A 67 year-old man has history of progressive memory loss for 2 years. His examination is otherwise normal. A diagnosis of Alzheimer disease is made. Which of the following medications may result in some cognitive improvement?

You are able to pull your hand quickly away from hot water before pain is felt because:

A 50-year-old male has been moody and irritable for five weeks. He has lost interest in sex and his favorite leisure activities and nothing seems to cheer him up. He has difficulty falling asleep at night and his appetite is decreased, although he has lost 2 kg in one month. What is the most likely diagnosis?

A 1-year-old child has delayed mental development and enlarged head diameter after being diagnosed with encephalitis 6 months ago. His mother brought him to the hospital and later was diagnosed with hydrocephalus. Cerebrospinal fluid is mostly absorbed by:

A 58 years woman suddenly had difficulty to raise her right arm and leg, an also slurred speech. She brought to ER, her blood pressure 180/100 mmHg, pulse 80 x/minute, RR 16 x/minute, temperature 36,6 C. She was still alert and could communicate. Previously she had uncontrolled hypertension. Twelve hours later she had improvement, her complains resolved, she can raise her right arm and leg, also could speak normally. What is the most possible diagnosis for this patient?

A 27-year-old patient gave birth to a dead on delivery (DOD) male baby. Upon his examination, the doctor found that the baby has no calvaria (cranial vault), scalp, and major portion of the brain. The baby’s eyes bulged forward. Embryological structure that has the greater possibility as the cause of this congenital malformation is failure of the:

Betty remarks frequently that she is extraordinarily wealthy, despite being housed in a psychiatric hospital and having an empty bank account. When asked to explain this apparent contradiction, she indicates that the hospital is keeping her money, but that it is part of a vast conspiracy because the administrators fear her great power when she is not hospitalized. She has experienced symptoms such as these since she graduated high school. These symptoms are sometimes collectively referred to as:

A 30 year-old male patient presents at Emergency and states that he was discharged from a mental hospital three days ago. He complains of severe dysarthria because he is unable to retract his tongue properly. On further questioning he states that he stopped all medications when he left hospital but does not know which medication he was being given. What is the most likely diagnosis?

A 25 year old man is suspected of abusing drugs. His parents find him in comatose state in his room and was taken to the emergency where he is assessed to be in a stupor with bilateral pinpoint pupils, cold and clammy skin, skeletal muscle flaccidity and his respiratory rate is 6-8/min. Which of the following medication should be given for this situation?

The drugs donepezil, rivastigmine, and galanthamine are used in Alzheimer’s Disease to try to raise the availability of what transmitter in the brain?

A 54-year-old woman was brought to clinic and the daughter said that this morning she couldn’t sleep, became agitated and ran out to the street naked. She shouted, ”My son is still alive! I want to give food to my son!” Later on she became more agitated and was not cooperative. She had never had any education or formal occupation. She is a widow and her husband died 2 years ago because of cancer. What is the type for this condition?

A 19-year old man was brought by his family to emergency department. Patient says: “The voices told me to do ‘bad things’, there are often two or three voices talking, and they often comment to each other on his behavior.” He believes that someone wants to kill him. He repeated this statement of idea since one year ago. His affect is congruent, although it is flat and his mood is good. He has loose associations and ideation of killing his father occasionally. What psychopathologies are found in the patient above?

A 36-year-old male had a motor vehicle accident. His head hit the road and afterwards he complained numbness in his right arm and leg. The brain CT scan examination showed an intracranial hemorrhage at left parietal lobe. Which Broadman area number is the most probably injured?

A 32-year-old female came to clinic with difficulty walking since a month ago after accident which broke her left leg. The doctor said she had nerve injured and cause lower motor neuron lesion of the left leg. Which of the following signs could present in this patient?

Mr. Hugo, 60 years old, presents with complaint of sleeping difficulty since 2 months ago. He feels easily awake during night sleep, but no complaint of any pain, shortness of breath, or chest pain at night. He also has decreasing appetite and feel that he could hardly smell any familiar scent. Previously, since one year ago, he was diagnosed with Parkinson’s disease due to tremor in his hand during resting position and stiffness in extremities. He routinely consumes medication which contained Levodopa and could do his daily activities relatively normal as usual. The supportive criteria for diagnosis of Parkinson’s disease:

A 68 year old man is found fall on the ground because he is suddenly unable to move his right hand and leg. Which of the following region was most likely directly affected?

A 17-year-old man visited the physician because he had severe headache and seizure. He was suspected with brain tumor that originated from neuron or glial cell. What is the characteristic of dendrit?

Mrs N, 32 years old, is complaining about lack of energy, depressed mood, insomnia, lack of motivation, and loss of weight for about 1 month. Which neurotransmitter is primarily responsible for the symptoms in Mrs N?

A 28-year-old male patient has a loss of voluntary motor control below the L2 spinal level on the right side of his body, with no sensory losses. Which of the following demarcated regions indicates the site of the lesion?

A 50-year-old patient with recent damage to the hippocampus from a stroke would likely have cognitive deficits, which cognitive ability is probably remain intact in this patient?

An 18-year-old high school senior was brought to the emergency room by police after being picked up wandering in traffic on the Benton Junction. He was angry, agitated, and aggressive, and he talked of various people who were deliberately tryng to confuse him by giving him misleading directions. His story was rambling and disjointed, but he admitted to the police that he had been using speed. In the emergency room he had difficulty focusing his attention and had to ask that questions be repeated. He was disoriented as to time and place and was unable to repeat the names of three objects after five minutes. From the case above, you can also make the same diagnosis if the patient uses:

An infant has a head CT examination because of a large head and failure to thrive. The diagnosis of hydrocephalus is made by the physician. Congenital hydrocephalus may develop as a consequence of which of the following first-semester maternal disorders?

An elderly man has an expressionless face and has uncontrollable movements caused by muscular rigidity. When in sitting, his hands have a pill-rolling tremor. Which of the following pathologic conditions of his brain is the most likely happened?

A 30-year-old woman, married 6 years ago, is complaining of having pain during sexual intercourse with her husband. She did not enjoy having sex with him, and she has got no infection or abnormality in her vagina. What is the diagnosis of the case above?

