1.

An injury to the facial nerve as it leaves the styloid foramen would disrupt which
function?
A. Taste to the posterior tongue
B. Sensation to the cornea
C. Sensation to the cheek
D. Sensation the anterior scalp
E. Wrinkling the forehead.

2. 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

3. According to the problem above, which vessel is most likely injured?

A. Branch of pericalosal artery
B. Branch of anterior communicating artery
C. Lateral branch of medial cerebral artery
D. Central branch of posterior communicating artery
E. Branch of basilar artery

4. A 37 year old man felt down when he fixed the roof of his house. Afterwards he suffered
from urinary incontinence. Which segment of spinal cord region is the most likely has
trouble?
A. L1-2
B. L3-4
C. L5-S1
D. S 2-4
E. S5

5. A 9 years old boy is brought to your clinic by his parents because he has begun to have
episodes of eye fluttering lasting several seconds. Sometimes he loses track of his
thoughts in the middle of a sentence. There are no other associated symptoms, and the
episodes may occur up to 1 minute and occur 3-5 times per day. The boy’s development
and health have been normal up until this point. He did have two head injuries as a young
child. Both episodes resulted in a brief loss of consciousness and he did not think clearly
for part of the day afterward, but had no medical intervention. Which of the following
test is the most appropriate to confirm patient’s diagnosis?
A. CT scan
B. MRI
C. Electroencephalogram
 D. Lumbar puncture
E. Nerve conduction study

6. A 52-year-old successful businessman came to the emergency department because of

weakness of her left extremities. His wife said that 1 hour ago He fell from his bed when
he woke up in the morning. The physician did MRI of the brain and the result show no
sign of hemorrhage. What is the best treatment option for this patient?
A. Surgery
B. Warfarin
C. Aspirin
D. r-TPA
E. Heparin

7. A 50-year-old man brought to the emergency department after suddenly had weakness on
right side of his body. On physical examination his BP was 170/90 mmHg, Pulse 80
x/min, RR 18x/min. Neurologic examination found that the deep tendon reflex was loss
on the right side and he developed non-fluent aphasia. Which of the following vessel is
the most likely involved in this case?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Internal carotid artery
E. Basilar artery

8. A 68-year-old woman is noted to have memory loss and confusion. Her daughter relates a
history of progressive decline in her mother’s cognitive function over the last year. The
mother has lost interest in her usual activities, such as gardening and reading. Her
daughter noted that she wear the same clothes for several days. Yesterday, the mother
was lost in a shopping mall that they used to visit every week. The physician did a
MMSE and it reveals a score of 22. What is the most likely diagnosis?
A. Alzheimer’s disease
B. Schizophrenia
C. Mood disorder
D. Vascular dementia
E. Parkinson’s disease

9. A 27 years old male, complaining shortness of breath when he woke up this morning.
Two days ago he developed weakness on both of lower extremities. The next day, he felt
difficulty to raise both arm and felt hand and foot paresthesia. From history, we knew that
5 days ago he was just healed from infection of his intestinal. From physical examination,
BP 120/80, RR 24x/min, HR 70x/min, temp 36,7°C. Reflex were absent. Abdominal
showed normoactive bowel sound. Lung clear (normal). Lab exam showed respiratory
acidosis. CSF analysis revealed Albumin cytologic dissociation. Which of the following
complications is the most common to occur with this disease?
A. Infection
B. Respiratory failure
 C. Cardiac arrhythmia
D. Complete paralysis
E. Irritable bowel syndrome

10. A 48-year-old widow was previously diagnosed with schizophrenia. She lived with her
only daughter who is willing to take care of her. She has been in medication for five
months with haloperidol 20 mg daily. Her daughter says that she has shown some
improvement but since 3 days ago her daughter noted that she began to have tremor and
slurred speech. What drug is best prescribed to reduce the tremor and slurred speech?
A. Chlorpromazine
B. Risperidone
C. Diazepam
D. Clozapine
E. Trihexyphenidyl

11. A 60 years old male with third nerve palsy that happened acutely. If you consider
aneurysm as a differential diagnose, what is the best way to depict the abnormal vessel?
A. Magnetic Resonance Imaging (MRI)
B. PET Scan
C. Plain skull X ray
D. Angiography
E. Ultrasound

A 35 years old male got a motor vehicle accident, he was unconscious for 15 minutes, forgot all
memory around the accident time frame. He was conscious when he admitted to emergency unit.
BP 130/80 mmHg, HR 88 x/minute. During clinical investigation in emergency unit, he became
unconscious. He also developed right pupil dilatation, and left side weakness.

