SOAL NEURO 5 desember 2011

CASE :

A 28 yo woman come to neurologist, complaining headache pulsating on left side accompanied by vomiting and phonophobia. Headache like this have been experienced since last week, reccuring frequency 3x/day. No abnormality on physical examination.

1. Very possible diagnose in this patient is:

a) Tension headache b) Migrain with aura c)MIgrain without aura d) Cluster Headache e) Neuralgia trigeminus

2. Medikamentous therapy :

a) Ergotaminb) Antihistaminc) Steroidd) Azatioprine) None of the above

3. Possible precipitating factor from disease:1. Fatigue2. Climate3. Food containing MSG4. Menstruate

CASE :A 30 yo man, admitted to neurologist complain of pain in right side cheek felt like electrical suddenly since last week, with duration of 10 seconds. Outside of attack the patient didn’t feel pain at all. Pain triggered while he was brushing teeth. No abnormality of physical examination

4. Very possible diagnosis :

a) Tension headache b) Migrain with aura c)MIgrain without aura d) Cluster Headache e) Neuralgia trigeminus

5. Drug of choice :

a) Ergotamineb) Morphine c) Carbamazepind) Minor Tranquilizere) None of the above

CASE :A 76 yo woman, complained a dull, left sided headpain with some radiation of the discomfort to the right side of the head. He had no nausea pr vomiting with the pain, but had lost 10 pounds over previous 2 months. His eritrocyte sedimentation rate was 102 and he was mildly anemic. An investigation for malignancy revealed no signs of lymphoma, carcinoma, or leukemia.

6. Diagnosis of this :

a) a) Tension headache b) Migrain with aura c) MIgrain without aura d) Cluster Headache

e) Giant cell arthritis

7. Correct statement according to disease :

a) Healed with carbamazepinb) Reliable to therapy of hormonalc) Associated with polymialgia

rheumatic complexd) Associated with allodiniae) Triggered by food containing thiamin

8. SAME WITH ABOVE

9. Management :a) Steroidb) Carbamazepinc) Ergotamined) Morphinee) Surgery

CASE :A 30 yo man come to the hospital with chief complain weakness on the left side of the body, which was happened after he got fever, numbness of the side of weakness body, eyesights complaints such as double and blurry vision. Patient also complaint that he was always urinate. He has experienced the same condition a year ago. From neurologic examination paralysis on the left side of his body, spastic type, paresthesis, diplopia and Lhermitte’s sign (+)

10. The other examination to support diagnose :a) MRSb) MRIc) CT-scand) X-Raye) EEG

11. Differential diagnosis for this patient, except a) Neuritis opticb) Devic’s diseasec) Myelitis Transversad) ADEe) Encephalitis

12. The appropriate diagnosis for this patient is :a) neuritis opticb) Mielitis Akutc) Multiple Sclerosisd) Encephalitise) Devic’s disease

CASE :A 60 yo man has a history of 2 years of progressive memory impairment. Within the past 7 months he has been confused and world finding difficulty when speaking

13. The most likely diagnosis isa) Creatfield Jacob diseaseb) MUltiinfarcts dementiac) Alzheimer diseased) Normal pressure hydrocephaluse) Binswanger’s disease

14. The patient undergoes head CT scan and reveled ….. on :

a) Frontal Lobeb) Parietal and Temporal Lobec) Occipital and Parietal Lobed) Subcortical parts of the braine) Limbic gyrus

15. Which of the following medication may effort progress of patient deterioration :

a) Donapezilb) L- Dopac) Rapeldoned) Prednisonee) Vit. B12

CASE :A 55 yo woman has a history of right hemiparesis which occural suddenly 2 months ago. Since 2 days later, she become anorexia and getting difficulties in her daily communications

16. The most possible diagnose :a) Creatfield Jacob diseaseb) Alzheimer diseasec) Normal pressure hydrocephalusd) Binswanger’s diseasee) Vascular dementia

17. She also possible has :a) Agraphiab) Acalculiac) Aphasiad) ….e)…..

18. CT – SCAN .. Bulan sabit a) Epidural Hem.b) Subdural Hem.c) Subrachnoid Hem.d) Interventricular Hem.e) Intracerebral Hem.

19. CT-SCAN.. yg ventriclenya keliatana) Epidural Hem.b) Subdural Hem.c) Subrachnoid Hem.d) Interventricular Hem.e) Intracerebral Hem.

20.A man 56 yo delivered to emergency room with complained decreased of awareness. This situation ws complained from about 7 hours ago. At home, initially the patient complained with …. About 4 hours ago and he become unconscious. GCS examination is 3, pulse pressure 130/90 mmHg, pulse freq. 80x/sec. The CT scan showed infarct cerebri. Wht is the sign that can be found in CT-scan exam.?

a) Area with massb) There is a hiperdense area in the hemispherec) Hiperdense area in lateral ventricle regiond) Hipodense area on the hemisphere cerebrie) Hiperdense area which is surrounded by hipodense area in the hemisphere region.

