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a) Astrocytes
b) Oligodendrocytes
c) Schwann cells
d) Microglial cells
e) Ependymal cells
24) Which of the following types of neuroglia is star shaped?
a) Astrocytes
b) Oligodendrocytes
c) Schwann cells
d) Microglial cells
e) Ependymal cells
25) Which of the following types of neuroglia is associated with CSF?
a) Astrocytes
b) Oligodendrocytes
c) Schwann cells
d) Microglial cells
e) Ependymal cells
26) Which of the following types of neuroglia is able to act as neural stem cells to
regenerate neurons?
a) Astrocytes
b) Oligodendrocytes
c) Schwann cells
d) Microglial cells
e) Ependymal cells
27) Tight junctions in the blood-brain barrier (BBB) prevent the movement of what type
of molecules from the blood into the interstitial fluid bathing the neurons?
a) Toxic
b) Polar
c) Non-polar
d) Small
e) Lipid-soluble
28) GLUT-1 provides facilitated diffusion for glucose across the endothelial membranes
and glia. Thus, a deficiency in GLUT-1 (De Vivo disease) would lead to which of the
following (treated with a ketogenic diet)?
a) Hypoglycorrhachia
b) Hyperglycorrhacia
c) Hypoglycemia
d) Hyperglycemia
e) Hypovolemia
29) During starvation, ketone bodies become elevated and upregulation of all of the
following occurs EXCEPT:
a) Lactate
b) Pyruvate
c) Acetate
d) Glucose
e) Acetoacetate
f) "-hydroxybutyrate
30) In phenylketonuria (PKU) disorder, the large neural amino acid (LNAA) transporter
is overwhelmed by increased phenylalanine (Phe) in the blood. What is the result of this?
a) Increased phenylalanine in the blood leading to heart damage
b) Decreased phenylalanine in the blood leading to heart damage
c) Increased phenylalanine in the brain leading to brain damage
d) Decreased phenylalanine in the brain leading to brain damage
31) Insulin and lactoferrin are transported across endothelial cells via what mechanism?
a) Diffusion/Osmosis
b) Electrogenic sodium pump
c) Active transport using ATP
d) Receptor-mediated endocytosis
e) Receptor-mediated transcytosis
32) An action potential in the pre-synaptic neurons allows what ion to enter, which
stimulates exocytosis of the neurotransmitter into the synaptic cleft?
a) Sodium
b) Chlorine
c) Potassium
d) Calcium
e) Lithium
33) Which of the following is NOT a catecholamine?
a) Acetylcholine
b) Epinephrine
c) Dopamine
d) Norepinephrine
34) Which of the following is the rate limiting step in the production of catecholamines?
a) Tyrosine hydroxylase
b) DOPA decarboxylase
c) Dopamine "-hydrolase
d) PNMT (phenylethanolamine N methyltransferase)
e) Phenylalanine hydroxylase
35) Which of the following is only synthesized in the adrenal medulla and is not also
synthesized in neurons?
a) L-Tyrosine
b) Dopa (L-DOPA)
c) Dopamine
d) Norepinephrine
e) Epinephrine
36) S-adenosylmethionine (SAMe or SAM-e) is a sold as a nutritional supplement and
may have some use in osteoarthritis, depression, and liver disease. How does SAM-e
theoretically work in body reactions?
a) It accepts adenosine
b) It donates adenosine
c) It accepts methyl groups
d) It donates methyl groups
e) It reduces the requirement of ATP
37) The inside of a catecholamine storage vesicle is ____; when protons are pumped into
the vesicle by vesicular-ATPase, they are exchanged for a ____ charged catecholamine.
a) Acidic; Positively
b) Acidic; Negatively
c) Basic; Positively
d) Basic; Negatively
38) Which of the following would NOT be found in a catecholamine vesicle?
a) Dopamine "-hydroxylase (d"h)
b) Chromogranins (acidic proteins)
c) Neurotransmitter
d) Lactate
e) ATP
f) PNMT
39) Tyramine mimics norepinephrine and is a degradation product of tyrosine that can
lead to headaches, palpitations, nausea, vomiting, and elevated BP if present in large
quantities. Foods with tyramine should be avoided if a patient is taking what type of
drugs?
a) NSAIDs
b) MAOIs
c) Narcotics
d) Steroids
e) Beta-blockers
40) Which of the following in urine and blood is used as a marker for dopamine
turnover?
a) Homovanillic acid (HVA)
b) Vanillylmandelic acid (VMA)
c) Monoamine oxidase (MAO)
d) Catechol-o-methyltransferase (COMT)
e) 5-HT binding protein
41) Which of the following in urine and blood is used as a marker for epinephrine and
norepinephrine turnover?
a) Homovanillic acid (HVA)
b) Vanillylmandelic acid (VMA)
c) Monoamine oxidase (MAO)
d) Catechol-o-methyltransferase (COMT)
e) 5-HT binding protein
42) Which of the following is true regarding the catabolism of 5-HT and DA?
a) Both are activated by COMT
b) Both are inactivated by COMT
c) Both are activated by MAO
d) Both are inactivated by MAO
e) 5-HT and DA do not share catabolism attributes
43) Regarding the function of dopa decarboxylase, which of the following would be a
more descriptive name for this enzyme?
a) Polar amino acid decarboxylase
b) Non-polar amino acid decarboxylase
51) Which of the following excitatory metabotropic receptors (linked to DAG, IP3, PKC)
is associated with epinephrine and norepinephrine?
a) m1, m3, m5
b) !1
c) 5HT2
d) mGluR1&5
e) H1
f) P2x, P2y
52) Which of the following is NOT an excitatory metabotropic receptor (linked to cAMP,
PKA)?
