fibromas
c. Benign sweat gland tumors
d. Premalignant
b
78. Railroad track pattern of calcification of skull X-ray is seen in
a. tuberous sclerosis
b. ataxia telangiectasia
c. Sturge-Weber disease
d. neurofibromatosis
c
79. Which IS NOT TRUE of Freidrich's ataxia?
a. recessive inheritance
b. scanning speech
c. absent tendon reflexes
d. Babinski sign –ve
d
80. Phakomatoses include (more than one answer is suggested):
a. Arnold-Chiari malformation
b. sclerosis tuberosa
c. Dandy-Walker syndrome
d. neurofibromatosis generalisata
b, d
81. The most common type of epilepsy is
a. petit mal
b. grand mal
c. infantile spasms
d. atypical absence
b
82. Which IS NOT a usual preparation for EEG?
a. adequate rest
b. no sedation
c. nothing taken orally for 12 hours
d. defer antiepileptics
c
83. Normal EEG with eyes closed has a predominance of
a. alpha waves
b. beta waves
c. theta waves
d. k waves
a
84. Flat isoelectric EEG is suggestive of
a. barbiturate poisoning
b. severe hypothermia
c. brain death
d. all of the above
d
85. Antiepileptic therapy can be stopped as per following criteria EXCEPT
a. presence of abnormal EEG
b. normal neurologic examination
c. 2 years seizure free interval
d. combination drug therapy on
d
86. The drug which is effective in both Petit mal and Grand mal epilepsy is
a. phenytoin
b. sodium valproate
c. clonazepam
d. primidone
b
87. Teratogenic antiepileptic drug is
a. phenytoin
b. diazepam
c. phenobarbital
d. carbamazepine
a
88. Drug of choice in febrile convulsions is
a. diazepam
b. phenobarbital
c. carbamazepine
d. phenytoin
b
89. Carpal tunnel syndrome is seen in
a. acromegaly
b. myxedema
c. diabetes mellitus
d. all of the above
d
90. Which of the following are the signs of an injury to the common peroneal nerve (more
than one answer is suggested):
a. inability to evert foot
b. loss of plantar flexion
c. loss of sensation on dorsum of foot and lateral aspect of leg
d. loss of sensation on sole of foot
a, c
91. Damage of which nerve results in clawhand, inability to flex 4 and 5 fingers, sensory
loss over the ulnar side of the hand and 4 and 5 fingers, mild trophic changes?
a. radial
b. ulnar
c. axillar
d. median
b
92. Damage of which nerve leads to ape hand appearance, inability to grip hand, flex 1 and
2 finger and appose the thumb, sensory loss over the radial portion of the hand, index and
middle fingers, wasting of thenar muscles, trophic changes and pain?
a. radial
b. ulnar
c. axillar
d. median
d
93. Damage of which nerve results in wrist drop with flexed fingers, sensory loss on dorsum
of the hand and forearm
a. radial
b. ulnar
c. axillar
d. median
a
94. Damage of which nerve leads to weakness of plantar flexion and invertion of the foot,
inability to stand on toes, sensory loss over the sole, loss of ankle jerk?
a. tibial
b. common peroneal
c. femoral
d. sciatic
a
95. Damage of which nerve results in weakness of dorsiflexion and eversion of the foot,
walking with “foot drop”, sensory loss over the dorsum and outer aspect of the foot?
