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Luky Adlino

COMPRE 3rd YEAR 2015


NEURO
1. Bulging cyst-like in his back. Closure bagian mana yg bermasalah?
A. Neural tube
B. Anterior neuropore
C. Posterior neuropore
D. Neural plate
E. Mesenchyme

* curiga spina bifida  maka menurut slide dr vinia dan dr Bernard karena neural tube defects.
Neural tube defects sendiri bisa dibagi jadi anterior neuropore defect (anencephaly atau
encephalocele) dan posterior neuropore defect (spina bifida). Posterior neuropore seharusnya
nutup sehari setelah anterior neuropore.

2. Urutan yg bener gimana?

1. Neural crest 3. Neural plate 5. Neural groove

2. Notochord 4. Neural tube

E. 2-3-5-1-4

* yang pertama kali muncul adalah notochord, lalu neural plate terbentuk, disusul terbentuk nya
groove dan kemudian neural crest, apabila sudah semua terbentuk, struktur akhir disebut sebagai
neural tube.

3. Medulla spinalis begins to become conus medullaris at the level of:


A. L1
B. L2
C. L3
D. L4
E. L5

* lokasi conus medullaris biasa di L1-L2. Sehingga bisa di lakukan lumbar puncture pada L3-L4.
Luky Adlino

4. A 1-year old infant has delay in mental development and wider the diameter of his head than
normal. His mother brought him to the doctor and was diagnosed with hydrocephalus. CSF flows
from lateral ventricle to third ventricle through:
A. Aqueduct of Silvi
B. Foramen Magendie
C. Foramen Luschka
D. Foramen Monro
E. Interventricular Foramen

* CSF dihasilkan oleh plexus choroidalis  ke lateral ventricles  melalui foramen of monro ke third
ventricle  melalui cerebral aqueduct of sylvii ke fourth ventricle  melalui lateral foramen
(Luschka) and medial foramen (Magendie) ke cisterna magna.

5. Common Carotid artery bifurcation di vertebral level berapa?


A. C1
B. C2
C. C3
D. C4
E. C5

* common carotid artery bakal pecah menjadi internal ; external carotid artery di C4 (carotid
bifurcation).

6. Mary, 60 years old, came with stroke and hemiplegia and expressive aphasia (Broca’s). Which is the
branch of internal carotid artery that contribute to the pathology?
A. Basilar
B. Vertebral
C. Middle cerebral
D. Anterior communicating artery

* Expressive aphasia itu sama dengan Broca’s aphasia. Daerah Broca di supply oleh middle cerebral
artery.

7. Bambang 60 thn jatuh dr tangga, fracture C1-4. Yg kena arteri apa?


A. Common carotid
B. External carotid
C. Vertebral
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D. Internal Carotid

* curiga ruptur vertebral artery karena lokasi nya dalam foramen tranversarium di spine, kasus
fraktur nya di spine sehingga paling prone.

8. Wanita 30thn kena di C5-C6, itu buat apa?


A. Neck
B. Triceps
C. Biceps and deltoid

* dermatom C5-C6 ada di daerah biceps dan deltoid.

9. Ms denti, 65 th, ada av malformation. anterior jugularis vein emptys kemana?


A. Inferior vena cava
B. Superior vena cava
C. Subclavian vein
D. Internal jugular vein
E. External jugular vein  (lebih sering kesini daripada subclavian).
Luky Adlino

10. N / A
11. An 18 year old college student presented with the following signs after having a midthoracic spinal
injury. With eyes closed he could not tell whether his toe was dorsiflexed or plantarflexed. In
addition, there is loss of tactile discrimination and vibration sense. The lesion is involved in which of
the following tracts?
A. Corticobulbar
B. Spinocerebellar
C. Spinothalamic
D. Corticospinal
E. Dorsal column

* posterior column / dorsal column is a sensory pathway of the central nervous system that conveys
sensations of fine touch, vibration, two-point discrimination, and proprioception (position) from the
skin and joints. Dorsal column dibagi menjadi 2  cuneatus (T6 keatas) dan gracillis (T6 kebawah).

12. A 37 years old man fell down when fix the roof of his house. His back hit big stone on the ground
then suddenly he feels sensory deficit for temperature and pain. Which tract of the spinal cord is the
mostly affected?
A. Faciollus Gracillis
B. Cuneatus
C. Spinothalamic Anterior
D. Spinothalamic Lateral  untuk merasakan temperature and pain.
Luky Adlino

13. N / A
14. A 30 years old man presented to the emergency department after traffic accident. he was
unconscious, his neurological exam revealed absent of corneal reflex in both eyes. which cranial
nerves is impaired?
A. Optic
B. Oculomotor
C. Trigeminus
D. Vagus
E. Accessory

* corneal reflex diatur oleh ophthalmic branch (V1) of the 5th cranial nerve.

15. N / A
16. N / A
17. Pasien 59 tahun fluent bicaranya, tapi gak ngerti pembicaraan  Wernick’s aphasia

* receptive aphasia disebut juga Wernick’s aphasia  bisa ngomong tapi ga nyambung, expressive
aphasia disebut juga Broca’s aphasia  nyambung tapi ga bisa ngomong.