a) D1
b) D5
c) " adrenergic
d) H2
e) 5HT5
53) Which of the following receptors does NOT decrease cAMP?
a) m2, m4
b) D2, D3, D4
c) 5HT4, 5HT6, 5HT7
d) 5HT1, mGluR2&3
e) !2
54) During hypoglycemia (e.g. during an insulin overdose), which of the following
builds-up and leads to a constant influx of calcium ions, leading to neuronal cell death?
a) Oxygen
b) Glucose
c) Ketones
d) GABA
e) Aspartate
f) Glutamate
55) Synthesis of glutamate removes what from the TCA cycle, which reduces the
regeneration of oxaloacetate?
a) Citrate
b) Isocitrate
c) Oxalosuccinate
d) #-ketoglutarate
e) Succinyl-CoA
56) Which of the following fatty acids can cross the blood-brain barrier?
a) Arachidic
b) Stearic
c) Palmitic
d) Arachidonic
e) Linoleic
57) What is the major myelin protein in the peripheral nervous system?
a) Hydrophilic myelin basic proteins (MBPs)
b) Hydrophobic proteolipid protein (PLP)
c) Po glycoprotein
58) Glutamate can bind to AMPA and NDMA receptors. NDMA receptors are also able
to bind which of the following?
a) Glutamine
b) Aspartate
c) Glycine
d) !-Aminobutyric Acid
e) Serine & Cysteine
59) Which of the following is an antagonist of glycine?
a) Organophosphates
b) Ketamine
c) Cocaine
d) Botulism
e) Strychnine
60) Lysergic acid diethylamide (LSD) has an excitatory affect on serotonin 2A and 2C
receptors. Which of the following types of drugs works to inhibit these same receptors?
a) Novel anxiolytics
b) MAOI antidepressants
c) Migraine drugs
d) Atypical antipsychotics
e) Tri-cyclic antidepressants and SSRI antidepressants
d) Caffeine
e) Glutamate
5) Which of the following is true of GLUT 1 and GLUT 3?
a) Have a high Km value for glucose
b) Have a low Km value for glucose
c) Have a high Vmax value for glucose
d) Have a low Vmax value for glucose
e) Prevent the transport of glucose into the brain
6) Sports drinks/shakes for athletes contain branched-chain amino acids that compete
with what amino acid, a precursor for serotonin and melatonin, which seem to be
involved in tiredness, relaxation and sleep?
a) Glutamate
b) Glycine
c) Tryptophan
d) Tyrosine
e) Cysteine
7) How long after a reversible injury (e.g. inflammatory or neoplastic disease) will the
blood-brain barrier remain defective?
a) 2-3 hours
b) 2-3 days
c) 2-3 weeks
d) 2-3 months
e) Indefinitely
8) Mental retardation in untreated PKU may be due to reduced uptake of other amino
acids due to competition for the same amino acid transporter as well as a deficiency in
what amino acid?
a) Glutamate
b) Glycine
c) Tryptophan
d) Tyrosine
e) Cysteine
9) At body rest, the brain accounts for about what percentage of total body metabolism
and about what percentage of cardiac output?
a) 1%
b) 3%
c) 5%
d) 15%
e) 35%
10) The brain requires about 120 grams of glucose per day and is able to get energy from
absorbing fatty acids.
a) True
b) False, the brain requires only 12 grams of glucose per day
c) False, the brain cannot absorb fatty acids
11) In acute hypoglycemia, what is the major energy source for the brain?
a) Ketone bodies
b) Liver glycogen
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c) Glucose
d) Oxygen
e) Epinephrine
12) What is the major energy source for the brain in prolonged hypoglycemia greater than
48 hours (starvation)?
a) Ketone bodies
b) Liver glycogen
c) Glucose
d) Oxygen
e) Epinephrine
13) Glucose is used as a substrate for the pentose phosphate pathway to provide ____,
which is required for fatty acid synthesis (myelogenesis) as well as glutathione reductase
activity (antioxidant defense system).
a) Acetyl-CoA
b) Pyruvate
c) CO2
d) NAD+
e) NADPH
14) Ceramide is a fatty acid derivative of:
a) Glycerol
b) Sphingosine
c) Glucose
d) Galactose
e) Ethanol
15) Which of the following is true of Niemann-Pick disease?
a) Type A is an accumulation of sphinomyelin due to a deficiency of
sphingomelinase and is common in the Ashkenazi Jewish population
b) Type C is an accumulation of sphinomyelin due to a deficiency of
sphingomelinase and is common in the Ashkenazi Jewish population
c) Type A is due to a defect in lipid transport and is common in the Ashkenazi
Jewish population
d) Type C is due to a defect in lipid transport and is common in the Ashkenazi
Jewish population
16) Which of the following is due to a deficiency of "-glucosidase, causes
glucocerebroside to accumulate, and can be treated with enzyme replacement therapy?
a) Niemann-Pick disease
b) Fabry disease
c) Gaucher disease
d) Krabbe disease
e) Metachormatic leukodystrophy (MLD)
17) Which of the following is due to a deficiency in "-galactosidase, causes
galactocerebroside to accumulate, and forms multinucleated globoid cells around blood
vessels?
a) Niemann-Pick disease
b) Fabry disease
c) Gaucher disease
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d) Krabbe disease
e) Metachormatic leukodystrophy (MLD)
18) Which of the following is due to a deficiency in !-galactosidase A, causes ceramide
trihexoside to accumulate, and can be treated with enzyme replacement therapy (ERT)
using agalsidase beta?
