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Main » 2011 » December » 7 » Examination Paper of Neurology
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Examination Paper of Neurology
The Southern Medical University
Examination of the First Clinical Medical College
Autumn term, 2010 Academic Year
Exchange Student of Grade 2006
Examination Paper of Neurology (Paper...)

Part I: Select the correct answer by marking the appropriate capital letter. There is only one correct answer.

1. Lesion in inferior frontal gyrus causes:
A. Defect in articulation
B. Incomprehension of written language
C. Incomprehension of spoken language
D. Motor Aphasia

2. All are pyramidal tract lesion, Except:
A. Involuntary movement
B. Positive Babinski's sign
C. Spasticity
D. Increased deep tendon reflexes

3. Upper motor neuron is characterised by:
A. Weakness & spasticity
B. Fasciculations
C. Rigidity
D. Localised muscle atrophy

4. Fasciculation is seen in:
A. UMN type of lesion
B. LMN type of lesion
C. Myoneural junction
D. Peripheral neuropathy

5. Which is not affected in lesion of posterior column of spinal cord?
A. Romberg's sign
B. Temperature sense
C. Vibration sense
D. Peripheral neuropathy

6. TRUE regarding upper motor neuron VIIth nerve paralysis is:
A. Ipsilateral upper face paresis
B. Ipsilateral lower face paresis
C. Contralateral upper face paresis
D. Contralateral lower face paresis

7. EEG is usually abnormal in all of the following Except:
A. Subacute sclerosing panencephalitis
B. Locked-in state
C. Creutzfoldt-Jackob disease
D. Hepatic encephalopathy

8. Type of sensation lost on same side in Brown sequard syndrome is:
A. Pain
B. Touch
C. Proprioception
D. Temperature

9. Which of the following is not a feature of extramedullary tumor:
A. Early Corticospinal signs and paralysis
B. Root pain or midline Back-pain
C. Abnormal CSF
D. Sacral sparing

10. A 27-year old woman has been sad for the past two weeks. She is fatigued and has a hard time concentrating at work. Just a few weeks earlier she was energetic and enthusiatic, and was able to work 10 to 12 hours a day with little sleep and go dancing at night. Her husband wants a divorce because hs is tired of "these constant ups and downs." The most accurate diagnosis is:
A. Borderline personality disorder
B. Seasonal mood diorder
C. Dissociative identity disorder
D. Cyclothymic disorder
E. Recurrent major depression

11. The commonest cause of Intracerebral Bleed is:
A. Thrombocytopenia
B. Diabetes
C. Hypertension
D. Berry aneurysm

12. The most common location of hypertensive intracranial hemorrhage is:
A. Subarachnoid space
B. Basal ganglia
C. Cerebellum
D. Brainstem

13. The common cause of subarachnoid hemorrhage is:
A. Arterio-venous malformation
B. Cavernous angioma
C. Aneurysm
D. Hypertension

14. A 45 year old hypertensive male presented with sudden onset severe headache, vomiting and neck stiffness. On examination he didn't have any focal neurological deficit. His CT scan showed blood in the sylvain fissure. The probable diagnosis is:
A. Meningitis
B. Ruptured aneurysm
C. Hypertensive bleed
D. Stroke

15. Anterior cerebral artery occlusion can cause:
A. Urinary retention
B. Contralateral lower leg weakness
C. Hemianaesthesia of opposite side of face
D. Hemianopia

16. Memory impairment occurs in embolism of posterior cerebral artery because of damage to:
A. Hippocampal gyrus
B. Superior temporal gyrus
C. Prefrontal gyrus
D. Angular gyrus

17. All of the following manifestations may be associated with lacunar infarcts, except:
A. Pure motor loss
B. Pure sensory loss
C. Ataxia
D. Dysarthria
E. Quadriplegia

18. All are features of Wallenberg's syndrome, except:
A. Ipsilateral loss of pain and temperature
B. Ipsilateral loss of taste sensation
C. Ipsilateral loss of posterior column sensations
D. Ipsilateral involvement of lower cranial nerve

