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CNS
Functional anatomy of cerebral cortex
1. Primary motor area (m1)
a) corresponds to area 6 of brodmann which is
present in post-central gyrus and posterior part
of paracentral lobule
b) cortex is granular
c) controls the movements of voluntary muscles
of ipsilateral side
d) most characteristic feature is the presence in
lamina v of extremely large pyramidal cells (of
betz), measuring 15-60 micrometer or more in
diameter
e) part of the body is not represented
proportionate to size but rather to intricacy of
movement
e)
e)
a) red nucleus
b) corpus striatum
c) substantia niagra
d) olivary nucleus
e) limbic system
3. Regarding the medial medullary syndrome
a) result from occlusion of anterior spinal artery
b) ipsilateral upper motor neuron paralysis
c) involved spinal lemniscus, spinal nucleus and
tract of trigeminal nerve and nucleus ambiguous
d) loss of discriminative senses of the body in
contralateral side
e) involve hypoglossal nerve, corticospinal tract of
the pyramid and medial lemniscus
4. Clinical features of webers syndrome
a) ptosis
b) contralateral hemiplegia
c) contralateral loss of pain, touch, temperature,
vibratory and proprioceptive senses
d) tremor, chorea and athetosis
e) loss of accommodation
Pathology of cerebrovascular disease
1. Regarding the gross morphology of global cerebral
ischemia
a) widened gyri & narrowed sulci
b) well demarcation bet. gray & white matter
c) fluid-filled cavity lined by dark gray tissue
d) brain edema
e) sickle-shaped band of necrosis in border zone
bet. anterior & posterior cerebral artery
distribution
2. Microscopic features of focal cerebral ischemia
a) red neurons (after 24hrs)
b) neutrophilic emigration (up to 48hrs)
c) macrophages predominate (2 to 3 wks)
d) gliosis developing esp around the cystic cavity
e) influx of macrophages (24 hrs to 2 wks)
3. The causes of the subarachnoid hemorrhage are
a) saccular (berry) aneurysm
b) vascular malformation
c) amyloid angiopathy
d) vasculitis
e) tumours
4. Based on the morphology of berry aneurysm
a) dark red, shiny surface & thin, translucent wall
b) rupture is usually at base
c) atheromatous plaques, calcification or thrombus
d)
e)
5. True or false
a) intracranial hemorrhage peak at the age of 30
b) mechanism of intracranial hemorrhage is rupture
of small intraparenchymal vessels
c) development of charcot-bouchard aneurysm due
to effects of hypertension
d) location of capillary telangiectasia is at pons
e) cigarette smoking may not lead to berry
aneurysm
Radiology of cerebrovascular disease
1. Ct scan can detect :
a) density change
b) vessel occlusion
c) effect to nearby structure
2. Features of ischaemic stroke on ct scan are:
a) mild focal oedema
b) hypodense area
c) usually follow arterial distribution
d) commonest region basal ganglia, internal
capsule, thalamus
e) hyperdense area
3. Stroke mimics are:
a) brain tumour
b) hypernatremia
c) systemic infection
d) hepatic encephalopathy
e) seizure
4. Role of ct scanning:
a) distinguish between ischaemic and hemorrhagic
infarction
b) identifies the site and size of the infarct
c) rule out life threatening process e.g hematomas,
neoplasm and abscess
d) defining the anatomic distribution of stroke
e) confirm the diagnosis
5.MRI
a) less sensitive than ct to detect stroke in very early
cases
b) not practically possible to do as urgent case
c) t2, diffusion series are sensitive
d) t1-sf is white
e) t2 csf is black
Diagnostic approach to hemiplegia
d)
e)
c)
d)
e)
a) speech therapy
b) repositioning and range of motion of exercise
c) occupational therapy
d) rehabilitation program by professional team
4. What is the primary prevention for stroke
a) aspirin, ticlopidine, clopidogrel
b) ace inhibitor and statins
c) surgical treatment
d) exercise
Neurochemistry of movements disorder
1. Regarding hyperkinetic:
a) is a rigid akinetic syndrome
b) is a stereotypic movement
c) hemibalismus define as a high amplitude flailing
of the limbs on one side of body
d) parkinson disease include in hyperkinetic
movement disorder
e) dystonia is a voluntary muscle
contraction,causing sustained twisted.
2. Basal ganglia
a) help monitor and coordinate slow,sustained
contractions related to posture and support
b) neurotransmitters at inhibitory synapses are
dopamine,glutamate and gaba
c) it inhibit muscle tone throughout the body
d) neuromodulator released together with a small
molecular weight transmitter
e) neuromodulator have less term effects than
neurotransmitter
3. Concerning dopamine
a) derived from tyrosine
b) high concentration of dopamine will inhibit
tyrosine hydoxilase
c) dopamine will undergoes methylation and
deamination.
d) d2 receptors involve in indirect pathway
e) dopamine can cross blood brain barrier
4. Overall influence of the striatal dopaminergic
innervation
a) d1 receptors are activated by dopamine through
direct pathway
b) in direct pathway,dopamine stimulates cell firing
and increasing of gabaergic tone in basal ganglia
output nuclei.
c) inhibition of cell firing occur when dopamine
activates d2 receptor.
