Quiz Neuroscience Part 3 of 4

Neuroscience – Part 3 14Mar2009

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Neuro #1 – Biochemistry: Neurochemical Messengers

1) Which of the following biogenic amines is NOT derived from the amino acid tyrosine?

a) Acetylcholine (Ach)

b) Epinephrine (Epi)

c) Norepinephrine (NE)

d) Dopamine (DA)

2) Which of the following biogenic amines is/are derived from the amino acid

tryptophan?

a) Histamine (His)

b) Acetylcholine (Ach)

c) Epinephrine & Norepinephrine

d) Serotonin (5-HT)

e) Serotonin & Melatonin

3) Which of the following amino acid neurotransmitters is the chief inhibitory

neurotransmitter in the central nervous system?

a) Glutamate (Glu)

b) Aspartate (Asp)

c) Glycine (Gly)

d) !-Aminobutyric Acid (GABA)

e) Serine (Ser) & Cysteine (Cys)

4) What type of neurotransmitters are adenosine and ATP?

a) Biogenic

b) Nucleic acid

c) Amino acid

d) Peptide

e) Non-purigenic

5) Which of the following is NOT a peptide neurotransmitter?

a) Beta-endorphin

b) Met-enkephalin

c) Acetylcholine

d) Somatostatin

e) Substance P

f) Angiotensin II

6) Regarding neurotransmitter storage, which of the following is specifically contained

within dense core vesicles?

a) Epinephrine

b) Norepinephrine

c) Dopamine

d) Proteins

e) Peptides

7) Peptide transmitters are synthesized in the ____ and ____ recycled.

a) SER; Are

b) SER; Are not

c) RER; Are

d) RER; Are not

Match the drug and the process of the acetylcholine life-cycle that is affected:



8.1) Acetylcholine transporter a) Hemicholinium (HC-3)

8.2) Breakdown by acetylcholinesterase b) Vesamicol

8.3) Sodium choline transporter c) Botulinum toxin

8.4) Release of Ach into the synaptic cleft d) Sarin (agent GB)

9) Where is choline acetyltransferase found during the synthesis of acetylcholine?

a) Nucleus

b) Cytoplasm

c) Synaptic cleft

d) Extracellular side of membrane

10) Nicotinic acetylcholine receptors are excitatory and associated with what kind of

ligand gated channels?

a) Sodium

b) Potassium

c) Chlorine

d) Calcium

11) Where are N2 nicotinic receptors found?

a) Muscles

b) Bones

c) Neurons

d) Heart

e) Lungs

12) Which of the following muscarinic acetylcholine receptors is NOT matched correctly,

with excitatory receptors increasing IP3/DAG and inhibitory decreasing cAMP?

a) M1 receptors are excitatory

b) M2 receptors are inhibitory

c) M3 receptors are excitatory

d) M4 receptors are inhibitory

e) M5 receptors are inhibitory

13) Which of the following can bind different receptor types due to three stereochemical

torsion angles?

a) Nicotine

b) Muscarine

c) Acetylcholine

14) What is the role of tyrosine hydroxylase (deficiency seen in Parkinson disease)?

a) Converting phenylalanine to tyrosine

b) Converting tyrosine to L-DOPA

c) Converting L-DOPA to dopamine

d) Converting dopamine to norepinephrine

e) Converting norepinephrine to epinephrine

15) Which of the following converts L-DOPA to dopamine with the help of vitamin B6?

a) Tyrosine hydroxylase

b) DOPA decarboxylase

c) Dopamine "-hydrolase

d) PNMT (phenylethanolamine N methyltransferase)

e) Phenylalanine hydroxylase



16) Interruption of the melanocyte dopa (L-DOPA) pathway (tyrosine hydroxylase) is

seen in which of the following cases?

a) Vitiligo

b) Albinism

c) Addison disease

d) Melasm

e) Hyperpigmentation

17) Parkinson disease is caused by the loss of ____ cells in the ____.

a) Pigmented; Raphi nucleus

b) Non-pigmented; Raphi nucleus

c) Pigmented; Substantia nigra

d) Non-pigmented; Substantia nigra

18) Amphetamines cause an increase in the release of which of the following?

a) Acetylcholine

b) Epinephrine

c) Norepinephrine

d) Serotonin

e) Dopamine

19) Cocaine and tri-cyclic antidepressants block the reuptake of which of the following?