A 25 years old woman was suddenly becoming aggressive, impulsive, having sleep disturbance, and sometimes speaking or giggling by herself. She told to everybody that she was a princess from outer space. Her mind and her body were being controlled from outer space. Her mission was to protect the earth from outer space enemies; she was suspicious with the neighbors. The condition started seven month ago. Which dopaminergic pathways that responsible for positive symptoms of schizophrenia?

What is the main factor to influence the secretion of Cerebro spinal fluid?

A 25-year-old man came to emergency department, fully alert, no fever. He complained sudden left sided weakness when he is working at home. He denied any history of hypertension, nor diabetes mellitus. No history of smoking. He works as physical education teacher. In history taking, which component should be asked to narrow down the differential diagnosis of the patient?

Male, 60 years old was brought to emergency department with history of recurrent seizure since 2 days prior to admission. He also complained of visual hallucination that he saw black shadow which chasing him. On physical examination, blood pressure 110/60 mmHg, heart rate 89 bpm, respiratory rate 16x/minutes, temperature 38oC. Meningeal sign was negative and no focal neurological deficit was found. Which pathogen of CNS infections that frequently causes neurological sequel?

A 25-year-old man is brought to the emergency unit with a high fever, lethargy, and a stiff neck. Based on the history taking, physical examination, lumbar puncture, and laboratory analysis that indicated bacterial growth in the cerebrospinal fluid, the attending physician suspect infection of central nervous system. Embryological structure that has the greater possibility involved in the above case is the derivative of mmesenchyme surrounding:

A 17 year old male patient came to the Emergency Department of Siloam Hospitals with chief complaint having seizures for 1 minute. While having seizures, patient was unconscious, both legs and arms were stiff and twitched, his head and eyes faced upwards. After the seizure, he regained conscious again. This was his first seizure in his life. He had no remarkable previous history. What is the basic pathophysiology of a seizure to happen?

Following Mita’s near-fatal car accident, her doctor noticed that the pupillary reflex of her eyes was abnormal. Which of the following indicates the damage because the accident?

A man came to the doctor with history of run out of the oxygen reserve during climbing the high mountain to the 24.000 ft altitude. After descent, he had suffered memory deficient. The doctor suspected that he had a problem in his neuron cellular signaling or conducting synapse transmission. What is the characteristic of graded potential?

A 25-year old girl came to her physician consulting her multiple nodules around 1.1 to 2.0 cm scattered dominantly in the extremities and torso. The physical examination found café-au-lait, irregular borders in her skin beside multiple nodules. The biopsy from one of her nodules showed a benign neoplasm. What is the best diagnosis for her?

A 25 years old woman was suddenly becoming aggressive, impulsive, having sleep disturbance, and sometimes speaking or giggling by herself. She told to everybody that she was a princess from outer space. Her mind and her body were being controled from outer space. Her mission was to protect the earth from outer space enemies; she was suspicious with the neighbors. The condition started seven month ago. Her mind and her body were being controled from outer space. What is the interpretation of this statement?

The microscopic appearance of a mass from the left cerebellum of a 10 year-old boy showed a rosette structure from a blastemal cells. What is the most possible diagnosis for his cerebellum mass?

Mrs. Pamela, 78 years old, was brought to neurology clinic by her son because he noticed that patient had problems with her memory, particularly short term memory loss, with patient not being able to remember the task she was doing at a time since 1 year ago. She forgot where she kept her purse and eyeglasses. Sometimes she also found difficulty to remember way back home from the market that she regularly visited every week. She could not do her daily activities on her own, such as eating, taking bath, and dressing. The patient had no history of hypertension, diabetes mellitus, or previous stroke event. She is diagnosed with Alzheimer’s disease. Classical conditioning is an example of:

A bodybuilder friend suddenly seems to have grown several centimeters in height. You suspect that your friend’s growth spurt has occurred he has been using drug tThalamusat effect the:

Mrs. Dora, 23 years old, came to neurology clinic with complaint of tingling sensation on first to fourth fingers of both hands since 6 weeks ago. At first, the tingling only appeared during night and resolved by shaking her hands. The tingling was worsened and felt the whole day. Mrs. Dora had a hobby of playing badminton routinely 3 times a week and riding a motorcycle for daily transportation. What is the most possible diagnosis for this patient?

Glial-appearing cells, called pituicytes, are found within which region of the pituitary gland?

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 was 130/80 mmHg and HR 88 x/minute. During clinical investigation in emergency unit, he became unconscious. He also developed right pupil dilatation, and left side weakness. Why he develops right pupil dilatation?

A 35- year old male has had increasing difficulty with activities of daily living for the past years which mainly because of choreiform movements. His families have also observed that he has exhibited behavioral changes although his memory remains intact. The most likely finding in the CNS changes you will get is,

In testing for motor dysfunctions, a neurologist identified an upward movement of the patient toe when the plantar surface of his foot was scratched. This response is indicative of a lesion of a part of the nervous system. Which of the following is linked to this response?

A 13 year-old girl has severe case of mastoiditis. Despite treatment she develops a fluent aphasia. Her aphasia is most likely the result of extension of the infection into which portion of the brain?

Mr.X, 27 years old, was brought to the mental hospital by his father because he was found on the street as a vagabond (gelandangan) after he left his house 3 months ago. Previously, he often sat up all night, slept all day, and became very angry when his father tried to get him out of bed. He did not shave or took a bath for weeks. He smoked continuously, and ate very irregularly. He kept to himself (likes being alone) as much as possible and and rarely speaks with other people. This patient could be treat by conventional antipsychotics. What is the principles of the drugs?

A 25 year old man had walking while he was sleep. He also suddenly woke up in the middle of his sleep due to nightmare. Which of the following disorder is the most appropriate with this condition?

A 17-year-old man visited the physician because he had severe headache and seizure. He was suspected with brain tumor that originated from neuron or glial cell. What is the function of glial cell?

A 34 years old woman came to the physician with depression and sleep disorders problem. The doctor thinks she had a problem in some neurotransmitter. What is the mechanism of action of glutamate?

Female, 24 years old was brought to emergency department with loss of consciousness since 3 days prior to admission. One week ago, she complained headache and fever. She also had double vision and weakness of left arm and legs. During examination, the patient had generalized seizure for 2 minutes, which was stopped with injection of diazepam intravenously. On neurological examinations, the nuchal rigidity and Brudzinki’s sign were positive. Which components do not comprise the blood brain barrier?