a) Niemann-Pick disease
b) Fabry disease
c) Gaucher disease
d) Krabbe disease
e) Tay-Sach disease
19) Metachromatic leukodystophy (MLD) is caused by a deficiency of a lysosomal:
a) Neuraminidase
b) Glucosidase
c) Galactosidase
d) Iduronidase
e) Sulphatase
20) In ganglioside nomenclature, how many sialic acid residues are contained in GM2?
a) One
b) Two
c) Three
d) Four
21) In which of the following is there an accumulation of GM2 due to a deficiency in
hexosaminidase A?
a) Niemann-Pick disease
b) Tay-Sach disease
c) Gaucher disease
d) Fabry disease
e) Krabbe disease
22) Which of the following has an X-linked mode of inheritance?
a) Niemann-Pick disease
b) Tay-Sach disease
c) Gaucher disease
d) Fabry disease
e) Krabbe disease
23) Which of the following is the most prevalent sphingolipidosis?
a) Niemann-Pick disease
b) Tay-Sach disease
c) Gaucher disease
d) Fabry disease
e) Krabbe disease
24) Methylmalonyl CoA accumulates as a consequence of what vitamin deficiency,
leading to impaired myelin sheath formation and megaloblastic anemia?
a) Vitamin B1
b) Vitamin B2
c) Vitamin B3
d) Vitamin B6
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e) Vitamin B12
25) Congenital hyperammonaemia ____ occurs with ornithine transcarbamoylase
deficiency and is ____.
a) Type I; Autosomal recessive
b) Type I; X-linked
c) Type II; Autosomal recessive
d) Type II; X-linked
26) Which of the following is associated with “crumpled tissue paper” shaped cells?
a) Niemann-Pick disease
b) Fabry disease
c) Gaucher disease
d) Krabbe disease
e) Tay-Sach disease
27) Which of the following is associated with a cherry red spot on the macula?
a) Niemann-Pick disease
b) Fabry disease
c) Gaucher disease
d) Krabbe disease
e) Tay-Sach disease
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f) Phenytoin
4) What N1 acetylcholine subunit is seen in neonates?
a) #1-subunit
b) "1-subunit
c) !-subunit
d) $-subunit
e) %-subunit
5) Which of the following acetylcholinesterase medications is reversible and is the
longest acting?
a) Edrophonium
b) Physostigmine
c) Neostigmine
d) Pyridostigmine
e) Diisoprophylfluorophosphate (DFP)
6) Which of the following is NOT seen in Parkinson disease?
a) Asterixis
b) Bradykinesia
c) Rigidity
d) Postural instability
e) Pill-rolling termor
7) Edrophonium (Tensilon) testing, in which muscles respond in about 30 seconds, is
used in which of the following?
a) Huntington disease
b) Parkinson disease
c) Alzheimer disease
d) Myasthenia Gravis
e) Alcoholism
8) About percentage of pigmented dopamine-producing cells in the substantia nigral must
be lost before Parkinson-like symptoms start to manifest?
a) 13-20%
b) 20-35%
c) 50-60%
d) 80-90%
e) > 95%
9) Which of the following treatment options for Parkinson disease is a dopamine receptor
agonist?
a) Deprenyl
b) Selegiline
c) Tolcapone
d) Entacapone
e) Bromocriptine
10) Which of the following drugs, used for hypertension, inhibits dopamine storage?
a) Reserpine
b) Selegiline
c) Carbidopa
d) Entacapone
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e) Bromocriptine
f) Chlorpromazine
11) Which of the following drugs, used as an antipsychotic, is a dopamine receptor
agonist?
a) Reserpine
b) Selegiline
c) Carbidopa
d) Entacapone
e) Bromocriptine
f) Chlorpromazine
12) Which of the following is a common side-effect of L-DOPA?
a) Tremors
b) Strabismus
c) Ataxia
d) Hallucinations
e) Diarrhea
13) Which of the following types of Parkinsonism is seen in professional miners?
a) Progressive supranuclear palsy (common Parkinson)
b) Multiple system atrophy (drug-induced)
c) Basal ganglia calcification (postencephalic)
d) Repetitive head trauma (MPTP Parkinson)
e) Cerebral anoxia (Manganese intoxication)
14) Which of the following induces the release of dopamine?
a) Mazindol
b) Amantadine
c) L-deprenyl
d) L-DOPA
e) Carbidopa
15) What suicide rate is associated with schizophrenia?
a) 0.5% (1 in 200)
b) 1% (1 in 100)
c) 3% (1 in 33)
d) 5% (1 in 20)
e) 10% (1 in 10)
16) A child is diagnosed with schizophrenia and physicians begin testing to see if the
child’s identical twin has schizophrenia. It is found that the children’s parents both have
schizophrenia. Along with altered orientation of hippocampal pyramidal cells, what area
of the brain may show enlargement for the child in question?
a) Cerebral cortex
b) Cerebellum
c) Ventricles
d) Amygdala
e) Corpus striatum
17) Which of the following has eosinophilic inclusion bodies filled with neurofilaments,
glycoproteins, ubiquitin, #-synuclein (Lewy bodies)?
a) Huntington disease
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b) Parkinson disease
c) Alzheimer disease
d) Myasthenia Gravis
e) Alcoholism
18) Excessive dopamine production (hyperdopaminergia) and an elevated number of
dopamine receptors (D2) are seen in which of the following?
a) Huntington disease
b) Autism
c) Alzheimer disease
d) Schizophrenia
e) Alcoholism
19) A patient presents with impaired cognitive function. On MRI scan, neurofibrillary
plaques and tangles are found in the cortex and hippocampus. Which of the following is
the most likely?