d) both pathways ultimately disinhibiting
thalamocortical relay neuron
e) direct pathway is like a gas pedal,while indirect
pathway is like a brake
b)
c)
d)
4. Regarding dystonia
a) it is a voluntary muscle contraction causing a
sustained, twisted or abnormal posture
b) it is not triggered by movement
c) frequently patients often have sensory tricks
d) viral encephalitis can cause dystonia
levodopa will work well in an inherited type of
dystonia
5. Regarding rigidity
a) it is characterized by plastic resistance to active
movement affecting both agonist and antagonist
c)
d)
e)
b)
c)
d)
e)
2. Vasogenic edema
a) increased permeability of capillary endothelial
cells caused by tissue necrosis
b) increased permeability of capillary endothelial
cells to serum proteins
c) edema fluid rich in electrolytes
d) increased interstitial space
e) may lead to cerebral herniation
3. Blood Brain Barrier(BBB)
a) cerebral capillary is the site of BBB
b) 10 times mitochondria compared to other
capillaries(3-4 times)
c) ATP ase is an important enzyme
d) Has a carrier mediated transport of glucose and
amino acid
e) Innervated by cholinergic and aminergic
only(para and simpa)
4. Vasogenic edema
a) grey matter edema >white (white>)
b) caused by mechanical failure of tight endothelial
junction of BBB
c) swelling of astrocytes
d) Focal inflammation
e) Reyes syndrome(in cytoyoxic edema)
5. Cytotoxic edema:
a) due to increased cell membrane Na+/K+
permeability
b) caused by disruption of blood brain barrier
c) edema bed rich in protein
d) no cell swelling
e) decreased interstitial space
6. Vasogenic edema
a) if severe can lead to cerebral herniation
1. Components of consciousness
a) Arousal- concurrent functioning of both cerebral
cortex and RAS
b) Wakefulness - concurrent functioning of both
cerebral cortex and RAS
c) Content cerebral cortex
d) Cognition cerebral cortex
2. The reticular activating system
a) Is primarily an antomic area in the midventral
portion of medulla and midbrain
b) Consists of diffuse, primitive system of interlacing
polysynaptic nerve cells
c) Consists of fibers in the brain stem
d) Axons of neurons have only ascending branches
e) Ascending fibers originate in the reticular
formation
f) Ascending fbers carry signals upward to arouse
and activate cerebral cortex
g) Ascending fibers involved in alertness
3. Levels of consciousness
a) Conciousness alertness
b) Confusion disturbed consciousness, impaired
ability to think clearly, perceive and respond to
stimuli
c) Delirium disturbed consciousness, motor
restlessness, transient hallucination,
disorientation, delusion
d) Obtundation decreased alertness, psychomotor
retardation
e) Stupor exhibits more spontaneous activity,
unconscious
f) Coma state of being unarousable and
unresponsive to external stimuli or internal
needs
4. Sleep
a)
b)
c)
d)
e)
Is a state of conciousness
Person can aroused by sensory or other stimuli
Follows a 24 hours diurnal and nocturnal rhythm
circadian rhythm
Is a restorative function
Sleep disorder will alter immune function, normal
circadian pattern of hormone secretion, and
physical and psychological functioning
5. Physiology of sleep
a) Stage I muscle contracted, dreaming
b) Stage II sleep spindles ( burst of alphalike
waves )
c) Stage III EEG showed lower frequency and
high amplitude
d) Stage IV maximum slowing ith large waves,
deep sleep
e) Progression from stage I to stage IV normally
takes 30-45 minutes, then it reverse by itself
f) REM follows NREM sleep
Pathology of brain and spinal cord tumor
1. The following are true regarding the symptoms
caused by a tumor according to its site;
a) Motor area: paraesthesia of a part of the body
b) Basal ganglia: weakness
c) Cerebellum: increased tone
d) Brainstem: problem with sensation, hearing and
facial movement
e) Spinal cord: loss of bladder and bowel control
2. Major classes of brain tumors include;
a) gliomass
b) peripheral nerve sheath tumor
c) neuronal tumors
d) lymphoma
e) papilloma
3. Astrocytoma
a) arises from neuroglial cells
b) is graded from grade I to VI by microscopic
examination of biopsy specimen
c) can either be fibrillary or anaplastic
d) is common in adolescent
e) may present with seizures and headache
4. Meningioma
a) is a malignant tumor seen in children
b) is more frequently seen in males
c) arises from meningothelial cells of the arachnoid
and stromal cells of choroids plexus
d) always present with a distinct localizing symptom
e) compresses underlying brain but is easily
separated from it
a)
b)
c)
d)
e)
It is vasodilation
Partial agonist 5HT2 and partial antagonist
receptor
Cerebral vessel not sensitive to it
Good to take after prodrome
Adverse effect usually GIT upset and prolonged
refractory vasospasm and gangrene
2. Neuromuscular junction:
a) has only Ach receptor
b) synaptic transmission are excitatory and
inhibitory
c) area of synaptic membrane is small
d) action potential causes release of Ca2+ from
sarcoplasmic reticulum and triggers muscle
contraction
e) choline is synthesized in the cytoplasm of the
neuron
c)
d)
e)
Localisation of sc lesion
1. True or false
a) Spinal cord supply by spinal artery
b) 2/3 of the spinal cord supply by anterior spinal
artery
c) 2/3 of the spinal cord supply by anterior spinal
artery
d) 1/3 of the spinal cord supply by posterior spinal
artery
e) 1/3 of the spinal cord supply by posterior spinal
artery
2. When compression occur...
a) Should have pain and progression of the
symptoms
b) pain at the vertebral body is aggravating by
movement
c) Referred pain is due to chronic disease
d) Radicular pain; the lesion is at the anterior root
e) Radicular pain is aggravating by increase in
spinal pressure
3. Ascending tracts
a) Tectospinal tract
b) Pontine reticulospinal tract
c) Dorsal spinocerebellar tract
d) Rubrospinal tract
e) Spinothalamic tract
2. Hydatoins:
a) Phenytoin
b) Phenobarbital
c) Primidone
d) Lamotrigine
e) Mephetoin
3. Regarding drugs for epilepsy
a) vigabatrin inhibit GABA degradation
b) felbamate can cause severe hepatitis
c) gabapentin excreted in the urine
d) Ethosuximide used in treatment of generalized
seizure
e) Oxazolidinediones can cause nephritic syndrome
4. Drugs that give effect of dizziness
a) febamate
b) gabapentin
c) vigabatrin
d) ethosuximide
e) oxazolidinediones
5. Drugs for generalized seizures
a) Benzodiazepins
b) Valproic Acid
c) Ethosuximide
d) Gabapentin
e) Vigabatrin
c)
d)
e)
