“Medicine, the only profession that labours incessantly to destroy the reason for its own existence.

”
-Sir James Bryce
1. Coma with focal neurologic deficits b) There is malabsorption of CSF

a) Stroke c) Obese females are more affected

b) Subarachnoid hemorrhage d) All are correct

c) Viral encephalitis 7. Post lumbar puncture headaches

d) Concussion a) May occur up to a year later after LP

2. Stroke infarction usually produces this type of severe b) Are due to increased ICP
hydrocephalus
c) Autologous blood patch may be treatment
a) Vasogenic
d) All are correct
b) Cytotoxic
8. The most probable pathologic process that will
c) Interstitial manifest as acute focal neurologic dysfunction.

d) None of the above a) Immunologic

3. The brain edema seen in association with severe b) Vascular

hydrocephalus
c) Neoplastic
a) Vasogenic
d) Traumatic
b) Interstitial
9. The physiologic system that may be found only at the
c) Cytotoxic supratentorial and posterior fossa level is

d) None of the above a) Cerebrospinal fluid system

4. Temporal arteritis is a neurologic emergency because b) Consciousness system

it may
c) Vascular
a) Lead to blindness
d) Internal regulation system
b) Produce intractable pain
10. Not characteristic of a mass lesion
c) Lead to glaucoma
a) Will not alter cellular function in the area of the
d) All are correct lesion

5. In temporal arteritis b) Interferes with neighboring cell functions

a) Males are more affected c) Remote or distant effects secondary to

increased ICP
b) A normal ESR will rule it out
d) None of the above
c) Corticosteroid is the drug of choice
11. The most probable pathologic process that will
d) All are correct present as a chronic, diffuse and progressive neurologic
syndrome.
6. In pseudomotor cerebri
a) Toxic metabolic
a) There is raised ICP
 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
b) Inflammatory d) Spasm of penetrating arterioles

c) Degenerative 17. Displacement of brain tissue to a compartment it

does not usually occupy
d) Neoplastic
a) Herniation
12. The most probable pathologic process that will
manifest as a chronic focal neurologic syndrome b) Locked-in syndrome

a) Immunologic c) Metastasis

b) Vascular d) Compression

c) Toxic-metabolic 18. Impaction of the anterior medial temporal lobe

through the tentorium
d) Traumatic
a) Tonsillar herniation
13. The CSF is found at the
b) Subfalcine herniation
a) Supratentorial level
c) Uncal herniation
b) Posterior fossa level
d) Central herniation
c) Spinal level
19. Downward movement of upper thalamic region
d) All of the above through tentorium
14. The dura that separates the cerebellar hemispheres a) Tonsillar herniation
is the
b) Subfalcine herniation
a) Tentorium cerebelli
c) Uncal herniation
b) Falx cerebelli
d) Central herniation
c) Tentorial notch
20. Displacement of the cingulate gyrus
d) Falx cerebri
a) Tonsillar herniation
15. A normal alpha pattern in the EEG of a comatose
patient may mean b) Subfalcine herniation

a) Catatonia c) Uncal herniation

b) Hysteria d) Central herniation

c) Locked-in syndrome 21. In transient ischemic attacks the neurologic deficits

should not last for more that
d) Any of the above
a) One hour
16. Headache may occur as the result of
b) 6 hours
a) Pressure on the somesthetic cortex
c) 12 hours
b) Traction of displacement of large intracranial
veins or their dural envelope d) 24 hours

c) Traction and pressure on the skull 22. In completed stroke

 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
a) The involved artery is usually the middle c) Stuporous
cerebral artery
d) Obtunded
b) The neurologic deficits has lasted more than 24
hours 28. The most common cause of a mild stroke

c) The manifestations are stepladder in evolution a) Transient Ischemic Attack

d) All the statements are correct b) Small ICH

23. Stroke is the number one killer in c) Pontine infarct

a) Western countries d) Lacunar infarct

b) European block 29. the following would be more characteristic of a

moderate stroke
c) Asia, China and Japan
a) Dense hemiplegia
d) African subcontinent
b) Stuporous
24. Worldwide stroke is
c) Localizes pain
a) No 1 killer
d) All
b) No 2
30. The following would be more characteristic of a
c) No 3 severe stroke patient

d) No 4 a) Decerebrate posturing

25. Stroke incidence in the Philippines b) Dense hemiplegia

a) 500/100,000 c) Seizures

b) 700/100,000 d) All

c) 500/400,000 31. In diagnosing stroke, the most reliable would be

d) 700/400,000 a) Cranial CT scan with contrast

26. Strokes worldwide may lead to death to around how b) Clinical Evaluation
many people?
c) MRI of the brain
a) One million
d) Dr. Dela Cruz
b) 20 million
32. The initial neuroimaging study of choice in stroke is
c) 5 million a

