1.

A 35 year-old man was brought to hospital with sudden onset of high fever, severe
headache, nausea and vomiting. His vital sign were T: 39,9 C; P: 121/min; BP: 91/61
mmHg. On physical examination, he unable to answer questions or follow commands. He
has a haemorrhagic skin rash in the extremities, neck rigidity, a positive Kernig’s sign,
and had no papilloedema. A head CT scan normal. Which of the following is most
appropriate etiologic organism?
a. Haemophillus influenza
b. Neisseria meningitides
c. Streptococcus agalactiae
d. Listeria monocytogenes
e. Pseudomonas aeruginosa

2. A 4 month old girl comes to the Serang Hospital with enlargement of the head since
birth. From physical examination shows the head circumference > 2 SD according to her
age and hepato-splenomegaly. Blood examination was slightly anemia with normal
leucocyte and thrombocyte. CT scan shows some calcifications in the brain. Which of
the following is the most likely diagnosis?
a. Congenital cytomegalovirus
b. Congenital toxoplasmosis
c. Congenital syphilis
d. Congenital TB meningitis
e. Congenital rubella

3. 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

4. A 16-year-old man is watching television program, suddenly stops her activity, becomes
unresponsive, then falls down and starts convulsed. 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 diagnosis of this case?
a. Acute symptomatic seizure
b. Status convulsivus
c. Status epilepticus
d. Epilepsy
 e. Idiopathic epilepsy

5. A 5 year old boy, several months ago was fell down from a tree and his head was collide
to the ground. Today he was brought to the hospital because several times since a week
ago he got seizures. The doctor has a plan to give him drug that blocks neurotransmitter
receptors. What neurotransmitter receptors that effectively will treat his seizure?
a. Noradrenalin
b. Glutamate
c. Glycine
d. Acetylchyoline
e. GABA

6. 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

7. An 18-year-old man notices tingling about his ankles 2 weeks after an upper respiratory
tract infection. Within 2 days, he has weakness in dorsiflexion of both feet, and within 1
week he develops problems with walking. He has no loss of bladder or bowel control. His
weakness progresses rapidly over the ensuing week and necessitates his being placed on a
ventilator to support his breathing. He is quadriplegic, but retains control of his eye
movements. Cerebrospinal fluid studies reveal a protein content of greater than 1 g/dl
with a normal white cell count. There are no red blood cells in the CSF. What is the most
likely diagnosis?
a. Multiple sclerosis
b. Guillain-barre syndrome
c. Paraneoplastic neuropathy
d. Myasthenia gravis
e. Poliomyelitis
8. A 72-year-old woman has an abrupt onset of right face and hand weakness, disturbed
speech production, and a right homonymous hemianopsia. Which of the following is
most likely attributable?
a. Left anterior cerebral artery
b. Left vertebrobasilar artery
c. Left anterior choroidal artery
d. Left posterior inferior cerebellar artery
e. Left middle cerebral artery

9. A 64-year-old man is diagnosed with an acute stroke. His main deficit is a partial loss of
his visual field. The neurologist diagnoses a lesion of the occipital lobe. Which of the
following arteries is likely to be involved?
a. Internal carotid
b. Lenticulostriated
c. Middle cerebral
d. Posterior cerebral
e. Anterior cerebral

10. A 7-year-old girl is brought to the emergency room after a motor vehicle crash. She and
her father were on their way to go home when he hit the pedestrian path. She reported
having a brief loss of consciousness but currently is oriented to name, place and time.
While waiting of her cervical spine series, she vomits and lapses into unconsciousness.
She becames bradycardia and developed irregular respirations. Which of the following
brain injuries is most likely in this case ?
a. Subdural hemorrhage
b. Epidural hemorrhage
c. Intraventricular hemorrhage
d. Post traumatic epilepsy
e. Brain contussion

11. A 45-year-old woman abruptly develops problems with language comprehension. She is
able to produce some intelligible phrases and produces sound quite fluently; however, she
is unable to follow simple instructions or to repeat simple phrases. On attempting to
write, she becomes very frustrated and agitated. Emergency MRI reveals a lesion of the
left temporal lobe that extends into the superior temporal gyrus. 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

12. A 50-year-old man is brought to emergency room 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

13. 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 II
b. Cranial nerve III
c. Cranial nerve IV
d. Cranial nerve VI
e. Cranial nerve VII

14. In an experiment using Barany chair to produce nystagmus, the subject sits with his head
bent down 300. Which part of the vestibular component will be effectively stimulated by
rotating the Barany chair?
a. Macula utriculus
b. Macula sacculus
c. Horizontal canalis semicircularis
d. Posterior canalis semicircularis
e. Superior canalis semicircularis

15. A 78-year-old woman was reported to have sleeping difficulty for the last 3 months. She
also agitated when she was unable to sleep, and angry to everybody. She was quite erratic
when attended for meals, she would spit the food out. She was very good remembering
her childhood memories, but she couldn’t recognize her grandchildren. What is the most
likely happened at this patient?
a. Depression
b. Bipolar disorder
c. Dementia
d. Schizophrenia
e. Delirium
16. 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

17. A 45-year-old homeless man refuses to stay in a shelter because he is convinced that the
other clients are devil worshippers and that they are going to murder him in his sleep. He
claims he has heard them plotting about cutting his throat and stealing his shoes. The
shelter volunteers have heard him reporting similar fears for the past 10 years. What is
the most likely diagnosis?
a. Schizoaffective disorder
b. Schizophrenia disorganized type
c. Schizophreniform disorder
d. Schizophrenia paranoid type
e. Shared psychotic disorder

18. A 37 year old man comes to the psychiatry clinic complaining of sudden shortness of
breath, palpitation, frequent of urination, numbness over his hands, sweting 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. Post Traumatic Stress Disorder
b. Panic disorder
c. General anxiety disorder
d. Obsessive-compulsive disorder
e. Social phobia

19. A 22-year-old man is brought by his parents to a psychiatrist person because he is very
quiet, will not and can’t make many friends. He only has one friend in this world. He has
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.
What kind of personality disorder he has?
a. Narcissistic
 b. Paranoid
c. Schizoid
d. Obsessive-compulsive
e. Avoidant

20. A 19-year old man is brought to emergency department after he was found sitting in the
middle of street. He says, voices told him 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. From 1 year ago, he began to isolate himself in his room and
dropped out school. On a mental status examination, He is to be dirty and disheveled,
with poor hygiene. His affect is congruent but flat and his mood is fine. His thought
processes are tangential and loose associations occasionally. What psychopathology
symptoms are found in this patient?
a. delusion, disorganized speech, social phobia
b. auditory hallucination, disorganized speech, social withdrawal
c. depersonalization, derealization, anti social
d. auditory hallucination, delusion, depersonalization
e. disorganized speech, disorganized behavior, disorganized thought