a. tibial
b. common peroneal
c. femoral
d. sciatic
b
96. Peripheral neuritis is seen with deficiency of
a. pyridoxine
b. thiamine
c. pantothenic acid
d. all of the above
d
97. Bell’s palsy syndrome includes (more than one answer is suggested):
a. sensory loss in the half of the face
b. weakness of mimic muscles in the half of the face
c. increased or decreased lacrimation
d. diplopia
b, c
98. Treatment of Bell’s palsy include:
a. diuretics, steroids, physical methods of treatment, acupuncture
b. carbamazepin, muscle relaxants (Baklofen, Sirdalud), surgical treatment
c. antibacterial treatment, analgetics, massage
d. ergotamine, caffeine, analgetics, vasodilating drugs, acupuncture
a
99. Complications of Bells’s palsy are:
a. facial pain
b. secondary contracture of mimic muscles
c. facial hemispasm
d. facial hemiatrophy
e. deafness
b
100. Trigeminal nerve consists of the following types of nerve fibers:
a. motor and sensory fibers
b. only sensory fibers
c. motor and vegetative (autonomic) fibers
d. motor, sensory and vegetative (autonomic) fibers
d
101. Symptoms of trigeminal neuralgia are (more than one answer is suggested):
a. sharp, shooting pain
b. Bell’s phenomenon
c. presence of trigger spots
d. loss of jaw reflex
a, c
102. Drug of choice in trigeminal neuralgia is
a. phenytom
b. carbamazepine
c. piroxicam
d. phenothiazine
b
103. Upper orbital fissure syndrome includes (more than one answer is suggested):
a. total ophtalmoplegia with midriasis
b. ptosis
c. sensory loss in the area supplied by ophthalmic branch of trigeminal nerve
d. convergent squint
a, b, c
104. Signs of polyneuropathy are (more than one answer is suggested):
a. paresis in hands and feet
b. sensory impairment in distal parts of limbs
c. Babinski sign
d. trophic changes in distal parts of limbs
a, b, d
105. The most prominent sign of Guillain-Barre syndrome is:
a. areflexia
b. imbalance
c. disorientation
d. central palsy of legs
a
106. Following are features of small fibre neuropathy EXCEPT
a. dysesthesia
b. loss of pin prick sensation
c. loss of tendon jerks
d. autonomic dysfunction
c
107. Which of the following IS NOT used for the treatment of painful polyneuropathy?
a. NSAIDs
b. tricyclic antidepressants
c. carbamazepine
d. dopamine
d
108. The majority of intervertebral disk herniations occur between (more than one answer
is suggested):