a) Huntington disease
b) Autism
c) Alzheimer disease
d) Schizophrenia
e) Alcoholism
20) MPTP, a by-product of mepertidine (“street heroin”), causes which of the following?
a) Huntington disease
b) Parkinson disease
c) Alzheimer disease
d) Myasthenia Gravis
e) Alcoholism
21) Which of the following types of drugs can prevent MPTP damage and thus can help
prevent the progression of disease?
a) NSAIDs
b) MAOIs
c) Narcotics
d) Steroids
e) Beta-blockers
22) Which of the following is associated with protein tau and the appearance of
extracellular " peptide?
a) Alzheimer disease
b) Huntington disease
c) Parkinson disease
d) Myasthenia Gravis
e) Alcoholism
23) What chromosome is Alzheimer disease associated with?
a) 4
b) 13
c) 18
d) 21
e) 23
24) Amyloid " protein (A"P) is neurotoxic in Alzheimer disease as it:
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a) Methionine sulfoximine
b) Dextrophan
c) Nimodipine
d) Antioxidants
e) Tissue plasminogen factor
32) Which of the following inhibits glutamate synthesis?
a) Methionine sulfoximine
b) Dextrophan
c) Nimodipine
d) Antioxidants
e) Tissue plasminogen factor
33) What is the role of nimodipine?
a) Dissolves clots
b) Inhibits free radical damage
c) Inactivates NMDA receptors
d) Inhibits glutamate synthesis
e) Blocks calcium entry
34) Alcohol will most increase the activity at which of the following sites, leading to an
increased Cl- current?
a) GABA site
b) Barbituate site
c) Benzodiazepine site
d) Steroid site
e) Picrotoxin site
35) Which of the following best describes the epidemiology of autism, with onset prior to
age 3 years?
a) 1 in 1000, more prevalent in females
b) 3 in 1000, more prevalent in males
c) 5 in 1000, more prevalent in females
d) 7 in 1000, more prevalent in males
e) 9 in 1000, more prevalent in females
36) A patient with which of the following should look into a gluten- and casein-free diet
due to lack of dipeptidyl peptidase IV (DPP-IV), causing leaky-gut syndrome?
a) Asperger syndrome
b) Autism
c) Rett disorder
d) Celiac disease
e) Alcoholism
37) Regarding autism and environmental factors, which of the following is most true?
a) Thimerosol (from vaccines) and mercury most likely cause autism
b) Thimerosol (from vaccines) and mercury do not cause autism
c) Thimerosol (from vaccines) may cause autism
d) Mercury may cause autism
38) What percentage of autistic individuals experience seizures?
a) 0%
b) 25%
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c) 50%
d) 75%
e) 100%
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c) Hyaluronic acid
d) Amino acids
e) Glucose
8) A patient presents with frequent “flashes” and “floaters” in their visual field. They say
the floaters are far more numerous than ever before. Which of the following should the
clinician be concerned about?
a) Blockage of the canal of Schlemm
b) Glaucoma
c) Cataracts
d) Posterior vitreous detachment (PVD)
e) Retinal detachment
9) Glaucoma is usually a consequence of ____ intraocular pressure and decreased
drainage of the ____ humor.
a) Decreased; Aqueous
b) Decreased; Vitreous
c) Increased; Aqueous
d) Increased; Vitreous
10) Which of the following is the most common form of glaucoma and results from
increased intraocular pressure?
a) Primary open-angle glaucoma
b) Acute angle-closure glaucoma
c) Chronic angle-closure glaucoma
d) Developmental glaucoma
e) Absolute glaucoma
11) Which of the following drugs used to treat glaucoma increases the outflow (drainage)
of aqueous humour?
a) Latanoprost
b) Timolol
c) Betaxolol
d) Dorzolamine
e) Pilocarpine
12) Which of the following is a cholinergic agonist that can be used for acute glaucoma
attacks to restore resportion and outflow of aqueous humour?
a) Latanoprost
b) Timolol
c) Betaxolol
d) Acetazolamine
e) Pilocarpine
13) Which of the following is a carbonic anhydrase inhibitor used to decrease the rate of
bicarbonate production and thus the rate of aqueous humour secretion?
a) Latanoprost
b) Timolol
c) Betaxolol
d) Acetazolamine
e) Pilocarpine
14) What happens as the concentration of !, ", and # crystallins in the lens decreases?
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21) Glycosaminoglycans (GAGs) in the cornea cause an uptake of water. Which of the
following counters this affect?
a) Passive transport of bicarbonate into the aqueous humour
b) Passive transport of bicarbonate out of the aqueous humour
c) Active transport of bicarbonate into the aqueous humour
d) Active transport of bicarbonate out of the aqueous humour
22) Which of the following has the highest rate of flux through the pentose phosphate
pathway of any tissue?
a) Conjunctiva
b) Cornea
c) Sclera
d) Retina
e) Fovea
23) Which of the following is found at 10-50 times greater concentration in the aqueous
humour than in blood plasma?
a) Glucose
b) Lactate
c) Ascorbic acid
d) Proteins
e) Salts
24) The HMP shunt is the major pathway of glucose metabolism for the ____ and
anaerobic glycolysis is the major pathway for ____.
a) Cornea; Lens
b) Lens; Cornea
c) Retina; Lens
d) Lens; Retina
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a) Listeria monocytogenes
b) Streptococcus pneumoniae
c) Staphylococcus saprophyticus
d) Klebsiella pneumonia
e) Streptococcus pyogenes
5) What is the primary (most important) virulence factor for common bacterial meningitis
in children?
a) Capsule
b) Teichoic acid
c) Pili
d) Toxin
e) M protein
6) An infant presents with fever, vomiting, nuchal rigidity, and maculopapular rash.