a) Acetylcholine

b) Epinephrine

c) Norepinephrine

d) Serotonin

e) Dopamine

20) Metanephrines and vanillylmandelic acid (VMA) are diagnostic in what type of

tumors?

a) Adrenal gland

b) Salivary gland

c) Parotid gland

d) Pituitary gland

e) Thyroid gland

21) Conversion of which of the following to the final product VMA requires catechol-o-

methyltransferase (COMT), not monoamine oxidase (MOA)?

a) Dihydroxymadelic acid

b) Metanephrine

c) Normetanephrine

d) Epinephrine

e) Norepinephrine

22) What is the final product of dopamine catabolism?

a) L-DOPA

b) 3-Methoxytyramine (3-MT)

c) Dihydroxyphenylacetic acid (DOPAC)

d) Homovanillic acid (HVA)

e) Epinephrine (Epi)

23) Which of the following types of glial cells (neuroglia) is the smallest and appears to

protect against infection?



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



c) Acidic amino acid decarboxylase

d) Basic amino acid decarboxylase

e) Aromatic amino acid decarboxylase

44) Which of the following is produced by mast cells to act on peripheral tissues and is

inactivated/degraded by astrocytes?

a) Histamine (His)

b) Acetylcholine (Ach)

c) Epinephrine & Norepinephrine

d) Serotonin (5-HT)

e) Serotonin & Melatonin

45) Along with folate (B9), what B vitamin is indirectly involved in the synthesis of

acetylcholine from dietary choline?

a) Vitamin B1

b) Vitamin B2

c) Vitamin B3

d) Vitamin B6

e) Vitamin B12

46) Pyridoxal phosphate (PLP) converts GABA to:

a) Glutamine

b) !-keto-glutarate

c) Glutamate

d) Phenylalanine

e) Tyrosine

47) What is the major inhibitory neurotransmitter of the spinal cord?

a) Glutamate (Glu)

b) Aspartate (Asp)

c) Glycine (Gly)

d) !-Aminobutyric Acid (GABA)

e) Serine (Ser) & Cysteine (Cys)

48) Nitric oxide (NO) is synthesized form arginine and has what effect?

a) Vasoconstriction and smooth muscle contraction

b) Vasoconstriction and smooth muscle relaxation

c) Vasodilation and smooth muscle contraction

d) Vasodilation and smooth muscle relaxation

49) Which of the following receptors is inhibitory?

a) Na & N2 nicotinic acetylcholine receptors

b) AMPA glutamate receptors

c) Kainate glutamate receptors

d) 5HT3 serotonin receptors

e) Glycine receptor

50) Which of the following is an inhibitory of potassium channels?

a) GABA-A

b) GABA-B

c) Glycine

d) 5HT2

e) 5HT3



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

Neuro #2 – Biochemistry: Metabolic Profile Of The Brain

1) A vitamin B12 deficiency would cause a(n) ____ in normal fatty acid synthesis, a(n)

____ in odd-chain fatty acids in brain tissue, and a(n) ____ in methionine synthesis.

a) Increase; Decrease; Increase

b) Increase; Increase; Decrease

c) Decrease; Increase; Decrease

d) Decrease; Decrease; Increase

2) Prolonged ammonia elevation produces mental retardation. With high levels of

ammonia in the brain, ATP is depleted and accumulation of which of the following

specifically results in cerebral edema?

a) Glutamine

b) !-keto-glutarate

c) Glutamate

d) Phenylalanine

e) Tyrosine

3) What type of cells produce myelin sheath?

a) Astrocytes

b) Oligodendrocytes

c) Schwann cells

d) Microglial cells

e) Ependymal cells

4) Which of the following would NOT cross the blood-brain barrier?

a) Alcohol

b) Cocaine

c) Nicotine



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



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?


b) Fabry disease

c) Gaucher disease



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?


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?


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?


b) Tay-Sach disease

c) Gaucher disease

d) Fabry disease

e) Krabbe disease

23) Which of the following is the most prevalent sphingolipidosis?


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



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?