A 80-year-old man with metabolic syndrome has had 6 episodes of sudden dysarthria, a feeling of weakness in his hand, and dizziness in the past 3 months. These episodes usually last less than 1 hour, and then he feels fine. Today, he suddenly lost consciousness while walking to the bathroom in his house and fell to the floor. On regaining consciousness 4 minutes later, he was unable to move his right arm. Which of the following underlying lesions is most likely to be found in his brain?

Mrs. Dora, 23 years old, came to neurology clinic with complaint of tingling sensation on first to fourth fingers of both hands since 6 weeks ago. At first, the tingling only appeared during night and resolved by shaking her hands. The tingling was worsened and felt the whole day. Mrs. Dora had a hobby of playing badminton routinely 3 times a week and riding a motorcycle for daily transportation. Which is the most possible nerve injury mechanism that underlying the patient’s condition?

A 29 year-old male had a brain tumor with bitemporal hemianopsia. Which location within visual tract that might be affected in this patient?

A 23-year-old man who has been receiving treatment for substance addiction presents to the physician's office with complaints of weakness and anorexia. Assessment of vital signs shows a pulse rate of 107 beats per minute and a respiratory rate of 24 breaths per minute. Lacrimation, rhinorrhea, and mydriasis are present, and the patient yawns repeatedly during the interview. These clinical signs and symptoms are most consistent with withdrawal from:

A patient is brought to the ER following a motor vehicle accident. On examination he has weakness on both arms and legs, dominantly in the upper extremities. He also complained for urinating difficulty. This clinical picture is most consistent with:

The histopathologic of a curettage biopsy from an ulcerative mass around Vertebra Thoracalis 12-L1 in a -2 year old baby girl showed necrosis caseousa, granulomas and Langhan’s cells. The best diagnosis for hers is:

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 was 130/80 mmHg and HR 88 x/minute. During clinical investigation in emergency unit, he became unconscious. He also developed right pupil dilatation, and left side weakness. The physician did a CT Scan, according to the clinical findings, what would you expected to find?

Female, 24 years old was brought to emergency department with loss of consciousness since 3 days prior to admission. One week ago, she complained headache and fever. She also had double vision and weakness of left arm and legs. During examination, the patient had generalized seizure for 2 minutes, which was stopped with injection of diazepam intravenously. On neurological examinations, the nuchal rigidity and Brudzinki’s sign were positive. What is the triad sign and symptoms of encephalitis?

As a result of an infection, a 50 year old woman experience a loss of taste affecting the front of her tongue and the ability to smile. If the sensory loss involves damage of cell bodies, which of the following would be so affected?

A 56-year-old female patient came to the clinic with chief complaint of having the first seizure in her life. Her family described her seizures as head and eye turning to the left side accompanied by stiffness and twitching of the left extremities and followed by the right extremities. She was unconscious while seizing and the seizure duration was 2 minutes. After the seizure, she was fully alert. She had a history of brain tumor removal over the right temporal area 1 year ago. According to your diagnosis above, what is the best treatment to be given to this patient?

A person has such a character that he is very quiet, will not and cannot make many friends what he had is only one friend in this world, he talks very little, tendency to withdraw from group of people, and can only work alone and prefer to handle a nonliving object rather than human such as work with computer only, he is having a personality disorder of type

An infant has a head CT examination because of a large head and failure to thrive. The diagnosis of hydrocephalus is made by the physician. In the patient above, uncorrected congenital hydrocephalus will produce which of the following?

A 45-year-old woman complains of recurring episodes of vertigo that began after she bumped her head rather forcefully 2 weeks ago. Her spells last 10 to 15 seconds and occurs whenever she goes to bed or wakes up. She denies any hearing loss or tinnitus. Her physical examination is normal except for a latent, rotatory nystagmus whe

Male, 36 years old came to the emergency department with headache after head trauma due to motorcycle accident since one day prior to admission. On physical examinations, there were open fracture of right temporal bone. No abnormal findings on neurological examination. He was suggested to be hospitalized, but decided to go home because of economical reason. Three days later, the patient had worsening headache and fever. He was re-hospitalized and diagnosed with meningitis. Which infection pathway or mechanism is most possibly happened in this patient?

A 22 year-old woman is involved in a car accident. She was not wearing a seatbelt and she received a skull fracture when her head hit the windshield. By what mechanism would this patient develop anosmia (loss of sense of smell)?

Following a head injury, a patient has ongoing difficulties to stay awake. Which of the following is the most likely structure to be injured?

A 72-year-old man complains that he frequently forgot what he just doing. He went to the doctor and was suspected as having a neurotransmitter problem which probably caused by a neurodegenerative disease. What is the characteristic of GABA?

A man went to the doctor given intramuscular injections in the right buttock. After the injection the patient experienced weakness on the right leg and cannot stand or squat. Which of the following nerve is affected?

After a car accident which produced trauma to her skull, a 25-year-old patient complains of double vision (diplopia). Knowing which cranial nerves innervate the muscles of the eye and their course from the brain stem to the orbit, the physician in charge can determine the extent of the damage. The physician would need to consider which of the following cranial nerves in his diagnosis:

A 1-year-old child has delayed mental development and enlarged head diameter after being diagnosed with encephalitis 6 months ago. His mother brought him to the hospital and later was diagnosed with hydrocephalus. Where is the obstruction located if the lateral and third ventricles are dilated, while the fourth ventricle remains relatively normal?

A 9 month baby boy was taken to a GP because there was tuft of hair in his lumbar region. After examination the GP explained to the parents that he suspected a congenital malformation. Therefore the GP told the parents that he would consult a Pediatric surgeon. Spinal cord develops from:

Where is the most conspicuous stimulation area for causing almost natural sleep?

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 was 130/80 mmHg and HR 88 x/minute. During clinical investigation in emergency unit, he became unconscious. He also developed right pupil dilatation, and left side weakness. He got a lucid interval, means conscious interval between two episodes of unconsciousness. What is the most probable cause of second episode of unconscious?

A 25-year-old mother develops an illness during pregnancy. A diagnosis of cytomegalovirus (CMV) infection is made by serology. What is the common neuroimaging findings in congenital CMV infection?

A 55 year-old man has been taking haloperidol for schizophrenia since his initial diagnosis 20 years ago. On examination he displays continual facial movements which look as though he is chewing his own mouth. These movements have been present for some time. Which ONE of the following side-effects is he suffering?