Aphasia Fluency Compre Repetition Naming Reading Writing


syndrome

Global - - - - - -

Broca’s - + - - - -

Wernick’s + - - - - -
Luky Adlino

Transcortical - + + - - -
motor

Transcortical + - + - - -
sensory

Conduction + + - + + +

Anomic + + + - + +

18. A 30-year-old man was crashed by motorcycle and felt down at his sacrum. The imaging showed
fracture of his sacrum. Afterwards he has problem of micturia and dysfunction of erection. What
nervous system is the most likely injured:
A. Parasymphatetic Nervous System
B. Symphatetic Nervous System
C. Sensoric Nervous System
D. Motoric Nervous System
E. Central Motor Neuron

* Ereksi dan mikturisi diatur oleh sistem saraf parasimpatis. Curiga pasien mengalami cidera plexus
sacralis bagian S2-S4.

19. 21 year old man motorcycle accident, undergoes surgery, then thumb, wrist drop. nerve apa yang
kena?
A. Musculocutaneous  tidak bisa fleksi biceps
B. Axillary  tidak bisa abduksi lengan
C. Median  Carpal Tunnel Syndrome, Hand of Benedict (Preacher’s hand)
D. Radial  Wrist drop
E. Ulnar  Claw hand

20. A man went into a doctor and was given injection in his right buttock. After the injection, he
experienced weakness in his right leg and he can't stand up nor squat. Which nerve is affected?
A. Inferior Gluteal nerve
B. Superior Gluteal nerve
C. Pundendal nerve
D. Sciatic Nerve
Luky Adlino

E. Inferior Cluneal nerve

* karena keluhan tidak bisa berdiri dan squat  kemungkinan lesi di M. gluteus maximus (the most
important hip joint extensor)  dipersarafi oleh N. gluteus inferior.

21. 72 thn cewe jatuh dr tangga. Unconcious. Pas di ct ada bleeding di between skull sama durameter.
Pendarahannya di mana?
A. Subgaleal
B. Epidural

* Epidural merupakan space antara duramater dengan skull. 3 lapisan meninges yaitu dura, arach,
pia (luar ke dalam). Antara dura dan arach ada subdural space, antara arach dengan pia ada
subarach space. Epidural hemorrhage akan memberikan gambaran lens-shaped, sedangkan
subdural hemorrhage akan memberikan gambaran crescent-shaped. Biasanya epidural hemorrhage
terjadi karena ruptur arteri middle meningeal (ada lucid interval). Sedangkan subdural hemorrhage
biasanya terjadi karena ruptur subdural bridging vein.

22. 45 y.o man previously healthy develop headaches over past month. No remarkable finding d PE,
Cerebral angiogram shows 7 mm saccular aneurysm di trifurcatio right MCA. Komplikasi:
A. Subdural hematom
B. Subarachnoid hemorrhage
C. Epidural hematom middle meningeal artery
D. Cerebellar parotid herniation
E. Hydrocephalus

*subarachnoid hemorrhage terjadi ketika pembuluh darah just outside the brain (di subarach space)
ruptur, biasa sering terjadi karena AVM atau aneurysm.

23. Nenek, 80 tahun, ke rumah sakit karena penurunan kesadaran. CT scan terlihat kumpualn darah di
subdural. Possible cause? Rupture of bridging vein  (subdural hemorrhage main cause).
24. 60 years old man died karena pneumonia. pada saat autopsy, bisa dilihat di mikro nya ada
tromboembolus. underlying diseasenya apa?
A. Hypertension with renal disease
B. Heart disease with stenosis in left
C. AIDS
D. Autoimmune
Luky Adlino

* soal tromboemboli seinget gw karena ada afib (heart disease) yang bikin darahnya jadi stasis di
jantung menyebabkan thrombus yang kalau lepas bisa masuk ke pembuluh darah otak jadi
tromboemboli.

25. N / A
26. N / A
27. Patient with visual disturbance, motoric incoordination, weakness in all limbs. MRI shows
abnormalities in brain and spinal cord. (Symptoms of MS). What is the underlying pathological
process?
A. Degeneration of white matter
B. Decreased dopamine production
C. Viral CNS infection
D. Inflammatory demyelinating process in CNS
E. Autoimmune process of radix and spinal nerves

* pada kasus multiple sclerosis, autoimmune menyerang myelin sheath di CNS (brain and/or spinal
cord) sehingga bisa menimbulkan gejala seperti visual disturbances, motorik disturbances, ANS
disturbances, depression, dll. Myelin yang inflamed akan menampilkan gambaran plak-plak sclerosis
pada hasil imaging MRI.

28. N / A
29. 37 tahun kena facial nervenya. symptom yg muncul apa?
* Lesi pada nervus facialis bisa berupa motorik atau sensorik. Gejala motorik bisa berupa facial
paralisis (termasuk di dalam nya Bell’s palsy). Sedangkan gejala sensorik bisa berupa kehilangan
sebagian kemampuan indra pengecapan (1/3 depan lidah).
Luky Adlino

30. Women, didiagnosis nerve injured, lesinya di LMN


A. Babinski positive
B. Spastic
C. Loss of tendon reflex

* ciri khas lesi di LMN adalah hyporeflex, tidak ada tanda babinsky, flaccid, hypotonic, presence of
fasciculation.

31. What is the nerve that is affected in gag reflex?


A. Trigeminal nerve
B. Oculomotoric nerve
C. Glossopharyngeal nerve
D. Accessory nerve
E. Hipoglossus nerve

* gag reflex bisa dicetuskan oleh 2 saraf yaitu N. glossopharyngeal dan N. vagus.