a. L4-L5
b. C5-C6
c. L5-S1
d. C6-C7
a, c
109. Sign of lumbar disc herniation is:
a. scalenus syndrome
b. torticollis
c. tunnel syndrome
d. prolonged root irritation syndrome
d
110. Cervical cord compression due to spondylosis most often occurs at the level of
a. C3,4
b. C4,5
c. C5,6
d. C6,7
c
111. Which IS NOT a feature of cord compression due to cervical spondylosis?
a. loss of vibration sense
b. pain on coughing
c. urinary incontinence
d. paresthesias in feet
c
112. Nuchal rigidity (meningismus) can be found in all of the following EXCEPT:
a. bacterial meningitis
b. multiple sclerosis
c. subarachnoid hemorrhage
d. raised intracranial pressure
e. exsiccosis
f. viral meningitis
b
113. Most common cause of meningitis in children is
a. Pneumococcus
b. H. influenzae
c. Meningococcus
d. E. coli
b
114. Most common cause of meningitis in the audit is
a. Pneumococcus
b. H. influenzae
c. Meningococcus
d. E. coli
a
115. Most common route of infection of meninges is through
a. olfactory nerve
b. otogenic route
c. haematogenous
d. direct spread
c
116. Meningitis associated with petechiae and large ecchymosis is seen with
a. H. influenzae
b. Streptococci
c. ECHO viruses
d. all of the above
d
117. Pneumococcal meningitis is common in
a. alcoholism
b. sickle cell anemia
c. basal cell fracture
d. all of the above
d
118. CSF glucose is reduced in
a. pyogenic meningitis
b. TB meningitis
c. sarcoidosis
d. all of the above
d
119. Persistent elevation of intracranial pressure in an infant with meningitis, despite
antibiotic treatment is due to
a. subdural effusion
b. communicating hydrocephalus
c. arachnoiditis
d. all of the above
d
120. CSF in bacterial meningitis is:
a. transparent
b. xantochromic
c. with PMN leucocytes increased
d. with lymphocytes increased
c
121. Features of tuberculous meningitis are (more than one answer is suggested):
a. involvement of convexital meninges
b. involvement of basal meninges
c. increased lymphocytes in CSF
d. increased PMN leucocytes in CSF
b, d
122. Serous meningitis with reduced CSF sugar is seen with
a. rubella
b. tuberculosis
c. AIDS
d. Coxsackie virus
b
123. Which of the following are serous meningitis (more than one answer is suggested)?
a. tuberculous
b. fungal
c. meningococcal
d. pneumococcal
a, b
124. Polymorphonuclear leukocytosis in the CSF may be a feature of:
a. meningococcal meningitis
b. tuberculotic meningitis
c. viral meningitis
d. leptospiral meningitis
e. meningeal carcinomatosis
a
125. The most common signs of encephalitis include (more than one answer is suggested):
a. altered consciousness
b. taste disturbance
c. epileptic seizures
d. peripheral paresis
a, c
126. Acute cerebellar ataxia in common viral encephalitis due to
a. varicella virus
b. mumps virus
c. rabies virus
d. polio virus
a
127. The drug of choice in Herpes simplex encephalitis is
a. idoxiuridine
b. acyclovir
c. vidarabine
d. interferon
b
128. Following are seen in tabes dorsalis EXCEPT
a. ataxia
b. exagerated reflexes
c. romberg's sign
d. absent pupillary light reflex
b
129. Following are seen in tabes dorsalis EXCEPT
a. small muscle weakness
b. muscle bulk normal
c. reflexes preserved
d. painful
a
130. The most common cause of viral myelitis is
a. poliomyelitis
b. herpes zoster
c. herpes simplex
d. CMV
a
131. Which of the following structures are affected in poliomyelitis (more than one answer
is suggested)?
a. posterior horns of the spinal cord
b. motoneurons of the ventral horns in the spinal cord
c. pontine tegmentum
d. nuclei of the caudal cranial nerves
b, d
132. Human immunodeficiency virus infection may be associated with all EXCEPT:
a. vacuolar myelopathy
b. meningioma
c. lymphoma
d. cryptococcal meningitis
b
133. Neurological complications of AIDS include:
a. opportunistic infections
b. dementia
c. malignant intracranial tumors
d. peripheral neuropathy
e. all of the above
e
134. Which IS NOT a clinical symptom of the Jakob-Creutzfeldt disease?
a. myoclonus
b. dementia
c. hyperkinesis
d. epileptic seizures
e. ataxia
f. pyramidal signs (i. e., signs of central palsy)
d
135. Fasciculations in muscle is seen in all EXCEPT
a. amyoitrophic lateral sclerosis
b. normal persons
c. spinal muscular atrophy
d. myotonic dystrophy
d
136. Criteria for brain death include:
a. the limbs are flaccid
b. no eye movement can be elicited by the oculocephalic reflex and caloric stimulation