21. Wht is the radiological examination assess the condition of the spinal cord using X-Ray modalities with injection of contrast into the spinal canal called the examination :

a) MRI-vertebrab) Myelographyc) Angiography d) CT-Scan Vertebrae) X-Ray vertebra

22. A man 45 yo come to generl practioner with complaints of severe headache since last 2 days. Previously he had often complained of headache since last 1 year. Doctor suspected he was suffering Increasing ICP. He has skull X-Ray examination. Wht signs that can be found in skull x-ray in those conditions?

a) Mass effectb) impressio digitatoec) Dysplacement of Gland. Pinealisd) Multiple coin lesion appearancee) Change of size and shape of the skull

23. Neuropsychiatric disorder account for the largest burden of disease in the world becos of:

a) The death causeb) The disability derivedc) The numbers of sufferedd) Age groupse) Sex involved

24. Neuropsychiatric disorder has burden (DALY)

a) the 2nd largest after AIDSb) ….c) in development countriesd)…e)….

CASE : 25 yo man, was brought to mental hospital, becoz of restlessness, violent behavior

(throwing and destroying everything in his house). In the last month, the patient has been always talking….. and has a delusion that he is the God.27. Providing supportive environment (physical, psychological and social) to the ptient from his family aand neighbourhood after he returns home is good preventive measure in the stage of :

a) Primary prev.b) Health promotionc) Secondary prev.d) Early diagnosis and prompt treatmente) Rehabilitation

CASE :A 50 yo man, civil employee visited health clinic in his office complining of lost of desire to life, lost of concentration, and decresed appetite. His complaints has been happened in the last 3 months. He viewed him self negatively ( he feels he is nothing doesn’t have future). Sometimes he wants to feel his life.

28. Psychotherapy , providing by the clinics physician is a part of the 5 Levels of prevention at the level of :

a) Health promotionb) Specific protectionc) Early diag. and prompt. Treatmentd) Disability limitatione) Rehabilitation

29) Councelling facilities from psychiater and physiology. Jika pd kantor laki2 tsb diadakan sarana konseling bagi pr pegawai untuk mereka yg beresiko terkena gangguan jiwa terutama ggn. Jiwa terselubung (kecemasan dn depresi), mk bagian tsb adlh bagian dr tindakan :

a) Health promotionb) Specific protection

c) Early diag. and prompt. Treatmentd) Disability limitatione) Rehabilitation

30. The most uncommon organ involved in caissons disease is :

a) Skinb) Upper Thoracic spinal cordc) Braind) Knee Jointe) Peripher nerves

31. The most common symptoms found in Caissons dis. Type I is :

a) Pitting Oedemab) Unconsciousnessc) Heart burnsd) Parapharesise) Twitching

32. Caisson Disease cant occur if the person dive in :

a) 10 m depthb) 15m depthc) 20 m depthd) 25 m depthe) 30 m depth

33. Condition below may cause Caissons Disease :

a) A diving using a pure oxygen (O2 100%) on 10 m depthb) A diving using a pure oxygen (O2 100%) on 20 m depthc) A diving using a pure oxygen (O2 100%) on 30 m depthd) A diving using air compression on 10m depth e) A diving using air compression on 20m depth

34. The principles for HyperbaricOxygen Therapy of Caisson disease :

……..

CASE :A 5 yo boy brought to emergency room by his parents with complaint of fever after rupture of the cyst between his eyes and a … drainage out. According to his mother, the cyst …. Since born and become large and large with the skin.

40. the probable diagnose is :a) Dermoid Cystb) Meningocelec) meningomyeloceled) Subarachnoid cyste) Crowson’s disease

41. This patient, radiological exam (head scan) has been done. Found ventricle enlarge. The earliest treatment is :

a) VP shuntingb) VA shuntingc) External Drainaged) Excition of the cyste) Antibiotic with wound management

42. a 45 yo man cme to the doctor with complaints …., and anxiety. Ptient was diagonesed depression and the doctor gave him trycylic antidepressant drugs. Which of the following drug is trycylic antidepressant drugs?

a) Amoxapineb) Bupropionc) Irripramind) Paroxefinee) Trazodone

43. what is the side effect?a) Anorexiab) Anorgasmiac) Agitation

d) GI disturbancee) Postural Hypotension

44. Which is following drugs is selective serotonin reuptake inhibitor

a) Amytriptilinb) Buproprionc) Maprophillined) Sertrallinee) Vanflaxine

45. Which of the following antipsychotic agent is butrophenone derivative?

a) Chlor……b) Clozapinec) …..