32. 55 yo. pusing berputar sejak 2 hari lalu. gejala ringan, tidak dipengaruhi posisi, tidak mempengaruhi
aktivitas sehari". tidak mual muntah. punya history hipertensi, makan obat tak teratur. bp 190/110.
underlying causes?
A. Vestibular neuritis
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B. BPPV
C. Ischemic stroke
D. Cerebral tumor
E. Cereberal infection

* curiga pasien mengalami gejala vertigo central yang diakibatkan stroke pada CNS (risk factor nya
hypertension).

33. Female 37 thn dtng dgn keluhan sperti berputar di perparah klo turn headnya ada dizziness nausea
beberapakali vomit, kluhan spiningnya cma bertahan bbrp jam trus ad rocking sensation, hilang 1
mingguan
A. Semicircularis
B. Labirinth
C. Tymphanic membrane
D. Macula

* curiga BPPV sehingga sesuai dengan patof nya kelainan terjadi di dalam kanalis semisirkularis.

34. Wide based gait cenderung ke kanan. Namanya apa?


A. Sensory ataxia  menghasilkan stomping gait karena gabisa proprioceptive
B. Cerebellar ataxia  wide-based dan gaseimbang, orang intox alkohol akut juga bisa gini.
C. Parkisonian gait  small steps
D. Marche e petit  nama lain gait nya Parkinson (walk of little steps)
35. kl ada cerebellar gait yg wide based gait cara testnya gimana?
A. Rhomberg  tes keseimbangan, bisa cek proprioceptive, equilibrium dsb. (tes lainnya ada
fukuda stepping test, tandem gait, dll).
B. Brudzunski  meningitis diagnostic test
C. Rinne test  tes gangguan pendengaran
36. You are able to pull your hand away quickly away from hot water before the pain is felt because:
A. Movement of the hand involves the intervention from the spinal cord only
B. Movement of the hand does not require intervention from the CNS
C. The brain reacts quickly to prevent serious injury
D. Autonomic division of the PNS ... speed contraction of the muscles of the hand.

* intinya mengenai gerakan reflex dimana reflex loop terjadi di spinal cord, tanpa perlu naik ke brain
terlebih dahulu.
Luky Adlino

37. In order, to pinpoint the location of a tumor, a neurosurgeon electrically stimulated parts of the
patient's sensory cortex. If the patient was conscious during the procedure, which of the following
was probably experience.
A. "hearing" faint sounds
B. "seeing" random pattern
C. Moving upper and lower extremities
D. Sense of having the skin touched

* dikatakan bahwa stimulus diberikan pada sensory cortex (somatosensory) sehingga seharusnya
interpretasi sensoris lah yang dirasakan pasien. Sedangkan melihat dan mendengar terdapat pada
bagian cortex cerebral yang berbeda.

38. Writing with pencil is a movement directed by :


A. Sympathic  bagian dari ANS
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B. Parasympathic  bagian dari ANS


C. Somatic  voluntary movement dan sensory function
D. Autonomic
39. Lastri scladed in a tube of hot water. Pain message nya di transmit ke spinal cord lewat sistem saraf
apa?
A. Somatic  voluntary movement dan sensory function
B. Simpatik
C. Parasimpatik
D. Autonomic nervous system
40. Melissa just finished marathon. She feels less pain. What neurotransmitter is affected?
A. Acetylcholine  untuk ANS, muscle contraction
B. Norepinephrine
C. Serotonin  mengatur biological activity of the body such as sleep, appetite
D. Dopamine

* neurotransmitter yang utama bisa reduced pain adalah endorphin. Selain itu serotonin juga bisa
mengurangi rasa sakit. Sedangkan neurotransmitter yang dikeluarkan ketika olahraga adalah
endorphin, dopamine, serotonin, dan norepinephrine. Jadi kalau tidak ada pilihan endorphin pilih
serotonin (ada di slide dr herman).

41. Following a nail gun wound on his head, Jack became irritable, dishonest, and profane. This
behavioral change is most likely attributed to a lesion in
A. Frontal lobe  may cause changes di kontrol emosi, motivasi, mood swings, aggression, dan
inability untuk melakukan planned complex movements
B. Occipital lobe
C. Parietal lobe
D. Temporal lobe  bisa mempengaruhi behavior change juga terutama aggression (tipe nya
unprovoked and very abrupt), namun yang paling menonjol adalah kelainan memori atau
ingatan
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42. N / A
43. A scientist wishes the study the simplest brain mechanism underlying emotions and memory. which
of the following you recommend to study?
A. Brainstem of a frog
B. Limbic system of a dog
C. Cortex of a human
D. Basal ganglia of monkey

* struktur brain monkey paling menyerupai manusia dan paling sering di pelajari, but in terms of
memory and emotions lebih kearah limbic system (Hippocampus for memory; Amygdala for
behavior, stress, and anxiety control) daripada basal ganglia (responsible primarily for motor control
 memperhalus gerakan motorik).

44. Following of head injury, a person ongoing difficulties stay awake, injury dimana?
A. Thalamus
B. Corpus callosum
C. Cerebellum
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D. Reticular formation  (plays a central role in states of consciousness like alertness and sleep)
45. Body builder tiba2 tinggi, dia minum obat apa untuk bikin tinggi?
A. Thalamus
B. Pituitary gland
C. Adrenal gland
D. Thyroid gland

* yang mengatur tinggi dan tumbuh badan seseorang  Growth Hormone (Somatotropin). Growth
hormone is synthesized and secreted by cells called somatotrophs (dari anterior pituitary). GH is a
major participant in control of several complex physiologic processes, including growth and
metabolism.