12. What is the most probable cause of his unconscious for the first 15 minutes after the
injury?
A. Direct Compression at the brainstem
B. Disruption of reticular formation function
C. Probably hypoglycemia
D. Probably hyponatremia
E. Probably alcohol intoxication

13. Why he develops right pupil dilatation?

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

14. 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

15. Before he develop increase intracranial pressure signs, which of the following is the
compensation mechanism that keep the intracranial pressure stable?
A. The brain will be pushed out through foramen magnum
B. The CSF will be pushed to spinal arachnoid space
C. The intracranial pressure will avoid blood coming to the brain
D. The brain will be shift to the lower pressure area
E. The absorbtion of the CSF will increase
16. A 37 year old man falls 4 meters off of a roof and fractures his cervical spine, causing
damage at the C4 level. He is initially a flaccid quadriplegic with areflexia. This areflexia
and flaccidity evolve into hyperreflexia and spasticity within 2 weeks later. What is the
cause of this phenomenon?
A. Spinal shock
B. Spinal cord hypoxic
C. Spinal cord contusion
D. Spinal cord compression
E. Spinal cord laceration
17. A 30 year old man injured his thoracic spine in motor vehicle accident 2 years ago. Now
he still has pain and thermal sensation loss on part of his left body and propioception loss
in his right foot. There is still a paralysis of the right lower extremity as well. This patient
most likely has which of the following spinal cord conditions?
A. Hemisection syndrome
B. Complete transection
C. Anterior cord syndrome
D. Posterior collum syndrome
E. Central cord syndrome
A 70 year old woman has had a gradual memory decline over the past 5 years. Her MMSE was
16, other examination otherwise normal. No history of hypertension or diabetes mellitus. Brain
MRI showed cortical atrophy and enlargement of ventricles spaces.

18. Which of the following is most characteristic of the brain in this patient?

A. Neuronal loss in the cerebral cortex

B. Demyelination in the cerebral cortex
C. Posterior column degeneration
D. Neuronal loss in the cerebellar cortex
E. Degeneration of substantia nigra
19. What is the most appropriate medication to improve his cognitive?
A. Donepezil
B. Levodopa
C. Risperidone
D. Haloperidol
E. Prednisone
20. A 56 years old man came to ER with sudden weakness of his left extremities. He had
history of hypertension and diabetes. On examination his strength on left extremities was
grade 2. His rest examination was normal. Brain MRI showed infarct on right internal
capsule. The fiber tract affected by this syndrome decussates at what level?
A. At the anterior thalamus
B. At the junction of the medulla ob. and the spinal cord
C. At the junction of the midbrain and the medulla ob.
D. At the junction of the pons and the medulla ob.
E. Within one to two levels after entering the spinal cord
21. A young adult,16 year-old is watching tv programme, suddenly stops her activity,
unresponsive, then falls down and starts convulsion. She had previous same attacks ,
twice in a month since two months before. When there is no attack, she is normal.
What is the working diagnose of this case?
A. Acute symptomatic seizure
B. Status convulsivus
C. Status epilepticus
D. Epilepsy
E. Idiopathic epilepsy

22. Patient with partial seizures gets repeated attacks and longer than ten minutes ,
also never regains her consciousness . She should be referred to hospital soon. What
is the reason?
A. She gets disabling seizures
B. She suffers from prolonged seizures.
C. She gets status epilepticus.
D. She suffers from remote symptomatic epilepsy.
E. She need blood examination.