CASE :…… Associated symptoms include numbness…. Arms, vomiting, diarrhea. No physical abnormalities. A mental status exam. Reveals a… dysphoric affect.

46. wht is d most likely diagnose :a) Bullimia Nervosab) Anxiety Disorderc) Depression episoded) Somatization Disordere) Panic Disorder

47. Best treatment :a) Aspirinb) Benzodiazepinc) Corticosteroidd) Physical Exercise e) Psychoterapy

48. Best likely prognosis :a) Chronic Conditionb) Debitatingc) Worsed) All true

e) All false

CASE : A 24 yo man presents with new onset blindness…. Is no psychologic explanation. The patient says …. Recently, after he was unable to sent her mother to ….. addicted to drugs. He dosnt seem to be bothered.

49. most likely diagnosis :a) Somatiztion disorderb) Anxiety disorderc) Conversion disorderd) Hypochondriasise) Social Phobia

50. Best treatment :a) Hypnosisb) anxiolyticsc) behavioral relaxationd) All truee) All flse

51. Which of the following is most characteristic …. Conversion disorder?

a) Male predominanb) higher socioeconomic statusc) Less educationd) Greater psychological insighte) All false

52. which of the following in the most effective …. With conversion disorder?

a) Confrontation about intentionally prod..

b) Explaining tht their symptoms are not real

c) Reassurance tht a neurologic cause is …

d) Suggestion tht symptoms will improve

e) All false

53. a 28 yo man describe a persistence ….. public. Although he doesn’t have difficult …………………………………….

a) …B) ….c) Social phobiad) Specific phobiae) Post traumatic stress disorder

54. 40 yo woman presents with complaints of not being able to leave her house. For the pst 5 years, she has had increasing difficulty travelling far from home. She constantly worries that she will not able to get help if she “freaks out” . In fact, she had numerous unprovoked episodes of intense fear, associated with shortness of breath, chest pain, diaphoresis, and dizziness. That lasted fot 20 minutes. She convinced that if she drives too far from home, she will have an attack and not be able to obtain help. Which is the following is the most likely diagnosis?

a) Generalized anxiety disorderb) Panic disorderc) Social phobia d) Specific phobiae) Post traumatic stress disorder

55. A 25 yo woman describes a long life being “scared of heights”. She becomes uncomfortable when higher than 3 stories and knowing the height og buildings. On finding herself at significant elevation, she has severe anxiety symptomps such as trembling, lightheadedness, numbness and tingling and a fear of dying. Which of the most likely diagnosis?

a) Generalized anxiety disorderb) Panic disorderc) Social phobia d) Specific phobiae) Post traumatic stress disorder

56. a 56 yo woman comes to ER with a chief complaints of “ I think iam going crazy”. She states tht for the past 2 months, she has been experiencing sudden episodes of palpitation, trembling, shortness of breath and feeling as if she is going to die. She hs been to the ER in the past 2 weeks convinced that she is having a heart attack. However, the result of her physical and lab exam hv been within normal limits.

a) Generalized anxiety disorderb) Panic disorderc) Phobia disorderd) Social phobia disordere) Somtoform disorder

57. The most common psychopharmacologic treatment :

a) Halloperidolb) …..

CASE :A 27 yo woman lifelong history of being scared of heights…….

58. Which of the following is the most likely diagnosis?

a) Social phobia disorderb) Specific phobiac) Panic disorderd) Agarophobiae) Anxiety disorder NOS

59. Wht is psychotherapy that necessary to this patient?

a) Psychodynamic therapyb) Psychoanalitic therapyc) Exposure therapyd)…..

60. Contraindication of ECT is :a) HTNb) Respiratory disorder

c) Pregnancyd) Glaucomae) none of all above

61. The phenomena patient-doctro realationship consist of the :

a) Only Transferanceb) Counter trnsferancec) Resistentiond) Transferance and Resistancee) Transferance and counter transferance

62. Most important component to establish doctor-patient relationship :

a) Organic Biologic Aspectb) Socialc) Spiritual Aspectd) Psychological Aspecte) Culture Aspect

63. Classification used for mental disorder in Indonesia were based on :

a) DSM III-Rb) DSM IVc) DSM IV –TRd) ICD 9e) ICD 10

64. The criterion of mental disorder in Indonesia was published by :

a) The Asian medical College for Mental Disorderb) American Psychiatric Associationc) The Royal British College for Mental Disorderd) WHOe) The Collegium of Internationale Neuropsychiatric