46. 53 years old man came with sudden paralysis on his extremities. Brain MRI showed infarct on
internal capsular. Motor defect nya apa:
A. Paralysis of all skeletal muscles on opposite side
B. Paralysis of all skeletal muscles on same side
C. Paresis of axial extremity on same side
D. Paralysis of distal muscles on opposite side  (biasanya apabila kelemahan atau kelumpuhan
tidak keseluruhan (distal only or prox only)  mengarah ke lesi LMN, sedangkan internal
capsule adalah bagian dari UMN

* karena soal nya ditanya mengenai skeletal muscles (motorik)  dipengaruhi oleh decussatio
piramidalis (di brain stem), jadi kalau stroke di atas dec. piramidalis maka menyebabkan kelumpuhan
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atau kelemahan contralateral dengan lesi sebenarnya. Lesi pada internal capsule juga dapat
menyebabkan timbulnya ciri khas UMN signs.

47. Stimulation of the most natural sleeping? raphe nuclei  (contain mostly serotonergic neurons
yang bisa hasilkan serotonin  help regulates sleep-wake cycles)
48. A 4 year old boy observed by his parents for the past month, after the patient going bed to sleep
have being wake up in the middle of the night. sometimes he is found standing somewhere in the
house, crying and seemingly disoriented with rapid breathing and profuse sweating. in the morning
he wakes up in usual happy mood and does not remember what occured the previous evening. this
behaviour occurs one/twice a week. the doctor diagnoses him had a nightmare/night terror. when
will this occur
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
E. REM

* Nightmares and Night terror sebenarnya berbeda menurut beberapa sumber, dimana night terror
anak nya biasanya tidak ingat kejadian semalam beda dengan nightmares. Night terrors, on the
other hand, occur during a phase of deep non-REM sleep usually within an hour after the subject
goes to bed. This is also known as stage 4.

49. A 24 year-old woman is diagnosed with complex partial seizure disorder. Which of the following
would be typical automatisms that can occur in complex partial seizure?
A. Lip-smacking, chewing, gesturing
B. Singing and coughing
C. Choreiform dance-like movements
D. Rigid arm motions directed to laterally
E. Jerking on extremities

* Nama lain nya adalah Focal Onset Impaired Awareness Seizures. May have an aura, lalu biasanya
gejala berupa automatisms (such as lip smacking, picking at clothes, fumbling), becoming unaware
of surroundings, and wandering

50. 9years old boy has absence seizure. Which is the best describe absence?
A. Right arm tremulous
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B. Momentarily lapses in awareness accompanied by motionless staring & cessation of any


outgoing activity
C. Flexion extension of arm leg
D. Loss of tonus and fall to ground

* Older term disebut sebagai petit mal seizure, merupakan generalized onset seizure dimana artinya
ketika serangan terjadi dia langsung di kedua belah otak, lasting only a few seconds, biasa gejala
hanya berupa kehilangan kesadaran sementara (bengong  lapses in awareness or consciousness
and sometimes dibarengi staring)

51. the drug donepezil, rivastigmine, and galanthamine are used in Alzheimer Disease to try to raise the
availability of what transmitter in the brain?
A. Dopamine
B. Norepinephrine
C. Glutamate
D. Acetylcholine  (ketiga jenis obat itu adalah jenis cholinesterase inhibitors)
52. Abnormal processing of which of these proteins is felt to be particularly important in the
pathophysiology of Alzheimer’s disease?
A. Acetylcholinesterase
B. Alpha-synuclein
C. Huntingtin
D. Amyloid precursor protein  (APP akan di cleavage dimana akan menghasilkan beta amyloid
protein  akan tertumpuk dalam bentuk plak menjadi salah satu hallmark dari patologi
penyakit Alzheimer).
E. A right spinal cord hemisection
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53. laki-laki 54 tahun terdapat tremor di tangan kanan yang semakin parah sejak 6 bulan serta sulit
untuk menggerakkan tubuh terutama untuk jalan. PF: tremor tangan kanan pada saat istirahat,
mask face, slow and deliberate gait, tonus tangan dan kaki kanan naik. Treatment-nya apa?
A. Amantadine
B. Anticholinergic
C. Dopamine
D. Levodopa
E. SSRI

* Merupakan ciri-ciri dari penyakit Parkinson (4 cardinal features  bradykinesia, tremor, rigidity,
and postural instability) dimana terapi utama nya adalah pemberian tambahan neurotransmitter
dopamine melalui levodopa.

54. A construction worker had difficulty to open the jaw. Previously he had nail wound. What is the
bacteria responsible for it? Jaw Trismus (Lock Jaw) yang pada kasus ini disebabkan oleh Tetanus
A. Clostridium botulinum
B. Clostridium perfringens
C. Clostridium butyricum
D. Clostridium tetani
E. Clostridium sordelli
55. A young woman present with sudden onset of double vision, dry mouth, and weakness. No
previous history of episodic weakness or dog/tick bite. Last night she ate some canned-food.
Physical examination show she alert and no fever. Doctor notice ptosis (dropping eyelids): bilateral
third and tenth cranial nerve, symmetric flaccid of all four extremities, decrease deep tendon reflex,
decrease bowel sound, no sensory loss. Mechanism?
Biasa nya gejala tersebut disebabkan oleh keracunan Clostridium botulinum (risk factor nya dari
canned food). Botulinum toxin melekat pada recognition sites di ujung neuron cholinergic sehingga
menyebabkan penurunan produksi dan pelepasan acetylcholine  terjadi neuromuscular blocking
effect.
A. Close contact with infected animal
B. Stop elongation factor 2 (EF-2)
C. Inihibition release of acetylcholine
D. Contagious of infectious
Luky Adlino