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?


b) Fabry disease

c) Gaucher disease

d) Krabbe disease

e) Tay-Sach disease

Neuro #3 – Biochemistry: Neuropsychiatric Disorders

Match the neuropsychiatric disorder with the change seen:

1.1) Huntington disease a) Decreased N1 receptors

1.2) Autism b) Decreased dopamine

1.3) Stroke c) Increased dopamine

1.4) Parkinson disease d) Decreased acetylcholine

1.5) Epilepsy e) Increased glutamate

1.6) Schizophrenia f) Increased opiod peptides (suspected)

1.7) Alcoholism

1.8) Alzheimer disease

1.9) Myasthenia Gravis

2) A 30-year-old woman presents with recurrent episodes of muscle weakness and

clinical symptoms chiefly affecting muscles supplied by cranial nerves. Which of the

following is the most likely?

a) Huntington disease

b) Parkinson disease

c) Alzheimer disease

d) Myasthenia Gravis

e) Alcoholism

3) Along with a thymoma, which of the following drugs is a possible trigger for

myasthenia gravis?

a) Penicillin G

b) Atropine

c) Chloramphenicol

d) Telithromycin

e) Penicillamine



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?





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



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)?







e) Alcoholism

18) Excessive dopamine production (hyperdopaminergia) and an elevated number of

dopamine receptors (D2) are seen in which of the following?


b) Autism


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?


b) Autism


d) Schizophrenia

e) Alcoholism

20) MPTP, a by-product of mepertidine (“street heroin”), causes which of the following?





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


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:



a) Increases intracellular Ca++

b) Decreases intracellular Ca++

c) Increases extracellular Ca++

d) Decreases extracellular Ca++

25) There are several hypotheses to account for the progression of Alzheimer disease.

Which of the following has been isolated in plaques, but may be due to other causes?

a) Tin

b) Lead

c) Copper

d) Aluminum

e) Manganese

26) What is the genetic inheritance pattern of Huntington disease?

a) Autosomal recessive

b) Autosomal dominant

c) Incomplete dominance

d) X-linked

e) Y-linked

27) What chromosome is Huntington disease associated with?

a) 4

b) 13

c) 18

d) 21

e) 23

28) Huntington disease causes neurons to die and be replaced with glial cells in what

location?

a) Substantia nigra

b) Lenticulostriatum

c) Hippocampus

d) Raphi nucleus

e) Corpus striatum

29) What is released from oxygen-starved neurons during a stroke and binds to N-

methyl-D-aspartate (NDMA) receptors on surrounding neurons, leading to toxic levels of

calcium entering these cells?

a) Lactate

b) Opiod peptides

c) Acetylcholine

d) Glutamate

e) Dopamine

30) Excessive trinucleotide CAG repeats are seen in what disease?

a) Alzheimer disease

b) Huntington disease

c) Parkinson disease


e) Alcoholism

31) Which of the following is used immediately after diagnosis to help dissolve clots in

stroke patients?



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%



c) 50%

d) 75%

e) 100%

Neuro #4 – Biochemistry: Metabolic Profile Of The Eye

1) Most of the ATP produced in the lens comes from:

a) Oxidative metabolism

b) Anaerobic glycolysis

c) Gluconeogenesis

d) Glycogenesis

e) Glycosylation

2) Along with the lens, what part of the eye does NOT contain blood vessels nor

significant numbers of mitochondria?

a) Conjunctiva

b) Cornea

c) Sclera

d) Retina

e) Fovea

3) Increasing water content (percentage) in the cornea results in it becoming:

a) Less viscous and more transparent

b) Less viscous and more opaque

c) More viscous and more transparent

d) More viscous and more opaque

4) Which of the following is required as a coenzyme for glutathione reductase in the

pentose phosphate pathway to remove oxidative radicals from the cornea?

a) Acetyl-CoA

b) Pyruvate

c) CO2

d) NAD+

e) NADPH

5) Prolonged wearing of contact lenses can cause hypoxic conditions leading to which of

the following, which creates corneal swelling?

a) Increased lactate production and increased corneal pH

b) Increased lactate production and decreased corneal pH

c) Decreased lactate production and increased corneal pH

d) Decreased lactate production and decreased corneal pH

6) The ____ humour brings nutrients to the cornea and lens and is secreted in the ____

chamber.

a) Aqueous; Anterior

b) Aqueous; Posterior

c) Vitreous; Anterior

d) Vitreous; Posterior

7) Collagen fibrils (Type II) in the vitreous humour are connected by proteoglycan

bridges and held apart by ____, preventing its collapse.

a) Bicarbonate

b) Ascorbic acid



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?



a) The transparency of the lens increases

b) The transparency of the lens decreases

c) The pH of the lens increases

d) The pH of the lens decreases

e) The blood supply to the lens becomes blocked

15) Inhibitors of de novo cholesterol synthesis may increase susceptibility to which of the

following?