Which of the following tests for meningitis involves flexion of the neck with reflexive
bending of the knees to alleviate pain and tension on the spinal cord?
a) Kienbock sign
b) Kernig sign
c) Babinski sign
d) Brudzinski sign
e) Thomas sign
7) A one-year-old with sickle-cell anemia presents with headache, fever, and stiff neck
with opisthotonos. Blood cultures show Gram-positive diplococci. Spinal tap shows
increased PMNs. What drug should be given?
a) Penicillins
b) First generation cephalosporins
c) Third generation cephalosporins
d) Aminoglycosides
e) Fluoroquinolones
8) During an overseas mission, many members of a military base become acutely ill with
headache, fever, and stiff neck. A few of the patients have pupuric rash and some develop
Waterhouse-Friedrichsen syndrome involving the adrenal glands. Blood cultures show
Gram-negative diplococci. Penicillin is immediately administered to all involved as
untreated mortality is 100%. Which of the following is responsible for the outbreak?
a) Neisseria gonorrhea
b) Neisseria meningitidis
c) Staphylococcus aureus
d) Staphylococcus saprophyticus
e) Staphylococcus pyogenes
9) A patient who has received either the MPSV4 or MCV4 vaccine would most likely
have which of the following serotypes if they presented with a Neisseria meningitidis
infection?
a) A
b) B
c) C
d) W-135
e) Y
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a) Dopamine
b) Calcium
c) Acetylcholine
d) Acetylcholine esterase
e) GABA
17) A patient presents with suspected meningitis. Lumbar puncture reveals 500 cells/mL
(mostly mononuclear), moderately high protein, and normal glucose levels in the CSF.
Which of the following is the most likely?
a) Bacterial meningitis
b) Viral meningitis
c) Toxic meningitis
d) Neurosyphilis
e) Mycobacterium tuberculosis infection
18) What is the treatment of choice for neurosyphilis?
a) Oxacillin
b) Ampicillin
c) Penicillin G
d) Amoxicillin
e) Ticarcillin-clavulanate
19) A patient presents with depression, headache, fatigue, and undulating fever. Upon
neurologic exam, neuroencephalitis is found. The clinician prescribes doxycycline with
rifampin. Which of the following is the most likely cause?
a) Streptococcus pneumoniae
b) Pseudomonas aeruginosa
c) Bordetella pertussis
d) Francisella tularensis
e) Brucella species
20) Which of the following groups of people are at risk for Leptospira infections?
a) Infants
b) Elderly
c) Farmers
d) Milk drinkers
e) Diabetics
21) A patient presents with altered mental status. Blood tests reveal Gram-positive,
catalase-positive filamentous rods. CSF fluid shows increased protein, decreased glucose,
and increased leukocytes. Sulfonamides are administered. Which of the following is the
most likely cause?
a) Nocardia
b) Bartonella henselae
c) Rickettsia rickettsii
d) Mycoplasm
e) Leptospira
22) Which of the following fungi is dimorphic and grows at 37 degrees Celsius?
a) Cryptococcus
b) Aspergillus
c) Yeast
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d) Mold
23) An AIDS patient becomes ill days after a picnic in a park. The patient remembers
moving to a new picnic location after finding several pigeon droppings. Amphotericin B
is started after completing a hospital-required process for administering the drug. Which
of the following is the most likely cause?
a) Cryptococcus neoformans
b) Haemophilus influenzae
c) Mycobacterium tuberculosis
d) Aspergillus species
e) Histoplasma capsulatum
24) A patient’s culture reveals broad-based budding yeast. The clinician begins treatment
with ketoconazole. Which of the following is the most likely?
a) Coccidioides immitis
b) Blastomyces dermatitidis
c) Histoplasma capsulatum
d) Cryptococcus neoformans
e) Acanthamoeba species
25) Which of the following is found in stagnant fresh water, is very rare, gram stains
negative, causes primary ameobic meningoencephalities (PAM), and is nearly 100%
fatal?
a) Mycobacterium tuberculosis
b) Cryptococcus neoformans
c) Aspergillus species
d) Naegleria fowleria
e) Acanthamoeba species
26) A male AIDS patient presents with fever, headache, altered mental status, and stiff
neck. Kernig sign is present. Skin lesions are found as well as pulmonary rales. CSF
culture is negative with elevated WBCs, elevated protein, and lowered glucose. CT rules
out a brain abscess and tumors. The patient recalls a recent camping trip in Minnesota
where a group visited many lakes. The clinician begins extremely aggressive treatment,
as the prognosis is nearly always fatal. Which of the following is the most likely cause?
a) Balamuthia species
b) Cryptococcus neoformans
c) Aspergillus species
d) Naegleria fowleria
e) Acanthamoeba species
27) A 17-year-old man presents to the emergency department (ED) complaining of a
headache that has lasted for the past 2 days. The patient states that he returned to the
United States 2 days ago after spending 3 weeks in Nigeria. He complains of subjective
fevers and intermittent sweats, especially at night, but he has not taken his temperature.
On physical examination, his temperature is 103.0° F (39.4° C), his pulse is 83 bpm, his
blood pressure is 120/70 mm Hg, his respiratory rate is 16 breaths/min, and his oxygen
saturation is 96% while breathing room air. A blood smear is performed (see image).