56. A 18 year old woman was brought to ED. She had history of 12 hours of fever, chills and headache.
In the ED, she looked confused and was highly agitated. She can’t speak and follow commands. Neck
stiffness and Purpuric rash was noted. Transmission?
Menuju kearah meningitis et causa Neisseria meningitidis (ciri khas nya nuchal rigidity dan purpuric
rash  slide dr cucu)
A. Fecal oral
B. Droplet  (melalui saliva and other respiratory secretions  batuk, bersin, kissing, chewing on
toys)
C. Close contact
D. Mosquito bite
E. IV

57. A 62 years old male came to neurology clinic with a history of seizure 5 times in the last week.
Previously he had seizure 3 times in a month. His seizure starts with face and eyes turning to left,
tonic-clonic of the left extremities, and then spreads to the right extremities with loss of
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consciousness. His seizure last for 2 minutes and then stopped and he regained consciousness. What
is the diagnosis:
A. Acute symptomatic seizure
B. Chronic symptomatic seizure
C. Epilepsy  (seizure yang sudah berulang tetapi bukan suatu status epilepticus  pengertian
ada di slide seizure dan epilepsi)
D. Status epilepticus  is when a seizure lasts longer than 5 minutes or when seizures occur close
together and the person doesn't recover between seizures. Ada dua macam yaitu convulsive
(more dangerous) dan non-convulsive.
E. Non psychogenic epileptic seizure
58. What would be the mechanism of a seizure like the patient above?
A. Increase Glutamate
B. Increase GABA
C. Increase dopamine
D. Increase acethylcholine
E. Increase cholinesterase

* Ketika terjadi seizure ada 2 neurotransmitter yang berperan yaitu GABA (sebagai inhibitory) dan
Glutamate (sebagai excitatory). Normal nya keduanya seimbang namun apabila GABA kerendahan
agtau Glutamate ketinggian maka involuntary muscles contraction (kejang) terjadi.

59. A 65 years old man is diagnosed with a form of a peripheral neuropathy. this individual will likely
display which of the following :
A. A loss in motor function, but sensory functions will remain largely intact
B. A reduction in conduction velocity of affected nerve  biasanya pada peripheral neuropathy
terjadi kerusakan dari selubung myelin terlebih dahulu, lalu jika lebih parah maka akan terjadi
kerusakan pada axon. Karena myelin rusak maka akan terjadi perlambatan jalan nya impuls.
Apabila akson yang terputus maka akan terjadi hambatan atau kegagalan dalam penghantaran
impuls.
C. An increase in the number of Ranvier's nodes
D. Degeneration of myelin but the axon will typically remain intact
E. Signs of an upper motor neuron (UMN) paralysis
60. Multiple sclerosis, ada IgG nya, yg bkin lemes apa? E. Increas k efflux
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* Pada multiple sclerosis terjadi proses demyelinasi akson sehingga akan lebih banyak akson yang tidak
terbungkus myelin, otomatis akan terjadi proses penghantaran impuls melalui akson yang botak
tersebut (penghantaran impuls jadi lebih lama dan semakin banyak Na/K channel yang harus dilalui
{biasanya di skip pake myelin jadi cepat})  bisa dibilang Increase Na influx atau Increase K efflux

61. Pasien trauma tabrakan fraktur rib sama hemorrhage, dokter tingkatkan pCO2, buat apa?

* hypoventilation akan menurunkan pH dan arteriolar resistance  nanti akan membuat increased
CSF pressure karena cerebral blood flow naik. Hyperventilation has the opposite effect.

62. Which of the items listed below best characterizes the following statement: A graded, fast potential,
lasting from several milliseconds to seconds, resulting from a chemical transmitter binding to a
receptor to produce either an excitatory postsynaptic potential (EPSP) that depends upon a single
class of channels for sodium and potassium or an inhibitory postsynaptic potential (IPSP) that is
dependent upon chloride or potassium conductance.
A. Receptor potentials
B. Electrical postsynaptic potentials
C. Increased-conductance postsynaptic potentials (USMLE)
D. Decreased-conductance postsynaptic potentials
E. Decreased-conductance postsynaptic potentials
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* ciri diatas menggambarkan fenomena action potential, artinya akan memberikan konduksi
stimulus pada sel saraf atau sel otot berikutnya (post-synaptic) yang dapat berupa excitatory
maupun inhibitory.

63. Pasien didiagnosis infeksi bakteri Lactrodectus mactans, ada sharp pain, numbness, cramp, vertigo,
vomiting, nausea, hyperhydrosis. Doctor bilang disebabkan karena toxin alpha- lactrotoxin di
presynaptic membrane menyebabkan depol sehingga increase Ach binding. Principle of axosomatic
synapse?
A. Type 1
B. Connection between pre and post synapse
C. Mostly inhibitory (USMLE)  untuk memberikan suatu impulse inhibitory lebih cepat apabila
langsung ditransmisikan menuju badan neuron.
D. Signalling with glutamate
E. Ada di neostriatum

64. 25 years old girl consult to her physician that she has multiple nodule around 1.1 to 2.0 cm sacttered
dominantly in her extremities and torso. PE found café au lait in her skin and irregular multiple
nodules biopsi from one of her nodule showed a benign neoplasm. best diagnostik is :
A. Dermagofibroma
B. Liposarcoma
C. Angiofibrolipoma
D. Benign low grade perineural shearh tumor
E. Neurofibromatosis von reckling haussen

* Von Recklinghausen’s disease (VRD) is a genetic disorder characterized by the growth of tumors on
the nerves (terutama peripheral nerves) sehingga bisa menimbulkan gejala multiple nodules di kulit
da nada specific sign café au lait.