A patient came to a clinic with uneasy state preoccupied by the feeling that his proportion of chest to waist and other parts of body do not satisfy him. He wished that his physical appearance should be more manly rather than his current proportion. He feels that his body stature is so girlish. What condition is described above?

A man came to the doctor with history of run out of the oxygen reserve during climbing the high mountain to the 24.000 ft altitude. After descent, he had suffered memory deficient. The doctor suspected that he had a problem in his neuron cellular signaling or conducting synapse transmission. What is the characteristic of electrical synaps?

A 17 year old male patient came to the Emergency Department of Siloam Hospitals with chief complaint having seizures for 1 minute. While having seizures, patient was unconscious, both legs and arms were stiff and twitched, his head and eyes faced upwards. After the seizure, he regained conscious again. This was his first seizure in his life. He had no remarkable previous history. What is the type of seizure mentioned above?

One of the tasks of participants of the Students Dissecting Program is to remove cadaver’s visceral organs. After having removed cadaver’s brain the students found that the cerebellum still remain at the posterior cranial fossa because the student forgot to dissect reflexion of meninges that covers cerebellum. Reflexion of meninges that the student forgot to dissect is:

A 20-year-old man came to outpatient 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?

An 18-year-old high school senior was brought to the emergency room by police after being picked up wandering in traffic on the Benton Junction. He was angry, agitated, and aggressive, and he talked of various people who were deliberately tryng to confuse him by giving him misleading directions. His story was rambling and disjointed, but he admitted to the police that he had been using speed. In the emergency room he had difficulty focusing his attention and had to ask that questions be repeated. He was disoriented as to time and place and was unable to repeat the names of three objects after five minutes. Which of the following would be your diagnosis to this patient?

A 56-year-old female patient came to the clinic with chief complaint of having the first seizure in her life. Her family described her seizures as head and eye turning to the left side accompanied by stiffness and twitching of the left extremities and followed by the right extremities. She was unconscious while seizing and the seizure duration was 2 minutes. After the seizure, she was fully alert. She had a history of brain tumor removal over the right temporal area 1 year ago. According to ILAE (International League Against Epilepsy) classification, what is the best diagnosis of this patient?

A 27-year-old male patient is in a car accident in which he is thrown from the vehicle because he was not wearing a seat belt. He has sustained several fractures, including a fracture on the base of his skull. Upon regaining consciousness in the hospital, he notices that he cannot move the muscles on the right side of his face, leading to drooling and a dry eye on that side. Further testing by his neurologist indicates that the motor component of the facial nerve (VII) on his right side is not functional (although lacrimal secretion, submandibular secretion, and taste are all intact). This suggests that the nerve was severed as it passed through the:

Mr. Vinson, 34 years old, came to neurology clinic with low back pain that radiated to right legs since 1 week ago. No numbness or tingling sensation in the leg and no weakness of both legs. Before the complaint, he had history of lifting heavy objects. Which nerve fibers that responsible for causing the symptoms of this patient?

A 58 years woman suddenly had difficulty to raise her right arm and leg, an also slurred speech. She brought to ER, her blood pressure 180/100 mmHg, pulse 80 x/minute, RR 16 x/minute, temperature 36,6 C. She was still alert and could communicate. Previously she had uncontrolled hypertension. Twelve hours later she had improvement, her complains resolved, she can raise her right arm and leg, also could speak normally. Which of the following tract make her could not move her right arm and leg?

A 25-year-old man has complained of headaches for the past 5 months. During that time, family members noticed that he was not as mentally sharp as he has been in the past, and that he has become more emotionally labile. Over a 2-week period, he has 4 generalized seizures. On physical examination, he now has no papilledema or movement disorder. CT scan of the head shows a 2-cm mass in the right frontal lobe. A stereotactic biopsy specimen of this lesion shows only gliosis and evidence of recent and remote hemorrhage. The mass is removed, and histologic examination shows a conglomerate of various-sized tortuous vessels surrounded by gliosis. What is the most likely diagnosis?

A 28-year-old female is involved in a car accident in which her spinal cord is damaged at the T6 level. Detailed testing of her sensory and motor systems reveals that her motor system is intact and she has no loss in pain or temperature sensation. However, she has lost fine touch, vibration, and proprioceptive sensation from the left side of her body below the T6 level. Therefore, she has damaged her:

A 45 year old women complains of imbalance and unsteadiness while standing up or walking. On neurological examination, she could not distinguish the position and direction of her toes directed by the examiner while she close her eyes. The neurologic tract that may be involved is

A 40-year-old, previously healthy man has developed headaches over the past month. There are no remarkable findings on physical examination. A cerebral MR angiogram shows a 7-mm saccular aneurysm at the trifurcation of the right middle cerebral artery. Which of the following is the most likely complication from this lesion?

A 37-year-old man comes to a clinic complaining sudden shortness of breath, palpitation, frequent urination, numbness over his hands, sweating all over his body, and neck rigidity. He is very afraid that his heart would suddenly stopped. This condition appeared since 2 months ago. What is the most likely diagnosis for this condition?

A college student received an injury as a result of being tackled in a football game. After the game, the student was found to be unable to abduct and rotate the left arm at the shoulder, flex the elbow and extend the wrist of the left side. Further examination revealed depression of the biceps reflex of this limb, but the reflex involving the other limbs was normal. Which of the following is the most likely site of the injury?

A 63 year-old man presents to the emergency room with a right hemiparesis and non-fluent aphasia that began acutely 45 minutes ago. Blood pressure is 160/90 mmHg, and there is no recent history of bleeding. A head CT scan shows no evidence of intracranial hemorrhage. Which of the following is the most appropriate therapy at this point?

Mr.X, 27 years old, was brought to the mental hospital by his father because he was found on the street as a vagabond (gelandangan) after he left his house 3 months ago. Previously, he often sat up all night, slept all day, and became very angry when his father tried to get him out of bed. He did not shave or took a bath for weeks. He smoked continuously, and ate very irregularly. He kept to himself (likes being alone) as much as possible and and rarely speaks with other people. What is your diagnosis?

A woman 37 year old, came to the emergency room with a spinning sensation since 1 day ago. She instantly felt dizzy and nauseated and had been vomiting many times. The spinning sensation was felt continuously, accompanied by hearing loss of the left ear and fever. The patient problem is probably caused by disorder in which site?