What is the diagnosis?
a) Malaria
b) Babesiosis
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c) Lyme disease
d) Toxoplasmosis
e) Aspergillosis
28) Which of the following would be transmitted mainly by cats (e.g. litter boxes) but can
also be caused by undercooked meat and is associated with ring-enhancing lesions on CT
scan of the head?
a) Malaria
b) Babesiosis
c) Lyme disease
d) Toxoplasmosis
e) Aspergillosis
29) West African sleeping sickness (T. brucei gambiense) and East African sleeping
sickness (T. brucei rhodesiense) are transmitted by what reservoir?
a) Mosquito
b) Flying squirrel
c) Cows (milk)
d) Tsetse fly
e) Tick
30) Which of the following drugs would be used to treat malaria (P. falciparum)?
a) Chloroquine
b) Metronidazole
c) Tetracycline
d) Oral griseofulvin
e) Melarsoprol
31) Which of the following drugs would be used to treat African sleeping sickness?
a) Chloroquine
b) Metronidazole
c) Amphotericin B
d) Oral griseofulvin
e) Melarsoprol
32) Which of the following is found worldwide and involves larvae being ingested in
undercooked meat, especially pork and bear meat?
a) Taenia solium (Pork Tapeworm)
b) Trichinosis
c) Malaria
d) Aspergillosis
e) Toxoplasmosis
33) Which of the following is associated with calcified cysticerci in the brain
(neurocysticercosis)?
a) Taenia solium (Pork Tapeworm)
b) Trichinosis
c) Baylisascaris procyonis (Raccoon Roundworm)
d) Angiostrongylus cantonensis (Rat Lungworm)
e) Toxoplasmosis
34) A patient presents with signs of meningitis. History reveals a recent upper respiratory
infection. Lumbar puncture reveals CSF with Gram-negative coccobacilli that grows on
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Chocolate agar. Which of the following drugs should be given prophylactically to the
patient’s immediate family members and contacts?
a) Ampicillin
b) Vancomycin
c) Rifampin
d) Amphotericin B
e) Fluconazole
35) A two-week old child presents with fever, drowsiness, vomiting, and possible neck
stiffness. Which serotype of Streptococcus agalactiae is the most likely?
a) Ia
b) Ib
c) Ic
d) II
e) III
36) What percentage of ethyl alcohol is required in hand sanitizers, per the Center for
Disease Control (CDC), to kill bacteria and viruses?
a) 20% or greater
b) 40% or greater
c) 60% or greater
d) 80% or greater
e) 99% or greater
37) A newborn presents with bulging fontanelle and PMNs in the CSF. CSF culture show
Gram-negative bacteria that grows with the CAMP test and at 4 degrees Celsius. Which
of the following is most likely?
a) Streptococcus agalactiae
b) Echerichia coli
c) Neisseria meningitidis
d) Listeria monocytogenes
e) Staphylococcus saprophyticus
38) A professional house cleaner in Hawaii presents with headache. The patient recalls
recently cleaning a cellar, which had mice. Lumbar puncture reveals aseptic CSF. Blood
culture reveals elongated organisms with hooked or “question mark” ends. Which of the
following is most likely?
a) Brucella species
b) Borrelia burgdorferi
c) Leptospira species
d) Nocardia species
e) Bartonella henselae
39) Which of the following stains in negative contrast with India ink preparations of the
CSF and cultures on Saboraud Dextrose Agar (SDA) at 37 degrees Celsius?
a) Coccidioides immitis
b) Cryptococcus neoformans
c) Aspergillus species
d) Naegleria fowleria
e) Acanthamoeba species
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40) A patient from the Southwestern United States presents with a pulmonary infection,
headache, vomiting, and nuchal rigidity. KOH culture reveals dimorphic spherules.
Which of the following is most likely?
a) Coccidioides immitis
b) Cryptococcus neoformans
c) Histoplasma capsulatum
d) Naegleria fowleria
e) Acanthamoeba species
41) AIDS patients who have been exposed to Cryptococcus should begin life-long
treatment with which of the following?
a) Ketoconazole
b) Vancomycin
c) Rifampin
d) Amphotericin B
e) Fluconazole
42) A patient presents to the Emergency Room after a recent group trip spelunking (cave
diving) along the Mississippi river basin. Culture reveals intracellular yeast. Which of the
following is the most likely?
a) Coccidioides immitis
b) Cryptococcus neoformans
c) Histoplasma capsulatum
d) Blastomyces dermatitidis
e) Acanthamoeba species
43) A patient presents with an altered sense of smell. Physical exam leads the clinician to
suspect meningoencephalitis. Lumbar puncture reveals blood in the CSF and Gram-
negative organisms. Which of the following is most likely?
a) Balamuthia species
b) Toxoplasma gondii
c) Histoplasma capsulatum
d) Naegleria fowleria
e) Acanthamoeba species
44) Which of the following is associated with granulomatous amoebic encephalitis
(GAE) as well as keratitis?
a) Balamuthia species
b) Toxoplasma gondii
c) Histoplasma capsulatum
d) Naegleria fowleria
e) Acanthamoeba species
45) Sausage, kidney, or boomerang shaped gametocytes on blood smear are associated
with which of the following?
a) Malaria
b) Babesiosis
c) Lyme disease
d) Toxoplasmosis
e) Aspergillosis
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46) Which of the following is associated with eating raw mollusks (e.g. clams, squid) and
has been seen in Louisiana and Puerto Rico?
a) Taenia solium (Pork Tapeworm)
b) Trichinosis
c) Baylisascaris procyonis (Raccoon Roundworm)
d) Angiostrongylus cantonensis (Rat Lungworm)
e) Toxoplasmosis
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a) Flies
b) Fomites
c) Food
d) Fingers
7) A neonate presents with severe purulent conjunctivitis (opthalmia neonatorum). A
Neisseria gonorrhoeae infection is diagnosed. What should be used to treat this patient?