65. 4 cm mass attached to duramater right parietal lobe was found incidentally on ct scan performed on
a 42 yo woman who was fallen and had her head hitten by a bicycle. After neurosurgery
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histopathologically showed proliferated elongated cells, oblong nuclei, and occasional psammoma
bodies. Best diagnosis:
A. Astrocytoma
B. Oligodendroglioma
C. Meningioma
D. Ependymoma
E. Meduloblastoma

* terdapat massa tumor di meninges, lalu disertai penemuan psammoma bodies di PA  curiga
meningioma.

66. A 23 Year old man came to Emergency Department after Motor Cycle Accident. He is unconscious
and physical Examination shows assymetrical pupil dilatation. (Picture 1: without light.. widened
right pupil, left pupil nomal. Picture 2: light to the right eye, right pupil still widened, left pupil
constrict). Which of the following occurred?

A. Lesion of the Right Second Nerve


B. Lesion of the Left Second Nerve
C. Lesion of the Right Third Nerve
D. Lesion of the Left Third Nerve
E. Lesion of both Third Nerve
67. While playing hockey a boy falls and hits his head on the ice. X-ray : linear fracture behind the ear
toward the foramen magnum and involving jugular foramen. Which of the following you would
expect to find?
A. Difficult open right eye
B. Lost control lip movements
C. Unable to close his jaw properly
D. Signs attributable to a hemmorhage middle meningeal artery
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E. Difficult to swallow  (jugular foramen dilewati CN IX, X, XI)


68. 2 y.o baby girl, dtg dengan keluhan ulcerative mass di T12-L1, di CT scan nunjukin abcess, di
curettage biopsy ada necrosis caseous, langhan cell, dia kena apa?
A. spondilitis TB
B. Synovitis non-spesifik
C. Poliomyelitis
D. spina bifida
E. HNP

* curiga ada cold abscess hasil infeksi TB di spine  ada necrosis caseosa dan langhans  TB
spondylitis.

(soal 69) 35 y.o male kecelakaan, 15 menit dia ga sadar. Dia sadar pas masuk ke emergency. BP 130/80,
HR 88x/menit. Selama pemeriksaan, he became unconscious. He also develops right pupil dilatation and
left side weakness.

69. Why he develops right pupil dilatation?


A. Direct uncal compressing at pons level
B. Direct uncal compressing at medulla oblongata
C. The uncus cause stretching of the third nerve
D. The uncus cause stretching of thesixth nerve
E. The uncus cause stretching of the fourth nerve

* curiga ada hemorrhage, uncus terdorong ke belakang kearah brainstem, kebetulan deket dengan
CN III, sehingga terjadi dilatasi pupil kanan. Artinya kerusakan disebelah kanan, maka untuk
ekstremitas yang terganggu adalah kiri karena ada persilangan.

70. the physician did a CT scan, according to the clinical findings, what would you expected to find?
A. Intraventricular hemorrhage
B. Epidural hemorrhage at posterior fossa
C. Subdural hemorrhage at interhemispheric
D. Epidural hemorrhage at occipital region
E. Epidural hemorrhage at temporal region

* karena ada lucid interval, curiga epidural. Karena dia lesi hanya sebelah, kemungkinan temporal
yang kena.
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71. He got a lucid interval, means conscious interval between two episodes of unconsciousness. What is
the most probable cause of second episode of unconscious?
A. Direct uncal compression at the pons level
B. Direct uncal compression at the medulla oblongata
C. Direct uncal compression at midbrain  (ARAS ada di midbrain)
D. Direct uncal compression at cingulate gyrus
E. Direct uncal compression at corpus callosum

* karena ARAS dari midbrain sampe ke MO. Curiga di daerah midbrain karena pasien ada juga gejala
CN III (lokasi asal dari midbrain).

72. 25 year old male injured himself because falling from a roof top. She can’t move his both legs.
Babinsky (+). What is the tract injured?
A. Corticospinal tract  untuk mengatur gerakan, curiga lesi di UMN, corticospinal merupakan
traktur yang termasuk descending dari brain ke medulla spinalis. Pilihan lain mengantar impulse
sensoris dari perifer ke CNS. Babinsky sign juga ada pada kondisi kelainan UMN saja (bukan salah
dari perifer).
B. Lateral spinothalamic
C. Cuneatus gracillis
D. Dorsal column
73. 35 yr old male unconscious. History of headache and fever for at least 1 week. Pupil normal, no
laceration. Extensor plantar reflex and neck stiffness positive. Papilledema present. What is your
diagnosis?
A. Meningitis  (ada fever, neck stiffness, papilledema, babinsky positif).
B. Ischemic stroke
C. Brain hemorrhage
D. Subarachnoid hemorrhage
E. Obstructive hydrocephalus
74. Cowo 54 tahun, keluhan tremor tangan kanan. Hasil PF ada resting tremor di tangan kanan, ada slow
gait. Obat apa yang cocok
A. Amphetamine
B. Acethylcolinergic
C. Dopamine
D. Levodopa  curiga pasien Parkinson , obat nya levodopa.
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E. SSRI
75. Cewe 70 tahun mengeluh sudden onset weakness of her arm and leg, slurred speech, and aphasia.
Ct brain nya ischemic stroke affecting left MCA territory. Treatment for reduce future stroke?
A. Streptokinase
B. R-TPA
C. Acethylcholine esterase inhibitor
D. Aspilet  ischemic stroke, curiga karena terbentuk thrombus-thrombus darah yang dimulai dari
platelet clotting. Jadi untuk mencegah next stroke harus kasi antiplatelet.
E. Levodopa