6. Status epilepticus.
a) epileptic seizure that prolonged
b) others definitions is not repeated seizures in brief
intervals
c) duration is 5 minutes
d) serial seizure is like status epilepticus
e) serial seizure not uncommonly evolve into status
epilepticus
Epileptic syndrome in children
1. Regarding epilepsy in children
a) seizure (electrical or clinical) not provoked by
fever on more than 2 occasion within 12 months
period
b) electrical seizure (partial or generalized) can
occur itself without clinical seizure
c) clinical seizure can occur without electrical
seizure
d) clinical seizure is motor movement disorder due
to electrical seizure
2. Pathophysiology of seizure include
a) activation of peripheral nerve action potential
b) potassium channel involvement
c) excitatory and inhibitory neurotransmitter
d) causative agents such as trauma, poison,
infection, metabolic and endocrine
e) clinical seizure
3. True or false
a) in neonate, seizure is presented by subtle clinical
features such as abnormal breathing and
unpredictable swing of body temperature
b) neonate suffering with meningitis will have
seizure, eye move to one side and arching of the
body
c) in infant all causes of epilepsy are due to brain
malformation
d) infantile spasm start in neonatal state
e) febrile convulsion begins in infancy (within 6
months until 6 years old) and do not occur in
neonate
4. True or false
a) myoclonic epileptic syndrome occur in toddler
age
b) a child who is walking and suddenly fell down is a
feature of myoclonic epileptic syndrome
c)
d)
4.
5.
3. True or false
a) Cognitive and motor syndromes are common
CNS complications of primary HIV infection
b) Crytococcal meningitis involve T cells mediated
immunity
c) Primary HIV infection presented with fever and
headache
d) Route of infection in cryptococcal meningitis is
hematogenous spread
e) Cryptococcal meningitis presented with subacute
or chronic meningitis
4. Regarding primary HIV infection
a) Its infect the meninges early and persist in the
CNS after initial infection
b) Viral load high in hippocampus and basal
ganglia can lead to dementia
c) HIV-1 free viral particles and infected
monocyte penetrate brain tissue through BBB
d) Most common features are headache, fever
and meningeal signs
e) the illness is self-limited or recurrent rather
than progressive
5. Regarding encephalitis
a) It is inflammation of the brain parenchyma
b) Not always accompanied by inflammation of
the adjacent meninges
c) Routes of infection are hematogenous and
lymphatic
d) Common viruses that can cause encephalitis
are enterovirus, Herpes Simplex virus,
arbovirus, St Louis and JE
e) Primary site of entry in hematogenous spread
are respiratory tract, gastrointestinal tract,
genital tract and subcutaneous tissue
6. Regarding tuberculous meningitis
a) There is hematogenous spread of the tubercle
bacilli in military tuberculosis
b) There is fibrotic thickening of the meninges
c) Typical caseous granuloma is formed in the
subarachnoid space
d) The brain tissue reveals edematous change
e) Treat with antimicrobial agents like Rifampicin,
Ethambutol, Streptomycin, Pyrazinamide and
Isoniazide
d)
MYOPATHY
e)
1. Regarding myopathies
a) In Duchene/ Becker Muscular Dystrophy,
destruction of cell is due to efflux of intracell
Ca2+ b) Polymyositis is a cell-mediated
immune response to antigen on muscle fibers
b) Segmental necrosis with myo-phagocytosis
occur in Duchenne Muscular Dystrophy
c) Onset of autosomal dominant inheritance in
Spinal Muscular Atrophyn occur during later in
life
d) Small, angulated muscle fibers can be found in
infants with Spinal Muscularn Atrophy.
2. In Duchene/Becker Muscular Dystrophy, microscopic
findings are as below except
a)increased central nuclei >30%
b)variability of muscle fiber
c)myocyte hypertrophy
d)lymphocyte infiltration and replacement
e)atrophy of muscle fibers
3. Belows are true regarding hypokalemic periodic
paralysis
a) the onset is infantile/childhood
b) attacks last from 4-24 hours, long duration
c) Bulbar muscles/respiration unaffected
d) Precipitated by exercise, carbohydrate load
e) Precipitated by rest after activity or by cold
4. Belows are examples of metabolic myopathies
except
a) McArdles disease
b) Emery-Dreifuss syndrome
c) Systemic carnitine deficiency
d) Acid Maltase deficiency
e) Desmin myopathy
5. These endocrine abnormalities can cause myopathy
a) acromegaly
b) hypoparathyroidism
c) hyperadrenalism
d) Hypoadrenalism
e) hypothyroidism
DIAGNOSTIC APPROACH TO MYOPATHY
1. Morphology of skeletal muscle
a) Skeletal muscles is composed of a large number
of muscle fibers separated by epimysium
b) Myofibril contain filamens of myosin and actic
c) Type 1 muscle fiber is fast twitch and fatigue
dependent
2. Myopathy
a) Myopathy is a disease of voluntary muscle
b) Myositis indicates inflammation
c) Muscular dystrophy describes inherited disorder
with progressiven weakness
d) Myasthenia means fatiguable ( worse on exercise
) weakness
e) Myotonia is sustained contraction /slow relaxation
seen in myotonia-T
3. Features of muscle disorder
a) Proximal weakness will produce difficulty in
descending stairs
b) Distal weakness causes difficulty in rising from a
low chair
c) In disorder of glycolysis, a cramp develops in the
exercising muscle after a minutes
d) Fatiguability
occurs
in
neuromuscular
transmission disorder and mitochondrial disease
e) Muscle wasting is not a sign of muscle disorder
4. Myasthenia gravis
a) A disease characterized by weakness and
fatiguability of proximal limb, ocular and bulbar