23. A 40 year old female complained headaches . She fell and hit her head. A CT scan
showed a 3 cm mass beneath dura that compresses the underlying left lateral parietal
lobe. She is taken to surgery and after removal by her neurosurgeon, the mass send to
Pathology laboratorium. Microscopic showed elongated cells, oblong nuclei and pink
cytoplasm with psammoma bodies.
Which of the following lesions has probably occured ?
A. Meningioma
B. Schwannoma
C. Astricytoma
 D. Ependymoma
E. Glioma

24. A 40 year old man came to outpatient clinic with feeling shaky, headache, muscle
tension, shorthness of breath, hyperventilation, fatigability, autonomic hyperactivity,
paresthesia, and followed with difficulty concentrating, insomnia, decreased libido.
Which of the following is the most likely diagnosis?
A. Agoraphobia.
B. Anxiety disorders
C. Schizophrenia
D. Mood disorders
E. Demensia vascular

25. A 20 year old man came to outpatient-psychiatric clinic complaining that he is sexually
aroused by woman’s shoes, hair, and underwear. He felt uncomfortable and ashamed
with his condition. What is the most appropriate diagnosis?
A. Frotteurism
B. Fetishism
C. Exhibitionism
D. Voyeurism
E. Transvestic fetishism

26. 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 of
robbing her money. She is very good at remembering her past experience, she is able to
account very clearly about her childhood, even the names of all her childhood friends, but
she could not recognize her grand children, their names and identities. What is the most
appropriate diagnosis?
A. Mild cognitive impairment
B. Schizophrenia
C. Loss of consciousness
D. Organic delusional state
E. Behavioural and psychological symptoms of dementia

27. Mr.A 26-year old , He is schizophrenic man, feels restless / walk round in room and
cannot sit still. The doctor of psychiatry said, that this behavior is caused by medication.
What ‘s name this symptom ?
A. Catatonic
B. Chorea
C. Akathisia
D. Tardive Dyskinesia
E. Parkinsonism

28. Mr.X 30-year old man being treated for schizophrenia complains of tremor and slow gait
likes robot.What ‘s name this symptom ?
 A. Catatonic
B. Chorea
C. Akathisia
D. Tardive Dyskinesia
E. Parkinsonism

29. A boy was born with a big head and diagnosed as Primary hydrocephalusWhat is the most
possible cause?
A. Heredity
B. Abundant of arachnoid villi
C. Tumor of choroid plexus
D. Undeveloped of the apertures
E. Meningitis

30. A 50 years old man has trouble with sensory of temperature in his left upper limb after got spine
injury. These sensory is conveyed by the anterior spinothalamicus tract
Which is the most likely the pathway of the tract?
A. Crosses the midline of MS
B. Crosses the midline of the MO
C. Crosses the midline of the midbrain
D. Is uncrossed in the spinal cord
E. Is uncrossed the medulla oblongata

31. A 35-year-old man complains of the worst headache of his life, grabs onto the back of his neck,
and then slumps onto the floor. At the hospital, his CT findings are consistent with a
subarachnoid hemorrhage.
Which of the following is the most likely etiology?
A. Carotid artery occlusion
B. Vertebrobasilar artery occlusion
C. Middle meningeal artery laceration
D. Rupture of a berry aneurysm
E. Rupture of basilar artery

32. A 68-year-old man taking warfarin falls while in the hospital, is found on the floor, and is
difficult to arouse. He has a new right hemiparesis. An intracranial hemorrhage is suspected.
What is the most appropriate initial radiologic study?
A. Head CT with contrast
B. Head CT without contrast
C. Skull x-ray zero answer option
D. Cerebral angiography
E. Brain perfusion scan zero answer option

33. A 35-year-old woman presents to the emergency room with a few days of progressive
ascending muscle weakness. She had a viral infection a few weeks ago. On examination
you find diffuse weakness and areflexia. The most likely finding in the spinal fluid is:
A. High protein-high cell count
B. High protein-low cell count
C. Low protein-high cell count
 D. Low protein-low cell count
E. Normal protein-normal cell count

34. A 35 year old man has been complaining of sudden right facial weakness. He drops the saliva
when eating, and could not closing his right eye lid. There was no fever and his rest examination
reveal no abnormalities. Where is the lesion?
A. Trigeminal nerve
B. Hipoglossus nerve, LMN type
C. Hipoglossus nerve, UMN type
D. Facial nerve, LMN type
E. Facial nerve, UMN type