Psikiatri
76. Pria dateng2 ke dokter ada gejala2 autonomic hyperreactivity, irritable, apa penyakit psikiatri nya?
A. Anxiety disorder
B. Panic disorder
C. Schizoid disorder
D. Bipolar disorder
77. A 22 year old woman with episodic, uncontrolled, compulsive, and rapid ingestion of large amounts
of food within a short period of time (binge eating) followed by self-induced vomiting, use of
laxative or diuretics, fasting, or vigorous exercise to prevent weight gain. Which of the following
disorder is the most appropriate with these symptoms?
A. Anorexia nervosa
B. Bulimia nervosa  (ada binge eating)
C. Obesity
D. Kleine-Levin syndrome
E. Major depressive disorder
78. A 20 year-old man come to outpatient-psychiatric complaining he is sexually aroused by woman's
shoes, hair, and underwear. He felt uncomfortable and ashamed of his condition. What is the most
appropriate diagnosis?
A. Frotteurism
B. Fetishim
C. Exhibitionism
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D. Voyeurism
E. Transvestic fetishm  (ada hubungan dengan pakaian wanita)
79. A 78 years woman brought to the clinic by her daughters and reported to have difficulty in sleeping
for the last 3 months; she also started to be agitated when she was unable to sleep during the night.
She is also very emotional, angry at everybody, accusing them robbing her money. She is very good
at remembering her past experience. What is the most appropriate diagnosis?
A. Mild cognitive impairment
B. Schizophrenia
C. Loss of consciousness
D. Organic delutional state
E. Dementia
80. A 19 year old girl just delivered a baby one week ago. Ever since that she has been feeling sad,
blablabla (intinya dia depressed) what kind of condition that she has?
A. Post partum depression
B. Baby blue syndrome -> masih <2 minggu, kalo udh >2 minggu baru post partum depression
C. MDD
D. PTSD
E. Bipolar
81. A 30 years old woman, married 6 years ago complained of having pain during sexual intercourse
with her husband. She did not enjoy having sex with him. She has got no infection and abnomality in
her vagina. What does she got?
A. Chronic pain disorder
B. Does not like her husband
C. Dyspareunia  painful sexual intercourse
D. Vaginismus
E. Lack of estrogen
82. 28 years old man, schizo, restless/ walks round the room, can’t sit still, dokter bilang karena
medication. Nama symptom?
A. Catatonic
B. Chorea
C. Akathisia  Efek samping dari pemberian obat antipsychotic terutama yang typical
(Extrapyramidal Symptoms)
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D. Tardive dyskinesia
E. Parkinsonism
83. Mr x 30 thn, schizophrenia complains tremor ang gait like robot, itu symptomnya disebut apa?
A. Catatonic
B. Parkinsonism  bradykinesia + tremor
84. A person has such a character that he is very quiet, will not and cannot make many friends what he
had is only one friend in this world, he talks very little, tendency to withdraw from group of people,
a bit suspicious and can only work alone and prefer to handle a non-living object rather than human
such as work with computer only, he is having a personality disorder of type?
A. Narcisisitic  grandiose, need admiration, percaya dia itu special, etc.
B. Paranoid  pervasive distrust and suspicious towards others; mereka selalu suspect orang lain
harm mereka, etc.
C. Schizoid  detachment from social relationship: suka kerja sendiri, biasa gk ada atau sedikit
teman, detachment, etc.
D. Anancastic  aka OCPD: preoccupation with orderliness, perfectionism, mental and
interpersonal control, at the expense of flexibility, openness, and efficiency.
E. Avoidant  menghindar dari interpersonal contact karena takut akan criticism, rejection, etc.
Merasa dirinya inferior, intinya takut akan tidak disukai orang lain.
85. 37-year-old man comes to the psychiatry clinic complaining of sudden shortness of breath,
palpitation, freq urination, numbness over his bans, sweating all over his body, and neck rigidity. He
is very afraid if his heart suddenly stopped. This condition appears since 2 months ago. What is the
most likely diagnosis for this condition
A. PTSD  ada exposure ke traumatic event yang bikin dia teringat terus, flashback atau mimpi
tentang kejadian tersebut, jadinya dia avoid yang bikin teringat etc.
B. Panic disorder  recurrent panic attacks: palpitations, sweating, trembling, shortness of breath,
choking, chest pain, nausea, dizzy, chill/heat sensations, paresthesias, derealization, fear of
dying, fear of losing control.
C. General anxiety disorder
D. OCD
E. Social phobia
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86. People using drugs for many reasons, including non-medicinal indications. Some drugs can give
peaceful feelings, euphoria, increased self-confidence and stamina; and also used for body slimming
or reduce bodyweight. Which drugs do you think can provide those effects?
A. Opiate.
B. Cannabis.
C. Cocaine.
D. Amphetamine  euphoria, increased endurance, weight loss, appetite loss, difficulty urinating,
increase alertness, self confidence, concentration, sociability ,etc.
87. 20 year old male brought to hospital due to change in behavior. Like to steal things and becomes
manipulative. Restless, agitated, and pain fell all over the body. Both pupil dilated, he had
rhinorrhea and (lupa satu lg apa). The mother suspect her son is using illicit drugs. What symptoms?
A. Opioid withdrawal  dysphoric mood, anxiety, irritability, nausea, vomiting, myalgia,
lacrimation, rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever,
insomnia
B. Cocaine withdrawal
C. Cannabis withdrawal
D. Opioid intoxication
E. Cocaine intoxication
88. Ms. N depresi. Neurotransmitter apa yg kena? A. Serotonin
89. Mr. N depressed obat untuk memperbaiki moodnya dia :
A. Dopamine Inhibitor  antipsychotics, bipolar
B. SSRIs  most common antidepressants
C. Benzodiazepin  anxiety, panic disorder, sleep disorder
D. Chlorozapine
E. Risperidone  antipsychotic
90. Giggling. bedain jenis2 schizo, mdd, panic disorder dah pokonya
A. Hebefrenic schizo
B. Catatonic schizo