muscles
b) Heart is affected
c) It is twice as common in women as in men
d) Facial expression is not affected
e) Respiratory difficulties may occur
5. Investigations for muscle disorder
a) Serum creatine phosphokinase
b) Electromyography
c) Muscle biopsy
d) Electrocardiogram
e) MRI
Diagnostic approach peripheral neuropathy
1. Regarding nerve fibers and its function
a) A-alpha for proprioception
b) A-delta for temperature
c) C fiber at dorsal root for pain, temperature and
reflex
d) B fiber for preganglionic autonomic
e) A-gamma act from motor to muscle spindle
2. Signs and symptoms of peripheral neuropathy
a) paresthesia
b) Tinnels sign
c)
d)
e)
PSYCHI
NORMAL AND ABNORMAL BEHAVIOUR
1.True or false
a) There are 3 major types of psychiatric
abnormality
b) Asymptomatic disabled person is normal
c) Psychoses is a major physiological disorder
d)
e)
2. In psychoses
a) There is impaired ability to test reality
b) The patient is able to distinguish reality from
fantasy
c) It is not as severe as neuroses
d) Affective and somatoform disorders are 2 of the
main illnesses in psychosis
e) Does not involve total personality
3. True or false
a) In neuroses, there is no disturbance in affect and
speech
b) People with neuroses have poor insight
c) Perseveration is common in neuroses
d) Delusion is not a sign of psychoses
e) There may be abnormal in affect in psychoses
4. Organic Mental Disorder
a) This term is used in DSM-IV
b) It was divided into 3 sections
c) Substance-related disorders are 1 of the category
in OMD
d) Judgment of people with OMD cannot be trusted
e) Cognition is intact
5. Abnormal behaviour
a) The percentage of heritability in schizophrenia is
80%
b) Failing a major exam maybe the cause of
abnormal behaviour
c) A persons personality, childhood development
and social support are
a) important in the development of abnormal
behaviour
d) Genetic vulnerability is an important precipitating
factor
e) Genetic and environmental factor are the key
points in Three-hit hypothesis
BASIC CLASSIFICATION IN PSYCHIATRY
1. Definition of mental illness are
a) Absence of health only
b) Complete physical, mental and social wellbeing]
c) Mental illness means evidence disturbance of
part of function as well as general efficacy
2. Disorder that usually diagnosed in infancy are
a) Communication disorderSchizophrenic
b) MDD
c) Tics disorder
d) Learning disorder
3. True about behavior and mood disorder
a) Bipolar 1 = manic + hypomaniac + MDD
b) Paraphillia is under dissociative disorder
c) Orgasmic disorder is identify under sex
disorder
d) Kleptomania is a disorder of impulse control
morbid tendency to steal
e) Trichotillomania is a compulsion to pull out
ones own hair
4. Regarding multiaxial system,
a) Five axes are included in DSM-IV which refers
to a different domain of
a) information.
b) It facilitates comprehensive and systematic
evaluation with attention to the various mental
disorders only.
c) It does not include other general medical
conditions.
d) Personality disorders and mental retardation
are in the same axis.
e) It provides a convenient format for describing
the heterogeneity of individuals presenting with
the same diagnosis.
5. Regarding psychosocial and environmental
problems,
a) Reported in Axis IV.
b) It may be a negative life event.
c) It includes discord with teachers or
classmates.
d) It does not include birth of a sibling.
e) It may develop as a consequence of a persons
psychopathology.
SCHIZOPHRENIA
1. According to Kurt Schnieder, First rank symptoms are
a) thought broadcasting
b) visual hallucination
c) delusional perception
d) pathognomonic for schizophernia
e) catatonic behaviour
2. Positive symptoms of schizophernia are
a) avolition and anhedonia
b) hallucination and bizzare behaviour
c) due to loss of loss brain mechanism
d) responds to typical antipsychotics
e) present in Type 1 schizophernia
3. Schizophernia
a)
b)
c)
d)
e)
e.
5. Regarding chlorpromazine
A. It is typical antipsychotics
B. It is one type of butyrophenones
C. Parenteral form is not available
D. It is an expensive drug
E. It cause many adverse effects especially
autonomic
d)
PHENOMENOLOGY
4. Primary delusions:
a. derived from preceding morbid
experience
b. classify according to onset
c. out of blue delusion
d. can be present with delusional
perception
e. anxiety is a part of delusional mood
2. Hallucination:
a. experienced as originating in the mind
not in outside world
b. Olfactory and gustatory hallucinations
common in temporal lobe epilepsy
c. feeling like viscera being pulled out is
hypnogogic and hypnopompic
hallucinations
d. according to sensory modalities can be
divided into auditory and visual only
e. visual hallucination rarely associated
with organicity
2) Regarding Hypothalamus
a) It is the principles motor output pathway of limbic
system
b) Anterior part is involve in sympathetic and
posterior part involve in
a) parasympathetic
b) Ablation of medial zone cause hypophagia and
ablation of lateral zone cause
c) hyperphagia
d) Person can learned activities satisfactorily if the
hypothalamus is damage, but
e) they cannot learn new thing and have short term
memory.
f) Its function as cerebral association area for
control of behavior.
A
B
C
D
E
mandelian
tumor suppressor gene
multifactorial
chromosomal
somatic mutation
a)
b)
c)
d)
e)
a)
b)
c)
d)
e)
ANTI-DEPRESSANT
2. Regarding limbic function
6. Regarding TCA
1. Pathogenesis of antidepressant
a)
b)
c)
d)
e)
or 2 receptors.
trazodone & nefazadone will cause
omnolence, increased appetite, weight gain,
dizziness.