35. A 34 years old man brought to ER with unconsciousness. The examination revealed right pupil is
6 mm in diameter and left is 3 mm in diameter. Right pupil did not response with light stimulus
but consensual response did. Where is the most appropriate site of the lesion?
A. Cranial nerve I zero answer option
B. Cranial nerve II
C. Cranial nerve III
D. Cranial nerve VI zero answer option
E. Cranial nerve VII

36. What the cranial nerve probably involved in case above?

A. Oculomotor nerve
B. Trigeminal nerve
C. Abduscen nerve
D. Vagus nerve
E. Hipoglossus nerve

37. What is the tract involve which cause weakness of her extremities?
A. Anterior spinothalamicus
B. Lateral spinothalamicus
C. Anterior Serebelaris
D. Lateral corticospinal
E. Lemniscus medialis

38. A 56 year old man has been complaining suddenly weakness on one side of extremities. Brain CT
scan on one week after the onset showed infarct at capsula interna and right thalamus. Which
condition will expected for this patient ?
A. Flacid weakness of left extremities
B. Spastic weakness of left extremities
C. Flacid weakness of right extremities
D. Rigid weakness of his extremities
E. Spastic weakness of right extremities

39. A 50 year old man brought to ER with weakness of right extremities and paralysis of left facial
nerve since 2 days ago. What is your consideration to the location of the lesion?
A. Cerebri cortex
B. Capsula interna
C. Thalamus
D. Pons
E. Spinal cord
40. A 20 year old man brought to ER with unconsciousness after car accident. On examination, GCS
was 8 with large fixed pupils and unresponsive to light. The corneal reflex still intact and
occulocephalic response was normal. Where is the level of abnormalities?
A. Internal capsule
B. Thalamus
C. Midbrain
D. Pons
E. Medulla oblongata

41. A 24-year-old woman abruptly loses all speech during the third trimester of an otherwise
uncomplicated pregnancy. Her comprehension is good, and she is frustrated by her inability to
speak or write. She is unable to repeat simple phrases, but she does begin to produce simple
words within 5 days of the acute disturbance of language. Which of the following is the most
likely diagnosis?
A. Broca’s aphasia
B. Wernicke’s aphasia
C. Global aphasia
D. Transcortical sensory aphasia
E. Conduction aphasia

42. A 17-year-old male presents with 10 days of progressive tingling paresthesias of the hands and
feet followed by evolution of weakness of the legs two evenings before admission. He complains
of back pain. He has a history of a diarrheal illness 2 weeks prior. On examination, he has
moderate leg and mild arm weakness, but respiratory function is normal. There is mild sensory
loss in the feet. He is areflexic. Mental status is normal.
Spinal fluid analysis in this case is most likely to show?
A. No abnormalities
B. Elevated protein level
C. Elevated white blood cell count
D. Elevated pressure
E. Oligoclonal bands

43. The most frequent preceding infection before the onset of the syndrome above is?
A. Human Immunodeficiency Virus
B. Cytomegalovirus
C. Epstein-Barr virus
D. Mycoplasma pneumoniae
E. Campylobacter jejuni

44. Over the course of the following week, he has further evolution of weakness involving muscles of
the arms, face, and respiration. He is intubated and placed in the intensive care unit. Nerve
conduction and electromyogram (EMG) studies show widespread demyelination. Therapy with
which of the following may help to speed recovery?
A. Corticosteroids
B. Cyclophosphamide
C. Plasma exchange
D. Albumin infusions
E. Gabapentin
45. A 67-year-old woman has noticed blurry vision and weakness over the past 4 months. Her
symptoms are always worse toward the end of the day and improving when she woke up in the
morning. Where is the most obvious site of the disease?
A. Anterior horn cell
B. Neuromuscular junction
C. Sensory ganglion
D. Parasympathetic ganglia
E. Sympathetic chain