65. In assessing mental disorder , ….. diagnosesis used. The personality disorder is assessed in :

a) Axis Ib) Axis IIc) Axis IIId) Axis IVe) Axis V

66. Alexithymia is a disorder of :a) Motor behaviorb) Personality disorderc) Thought disorderd) Mood disordere) Memory disorder

67. Verbigeration is a disorder of a) Motor behaviorb) Personality disorderc) Thought disorderd) Mood disordere) Memory disorder

67. The man claimed that he is a propher of the Almighty…. He always hears voices saying so. Hering voices with … external object in is called

a) Derealizationb) Halucinationc)Illutiond)Depersonalizatione)Ides of Refferences

68. The psychoptological symptom of hearing voices with … external object is the disorder of :

a)Awarenessb) Attentionc) Motord) Thoughte) Perception

69. Bizarre delution, was he hallmark symptom of :

a) Schizoaffective disorderb) Schizophenia disorderc) Dellusional disorderd) Deliriume) Dementia

CASE :40YO woman, brought to Mental institution because confusion. It started a week ago, she always woke at night and …. At day time. She also sad, she also saw her passed way mother came and talked with her. At times, she couldn’t recognize, her husband and sons. She had a history of severe hypertension.

70. The most possible diagnose is :a) Dementiab) Deliriumc) Amnestic Organicd) Disociatione) Conversion

71. Impairment of memory especially wht term and recent … was the sign of :

a) Dementiab) Deliriumc) Amnestic Organicd) Disociatione) Conversion

CASE :A 26 yo man brought to hospital because he hardly … past week. He had history of hospitalization in Mental institution …. Times for the past 2 years. Sometimes he never talked and not …. His body at all for several hours

72. The most possible diagnose is :a) Paranoid Schizophreniab) Disorganized Schiz.c) Catatonic Shiz.d) Undifferentiated Schiz

e) Residual Schiz.

73. Blunted affect and negative symptoms are the sign of :

a) Paranoid Schizophreniab) Disorganized Schiz.c) Catatonic Shiz.d) Undifferentiated Schize) Residual Schiz.

74. Waxy flexibility can only be found in :a) Paranoid Schizophreniab) Disorganized Schiz.c) Catatonic Shiz.d) Undifferentiated Schize) Residual Schiz.

CASE:25 yo man was brought to ER becoz he hardly slept over 2 months. He talked a lot about everything, commenting almost about everything but sometime not related one another. He looked very happy and energetic. He even claimed tht he was the smartes person who ever lived in this world.

75. The most possible diagnosis is :a) Psychozomaticb) Schizophrenic) Delusional disorderd) Mania with psychotic featuree) mania without psychotic feature

76. If in the past he had a history of retarder psychomotor, lack of energy, difficult in concentrate, and disturbance of sleep, then the diagnosis should be :

a) Schizoaffective disorderb) Mixed type schizophreniac) Bipolard) Dysthmiae) Cyclothymia

77. if the patient also claimed that he always hear voices commenting everything that he did in the past 2 months, the diagnosis should be :

a) Schizoaffective disorderb) Mixed type schizophreniac) Bipolard) Dysthmiae) Cyclothymia

78. Anatomical abnormalities that could be found in schizophrenic :

a) Narrowing of the third ventricleb) Bigger brain volumec) Cortical hyperthropyd) Enlargement of the fourth ventriclee) Bigger hippocampus

79. All of the following are signs and symptoms of mania, except :

a) Euphoricb) Expansivenessc) Quited) Flight of idease) Decrese sleep

80. We can find the term “La Belle in Difference” in :

a) Panic disorderb) Post traumatic disorderc) Conversion disorderd) Depressione) Anxiety

CASE :15 yo boy was brought to psychiatric becoz he always acted like girls. He enjoyed wearing girls cloth. He even said to his parents that he wanted very much to be like girls at what ever the consequences.

81. The most possible diagnose :a) Dual role transvertism

b) Transvers feticishm.c) Transexualismd) Masochisme) Pygmalion

82. The diagnosis is the disorder of :a) Sexual deviation disorderb) Paraphilia disorderc) Sexual dysfunction disorderd) …e) …

83. What is the term for woman who is hypersex called :

a) Female maniab) …c) Nymphomaniad) Hypomaniae) Female paraphilia

84. In sexual response cycle, hypersexual is a phase of…

a) Desireb) Organicc) Resolutiond) Excitemente) Enjoyment

85. Persistent tendency to look a people do the sexual activity, is the behavior …

a) Voyeurismb) Exhibitionismc) Feticismd) Frotteurisme) Necrophilia

86. A man rubbing his penis against woman bottom and parts of fully clothed woman to achive orgasm, is …

a) Voyeurismb) Exhibitionismc) Feticism

d) Frotteurisme) Necrophilia