Male, 60 years old, presented with sudden onset of vertigo in the past 1 hour prior to admission. He

complained left sided weakness, slurred speech, and dificulty of swallowing. No history of trauma. Previous

medical history showed uncontrolled hypertension and smoking for 15 years. Which blood vessel is most

likely affected in this patient?

A male teenager was brought by his father to your clinic with history of hysterical screaming 2 hours after he

started to sleep. He was looked very frightened and inconsolable. This event occurred around 15 minutes and

already happened 3 times in the last 1 month. His parents were very worried, but the patient stated that he

did not remember anything regarding this matter. What type of sleep disorder that is happened in this

patient?

Female, 32 years old, had history of easily felt anxious since junior high school, lacking self-con�dence, and

had low self-esteem. She worked in multinational company with good performance. Due to her lack of

satisfaction, she often worked extra hours. She would like to have romantic relationship, but she felt not

con�dence enough. In this type of personality, which neurotransmitter system determines her

temperamental constitution?

Female, 48 years old, presented with fever, bad headache, and vomiting. History revealed that she loved fresh

soft goat cheese; 2 weeks before the onset of symptoms, she had purchased some at a rural roadside stand.

The local merchant told her he had obtained the cheese from a farm that pasteurized the goat milk. On

examination, her temperature was 39°C. She was lethargic but could give a reasonable history, had a stiff

neck, and was nauseated. Head CT was normal. Lumbar puncture showed an opening pressure of 260 mm

CSF, 500 white blood cells/mm3 (predominance of neutrophils), glucose of 26 mg/dL, protein of 95 mg/dL.

Random blood glucose after LP procedure was 100 mg/dL. What is the most possible diagnosis in this

patient?

A 75-year-old man is diagnosed with dementia for the past 5 years by neurologist in the hospital. The patient

is suspected to suffer from Alzheimer’s disease as indicated by neuronal degeneration in cerebral cortex.

What is the name of prominent neurons that degenerated as described in the vignette?

Female, 20 years old, presented with feeling of “pressed down” by something heavy during night sleep. It was

happened around 5 am in the morning that she felt awake, but unable to move or speak. She had breathing

difficulty, sensation of “evil spirit”, and saw a vague shadow. She came to your clinic because she felt anxious

and scared that this thing might happen again. What condition that is most possible happened in this

patient?

A 25-year-old man with numbness and tingling of the little and ring finger, weakness and wasting of the

dorsal interossei and abductor digiti minimi, sensory disturbance over the little and ring finger. Which of the

following site of peripheral nerve lesion for this condition?

A 62 year old male over a period of weeks begins to experience difficulty in swallowing and hoarseness in

speech. A thorough examination reveals the presence of growing tumor. Which of the following loci best

accounts for this deficit?

Female, 28 years old, presented with episodic unilateral headache in the past 10 years. She experienced

throbbing sensation in the left side, pain score 8-9, and duration of headache about 24-48 hours if left

untreated. During the attack, she felt nauseous and vomited several times. There were no other focal

neurological defict found. She already taken acetaminophen with no significant improvement. What is the

best abortive medication that should be given to the patient?

A 65 year old female patient with a history of ischemic stroke 3 months prior with weakness over the left

extremities and aphasia. She has a history of chronic hypertension and Diabetes Mellitus. On general

examination, GCS is E4M6Vaphasia BP 120/80, HR 88x/m, R 20x/m T 36,80C. She is scheduled for

neurorehabilitation. In what phase is this patient on her recovery journey?

A 35-year-old female is referred to neurology clinic by her primary care physician for right-sided facial

weakness. The patient notes that she been suffering from an upper-respiratory tract infection for the past

week. The previous morning, she noticed some pain over her right ear. This was followed over the next couple

hours by drooling from the right corner of her mouth and dryness in her right eye. When she looked in the

mirror, she noted that her face appeared distorted. Furthermore, she could not close her right eye. When she

ate lunch, her taste was blunted. The symptoms all came on over the course of 3 hours and have stayed

largely the same since. There is no associated blurring of vision, double vision, rash, hearing loss, numbness, or

weakness. Facial nerve examination revealed the result as shown below.

What is the most appropriate treatment that should be given to this patient?

A previously healthy man in his forties presented with confusion and ataxic gait that had progressed over

several days. On examination, he was febrile to 38.9°C. He was inattentive and disoriented, but his language

was fluent and he was able to follow most simple commands. He had marked sensory ataxia and grossly 3/5

power in all four extremities. Deep tendon reflexes were absent. CSF examination showed 100 nucleated

cells/mm3, elevated protein, normal glucose, and normal opening pressure.

Over the course of 2 days, his mental status rapidly declined to complete loss of brainstem reflexes. CT scan

showed diffuse cerebral edema and loss of gray/white differentiation. Further investigation into his history

revealed bat exposure in his home, although he had no known bites.

What is the most possible diagnosis in this patient?

Male, 57 years old, presented with sudden onset of persistence vertigo with no hearing loss or tinnitus. He

complained right sided weakness and lack of coordination in left side. He has history of uncontrolled

hypertension and diabetes mellitus for last 5 years. Which neurological examination result is most likely to

be found in this patient?

A 59-year-old male suffered a stroke and later presented with a spastic paralysis. Which of the following was

affected by the stroke that accounts for the spasticity?

Female, 28 years old, presented with episodic unilateral headache in the past 10 years. She experienced

throbbing sensation in the left side, pain score 8-9, and duration of headache about 24-48 hours if left

untreated. During the attack, she felt nauseous and vomited several times. There were no other focal

neurological deficit found. She already taken acetaminophen with no significant improvement. What is the

best prophylaxis medication that should be given to the patient?

Female, 20 years old, came to your clinic, accompanied by her mother. She was looked very thin with IMT 17

kg/m . In the last 6 months, she had a very restricted diet and had vigorous physical exercises, such as went to

the gym twice a day and consumed many diet pills. The patient stated that sometimes she could not control

the amount of food that she ate, so she threw it up again. What is the most possible diagnosis in this patient?

Mrs. N, 32 years old, is complaining about lack of energy, depressed mood, insomnia, lack of motivation, and

loss of weight for about 1 month. Mrs. N was given medication to improve her mood. Which of the following

antidepressant belongs to SSRIs class?