c. pupillary reflexes are absent
d. the corneal and gag reflexes are absent
e. the apnea test does not induce respiration
f. all the above
c
137. Which of the following IS NOT a usual sign of the normal pressure hydrocephalus?
a. dementia
b. remarkable protein elevation in the CSF
c. gait instability
d. urinary incontinence
e. enlarged ventricular system
b
138. Which IS NOT a feature of normal pressure hydrocephalus?
a. ataxia
b. hyperreflexia
c. aphasia
d. urinary incontinence
c
139. Causes of hydrocephalus may include:
a. excessive secretion of CSF
b. blockage to CSF circulation
c. Dandy Walker syndrome
d. posterior fossa tumors
e. all of the above
e
140. All of the following are indicative to tension headache EXCEPT:
a. it is often associated with visual symptoms (e. g. scotoma, loss of visual fields)
b. pain around the head
c. the scalp is tender
d. occipital headache
e. the neck muscle are tender
a
141. Characteristics of migraine include EXCEPT:
a. attacks last in average 12-48 hours
b. sensitivity to light and sounds
c. the erythrocyte sedimentation rate is usually elevated
d. throbbing or pulsating quality
e. the pain worsens with routine activity
f. unilateral head pain
c
142. The first choice for preventive therapy of migraine are:
a. dopamine agonists
b. benzodiazepines
c. GABA antagonists
d. selectice serotonine reuptake inhibitors
e. beta blockers
f. triptans
e
143. Ptosis is a common sign of:
a. Horner syndrome
b. sinus cavernous thrombosis
c. myasthenia gravis
d. tegmental lesion of the midbrain
e. all answers are correct
e
144. Vertigo is a sign of (more than one answer is suggested):
a. Méniere syndrome
b. Foster-Kennedy syndrome
c. cerebellar infarct of neoplasm
d. central pontine myelinolysis
a, c
145. Epileptic seizure often associates with (more than one answer is suggested):
a. intracranial tumors
b. chronic alcoholism
c. head injury
d. multiple sclerosis
a, b, c
146. Plasmapheresis is accepted for the treatment of (more than one answer is suggested):
a. myasthenia gravis
b. polymyositis
c. Guillain-Barré syndrome
d. Foster-Kennedy syndrome
a, b, c
147. Cerebral edema may be associated with (more than one answer is suggested):
a. brain abscess
b. leukodystrophy
c. glioblastoma multiforme
d. Huntington disease
a, c
148. Local injections of botulinum toxin are effective in the treatment of (more than one
answer is suggested):
a. athetosis
b. blepharospasm
c. chorea
d. spasmodic torticollis
b, d
149. Case. A 70-year-old man has a 2 day history of worsening generalized headache and
increasing obtundation. He now complains of stiffness in his neck. On physical examination vital
signs include T 38.7oC, pulse 85/minute, respirations 23/minute, and blood pressure 130/85 mm
Hg. A CBC reveals a WBC count of 16, 850109/liter. Serum electrolytes include a sodium of
145 mmol/L, potassium 4.3 mmol/L, chloride 103 mmol/L, CO2 26 mmol/L, urea nitrogen 2.98
mmol/L, and glucose 4.8 mmol/L. A lumbar puncture yields cloudy cerebrospinal fluid with a
glucose of 1.77 mmol/L, protein 1,46 g/L, and cell count of 3800 WBCs (95% PMNs and 5 %
mononuclears) and 122 RBCs. He receives antibiotic therapy and improves. Which is the
probable diagnosis of the patient?
a. cerebral infarction
b. cerebral hemorrhage
c. acute demielinating radiculopathy
d. encephalitis
e. meningitis
e
150. Case. A 50-year-old African-American man has had headaches for the past month. On
physical examination his blood pressure is 182/108 mm Hg. He refuses to take any medications.
He is admitted to the hospital after suddenly losing consciousness 2 months later. When he is
aroused, he cannot speak and he cannot move his right arm or his right leg. Which of the
following intracranial pathologic abnormalities is most likely to be present?
a. middle cerebral artery embolus
b. subfrontal meningioma
c. cerebral venous thrombosis
d. central pontine myelinolysis
e. hemorrhage into the putamen
e
151. Case. A previously healthy 31-year-old woman experiences a severe headache and loses
consciousness within an hour. She is taken to the hospital where an emergent head CT scan
reveals extensive subarachnoid hemorrhage at the base of the brain. She is afebrile. A lumbar
puncture yields cerebrospinal fluid with many red blood cells, but no white blood cells. The CSF
protein is slightly increased, but the glucose is normal. Which of the following is the most likely
diagnosis?
a. acute bacterial meningitis
b. ruptured berry aneurysm
c. progressive multifocal leukoencephalitis
d. Tay-Sachs disease
e. Parkinson disease
b
152. Case. A 66-year-old man is finding that he has more difficulty moving about for the past
year. He is annoyed by a tremor in his hands, but the tremor goes away when he performs
routine tasks using his hands. His friends remark that he seems more sullen and doesn't smile at
them, but only stares with a fixed expression on his face. He has not suffered any loss of mental
ability. Which of the following diseases is he most likely to have?
a. amyotrophic lateral sclerosis (ALS)
b. Alzheimer disease
c. Parkinson disease
d. Niemann-Pick disease
e. tuberous sclerosis
c
153. Case. A 26-year-old previously healthy woman has the sudden onset of mental confusion.
She has a seizure and is brought to the hospital. Her vital signs show temperature 37 C, pulse
89/minute, respirations 22/minute, and blood pressure 100/60 mm Hg. A lumbar puncture
reveals a normal opening pressure, and clear, colorless cerebrospinal fluid is obtained with 1
RBC and 20 WBC's (all lymphocytes), with normal glucose and protein. An MRI scan of the
brain reveals swelling of the right temporal lobe with hemorrhagic areas. Which of the following
infectious agents is the most likely cause for these findings?