19. A 45 year old man presents with a daily headache. He descirbes two attacks per day over the past 3 weeks. Each attack lasts about an hour and awakens the patient from sleep. The patient has noted associated stuffiness. The pain is deep, excruciating, and limited to the right side of the head. The neurologic examination is nonfocal. The most likely diagnosis of this patient's headache is:
A. Migraine headache
B. Cluster headache
C. Tension headache
D. Brain tumor

20. A female has episodic, recurrent headache in left hemicranium with nausea and parasthesia on right upper and lower limbs is most probably suffering from:
A. Migraine
B. Cluster headache
C. Angle closure glaucoma
D. Temporal arteritis

21. While the majority of women do not experience significant side effects when taking oral contraceptives, for those who do, the most commonly encountered psychological problem is:
A. Anxiety
B. Depression
C. Night terrors
D. Short-term memory deficits
E. Long-term memory deficits

22. Absence seizures are characterized on EEG by:
A. 3Hz spike & wave
B. 1-2Hz spike & wave
C. Generalized poly spikes
D. Hypsarrythmia

23. All of the following drugs are used for managing status epilepticus except:
A. Phenytoin
B. Diazepam
C. Thiopentone sodium
D. Carbamazepine

24. A delusion can best be defined as:
A. A false belief that meets specific psychological needs
B. A perceptual misrepresentation of a sensory image
C. A perceptual representation of a sound or an image not actually present
D. A viewpoint able to be changed when convincing evidence to te contrary is presented
E. A dissociative reaction

25. Dinesh, a 56 yr aged man presents with complaints of slowness of movements, postural instability, tremors, rigidity and memory loss. Most likely diagnosis is:
A. Multi infarct dementia
B. Alzheimer's disease
C. Parkinsonism
D. None of the above

26. Huntington's disease is due to the loss of:
A. Nigrostriatal dopaminergic neurons
B. Intrastriatal cholinergic neurons
C. Intrastriatal GABAergic neurons
D. Intrastriatal cholinergic and GABAergic neurons

27. Drug of choice in dopamine receptor agonists is:
A. Rasagiline
B. Entacapone
C. Pramipexole
D. Benzhexol
E. L-Dopa

28. A 7 year old girl hospitalized for tonsillectomy awakens in the middle of the night and cries out that a "big bear" is in her room. She is relieved when a nurse turns on he light revealing that the bear was an armchair covered with a coat. This experience is an example of:
A. A delusion
B. A hallucination
C. An illusion
D. A projection
E. A dissociative reaction

29. The following is not a feature of Alzheimer's disease:
A. Neurofibrillary tangles
B. Senile (neuritic) plaques
C. Amyloid Angiopathy
D. Lewy bodies

30. Which of the following is a cause of reversible dementia?
A. Subacute combined degeneration
B. Picks disease
C. Creutzfeldt-Jackob disease
D. Alzheimer's disease

31. Which of the following is the classical CSF finding seen in TBM?
A. Increased protein, decreased sugar, increased lymphocytes
B. Increased protein, sugar and lymphocytes
C. Decreased protein, increased sugar and lymphocytes
D. Increased sugar, protein and neutrophils

32. The drug of choice in Cryptococcal Meningitis is:
A. Penrostatin
B. Amphotericin B
C. Clotrimazole
D. Zidovudine

33. A young male develops fever, followed by headache, confusional state, focal seizures and right hemiparesis. The MRI performed shows bilateral frontotemporal hyper intense lesion. The most key diagnosis is:
A. Acute pyogenic meningitis
B. Herpes simplex encephalitis
C. Neurocysticercosis
D. Carcinomatous meningitis

34. A 23 year old woman arrives at the emergency room complaining that, "out of the blue", she had been seized by an overwhelming fear, associated with shortness of breath and a pounding heart. These symptoms lasted for approximately 20 minutes and, while she was experiencing them, she feared that she was dying or going crazy. The patient has had four similar episodes during the past month and she has been worrying that they will continue recurring. The most likely diagnosis is:
A. Acute psychotic episode
B. Hypochondriasis
C. Panic disorder
D. Generalized anxiety disorder
E. Post traumatic stress disorder