His wife noted that her husband had troubles with simple calculation and remembering recent

conversations. On one ocassion, while staying at an unfamiliar environment, he became confused, unclothed,

and attempted to enter the hotel rooms of other guests. These symptoms mostly refer to impairment in

domain:

Female, 36 years old, presented with sudden onset of episodic vertigo which is worsen by head movement.

Hearing problems, tinnitus, and fever is denied. Neurological examinations showed positive Dix Hallpike test.

Which part of vestibular system that is most likely caused the vertigo in this patient?

Female, 45 years old, presented with sudden onset of severe headache since 1 hour prior to admission. She

remained conscious, but vomited several times. Neurological examinations showed positive nuchal rigidity

test with no other focal neurological deficits. Non-contrast brain CT scan revealed the result as shown below.

Male, 60 years old, previously admitted to hospital with haemorrhagic stroke. He appeared awake and alert,

but unable to move his extremities and unable to speak. Neurological examinations showed intact vertical

eye movements. Where is the most possible location of lesion in this patient?

Male, 53 years old, presented with sudden left-sided facial weakness 2 hours prior to admission. He also

complained for double vision and slurred speech. He has previous medical history of uncontrolled

hypertension. Neurological examinations revealed right-sided hemiparesis, grade 4/5. Brain MRI showed

hyperacute infarct in left side of pons. What is the most appropriate thrombolytic medication in this

patient?

Female, 20 years old, came to your clinic, accompanied by her mother. She was consulted by obstetric

gynecology department with hypothalamic amenorrhea. She was looked very thin with IMT 17 kg/m . In the

last 6 months, she had a very restricted diet and had vigorous physical exercises, such as went to the gym

twice a day and consumed many diet pills. The patient stated that sometimes she could not control the

amount of food that she ate, so she threw it up again. What is the best treatment for this patient?

A 65 year old female patient with a history of ischemic stroke 3 months prior with weakness over the left

extremities and aphasia. She has a history of chronic hypertension and Diabetes Mellitus. On general

examination, GCS is E4M6Vaphasia BP 120/80, HR 88x/m, R 20x/m T 36,8 C. She is scheduled for

neurorehabilitation. What is the aim of neurorehabilitation ?

A 40-year-old man was brought to the Emergency Department of the Regional General Hospital (RSUD) by

the police. The victim was found lying on the side of the road as a result of being hit by a motorbike in an

unconscious condition and with injuries to the head and body. On physical examination, his consciousness

level showed drowsiness, the right pupil was larger than the left with slowed light reflexes and an injury to the

right temple. CT-Scan examination of the brain showed a buildup of blood in the subarachnoid space

(subarachnoid hemorrhage) and lateral ventricular space. The normal fluid that occupies the spaces which

are filled with blood as described in the vignette above is produced by specific structure inside the brain.

What is the name of the structure?

A 55 year old male patient with a history of surgery of brain tumor over the left hemisphere 3 years prior with

weakness over the right extremities and spacticity. She has a history of chronic hypertension and Diabetes

Mellitus. On general examination, GCS is E4M6Vaphasia BP 120/80, HR 60x/m, R 24x/m T 36,8 C. She is

scheduled for neurorehabilitation. What does augmenting interventions in neurorehabilitation consist of?

A person is suffering from typhoid fever with high temperature of 40 0C, and when in this state he became

very agitated, hallucinated shouting that so many people are jeering at him, and would drive all visitors not to

come near him stating that they are robbers, this person is suffering from:

A 60-year-old man came to the doctor with chief complaint of no pain in his sole when accidentaly stepped

upon nail a week ago. The patient has history of hypertension and uncontrolled diabetes mellitus. What is the

name of the dysfunctional structure which causes inability to sense pain as described in the vignette?

Female, 45 years old, came with chief complaint of episodic spinning sensation in the last 3 years, along with

tinnitus and left sided hearing loss. Fever and one-sided weakness is denied. What is the most appropriate

treatment for this patient?

A fashion model, 24 years old along with several celebrities attended a party after cocaine usage several days

ago. She was looked euphoric, hyperactive, and restless. Urine drug test showed negative results. She insisted

that this condition seldomly happened and she was originally emotional, with swing affect, tantrum, and

easily cried, in which supported by her spouse. She paid special attention for her physical appearance and

demanded for mirror so that she could make sure that she “looks good” during interview and put on make-

up before the interview. Along the interview, she was appeared fiirtatious and kept seducing you. Other

mental status examination showed normal. What is the most possible diagnosis in this patient?

A 67-year-old male patient came with acute onset progressive and ascending lower extremity weakness and

voiding difficulty for 3 days. He also had fever and chills. On neurologic examination, motor power was

decreased in both lower extremities (grade 2/5). Sensory testing showed hypesthesia from umbilical level

down. Babinski reflexes positive in both lower extremities. Cerebrospinal fluid (CSF) tests showed a white

blood cell count of 300/mm , an elevated concentration of protein (76.4 mg/dL), and a decreased

concentration of glucose (43/150 mg/dL). What is the most possible diagnosis in this patient?

An engineering faculty lecturer, 42 years old, came to your clinic to seek help for his history of alcohol abuse.

He was looked distant and lack of emotional engagement with his surrounding. He is unmarried and has no

close friends, but very dedicated to his job as economic researcher. His hobby is playing fantasy games and

chess in computer. He desctibed himself as very introspective, independent, and introvert. Which personality

disorder that is best described this patient?

Female, 25 years old, came to your clinic with chief complaint of anxious feeling before the bedtime. She

frequently had a nightmare in the past 3 months, about 3 times in a week. She felt very tired and sleepy

during daytime because of interrupted sleep. The patient could memorize her nightmare clearly and it felt

very realistic that she was chased by a man in black suit. During daytime, she continuously thought about the

dream and became easily irritated, which affect her work as administration staff in a university. In which sleep

phase that the sleep disorder in this case is most likely happened?

A 35-year-old man was brought to emergency room by his family due to repeated seizures in his whole body.

On physical examination, he appeared conscious with abrupt seizures upon stimulation and the presence of

neck and abdominal stiffness. Several days before, the man’s right toes were injured by a rusty nail. Doctor

placed working diagnosis tetanus infection for the patient. How is the mechanism of tetanus toxin spreading

in the vignette?