a) Penicillins
b) First generation cephalosporins
c) Third generation cephalosporins
d) Aminoglycosides
e) Fluoroquinolones
8) A child presents with conjunctivitis that was followed several weeks by fever, purpura,
and vascular collapse. What is the likely cause of this rapidly fatal disease (Brazilian
purpuric fever)?
a) Neisseria gonorrhoeae
b) Staphylococcus aureus
c) Chlamydia trachomatis
d) Pseudomonas aeruginosa
e) Haemophilus influenza aegyptius
9) Which of the following is NOT associated with sight-threatening bacterial keratitis?
a) Pseudomonas
b) Enterobacter
c) Proteus
d) Klebsiella
e) Serratia
10) Regarding ocular fungal infections, ____ is the most common worldwide, ____ is the
most common in the Northern U.S., and ____ is the most common in the Southern U.S.
a) Fusarium; Fusarium; Aspergillus
b) Fusarium; Aspergillus; Fusarium
c) Aspergillus; Aspergillus; Fusarium
d) Aspergillus; Fusarium; Aspergillus
11) What is the most common mode of transmission for ocular toxoplasmosis?
a) From cats
b) From cows
c) From soil/water
d) Directly from person to person
e) Genetically
12) What is the vector for African River Blindness (Onchocerca volvulus)?
a) Tsetse fly
b) Black fly
c) Chrysops fly
d) Mosquito
e) Bats
13) Which of the following is associated with acute hemorrhagic conjunctivitis?
a) Adenovirus
b) Herpes simplex virus
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c) Coxsackie virus
d) Chlamydia trachomatis
e) Neisseria gonorrhoeae
14) Which of the following generally affects both eyes at the same time?
a) Bacterial conjunctivitis
b) Fungal conjunctivitis
c) Parasitic conjunctivitis
d) Viral conjunctivitis
e) Allergic conjunctivitis
15) Which of the following best describes Adenovirus, the most common cause of
conjunctivitis?
a) Enveloped single-stranded RNA virus
b) Enveloped double-stranded DNA virus
c) Non-enveloped single-stranded RNA virus
d) Non-enveloped double-stranded DNA virus
16) A patient presents with an unknown vaccination history, respiratory infection, and
“salt and pepper” changes in the retina. Which of the following is the most likely?
a) Adenovirus
b) Herpes simplex virus
c) Coxsackie virus
d) Togavirus
e) Neisseria gonorrhoeae
17) A patient presents with “eye problems” several days after swimming in a lake.
Satellite lesions are seen in the left eye. Culture reveals filamentous fungi that branch at
45-degree angles. Which of the following is the most likely?
a) Coccidioides immitis
b) Fusarium species
c) Aspergillus species
d) Naegleria fowleria
e) Acanthamoeba species
18) A patient presents with keratitis. Culture does not gram stain, does not grow on blood
agar, but grows on SDA. Patient says they use “Renu with MoistureLoc” contact
solution. FDA information check reveals this contact solution was withdrawn from the
market in April 2006 due to contamination with:
a) Coccidioides immitis
b) Fusarium species
c) Aspergillus species
d) Naegleria fowleria
e) Acanthamoeba species
19) Which of the following, when transmitted genetically, can cause retinochoroiditis and
permanent blindness in the 2nd or 3rd decade of life for the affected child?
a) Taenia solium
b) Trichinosis
c) Malaria
d) Aspergillosis
e) Toxoplasmosis
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20) Which of the following is associated with periorbital edema and larvae that can
encyst the eye?
a) Taenia solium
b) Trichinella spiralis
c) Plasmodium falciparum
d) Aspergillus species
e) Toxoplasma gondii
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3) A 25-year-old presents with sensory and motor deficits after a traumatic accident. CT
scan of the spinal cord reveals a tubular cavitation which extends for variable distances
along the length of the spinal cord. Which of the following is likely?
a) Hydromyelia
b) Arnold-Chiari Malformation
c) Agenesis of the quadrigeminal plate
d) Syringomyelia
e) Hydrocephalus
4) A child presents to the Emergency Room with difficulty controlling urination,
difficulty maintaining balance, and throbbing headaches at the back of the head.
Extensive testing reveals beaking of the quadrigeminal plate, kinking of the spinal cord
near the medulla, minor herniation of the cerebellar tonsils, and hydrocephalus. Which of
the following is the most likely?
a) Dandy-Walker Malformation
b) Arnold-Chiari Malformation
c) Syringomyelia
d) Myelomeningocele
e) Chromosome 11 deficit
5) On autopsy, a child is found to have an enlarged bowl-shaped posterior fossa with a
rudimentary cerebellar vermis. Dysplasias of the brain stem nuclei are found. Which of
the following is likely?
a) Dandy-Walker Malformation
b) Arnold-Chiari Malformation
c) Syringomyelia
d) Myelomeningocele
e) Chromosome 16 deficit
6) Atresia to which of the following locations is the most common cause of congenital
hydrocephalus?
a) Choroid plexus
b) Foramen of Magendie
c) Fourth ventricle
d) Aqueduct of Sylvius
e) Foramen of Luschka
7) A 58-year-old man presents with headache, photosensitivity, fever, and nuchal rigidity.