35. Pure motor paralysis is seen in:
A. Polio
B. Gullien Barre syndrome
C. Diabetes mellitus
D. Sub-acute Combined Degeneration

36. All the following are features of Guillain-Baree Syndrome except:
A. Predominant motor involvement
B. Facial nerve involvement
C. Absence of pleocytosis in CSF
D. Bladder bower involvement

37. After a minor head injury a young patient was unable to close his left eye and had  drooling of saliva from left angle of mouth. He is suffering from:
A. VIIth nerve injury
B. Vth nerve injury
C. IIIrd nerve injury
D. Combined VIIth and IIIrd nerve injury

38. Which of the following statements regarding delusion is true:
A. Delusion are almost exclusively found in schizophrenia
B. Delusions  of grandiosity are rarely encountered except in mania
C. Delusions involve a disturbance of thought content
D. Delusions involve a disturbance of perception
E. Delusions are a type of hallucination

39. Drug of choice for myasthenia gravis:
A. Gallamine
B. Succinylcholine
C. Tubocurare
D. Pyridostigmine

40. A person is sitting alone and behaving as if listening intently, then suddenly begins to nod and mutter along. This person most likely is experiencing:
A. A delusion
B. A depersonalization episode
C. An hallucination
D. An idea of reference
E. Flight of ideas

41. Which of the following is used in the treatment of Multiple Sclerosis:
A. Interferon Alpha
B. Interferon Beta
C. Infliximab
D. Intereron gamma

42. All of the following are features of Pseudobulbar palsy, except:
A. Dysarthria
B. Dysphagia
C. Emotional lability
D. Hypoactive jaw jerk

43. Motor neuron disease, TRUE is:
A. Sensory involvement
B. Ocular motility is spared
C. Involvement of anterior and lateral columns of spinal cord
D. Intellectual improvement

44. 65 year old man presents with anemia and posterior column dysfunction, the likely cause is:
A. B1-deficit
B. B12-deficit
D. Multiple sclerosis

45. A lesion in the paracentral lobule causes:
A. Contralateral foot weakness
B. Seizures only
C. Migraine
D. Cognitive loss

46. Which of the following is not a component of Glasgow Coma Scale?
A. Eye opening
B. Motor response
C. Pupil size
D. Verbal response

47. During the hectic weeks preceding her wedding, a 22 year old woman in good health and without a previous history of psychiatric illness occassionally feels unreal and detached from her own body, "like in a dream." The episodes lasts a few minutes and resolve spontaneously. Choose the correct statement:
A. These symptoms are common in normal persons
B. The patient suffers from depressionalization disorder
C. Depersonalization symptoms are rare in other psychitric disorders
D. The patient suffers from somatization disorder
E. The patient is malingering

48. Hemiplegia is commonly associated with infarction of the area of distribution of the:
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Anterior communicating artery

49. The only thrombolytic agent approved for the treatment of acute ischemic stroke is:
A. Tissue plasminogen activator
B. Streptokinase
C. Urokinase
D. Pro-urokinase

50. Total score in Glasgow Coma Scale of a conscious person is:
A. 8
B. 3
C. 15
D. 10

Part II: Explanation of nouns
1. Triple paralytic syndrome
2. The circle of Willis
3. Status epileticus
4. Wernicks aphasia

Part III: Short answer questions.
1. Clinical features of Horner's sign
2. Please answer the concept of spinal shock.
3. Please define albuminocytologic dissociation (CSF)


45. What are the causes of left sided ptosis, central facial nerve palsy and hypoglossal nerve palsy and paralysis on the right side?

46. What is the most likely diagnosis of the patient?

47. What diseases should we take into account for differential diagnosis?

48. How to treat this patient if you are his doctor?
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بسم الله الرحمن الرحيم

لا اله الا الله محمد رسول الله
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