Male, 56 years old, presented with sudden onset of loss of consciousness 2 hours prior to admission. He

showed no response with verbal stimuli, but was able to open his eyes and shouted “Ouch!” on pain stimuli in

sternum area (extremities movement is shown in figure below).

What is the most possible Glasgow Coma Scale score of this patient?

A 70-year-old man is found on the ground, suddenly paralyzed in his right upper and lower limb, and unable to understand spoken words (receptive aphasia). Which of the following Broadman areas was most likely directly affected?

A 40-year-old man experiences excessive worry, muscle tension, and restlessness. He has difficulty controlling these symptoms and has been experiencing them for several months. He is described as excessively overthinking small matters about career, society, politics, and financial situation. What condition is he most likely suffering from?

A 45-year-old man has been experiencing periods of elation, decreased need for sleep, increased energy, and impulsive behavior. He has also engaged in risky financial investments and started multiple new projects simultaneously. There are no past episodes of depression. Which class of medications is often used as a first-line treatment for managing this condition?

A 7-year-old boy is referred to a pediatrician by his teacher due to concerns about his behavior in school. The boy often fidgets in his seat, has difficulty remaining seated during class, and frequently interrupts others. He struggles to follow instructions and frequently loses his school materials. Despite his intelligence, he is falling behind in his academic work due to his inattentiveness and impulsivity. His teacher reports that these behaviors have been ongoing for at least six months and are causing disruption in the classroom. After a thorough evaluation, what is the most appropriate psychopharmacological intervention for this child's condition?

A 30-year-old man was crashed by motorcycle and fell down at his back. Afterwards he loses the sensation of vibration and position in his limb contra-laterally. What tract of spinal cord is injured?

What is the most possible diagnosis in this patient?

A 28-year-old woman presents with a complex pattern of symptoms that have been ongoing for several years. During some periods, she experiences elevated mood, increased energy, and a decreased need for sleep. During these times, she engages in impulsive spending sprees, takes on numerous new projects, and reports feeling invincible. However, she also has recurrent episodes characterized by profound sadness, loss of interest in previously enjoyed activities, excessive guilt, and thoughts of worthlessness. During these depressive episodes, she isolates herself and experiences psychomotor retardation. Additionally, she sometimes hears voices that make derogatory comments, believes that the television is sending her hidden messages, and experiences visual hallucinations, often seeing shadowy figures in her peripheral vision. These psychotic symptoms occur independently of her mood episodes. What is the most likely diagnosis for this individual?

A 21-year-old man begins treatment with Haloperidol. Three weeks after the initiation of therapy, physical examination shows mask-like facies, drooling, tremors, pill-rolling motion, cogwheel rigidity and shuffling gait. Which of the following is the most likely pathophysiology of these symptoms?

A 65-year-old female, with a long history of severe hypertension, experienced a TIA and showed motoric dysfunction of the limb. Which gyrus of the cerebral cortex is most likely having less blood perfusion?

A 38-year-old man, Mark, has been exhibiting a range of concerning behaviors. He appears chronically sedated and has difficulty staying awake during the day. He often slurs his speech and struggles to maintain his balance while walking. Mark's work performance has deteriorated significantly, and he has been frequently absent from his job. His family has noticed his increasingly lethargic state and his inability to engage in normal family activities. When questioned about his condition, Mark is often vague and evasive. He has also been making frequent visits to different doctors, requesting medications to help him sleep and alleviate his anxiety. His family has found multiple prescription pill bottles in his possession, all containing various medications. What is the most probable substance of abuse in this vignette?

Male, 56 years old, presented with sudden onset of loss of consciousness 2 hours prior to admission after a car accident. Physical examinations showed abnormal breathing pattern as shown below. Where is the most possible location of lesion in this patient?

A 32-year-old woman has a history of unstable relationships, intense mood swings, and a chronic fear of abandonment. She often becomes emotionally reactive, alternating between idealizing and devaluing others, leading to tumultuous interpersonal dynamics. She engages in impulsive behaviors such as overspending and risky sexual encounters. She often feels empty and struggles with a shaky sense of self. What is the most likely diagnosis for this individual?

A 19-year-old man exhibits periods of extreme elation, racing thoughts, and decreased need for sleep. He engages in reckless behaviors such as driving at high speed and has inflated self-esteem. He also buys stocks in irrational amount that later cause him to suffer great deal of financial loss. What condition is most likely?

A 22-year-old woman has alternating periods of elevated mood, increased energy, and impulsivity, followed by episodes of severe sadness and hopelessness. What diagnosis is most likely?

A 78-year-old woman has great difficulty in appreciating vision since a year ago, she could not recognize what she sees. Which of the following lobe is the most likely locus of lesion that causes such a deficit?

A 35-year-old woman has been feeling sad, hopeless, and fatigued for the past several months. She reports a loss of interest in her hobbies and has difficulty concentrating. She reported occasional thoughts to end her life. What is the most likely diagnosis?

A 25-year-old man has been experiencing persistent auditory hallucinations and believes that he has special powers for five months. His mood appears to be in dysphoric stated for most of the months. He isolates himself from family and friends and barely take care of personal hygiene. Which disorder is most likely?

A 28-year-old man experiences sudden, intense fear accompanied by palpitations, sweating, trembling, and a fear of losing control. He avoids places where these attacks have occurred. The attacks occurred in the alley where he has been robbed and physically assault 5 years ago. What condition is this indicative of?

A child 1 year old has delayed mental development and a wider diameter of his head than normal after suffering encephalitis 6 months ago. He was diagnosed with hydrocephalus. What is the mechanism in the absorption of cerebrospinal fluid (CSF) in arachnoid granulation?

A 21-year-old man with a history of schizophrenia is brought to the emergency department by his mother because of the acute onset of neck stiffness. He says his neck has been locked to the right for the last hour, and he has been unable to move it. Physical examination shows that his upper body and neck are rigid, with his neck locked in flexion and rotated to the right. He recently took an additional dose of haloperidol. Which of the following best describes the physical findings in this patient?