A spinal tap is done and cultures come back showing increased neutrophils. The patient
recovers and is sent home. Which of the following complications may this patient suffer?
a) Herniation of the brainstem
b) Beaking of the quadrigeminal plate
c) Hydrocephalus
d) Cerebellar atrisia
e) Spinal cord stroke
8) According to the Hagen Poiseuille equation (Poiseuille Law), what is the major
determinant of pressure in any fluid-filled system?
a) Flow
b) Volume
c) Viscosity
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d) Gravity
9) Which of the following would occur with increased intracranial pressure?
a) Ipsilateral pupil constriction
b) Ipsilateral pupil dilation
c) Contralateral pupil constriction
d) Contralateral pupil dilation
10) A patient presents to a rural Emergency Room with head trauma from a tractor
accident. Examination indicates there is an intracranial bleed but the hospital does not
have CT scanning equipment. To prevent brain herniation during transport to a Level 1
trauma center, how would you decrease intracranial pressure?
a) Start two large bore IVs with normal saline and lactated Ringer’s solution
b) Administer dobutamine IV then furosemide (Lasix) IV
c) Administer mannitol IV then furosemide (Lasix) IV
d) Administer isoosmotic albumin IV or an artificial colloid IV
e) Administer milrinone IV then sodium nitroprusside IV
11) Which of the following can be done (controversially) for a patient during temporary
ambulance transport to decrease intracranial pressure?
a) Lay the patient down throughout transport
b) Administer normal saline throughout transport
c) Hypoventilate the patient throughout transport
d) Hyperventilate the patient throughout transport
e) Administer sodium bicarbonate throughout transport
12) Which of the following defects is NOT associated with mental retardation?
a) Polymicrogyria
b) Pachygyria
c) Lissencephaly
d) Hydrocephaly
e) Heterotropias
13) Patients with which of the following congenital abnormalities often develop
Alzheimer disease pathology by the 4th decade of life?
a) Chromosome 9 derangement
b) Chromosome 11 derangement
c) Chromosome 13 trisomy
d) Chromosome 21 trisomy
e) Chromosome 23 trisomy
14) A patient presents with fever, photosensitivity, and nuchal rigidity. A spinal tap
returns with clear fluid and neutrophil infiltration. In lab, the CSF does not culture.
Which of the following is likely?
a) Bacterial meningitis
b) Viral meningitis
c) Fungal meningitis
d) Toxic meningitis
15) Which of the following is markedly decreased in bacterial meningitis?
a) CSF glucose
b) CSF pressure
c) CSF protein
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d) Venous angiomas
22) Which of the following is a saccular aneurysm that most often occurs at branch points
of the internal carotid artery?
a) Berry aneurysm
b) Charcot-Bouchard aneurysm
c) Atherosclerotic aneurysm
d) Mycotic aneurysm
23) Which of the following arteries of the deep forebrain (diencephalon) feeds the
putamen, globus pallidus, internal capsule, and basal ganglia?
a) Medial striate artery
b) Lenticulostriate artery
c) Thalamoperforating artery
d) Medial posterior choroidal artery
e) Thalamogeniculate artery
24) A patient presents with a stroke involving the posterior cerebral artery. Although their
visual field is severely affected, they have macular sparing due to macular profusion from
what artery?
a) Anterior cerebral artery
b) Middle cerebral artery
c) Anterior inferior cerebellar artery
d) Posterior inferior cerebellar artery
e) Lenticulostriate artery
25) Which of the following would NOT be seen in a middle cerebral artery stroke, the
most commonly affected artery by cerebrovascular accidents (CVAs)?
a) Ipsilateral inferior quadrantanopia
b) Eye deviated toward the side of the infarct
c) Contralateral hemiplegia
d) Contralateral hemianesthesia
e) Wernicke aphasia
26) Which of the following areas is NOT supplied by the middle cerebral artery?
a) Motor and premotor cortex
b) Somatosensory cortex
c) Auditory cortex
d) Broca and Wernicke areas
e) Association areas
f) Visual cortex
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b) Lung
c) Breast
d) Kidney
e) Skin
15) A child presents with headaches and bitemporal hemianopsia. Which of the following
tumors would be the most likely cause?
a) Glioblastoma multiform
b) Medulloblastoma
c) Craniopharyngioma
d) Astrocytoma
e) Meningioma
16) A 45-year-old man has had wasting and weakness of the hands over the past several
months. Which of the following is the most likely?
a) Syphilis
b) Poliomyelitis
c) Multiple Sclerosis
d) Pernicious anemia
e) Amyotrophic lateral sclerosis
17) Which of the following disorders affecting myelin is the most likely to be found in a
30-year-old woman?
a) Multiple Sclerosis
b) Krabbe disease
c) Alexander disease
d) Metachromatic leukodystrophy
18) A disease characterized by widespread patches of demyelination with less prominent
axis cylinder destruction and glial growth is:
a) Syphilis
b) Poliomyelitis
c) Multiple Sclerosis
d) Pernicious anemia
e) Amyotrophic lateral sclerosis
19) Reactive astrocytes surrounding eosinophilic fibers radiating from a central core
which stains for amyloid is characteristic of:
a) Amyotrophic lateral sclerosis
b) Alzheimer disease
c) Olivopontocerebellar atrophy
d) Wilson disease
e) Parkinson disease
20) Lewy bodies are most commonly encountered in:
a) Idiopathic Parkinsonism
b) Post-encephalitic Parkinsonism
c) Rabies
d) Tay-Sachs disease
e) Herpes simplex encephalitis
21) The most radiosensitive primary intracranial neoplasm is:
a) Ependymoma
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b) Glioblastoma
c) Medulloblastoma
d) Oligodendroglioma
e) None are radiosensitive
James Lamberg
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