a. Herpes simplex virus
b. Influenza virus
c. Mycobacterium tuberculosis
d. Hemophilus influenzae
e. Neisseria meningitides
a
154. Case. A previously healthy 42-year-old former soccer player developed progressive,
symmetric muscular weakness of his upper extremities over the course of 3 years. Then he
developed difficulty speaking and swallowing. He did not have myalgias or arthralgias. He
remained afebrile. His mental function never became diminished. Which of the following is the
most likely diagnosis?
a. amyotrophic lateral sclerosis
b. von Recklinghausen disease
c. multiple sclerosis
d. Werdnig-Hoffman disease
e. Guillain-Barre syndrome
a
155. Case. A 77-year-old man has had a step-wise loss of mental function for the past 8 years,
but his condition has remained stable for the past year. He can no longer care for himself. On
physical examination he has decreased motor strength in his right upper extremity. He is able to
ambulate and his gait is normal. He cannot remember any of 3 objects after 3 minutes. A chest xray shows cardiomegaly. Which of the following is the most likely diagnosis?
a. Alzheimer disease
b. diffuse Lewy body disease
c. Huntington disease
d. Parkinson disease
e .vascular dementia
e
156. Case. A 50-year-old woman suddenly lost consciousness. On examination in the emergency
department, her temperature is 37 C, pulse 79/minute, respirations 18/minute, and blood pressure
160/95 mm Hg. A head CT scan shows a 4 cm area of bright attenuation in the left basal ganglia
region. There is effacement of the lateral ventricles and a shift of the midline to the right.
Through which of hte following mechanisms is death in the patient most likely to occur?
a. cerebellar tonsillar herniation
b. intraventricular hemorrhage
c. widespread metastases
d. septicemia
e. extensive watershed infarction
a
157. Case. A 53-year-old woman has had transient ischemic attacks (TIAs) for 3 years. She then
has the sudden onset of a left hemiparesis. Four months later, an MRI scan of the brain shows a 4
cm diameter cystic area in the right frontal-parietal region. Which of the following underlying
conditions is she most likely to have?
a. occlusive coronary atherosclerosis
b. chronic meningitis
c. alzheimer disease
d. glioblastoma multiforme
e. cerebral arterial vasculitis
a
158. Case. A 54-year-old woman has noted changes in sensation in her legs for the past 5
months. On physical examination she has a distal, symmetric, primarily sensory polyneuropathy.
She also has a non-healing ulceration on the ball of her left foot. She had a myocardial infarction
last year but recovered and is doing well following angioplasty. Which of the following
laboratory test findings would you most likely expect to be present in this woman?
a. increased CSF protein
b. positive Herpes simplex virus serology
c. chromosome analysis with a 47, xx, +21 karyotype
d. increased serum glucose
d
159. Case. A 53-year-old previously healthy man has had a rapid decline in mental function over
the past 4 months. On physical examination he exhibits profound dementia along with
myoclonus. He is afebrile. A cerebral electroencephalogram shows periodic biphasic
synchronous sharp-wave complexes that are superimposed upon a slow background rhythm. He
dies from bronchopneumonia. At autopsy, his brain appears grossly normal, but a spongiform
encephalopathy is seen microscopically in a section of the cerebral cortex (which was put in
concentrated formic acid for 1 hour prior to processing). Which of the following is the most
likely diagnosis?
a. Alzheimer disease
b. Creutzfeldt-Jakob disease
c. HIV encephalopathy
d. herpes viral encephalitis
e. lead poisoning
g. progressive multifocal leukoencephalopathy
h. rabies
b
160. Case. A 36-year-old man notices loss of sensation at the site of a mongoose bite he incurred
6 weeks ago while out working in a field on a trip to a game preserve in Madras. On examination
he is afebrile. Paresthesias are present only at the site of the bite. Over the next 4 days he
develops convulsions, then flaccid paralysis and coma. Which of the following conditions is
most likely to be present in this patient?