Mirtazapine is one of the example of atypical
antidepressant.
d)
e)
3. Regarding benzodiazepine
a) decrease potency of GABA
b) flumezil antagonize CNS depressant induce by
benzodiazepine
c) high dose cause delirium
d) benzodiazepine have narrow therapeutic index
than barbiturates
e) benzodiazepine has lesser tolerance
4. Non benzodiazepine :
a) duration of effect of zolpidime is 7 to 10 hours
b) zolpidime act on GABA A receptor
c) zalephon has rapid onset
d) zalephon causes dizziness,headache and
somnolence
e) zolpidine has little effect on sleep stage than
benzodiazepine
5. Regarding anxiolytic drugs,
a) Zolpidime is one of anxiolytic drug
b) -blockers such as propranolol is not used to
treat anxiety
c) Hydroxine is one of the antihistamine drug
which has antiemetic activity
d) Buspirone act on 5HT(2A) receptor
e) TCA is relatively safe if taken in overdose
6. True or false
a) Clorazepam and Lorazepam are anxiolytic drug
which has not produce any active metabolites
b) SSRI and TCA are effective in treating panic
disorder
c) Benzodiazepines drug has low abuse potential
d) SSRI is an anxiolytic drug which has slow onset
e) There is marked interaction between buspirone
and alcohol
7. Below are anxiolytic drugs,except
a) Benzodiazeoines
b) SSRI
c) TCA
d) MAOI
e) Barbiturates
INTRO TO PSYCHOTHERAPY
1.
D.
E.
2.
3.
4.
5.
6.
7.
Counseling
A. Supportive
B. Helps clients solve their problems
directly
C. In short duration which require 1-3
sessions
D. Need undergo special training and
supervision
E. Conducted in secondary and tertiary
care center
F. Done at primary care settings/schools
Psychotherapy
A. Supportive
B. Not directly helps clients to solve their
problems
C. Longer term(12 sessions or more)
D. Need to undergo special training and
need supervision
E. Conducted at secondary and tertiary
center
B.
C.
D.
E.
2.
3.
4.
Behaviour therapy
A. is a class of psychotherapy
B. operant conditioning is the sole basic
theory underlying behaviour therapy
C. involves the application of
experimentally derived principles of
learning to maintain maladaptive
thoughts, feelings and behaviours
D. is equivalent to supportive therapy
E. can be applied for anxiety and
depression
Cognitive behaviour therapy (CBT)
A. is not indicated by schizophrenia
B. takes into concern only cognitive
formulation of psychotherapy
C. is structured and focused to
understand normal behaviour
D. can be done both individually and in
groups
E. is not helpful in preventing relapse in
Depressive Disorder
Application of classic conditioning to anxiety
A. anxious behaviour will increase when
anxiety is uncoupled from situation
and avoidance
B. includes positive and negative
reinforcement
C. shows that a person can be
conditioned to feel fear in neutral
situation that has come to be
associated with anxiety
D. is taken after the Skinners mice
experiment
E. includes response prevention
Automatic thoughts
A. can only be seen in people with
anxiety
B. are normal in individuals suffering
from anxiety, depression and other
psychiatric condition
C.
D.
E.
5.
Operant conditioning
A. was demonstrated by Pavlovs dog
B. shapes the Social Learning Theory by
Bandura
C. depends of whether positive
reinforcement is applied or removed
after the behaviour is performed as its
principle procedures
D. is seen in Time Out
E. is the basis of Flooding
e)
2. Defense mechanism:
a) Does not alter the objective conditions of
danger
b) Simply change the way the person perceives
or think about it
c) Is always pathological
d) mostly interfere with a persons ability to
function or disturb inter-personal relationships
e) observational constructs inferred from their
own hypothesis of the way people behave.
3. True or false :
a) Narcissistic defenses are the most primitive
and appear in children and people who are
psychotically disturbed
b) Immature defenses are seen in adolescents
and some psychotic patients
c) Neurotic defenses are encountered merely in
obsessive compulsive and hysterical patients
d) Immature defenses include acting out,
introjections, identification and repression
e) Immature defenses include acting out,
introjections, identification and regression
4 Repression :
a) voluntary exclusion of thoughts, impulses or
memories, often not painful or conflictual to the
person
b) individuals themselves are unaware of
whatever it is that is repressed
c) The thoughts and feelings may return in a
disguised manner but are not consciously
related
d) Intentionally exclusion of material from
consciousness
e) An unconscious assimilation of an external
object, which may be loved or hated, into
oneself in a symbolic fashion
5.True or false :
a) reaction formation- a mechanism which is
represented by behaviour that becomes the
exact opposite of what is consciously or
unconsciously decided.
b) sublimation- manifestation of emotional conflict
by physical symptoms.
c) somatization - mechanism in which
unacceptable drives or impulses are channeled
into socially acceptable
d) Regression-An unconscious defense mechanism
in which a person undergoes a partial or total
return to earlier patterns of adaptation
SOMATOFORM DISORDER
1. Regarding somatizaton disorder
A. begins after 30 years old
B. commonly associated with major depression
disorder
C. according to DSM 4, 2 sexual symptoms have
been met
D. associated with significant distress
E. the symptoms are not intentionally feigned or
produced
2. Clinical features of conversion disorder are
A. blindness
B. pseudoseizure
C. movement better when attention is given
D. bilateral motor dysfunction
E. gait disturbances
3. Differential diagnosis for hypochondriasis included
A. Myasthenia gravis
B. Dementia
C. Multiple sclerosis
D. Conversion disorder
E. Factitious disorder
4. According to pain disorder
A. defined as the presence of pain that is the
predominant focus of clinical attention.
B. the associated symptom is pain
C. associated with emotional distress or emotional
impairment
D. antidepressdant such as TCAD & SSRIs are
useful
E. analgesics are generally helpful
5. Hypochondriasis can be diagnosed when
A. the belief is not of delusional intensity or about
body appearance
B. it causes significant distress & impairment of
function.
C. the duration is less than 6 months
D. the symptoms are not intentionally feigned or
produced
E. one or more symptoms or deficits affecting
voluntary motor or sensory function that
suggest a neurological or other medical condition
6.Commonly associated with:
A. A Major depressive disorder
B. Personality disorders
C. Substance related disorders
D. Generalized anxiety disorder
E. Phobias
7.Conversion disorder
A. A person preoccupation with the fear of
contracting, or the belief of having, a serious
disease
B. La belle indifference: the patient seems to be
unconcerned about what appears to be a major
impairment.