d) 10 million a) Cranial CT scan

27. the sensorium of a patient with mild stroke b) Skull X-ray

a) Alert c) MRI of the brain

b) Drowsy d) PET scan of the brain

 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
33. The role of diagnostic examinations b) 12 –lead EKG

a) Differentiate stoke pathology c) Carotid doppler

b) Rule out stroke mimickers d) MRI

c) Confirm and establish 39. An intracerebral hemorrhage is usually surrounded

by
d) Diagnosis
a) A penumbra of relative ischemia
e) All
b) Vasogenic edema
34. A finding that makes stroke highly unlikely
c) CSF
a) Pure Hemifacial weakness
d) Inflammatory cells
b) Transient numbness
40 Blood pressure control should be initiated when the
c) Seizures blood pressure is
d) Headaches a) 200 mmHg systolic
35. Emergent diagnostic examination in stroke should b) >120 mmHg diastolic
include
c) MAP <130
a) Cranial CT scan
d) All
b) CBC, PT, PTT
41. The pathognomonic sign of meningeal irritation
c) EKG
a) Nuchal rigidity
d) All
b) Kernig’s sign
36. Stroke mimickers
c) Brudzinski’s sign
a) Syncope
d) CSF Leukocytosis
b) Vertigo
42. A CT scan of MRI of the brain prior to LP may not be
c) Bell’s palsy necessary in the following
d) All a) Recent head trauma
37. Stroke is probably unlikely b) Papilledema
a) Headaches c) Focal neurologic signs
b) One sided weakness d) Nuchal rigidity
c) Fever prior to deficits 43. The clinical syndrome of bacterial meningitis is
primarily due to
d) All
a) Inflammation of the subarachnoid space
38. A diagnostic procedure needed for atrial fibrillation
patient b) Cerebral edema
a) 2D echo c) Cerebral vasculitis
 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
d) Increased ICP 49. During the cerebritis stage of cerebral abscess
formation
44. Increased ICP in meningitis is primarily due to
a) Early drainage is mandatory
a) Blockage of normal CSF flow
b) Empirical antibiotics may suffice
b) Increased CSF production
c) Burr hole drainage better than craniotomy
c) Cerebral edema
d) Withhold treatment until capsule formation
d) Impairment of CSF absorption
50. Cerebellar abscess is usually associated with
45. The pathologic hallmark of bacterial meningitis
a) Ethmoid sinusitis
a) Headache, fever, and meningisimus
b) Mastoiditis
b) Subarachnoid exudates
c) Sphenoid sinusitis
c) Diffuse cerebral edema
d) Lung infection
d) Subintimal infiltrates of arteries
51. In the local setting the most commonly significant
46. The main inducer of subarachnoid inflammation is cause of chronic meningitis
the
a) Partially treated bacterial meningitis
a) Release of interleukin
b) Mycobacterium
b) Release of TNF
c) Cryptococcus neoformans
c) Lipopolysaccharide of the pathogen
d) Parameningeal infection
d) Component of cell wall membrane of the
pathogen 52. The key procedure in patients with neuropathies is a

47. The more common pathogen in bacterial meningitis a) Electro diagnostic examination
in adults is
b) CT scan
a) N. meningitides
c) Electroencephalogram
b) Streptococci
d) Enzyme tests
c) S. pneumoniae
53. A specific sign of metabolic encephalopathy
d) Gram negative bacilli
a) Cheyne-stokes
48. The empirical therapy of bacterial meningitis in
adults with other debilitating illness b) Kussmaul respiration

a) Ampicillin c) Asterixis

b) Ampicillin + ceftriaxone d) Drowsiness

c) Ceftriaxone + vancomycin 54. Loss of adduction movement of the eyes with

dilatation of the pupils in a comatose patient localizes
d) Ampicillin + ceftriaxone + vancomycin the lesion at the level of the

a) Diencephalon
 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
b) Midbrain a) Some form of mass lesion