a. amyotrophic lateral sclerosis.
b. cryptococcal meningitis
c. rabies
d. abscesses
e. Creutzfeldt-Jakob disease
c
3. Neurosurgery
1. The most important aspect in examination of head injury is
a. verbal response
b. best motor response
c. deep tendon reflexes
d. pupil size
d
2. Most common type of fracture skull is
a. linear
b. basilar
c. compound
d. depressed
a
3. Battle's sign in basal skull fractures refers to
a. mastoid ecchymosis
b. haemotympanum
c. periorbital ecchymosis
d. CSF rhinorrhoea
a
4. Most common cranial nerve palsy in basilar skull fractures is
a. optic nerve
b. olfactory nerve
c. facial nerve
d. auditory nerve
c
5. In CSF rhinorrhoea, CSF is differentiated from mucus by demonstrating
a. cells
b. glucose
c. chloride
d. all of the above
b
6. The most common source of subdural haematoma is
a. venous blood
b. arterial blood
c. capillary ooze
d. rupture of sinus
a
7. Lucid interval is characteristic of which haematoma?
a. acute subdural
b. chronic subdural
c. acute epidural
d. subarachnoid
c
8. Epidural haematomas are usually bounded by:
a. sutures of skull bones
b. brain cortex
c. choroids plexuses
d. septa pellucida
e. falx cerebri
a
9. Recurrent headaches, more often at night, accompanied with nausea and vomiting, are
seen in:
a. stroke
b. trigeminal neuralgia
c. increased intracranial pressure
d. obsessive disorder
c
10. With rise in intracranial pressure there is
a. tachycardia
b. hypertension
c. bradycardia
d. hyperpnea
c
11. Intracranial pressure increases in the following EXCEPT
a. hypoxia
b. hypothermia
c. hypocarbia
d. mechanical ventilation
b
12. Most common brain tumor in childhood is
a. meningioma
b. astrocytoma
c. medulloblastoma
d. primayr lymphoma
c
13. Most common tumor of the spinal cord is
a. meningioma
b. ependymoma
c. schwannoma
d. glioma
c
14. Most common symptom of brain tumor is
a. headache
b. convulsions
c. vomiting
d. blurring of vision
a
15. Primary brain tumor which presents with cerebral hemorrhage is
a. glioblastoma
b. ependymoma
c. choroid plexus papilloma
d. pituitary adenoma
a
16. Most common type of primary brain tumor is
a. glioblastoma
b. grade I astrocytoma
c. meningioma
d. ependymoma
a
17. Which of the following neoplasm is mesenchymal in origin?
a. meningioma
b. astrocytoma
c. oligodendroglioma
d. ependymoma
e. gangliocytoma
f. medulloblastoma
a
18. Incontinence of urine with gait disturbance is suggestive of tumor in
a. frontal lobe
b. parietal lobe
c. occipital lobe
d. temporal lobe
a
19. Following tumors are more dense in CT than brain EXCEPT
a. meningioma
b. melanoma
c. primary lymphoma
d. medulloblastoma
d
20. The tumor with highest likelihood of metastases to brain is
a. lymphoma
b. lung cancer
c. melanoma
d. leukemia
c
21. Fried egg appearance on microscopy is seen in
a. astrocytoma
b. oligodendroglioma
c. ependymoma
d. medulloblastoma
b
22. Most common site of meningiomas is
a. falx cerebri
b. olfactory groove
c. sphenoidal ridge
d. tuberculum sellae
a
23. Choroid plexus papilloma in children occurs most commonly in
a. third ventricle
b. fourth ventricle
c. lateral ventricle
d. cerebellum
c
24. Choroid plexus papilloma most commonly present as
a. communicating hydrocephalus
b. convulsions
c. hemorrhage
d. noncommunicating hydrocephalus
a
25. Lipoma of CNS is most commonly seen in
a. optic nerve
b. corpus callosum
c. thalamus
d. mid brain
b
26. Disappearance of brain tumor with high dose of dexamethasone is seen in
a. lymphoma
b. melanoma
c. meningeal carcinomatosis
d. glioblastoma
a
27. Tumors of the pineal region include:
a. pineoblastoma
b. teratoma
c. germinoma
d. embryonal cell carcinoma
e. all of the above
f. none of the above
e
28. Following drugs are associated with pseudotumor cerebri EXCEPT
a. nalidixic acid
b. nitrofurantoin
c. tetracycline
d. methotrexate
d
29. Which IS NOT TRUE of pseudotumor cerebri?
a. normal CSF pressure
b. papilledema
c. severe headache
d. enlarged blind spot
a
30. Treatment of pseudotumor cerebri is
a. lumbar puncture
b. acetazolamide
c. ventriculo caval shunt
d. dexamethasone
b
31. Most common organism infecting shunts is
a. Staph. epidermidis
b. Proteus mirabilis
c. P. aeruginosa
d. Candida albicans
a
32. Most common cause of meningitis following neurosurgery is
a. E.coli
b. Staph. aureus
c. Proteus
d. Pseudomonas
b
33. Most common cause of subdural abscess is
a. Anaerobic streptococci
b. Aerobic streptococci
c. Staphylococci
d. E. coli
b
34. Which IS NOT a finding in CSF in subdural abscess?
a. raised pressure
b. raised proteins
c. normal sugar
d. culture positive
d
35. Most commonly isolated organisms from brain abscess are
a. Streptococci
b. Memngococci
c. Staph. aureus
d. Pneumococci
a
36. The most common site of brain abscess is
a. frontal lobe
b. parietal lobe
c. temporal lobe
d. cerebellum
a
37. Peripheral ring enhancement on CT scan is seen in
a. brain abscess
b. brain tumor
c. radiation necrosis
d. all of the above
d
38. Quadriplegia occurs in lesions of cervical cord above
a. C6
b. C5
c. C4
d. C3
b
39. Best method of assessing spinal cord injury is by
a. plain X-ray
b. myelogram
c. CT scan
d. MRI
d
40. In judicial hanging which vertebra is most commonly fractured?
a. C2
b. C3
c. C4
d. C1
a
41. Gradual development of symptoms: pain, paresthesias, sensory disorders in legs of
radicular origin, flaccid palsy of legs, bladder disorders, increased protein in CSF are more
likely in:
a. tumor of thoracic spinal cord
b. tumour of cauda equina
b. radiculopathy
c. mielitis
d. tabes dorsalis
b
42. Case. Following an episode of severe head trauma incurred in a motorcycle accident, an 18year-old woman is noted to have decerebrate posturing. Funduscopic examination reveals
marked bilateral papilledema. A CT scan of the head reveals marked diffuse cerebral edema with
effacement of lateral ventricles. This edema results from an increase in sodium and water
content. It is most likely to be severest in which of the following parts of the brain?
a. gray matter
b. meninges
c. white matter
d. dura
e. ependyma
c
43. Case. A 41-year-old woman has had a worsening headache for the past week, along with a
fever and increasing obtundation. On physical examination her temperature is 38.2 C. A head CT
scan reveals a solitary 3 cm diameter lesion with ring enhancement located in the right parietal
lobe. A stereotactic biopsy is performed and a frozen section shows granulation tissue with
adjacent collagenization, gliosis, and edema. Which of the following is the most likely
diagnosis?
a. chronic brain abscess
b. aspergillosis
c. progressive multifocal leukocencephalopathy
d. toxoplasmosis
e. rabies virus infection
a
44. Case. A 50-year-old man was involved in a vehicular accident in which he was not wearing
any restraint and struck his head against the windshield of his van. He did not lose consciousness
at that time or at any point thereafter. Physical examination showed a minor contusion to his
forehead. However, a month later he began complaining of headaches, becoming irritable and
acting strangely. Which of the following intracranial vascular abnormalities most likely
developed in this man?