46. A 21-year-old man reports several episodes over the previous 4 years during which he lost
consciousness. He had no warning of the impending episodes, and with each episode he injured
himself. Observers told him that he abruptly developed a blank stare and stopped talking. His
body became stiff and he arched his back. After several seconds of this type of posturing, his
arms and legs started shaking violently. He routinely bit his tongue and urinated in his pants
during the episodes. What the most likely diagnosis?
A. Complex partial
B. Generalized tonic-clonic
C. Generalized absence
D. Myoclonic
E. Simple partial zero answer option

47. The patient above was brought to local hospital. In the emergency room he slowly regained
consciousness but become restless and mumbles. During the work up he deteriorated with a
“blown pupil” on the right side and with pain stimulation showed left side weakness. What does
the clinical signs mean?
A. Hypoxia of his brain
B. Neurotransmitter disturbance
C. Right uncal herniating
D. Direct injury to the frontal lobe
E. Ischemia of the brain

48. An immediate CT Scan of the patient above shows an acute subdural hematoma and underlying
contusion on the right frontotemporal region. Then he was taken to the operating room for
evacuation of the hematoma. Following surgery, he was managed with aggressive medical
management of his ICP in the ICU.
Which of the following aggressive medical management appropriate for this case?
A. Give analgetic
B. Give diuretic
C. Give antibiotic
D. Give antiinflamation
E. Give sedative

49. A 1-day-old male infant with jaundice was born by spontaneously vaginal delivery to a 21- year-
old G1P1. On physical examination, this infant has abnormally small head circumference,
hepatospleenomegaly, and deafness. CT scan of the head reveals intracerebral calcifications. The
mother denied any significant medical history, tobacco, and drugs.
Which organism is most likely responsible for this condition?
A. Poliovirus
B. Rabies virus
C. Cytomegalovirus
D. Epstein-Barr virus
 E. Varicella-zoster virus

50. A 50 year old woman suddenly got experiences severe headache while teaching in her class .A
lumbar puncture shows numerous Red blood cells in the CSF,but there are no neutrophils. Which
of the following events has probably happened ?
A. Middle cerebral artery thromboembolism
B. Tear of subdural bridging veins
C. Subdural hemorrhage
D. Ruptured intracranial aneurysm
E. Epidural hemorrhage

51. A 51 year old man, complains a severe headache since a week ago. Using a photograph and
MRI, the doctor conclude that there is a mass that suppress the fourth ventricle.
Which of the following condition that cause the severe headache?
A. Production of pain substance by the tumor
B. Decrease GABAergic inhibition to the pain center
C. Increase glutamate production by the mass
D. Increase the brain ventricles pressure by the CSF
E. Stimulation of thalamic pain center

52. The characteristic that you can say about the above student is:
A. Delta wave
B. Teta wave
C. Atonia
D. Apnea
E. Sleep spindle

53. A 25 year old man suspected of abusing drugs. His parents find him comatose in his room and
taken by ambulance to the Siloam ER where he is noted to be in a stupor with bilateral pinpoint
pupils, cold and clammy skin, skeletal muscle flaccidity & respiratory rate 6-8/min. Which of the
following medication should be given for this situation?
A. Amphetamine
B. Caffein
C. Flumazenil
D. Naloxone
E. Neostigmine

54. A woman of 78 years 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. Also she was quite erratic when attended for meals, she would spit all the foods out.
She is also very emotional towards her surroundings, angry at everybody, accusing them of
robbing her money amounting to ten million rupiahs. She is very good at remembering her past
experience, she is able to account very clearly about her childhood, even the names of all her
childhood friends, but she could not recognize her grand children, their names and identities.
Which of the following condition is most likely for this case?

A. Depression
B. Bipolar disorder
C. Dementia
D. Schizophrenia
 E. Delirium

55. A 30 years old man is suffering from severe auditoric hallucination telling him that he must return
to planet Krypton immediately, he is very certain that somebody is implanting dozens of
microchips inside his brain which are made from green kryptonite stone. And because of that, he
lost his superhuman ability and sometimes he feels that his flesh is melting.
Which pathway is the most responsible for the patient’s symptoms above?
A. Mesolimbic
B. Mesocortical
C. Extrapyramidal
D. Nigrostriatal
E. Tuberoinfundibular