C. Hypnosis, anxiolytics and relaxation exercise are
effective in some cases
D. Patients believe that they have a serious illness
that has not yet been detected & cannot be
persuaded to the contrary
E. Most commonly associated with passiveaggressive, dependent, antisocial & histrionic
personality disorder
8.Pain disorder
a) primary symptom is pain, in one or more sites,
which is not fully accounted for by a medical
or neurological condition.
b) it may not be possible to reduce the pain, the
treatment approach must address
rehabilitation.
c) Analgesic are helpful
d) Nerve block and surgical ablation procedure
are ineffective as pain returns after 6 to 18
months
e) May accompanied by symptoms of depression
& anxiety.
9.Hypochondriasis
a) A person preoccupation with the fear of
contracting, or the belief of having, a serious
disease.
b) B The belief is not of delusional intensity or
about body appearance.
c) C The duration is more than 6 months
d) D May accompanied by symptoms of
depression & anxiety
e) E Usually pt is not resistance to psychiatric
treatment.
10. Body dysmorphic disorder
A. Cause significant distress or impairment of
function
B. Treatment with surgical or medical procedures
is almost invariably unsuccessful
C. If a slight physical anomaly is present, the
persons concern is marked excessive.
D. fear arises when a person misinterprets bodily
symptoms or functions
E. The fear arises when a person misinterprets
bodily symptoms or functions
DELIRIUM
1. Characteristic features of delirium are
a) disturbance of consciousness
b) perceptual disturbance
c) memory impairment
d) may have illusion
e) irreversible
2. Causes of delirium
a) dehydration
b) antihypertensive drugs
c) alcohol
d) steroid drugs
e) Urinary tract infection
3. Delirium also can be associated with
a) Anxiety
b) Depression
c) Tremor
d) dysnomia
e) irratibility
4. Regardind delirium
a) need medical emergency
b) can happen after recovery from anesthesia
c) chronic onset
d) fluctuating characteristic with lucid interval
e) duration usually brief
d)
e)
DISORDER OF MEMORY
1. Theories of forgetting
a) Consist of decay and interference.
b) Decay will lead to retrieval failure.
c) Interference will lead to storage failure.
d) Decay happen when the strength of
connection between neuron establish by
learning fade away over time.
e) Interference is distruption of the ability to
remember one piece of information by the
presence of other information
f) Interference can be cause by same retrieval
for certain memories
2. disorder of memory
a) Consist of amnesia and paramnesia
b) Amnesia is error of memory
c) Amnesia can be due to organic cause or
psychogenic cause.
2. Causes of dementia
a) drug toxicity
b) Wilsons disease
c) Cortical microinfarction
d) Biswangers disease
e) Normal pressure hydrocephalus
3. Criteria for dementia
a) more introvert
b) catastrophic reaction
c) loss sense of humour
d) dyslexia
e) dyscalsulia
4. Vascular dementia
a) abrupt decline in cognitive function
b) cause atrophy of the brain
c) affect both male and female equally
d) due to multiple infarct with multiple size
e) ventricle not dilated
c) Stroop test
d) Wisconsin card-sorting test
e) Trail making test
4. Characteristic features of frontal lobe syndromes
include
a) difficulties initiating behaviour
b) inability to stop a behavioural pattern once started
c) visual hallucination
d) sleep pattern disturbances
e) difficulties in planning and problem solving
5. Those are motor release phenomena except
a) perseveration
b) grasping reflex
c) manual groping behaviour
d) imitation and utilization behaviour
e) alien hand sign
COMMUNICABLE
DISEASE
INTRODUCTION TO COMMUNICABLE
DISEASES IN MALAYSIA
1. Below are communicable diseases in
Malaysia.
A) Tuberculosis
B) Viral hypertitis
C) Leprosy
D) Asthma
E) Chronic Ischemic heart disease
2. Below are elements that are needed for
communicable disease to occur.
A)
B)
C)
D)
E)
Infectious agent
Reservoir
Susceptible host
Toxicity
Pathogenicity
SCHISTOSOMIASIS
1. Trematodes divided into for group:
a. hermaphroditic liver flukes known as
Fasciolopsis
b. Hermaphroditic spleen flukes known as
Clonorchis
c. Hermaphroditic lung flukes known as
Paragonimus
d. Blood flukes which also known as
Schistosoma
e. Hermaphroditic intestinal flukes known as
Opisthorchis
2. About schistosomes
a. they reside in human mesenteric and vesicle
veins
b. acute schistosomiasis after infection,
especially by S. mansonia and
S.
haematobium.
c. It induce granulomatous inflammation in the
tissues.
d. Urinary symptoms occur in S. japonicum
infection
e. The female worm lies within the male at
gynecophoral canal.
3. regarding Fasciola hepatica
a. its intermediate host is variety of lymnaeid
snail
b. the site of infection is at the human liver
c. the cysts release immature flukes that migrate
to the liver and gallbladder
d. association of Fasciola with Schistoma
japonicum is common
e. rafoxanide is used for the treatment of
fascioliasis.
4. True statement about liver trematodes
5.
a.
b.
c.
d.
e.
6. Regarding platyhelminth
a. Nematodes and trematodes are included in
this phylum
b. These helminth consists of body cavity
c. It covered by cytoplasmic tegument
d. These helminth consist it own digestive
system
e. Most species are hermaphrodite
7. Clonorchis sinensis
a. Is a liver trematodes
b. Will infect bile duct by eating undercooked
fish
c. Stages of sporocyst, redia and cercaria
are occurring in final hosts.
d. Snail is the final hosts
e. In acute infection abdominal pain and
eosinophila are sign for the infection.