A 25-year-old man is brought to the physician by his parents due to abnormal behavior, acting strangely over the past eight months. He sometimes appears to be talking to people who are not there and responds to voices that no one in the room can hear. He said that these voices have told him to do “bad things” to his family, but he refuses because he loves his family. Additionally, the family states that he has been accusing them of working with the government to insert a chip in his brain. One year ago, he dropped out of college due to declining grades and poor performance. There is no past medical history of illicit drug use, head trauma, seizures or unknown fever. Which of the following is the most likely pathophysiology of this patient’s auditory hallucinations?

A 30-year-old man has a fracture of his sacrum, then he has problem of dysfunction of erection. What nervous system is the most likely injured?

A 22-year-old college student has recently begun exhibiting unusual behavior. He claims to hear voices that others cannot hear, telling him that he is being monitored by hidden cameras and that he must protect himself from impending danger. He also believes that he possesses special powers that allow him to communicate with extraterrestrial beings. These beliefs have caused him significant distress and impaired his ability to function socially and academically. What is the main underlying pathophysiological mechanism that is contributing to his symptoms?

Which pain sensitive structures is most likely affected and caused the headache in this patient?

A 40-year-old man was brought to the Emergency Department of the Regional General Hospital (RSUD) by the police. The victim was found lying on the side of the road as a result of being hit by a motorbike in an unconscious condition and with injuries to the head and body. On physical examination, his consciousness level showed drowsiness, the right pupil was larger than the left with slowed light reflexes and an injury to the right temple. CT-Scan examination of the brain showed a buildup of blood in the subarachnoid space (subarachnoid hemorrhage) and lateral ventricular space. The doctor plans to administer intravenous therapy to decrease cerebral edema. One of the structure that the drug have to traverse is formed by which cell?

A 65-year-old woman suddenly fell on the floor. The CT scan figures showed a hemorrhage in the occipital brain area. Which vessel is the most responsible for those area?

A 10-year-old boy is brought to a developmental clinic by his parents due to concerns about his intellectual and adaptive functioning. The boy has always been slower in reaching developmental milestones, such as walking and speaking, than his peers. He struggles with reading, writing, and basic arithmetic. Socially, he finds it challenging to make friends and often misunderstands social cues, leading to social isolation. Despite special education support, his academic progress is significantly behind his age group. His parents report that he has difficulty with daily tasks like getting dressed and brushing his teeth. What is the most likely diagnosis for this child?

A 28-year-old woman has been struggling with persistent intrusive thoughts about germs and contamination. These thoughts lead to intense anxiety, which she tries to alleviate by washing her hands excessively and avoiding public places. Her rituals have become time-consuming and interfere with her daily life. What is the most appropriate medication treatment for her condition?

A 25-year-old man has a history of episodes of extreme irritability, impulsivity, and reckless behavior. He also experiences periods of elevated mood and grandiosity. What is the probable diagnosis?

A 45-year-old man has been experiencing persistent low mood, loss of interest in activities he once enjoyed, significant changes in appetite and sleep patterns, feelings of worthlessness, and difficulty concentrating for the past six months. His symptoms have not been triggered by any specific event, and they are not accompanied by manic episodes. What is the underlying pathophysiological mechanism that is most likely contributing to his condition?

A 50-year-old woman reports hearing voices that criticize her constantly and tell her she is worthless, in the past one week. She experiences reduced pleasure in daily activities for 3 months, low mood, and low energy. She loses weight and sleep poorly, despite of wanting to sleep well. What is the likely diagnosis?

A 35-year-old woman has been excessively cleaning and washing her hands for hours each day, fearing contamination. These rituals interfere with her daily life for example causing her to come late 3 hours to the office. She is aware of this problem but cannot help to stop the thoughts and rituals. What condition is most likely?

A 30-year-old woman has a persistent, irrational fear of social situations and often avoids them to prevent embarrassment. She experiences physical symptoms of anxiety in social settings. What is the likely diagnosis?

A man came to the doctor with a history of running out of oxygen reserve during climbing a high mountain to the 24,000 ft altitude. After descent, he suffered memory deficiency. The doctor suspected a problem in his neuron cellular signaling or synapse transmission. What is the characteristic of a G protein-linked receptor?

A 36-year-old man got into a motor vehicle accident; his head hit the road, and afterwards he couldn't move. The MRI showed bleeding at the cortex of the motoric area. Which Broadman area number is most probably injured?

A 26-year-old man admitted to the psychiatric ward for the treatment of auditory hallucinations that have been commanding him to hurt others. He begins treatment with Aripiprazole. The following day he seems increasingly anxious and pacing the halls incessantly. He states that he feels as if he “has to move” and his pacing helps with this feeling. He denies that his thoughts are racing. What is likely going on with this patient?

A 57-year-old male presented with sudden onset of persistent vertigo with no hearing loss or tinnitus, right-sided weakness, and lack of coordination in the left side. He has a history of uncontrolled hypertension and diabetes mellitus for the last 5 years. Which input integration system is most likely affected in this patient?

A 30-year-old man fell from the staircase and the imaging showed a fracture of intervertebral C3-4. According to the injury, which muscle is possibly paralyzed?

A 4-year-old boy is brought to a pediatrician by his parents due to concerns about his behavior and development. The child avoids eye contact, rarely responds to his name, and seems disinterested in interacting with other children. He has a strong preference for routines and becomes distressed if there are changes in his daily schedule. The boy often engages in repetitive behaviors, such as repeatedly lining up toys or flapping his hands. He does not engage in imaginative play and does not seem to understand or use gestures like pointing. His parents also note that he is particularly sensitive to certain sensory stimuli, becoming overwhelmed by loud noises and bright lights. What is the most likely diagnosis for this child?

A 45 years old man, has a traffic accident of his right neck and bleeding. The doctor suspects that the blood come from the external carotid artery. At which vertebral level does the artery begin?

Extrapyramidal symptoms are side effects of antipsychotic therapy. Apart from dose reduction of antipsychotics, medications are often needed to reduce this adverse effect. Which of the following treatment is not a medication for extrapyramidal symptoms?

A 16 year-old girl is doing well at school. She is told by a friend that some of the boys think that she is too fat and this news, though apparently well meant, upsets her. She has not had many dates, though she would have liked them, and she decides to diet. She does so with success, and loses weight. However, she becomes too thin and her parents, though somewhat reassured by the way she maintains her school and sporting activities, are alarmed. Her mother finally takes her to a gynecologist to determine the reason for the amenorrhea that ensues. What is the girl most likely to be suffering from?