c) Pons b) Some form of nonmass lesion

d) Medulla 59. the temporal profile of the illness is

55. Compression of the ventricular system causing a) Acute

noncommunicating hydrocephalus may be seen in
b) Subacute
a) Uncal herniation
c) Chronic
b) Subfalcine herniation
60. the cause of the responsible lesion is most likely
c) Foraminal herniation
a) Vascular
d) Central transtentorial herniation
b) Degenerative
Part II – Clinical Problems
c) Inflammatory
Case # 1 (for numbers, 56-60)
d) Immunologic
A 54-year old, right-handed woman suddenly
became dizzy, with nausea and vomiting. Examination e) Neoplastic
revealed dysarthria, difficulty in swallowing (with
f) Toxic-metabolic
weakness of the left palate), loss of pinprick sensation
over the left side of the face and the right side of the g) Traumatic
body, and marked ataxia on using the left extremities.
Case # 2 (For nos. 61-65)
56. Based on the above protocol, what level of the
nervous system is affected? A 4 year old right handed boy complained of a
sore throat, chills, and fever. He was put to bed and
a) Supratentorial given aspirin and fluids, the next morning, he
complained of headache and an increasingly stiff neck.
b) Posterior fossa
His temperature was 40.5°C.
c) Spinal level
When seen at a physician’s clinic later that
d) Peripheral level afternoon, he was difficult to arouse. He was confused
and delirious when stimulated. He held his neck rigid
e) More than one level but moved his extremities on command.

57. within the level you have selected, the responsible 61. Based on the above protocol, what level of the
lesion is most probably: nervous system is affected?

a) Focal, on the right side of the nervous a) Supratentorial

b) Focal, on the left side of the nervous system b) Posterior fossa

c) Focal, but involving the midline and involving c) Spinal level

contiguous structures on both side of the
nervous system d) Peripheral level

d) Non focal, and diffusely located e) More than one level

58. the principal pathologic lesion responsible for the 62. within the level you have selected, the responsible
symptoms is most likely lesion is most probably:
 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
a) Focal, on the right side of the nervous system a) Supratentorial

b) Focal, on the left side of the nervous system b) Posterior fossa

c) Focal, but involving the midline and involving c) Spinal level

contiguous structures on both sides of the
nervous system d) Peripheral level

d) Non focal, and diffusely located. e) More than one level

63. The principal pathologic lesion responsible for the 67. Within the level you have selected, the responsible
symptoms is most likely lesion is most probably:

a) Some form of mass lesion a) Focal, on the right side of the nervous system

b) Some form of non-mass lesion b) Focal, on the left side of the nervous system

64. The temporal profile of the illness is c) Focal, but involving the midline and involving
contiguous structures on both sides of the
a) Acute nervous system

b) Subacute d) Non focal and diffusely located.

c) Chronic 68. the principal pathologic lesion responsible for the

symptoms is most likely
65. the cause of the responsible lesion is most likely
a) Some form of mass lesion
a) Vascular
b) Some form of non mass lesion
b) Degenerative
69. the temporal profile of the illness is
c) Inflammatory
a) Acute
d) Immunologic
b) Subacute
e) Neoplastic
c) chronic
f) Toxic-metabolic
70. the cause of the responsible lesion is most likely
g) Traumatic
a) Vascular
Case # 3 (for nos. 66-70)
b) Degenerative
A 68 year old, right handed man noted the
sudden onset of severe pain in the chest and abdomen. c) Inflammatory
Almost immediately after the pain, he became weak
and was unable to support any weight on his right leg. d) Immunologic

Examination revealed marked weakness of the right e) Neoplastic

lower extremity, with a decrease in perception of
f) Toxic-metabolic
pinprick in the left leg to about the level of the
umbilicus. g) Traumatic
66. Based on the above protocol, what ilevel of the Case # 4 (for nos. 71-75)
nervous system is affected?
 “Medicine, the only profession that labours incessantly to destroy the reason for its own existence.”
-Sir James Bryce
A 6 year old right handed girl with known e) Neoplastic
congenital heart disease began to complain of
headaches. Several days later, the severity of the f) Toxic-metabolic
headaches increased, and she was noted to have a left
g) Traumatic
hemiparesis and left homonymous hemianopsia.

71. Based on the above protocol, what level of the

nervous system is affected?

a) Supratentorial

b) Posterior fossa

c) Spinal level

d) Peripheral level

e) More than one level

72. within the level you have selected, the responsible

lesion is most probably:

a) Focal, on the right side of the nervous system

b) Focal, on the left side of the nervous system

c) Focal, but involving the midline and involving

contiguous structures on bot sides of the
nervous system

d) Non focal, and diffusely located.

73. The principal pathologic lesion responsible for the

symptoms is most likely

a) Some form of mass lesions

b) Some form of non mass lesion

74. the temporal profile of the illness is

a) Acute

b) Subacute

c) Chronic

75. the cause of the responsible lesion is most likely

a) Vascular

b) Degenerative

c) Inflammatory

d) Immunologic