8. Intestinal trematodes
a. Opisthorchis and fasciolopsis is include in
this class
b. The prevalence is lowest in children under
5 years old
c. Diagnosis is make by present of eggs in
the feaces
d. Acute fascioliasis will accur when < 10000
of metacercaria have been ingested at
once
e. Drug therapy are not effective
9. Schistosoma
A.
B.
C.
D.
E.
Immunization
Child nutrition
Maternal nutrition
Chemoprophylaxis
Personal and domestic hygiene
True or false
Chloroquine act on parasite on bowel lumen.
Metronidazole is a mixed type of amebicides
Iodoquinol act on amoeba in intestinal wall and
liver
D. Diloxanide furoate act on parasite on bowel
lumen
E. Paramomycin act on parasite on bowel lumen
2. Mechanism of action of Metronidazole
a. It requires reductive activation of the nitro
group by anaerobic or microaerophilic
organisms
b. Low or negative redox potential is
required to donate electrons to the drug
for its activation
c. Ferrodoxin donates electrons accepted by
metronidazole or a biological electron
acceptor
d. Metronidazole serves as an electron
acceptor
e. Protozoan parasite has low redox
potential electron transport proteins which
participate in metabolic reactions
3. True or False
a) Cemetidine will shorter the half life of
Metronidazole.
b) Unpleasant metallic taste is one of the
adverse effect of Metronidazole.
c.
3) Pathogenesis at shigellosis
a. A it caused tissue destruction by
secretion toxin
b. B presenting symptoms include
abdominal cramps,diarrhea with blood,pus
or mucus due to penetration and
destruction of colonic epithelium.
c. C Bloodstream invasion is common
d. D Produces endotoxin that irritate the
bowel wall
e. E severity of clinical illness depend on
type of species
4) Possible complication
A stress ulcer
B rectal prolapse
C Reiters syndrome
D Hemolytic uraemic syndrome(HUS)
E Intestinal obstruction and toxic megacolon
5) Treatment and control
a. A Adults give oral ciprofloxacin
b. B No need oral rehydration
c. C Agents decreasing intestinal motility
should not be used
d. D Control by chlorinated water and
waterborne sewage
e. E Eat well cooked food and rigorous hand
washing
EXANTHEMAS IN INFECTIOUS DISEASE
1. Measles
A. is caused by a virus from the Togaviridae
family
B. in pregnant women results in congenital
disease
C. usually shows rash spreading the same
way as rubella
D. can cause Subacute sclerosing
panencephalitis (SSPE) in the first week
after the onset of rash
E. rash can coalesce to form blotches
2. Chickenpox
A. can spread by fomites like measles
B. is caused by human parvovirus B19
C. is more likely to be more severe in
children
c) pregnant women
d) concomitant infection with other STDs
e) through vaginal sexual contact ; highest
chances of transmission
2. Neoplastic diseases in AIDS patient
a) Burkitts lymphoma
b) paraneoplastic syndrome
c) Kaposis sarcoma
d) Non Hodgkin lymphoma
e) invasive cervical cancer
3. HIV cases in Malaysia
a) the highest proportion of transmission is
through IDU
b) predominantly among homosexual men
c) majority are Malay
d) heterosexual transmission is increasing in
trends
e) concentrated epidemic
4. HIV prevention & control programs in Malaysia
a) anonymous voluntary HIV testing
b) PROSTAR
c) pre-marital HIV screening done 1 months
before marriage
d) subsidization by government for HIV
vaccination
e) post exposure prophylaxis for health
workers who have been expose
to HIV
SYSTEMATIC MYCOSES
1. Regarding systemic fungal infection
A. High incidence in AIDS patient
B. Also known as opportunistic fungal
infection
C. There is deficit in humoral immunity
D. Candidiasis is most common disease
of opportunistic infection
2. True or false statement
A. Candida albicans is the only causative
agent for candidiasis
B. Candida are members of normal flora
of the skin, mucous membranes and
gastrointestinal tract
C. cryptococcal metabolic products
melanin and mannitol function as
4. Naegleria fowleri
A. One of free living ameba
B. Infect immunocompetent children and
elderly
C. Has 2 stages: cysts and trophozoite
D. Route of infection through olfactory
neuroepithelium
E. Cause Granulomatous amebic
encephalalitis (GAM)
4. Cytomegalovirus infection
a. A Transmitted person-to-person by close
contact with virus-bearing
material via oral and respiratory spread
b. B Able to replicate in multiple tissue in-vivo
c. C risk factors are neonate, solid organ
transplant, bone marrow
transplant and AIDS
d. D AIDS patient may develop retinitis that
may lead to blind
e. E direct effects are fever, leucopenia and
thrombocytopenia
INTESTINAL COCCIDIAN
b)
c)
d)
e)
PARASITIC INFECTION IN
IMMUNOCOMPROMISED HOST
1. State true of false
a) Trypanosoma cruzi responsible for
end stage renal failure in South
America
b) Giardiasis can cause severe diarrhea
to immunocompromised patient
c) Ascariasis can cause bile duct
obstruct
d) Chagas disease caused by
Trypanosoma cruzi
e) Cutaneus Leishmaniasis have no
significant infection in organ transplant
recipient
2. Regarding acquired immune deficiency
a) Chemotherapy cause immune
suppression
b) DMARDs are used to suppress
immune activity in autoimmune
disease
c) Organ transplant of recipient is not
given immunosuppressive drugs
d) Drug that cause neutropenia cannot
cause immune suppression
e) AIDS is one of the immune deficiency
syndrome
3. Parasites that may be REACTIVATED in
immunocompromised host includes
a) Giardiasis
b) Amebiasis
c) Visceral leishmaniasis
d) Capillariasis
e) South American trypanosomiasis
MALARIA : PATHOGENESIS & CLINICAL