a. epidural hematoma
b. chronic subdural hematoma
c. cerebral contusions
d. subarachnoid hemorrhage
e. intracerebral hematoma
b
45. Case. A 50-year-old man is noted by his wife to have undergone personality changes over
the last year. In the past, he was noted to be obsessive-compulsive, but he became slovenly and
now does not appear to take an interest in his work. He has become more forgetful. On physical
examination he has frontal release signs and memory loss. He appears unconcerned about his
illness. MR imaging of the brain is performed and shows a 3 cm diameter left frontal lobe mass
with areas of calcification. Which of the following diagnoses is most likely to be made on
microscopic examination of this mass?
a. thrombosed berry aneurysm
b. oligodendroglioma
c. meningioma
d. schwannoma
e. organizing abscess
f. remote infarct
b
46. Case. A 22-year-old man has recently emigrated from China. He has the sudden onset of a
seizure disorder while working as a chef in a restaurant. On physical examination he is afebrile.
No papilledema is noted. MR imaging of the brain reveals a 2 cm rounded cyst in the right
temporal lobe cortex and another 1.5 cm cyst in the subarachnoid space over the left parietal
lobe. Both lesions are non-enhancing. A lumbar puncture yields colorless CSF under normal
pressure. The CSF protein and glucose are normal, and there are 5 WBCs/microliter (4 monos, 1
PMN). Which of the following conditions most likely to cause these findings?
a. metastatic adenocarcinoma
b. HIV encephalopathy
c. left atrial mural thrombosis
d. cysticercosis
e. hypertension
d
47. Case. A 61-year-old man has had a chronic cough for 6 years as a result of smoking 2 packs
of cigarettes per day for 45 years. He has noted the onset of headaches over the past 2 weeks. His
physician on neurologic exam can find no localizing signs. MR imaging of the brain reveals a
solitary 3.5 cm lesion that is located at the grey-white junction in the posterior left frontal lobe.
There is no ring enhancement. A stereotactic biopsy of this lesion is performed. Which of the
following microscopic appearances is most likely to be present in this biopsy?
a. an organizing abscess
b. viral inclusions
c. a plaque of demyelination
d. neuronal loss with gliosis
e. metastatic carcinoma
e
48. Case. A 47-year-old man has had the new onset of headaches for the past 4 months. The
headaches are associated with dull pain and seem diffuse, but they are becoming more frequent
and prolonged. On physical examination he has no focal neurologic deficits. His memory is
intact. MR imaging reveals enlargement of the lateral ventricles. There is a 4 cm homogenous,
well-circumscribed mass within the fourth ventricle. Which of the following is the most likely
diagnosis?
a. astrocytoma
b. choroid plexus papilloma
c. ependymoma
d. meningioma
e. metastastic bronchogenic carcinoma
f. schwannoma
c
49. Case. A 33-year-old HIV-positive woman has had increasing inability to think clearly, with
forgetfulness, over the past 3 weeks. She now has trouble doing everyday tasks. She has no
history of seizures, headaches, nausea, vomiting, fever, chills or diarrhea. On examination she is
oriented to time, place and date. She is indifferent to her surroundings. She is unable to perform
calculations and has difficulty in word finding. She is afebrile. MR imaging of the brain shows
an irregular ring-enhancing lesion in the white matter of the left frontal lobe. Her CD4 count is
90/microliter. Which of the following is the most likely diagnosis?
a. infarction
b. toxoplasmosis
c. contusion
d. astrocytoma
e. cysticercosis
b
50. Case. A 28-year-old man swerves to avoid an oncoming vehicle while riding his motorcycle.
He falls and rolls along the pavement for 100 m. On physical examination his vital signs include
temperature 37 C, pulse 78/minute, respirations 20/minute, and blood pressure 120/80 mm Hg.
He has multiple contusions and abrasions involving the skin of his torso and extremities, but
none on his head because he was wearing a helmet. He is unconscious. There is no decerebrate
posturing. A head CT scan shows no intracranial hemorrhage or edema and no skull fractures.
He remains in a persistent vegetative state. Which of the following pathologic findings is most
likely to be present?
a. central pontine myelinolysis
b. cerebral venous sinus thrombosis
c. demyelination
d. diffuse axonal injury
e. meningoencephalitis
f. neuronal loss
d