*Klasifikasi schizophrenia
 Paranoid
Prominent delusion or auditory hallucination with relative preservation of cognitive functioning and affect.
Symptoms of disorganized and catatonic types are not prominent. Associated feature: anxiety, anger,
aloofness, argumentativeness.
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 Disorganized/Hebephrenic
Essential feature: disorganized speech (may be accompanied by silliness and laughter not related to
content), disorganized behavior (may lead to disruption in performing activities of daily living), flat or
inappropriate affect. Criteria for catatonic types are not met, delusions and hallucinations not present, and
if present are only fragmentary and not organized into coherent theme.
 Catatonic
Marked psychomotor disturbance: motoric immobility (catalepsy or stupor), excessive motor activity,
extreme negativism (maintenance of rigid posture against attempts to be moved or instructions), mutism,
peculiarities of voluntary movement (voluntary assumption of bizarre postures), echolalia, echopraxia.
Associated feature: stereotypies, mannerisms, mimicry.

91. A 19-year old man was brought by his family to Psychiatrist. Patient says: The voices told me to do
“bad things”, there are often two or three voices talking, and they often comment to each other on
his behavior. He believes that someone want to kill him. He has ideation of killing his father
occasionally. What psychopathology are found for this patient? B. Auditory hallucination, delusion
92. A woman often remarks that she is extraordinarily wealthy, despite her being in a psychiatry
hospital and have an empty bank account. When asked about this apparent contradiction, she said
that the hospital keeps all her money because the administrators fear of her power if she's not
hospitalized. Her symptoms first began when she graduated from highschool. This symptoms can be
referred as...
A. Grandiose Delusion  belief that one is famous, extremely wealthy, omnipotent, very powerful,
etc.
B. Delusional Jealousy
C. Idea of reference
D. Thought Withdrawal
E. Thought Insertion
93. 5 bulan anhedonia,insomnia, penurunan nafsu makan, penurunan berat badan. diagnosis?
A. Bipolar 1  Manic episode ± Major depressive episodes
B. Bipolar 2  Major depressive episodes and hypomanic episodes
C. MDD  Major depressive episode (single, recurrent) : depressed mood most of the day, nearly
everyday, diminished interest or pleasure, weight loss or decreased appetite, insomnia or
hyperinsomnia, etc.
94. Ibu A bawa Ibu R (mak-nya) ke dokter. Ibu R 68 thn lupa nama cucunya dan kmrn sempet ke rs juga.
Intinya pertanyaan nya test apa yg mambantu screening Ibu R?
A. MACI  developed to assess adolescent psychopathology
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B. DPRS  measure patient’s psychological symptomatic distress


C. MMPI-2  screen for personality and psychosocial disorder in adults
D. TAT  projective psychological test
E. MMSE  measure cognitive impairment
95. Ada anak kecil, di denial di school performance. Abis itu dia ngurung diri di kamar , jaga
kebersihannya, ga mau bergaul lagi. Itu tipe personality disorder yg mana?
A. Skizoid personality disorder
B. Skizotipal
C. Avoidant
96. Cowo naik motor kecelakaan, kepala ngebentur street, 7 menit ngga sadar, dibawa ke ER ngga inget
accident momentnya. dia cuma inget 1 bulan sebelum accident. yang dia ngga inget : dari accident
sampe sekarang. disebut apa?
A. Anterograde amnesia  ga bisa convert short-term memory ke long term memory, hasilnya ga
bisa ingat recent event, tapi yang dulu-dulu tetap ingat.
B. Delirium
C. Narcolepsy
D. Retrograde amnesia  kehilangan ingatan yang telah terbentuk sebelumnya. Ingatan baru
tetap bisa dibuat.
E. Dissociative amnesia

*post-traumatic amnesia bisa anterograde (problems creating new memories after injury has taken place)
atau retrograde (loss of memories that were formed shortly before injury, particularly where there is damage
to frontal and anterior temporal regions).

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

*Delirium
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 Acute confusional state. Symptoms start suddenly. Due to underlying factors: infection, metabolic
problems (malnutrition, dehydration, endocrine disorders, etc.), medications, physical/psychological
stresses, etc.
 On second week of typhoid, patient have high fever of 40 degrees C and bradycardia and often have
delirium (giving nickname of “nervous fever”)
 Symptoms: agitated, aggressive, incoherent speech, disorganized thoughts, delusions, hallucinations,
disorientation.