PRESENTATION
1. Regarding the Malaria infection
5. True or false
a) The infectious stage of malaria
parasite is the schizonts
b) MSP-1 and MSP-2 are surface protein
appear on red blood cell after infected
by malaria parasite
c) Cytokine is released in falciparum
malaria
d) EBA 175 interacts with red blood cells
glycophorins
e) Hemozoin is responsible to excite
cytokine released (others such as
phospholipids and GPI)
6. Plasmodium falciparum will cause
a) Microvascular sequestration
b) Renal failure due to antimalarial drugs
that use rapidly
c) Black color urine on day 4
d) Anaemia due to DIC is commonly
seen
e) Sequeatration of parasitized RBC in
the lungs is common
7. Regarding malaria
a) P. Vivax attack only young red blood
cells that have Duffy antigen
b) Cytoadherence occur in P.Falciparum
but not in P.Vivax
c) P.malariae had knob on the
parasitized RBC
d) P.Malariae produce immune complex
glomerulonephritis
e) Severe anaemia is seen in
P.Falciparum infection
PLASMODIA : MORPHOLOGY, LIFE CYCLE
AND LAB DIAGNOSIS
1. Definitive diagnosis combines
a) Full history including travel
b) Results of blood film or other diagnostic
tests
c) Results of antimalarial drug therapy
d) Clinical examination
e) Clinical features
2. Diagnostic test for malaria
a)
b)
c)
d)
e)
blood smear
Immunocytography
Knotts concentration method
Membrane filtration method
Quantitative Buffy coat
1. Leishmania spp
a) is intestinal protozoa
b) sandfly is the vector
in the body, amastigote multiplication can
cause rupture of macrophage
c) Leishmania donovani causing Kala Azar
disease
d) weight loss is one of the symptom
2. Regarding Primaquine
a) Only agent for radical cure of P. vivax &
ovale
b) Cannot be excreted in the urine
c) Destroys gametocytic forms or prevents
maturation
d) Responsible for adverse effects such as
hemolysis & Methemoglobinemia
e) Slowly oxidized to many compounds
2. Trypanosoma spp
a) T. Brucei in Africa
b) American trypanosomiasis causing
sleeping sickness
c) African trypanosomiasis causing Chagas
disease
d) Tsetse fly is the vector
e) Winterbottom sign can be seen in Chagas
disease
3. Babesia spp
a) zoonotic infection
b) infection in human is by B. microti and B.
divergens
4. Regarding puberty
A. it begin 8-14 year old in girls
B. LH stimulates testosterone by leydig
cell
C. Puberty milestone influent by
nutritional.
D. underweight girl early menarche
E. thelarche is development of testis.
5. Regarding ectopic pregnancy
A. Abdominal cavity is the commonest
site
B. Chronic salphingitis is the
predisposing factor
C. Leimyoma is a risk factor
D. Tubal pregnancy progress to full term
E. Endometrial biopsy shows chorionic
vili.
6. Causes of primary amenorrhea :
A double uterus
B impeforated hymen
C anorexia verosa
D swyers syndrome
E androgen insensitivity syndrome
19.
20) Drug used to relaxed gravid ,uterus
A- Calcium lactate
B- Ritodrine
C- Bromocriptine
D- Prostaglandin F2-
E- Halothane
21) Attending skills in interview
A- Good eye contact
B- Awareness of body image
C- Parroting
D- Make interviewer feel comfortable
E- Posture
22) Classical conditioning
A- Timing of association between 2
stimuli is important
B- New behaviour acquired
C- Conditioned stimulus precedes
unconditioned stimulus
D- Also known as Pavlovian
conditioning
E- Require reinforcement
23) Disoredr of thought content
A- Delusion
B- Obsession
C- .
D- Pressure of speech
E- Thought broadcast
24) Shizophrenia
A- Male have better prognosis
B- Inherited as abnormal recessive
illness
C- Higher prevalence in mentallyretarded people
D- Negative symptoms are better
treated with conventional
antipsychotics
E- Amphetamine precipitate relapse
in stable patient
B. Characterized by presence of
neurological disorder
C. Symptoms intentionally
produced
D. Also known as factitious
disorder
E. Pharmacotherapy is the most
important treatment.
40.
41. Regarding blood brain barrier
A. It is a barrier between blood
and cerebrospinal fluid
B. Impermeable to cytokines
C. Astrocytes involved in its
formation
D. Protect brain from harmful
substance
E. Tight junction is one of the
component
42.
43.
44. Microscopic features of cerebral
infarction after 3 weeks include
A. red neurons
B. neutrophilics infiltration
C. macrophages infiltration
D. cystic space formation
E. surrounding gliosis
45.
46. Regarding Myasthenia Gravis,
A. it is due to impaired
neuromuscular junction transmission
B. characterized by weakness of
smooth muscle
C. associated with presence of
anti- acethylcholine receptor antibodies
D. present with ptosis
E. common in elderly
53.
59.
60. Complex partial seizure of temporal
lobe epilepsy
A. associated with alteration of
consciousness
65. Gastroenteritis
A. Coronavirus cause diarrhea in
child
69.
70. Transmission of communicable
disease
A. Direct transmission via droplet
air through coughing
B. Bacterial enter scalp causing
encephalitis.
C. Vertical transmission is a direct
transmission
D. Air borne with size more than
5 micrometre in air can be deposited in
lung
E. Direct contact with TB patient
71) Notifiable disease
A- Gonococcal infections
B- Relapsing fever
C- Leptospirosis
D- Viral encephalitis
E- AIDS
78) Antimicrobial
A- Chloramphenicol is protein
synthesis inhibitor
B- Sulfamethoxazole inhibit
dihydrofolate reductase
C- Cloxacillin is effective for treating
cellulitis caused by Staphylococcus
aureus
E. Schistosoma hematobium
80. Elapidae (cobra) cause
A. respiratory diaphgram
paralysis
B. haematuria
C. cardiotoxic effect
D. myoglobunuria
E. no envenomisation