a) Diabetes

b) Glaucoma

c) Cataracts

d) Posterior vitreous detachment (PVD)

e) Retinal detachment

16) Which of the following is NOT a risk factor for cataract (lens opacity) formation?

a) Diabetes

b) Smoking

c) Galactosemia

d) Non-fat diet

e) Radiation

17) In the Polyol Pathway, aldose reductase converts glucose to ____, which can

accumulate leading to cataracts.

a) Xylitol

b) Mannitol

c) Galactose

d) Sorbitol

e) Glycerol

18) In the case of radiation to the eyes, cataracts may form due to reduced glutathione

followed by an increase in what ion, promoting the binding of a protein that causes

crystalline aggregation?

a) Sodium

b) Potassium

c) Chlorine

d) Calcium

e) Magnesium

19) Which of the following forms of cataracts is likely a result of modification and

breakdown of lens proteins?

a) Drug-induced cataract

b) Traumatic cataract

c) Congenital cataract

d) Age-related cataract

20) Which of the following is true of the retina?

a) It produces ATP by anaerobic glycolysis only

b) It produces ATP by oxidative metabolism only

c) It produces ATP by anaerobic glysolysis and oxidative metabolism

d) It contains no vessels and no mitochondria

e) It contains low levels of vitamin A and vitamin C



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

Neuro #5 – Microbiology: CNS Infections (Chapter 24)

1) Encephalitis is usually caused by:

a) Parasites

b) Bacteria

c) Viruses

d) Fungi

2) Which of the following is NOT a mechanism for meningitis transport across the blood-

brain barrier?

a) Infecting cells lining the barrier

b) Crossing the barrier in infected leukocytes

c) Passively transported across the barrier in vaculoes

d) Binding with large, lipid-insoluble molecules

3) Which of the following is NOT a common cause of bacterial meningitis in neonates?

a) Streptococcus agalactiae

b) Echerichia coli

c) Neisseria meningitidis

d) Listeria monocytogenes

4) Which of the following is a common cause of bacterial meningitis in children, having a

10% mortality rate and 40% incidence of complications?



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



10) Haemophilus influenzae B, a Gram-negative pleomorphic coccobacilli, was the most

common cause of pediatric meningitis prior to developing a vaccine. Which of the

following is true regarding the laboratory growth of the bacteria?

a) Grows on MacConkey agar, but not blood nor chocolate agar

b) Grows on MacConkey and blood agar, but not chocolate agar

c) Grows on MacConkey, blood, and chocolate agar

d) Grows on chocolate and blood agar, but not MacConkey agar

e) Grows on chocolate agar, but not MacConkey nor blood agar

11) A premature newborn develops fever, abnormal behavior, and a bulging fontanel five

days after traumatic birth. Which of the following is the likely cause?


b) Echerichia coli



e) Staphylococcus saprophyticus

12) Mothers should avoid certain foods such as cold cuts during pregnancy due to the

chance of transmitting which of the following to their child, causing meningitis?


b) Echerichia coli




13) Which of the following non-viral meningitis pathogens should be treated with

amphotericin B and flucytosine?

a) Neisseria meningitidis

b) Haemophilus influenzae

c) Streptococcus pneumoniae

d) Echerichia coli

e) Listeria monocytogenes

f) Mycobacterium tuberculosis

g) Cryptococcus neoformans

14) An adult presents with dizziness, weakness, blurred vision, dry mouth, dilated pupils,

and constipation. No fever is present. Which of the following is the most likely?

a) C. difficile

b) C. perfingens

c) C. septicum

d) C. botulinum

e) C. tetani

15) Which of the following causes constipation, “failure to thrive,” and flaccid paralysis

(“Floppy Baby Syndrome”)?

a) C. difficile

b) C. perfingens

c) C. septicum

d) C. botulinum

e) C. tetani

16) C. tetani toxin prevents the release of glycine and:



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



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


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





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



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)?


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



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?


b) Echerichia coli




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?








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?






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





d) Blastomyces dermatitidis


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?


b) Toxoplasma gondii




44) Which of the following is associated with granulomatous amoebic encephalitis

(GAE) as well as keratitis?


b) Toxoplasma gondii




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



46) Which of the following is associated with eating raw mollusks (e.g. clams, squid) and

has been seen in Louisiana and Puerto Rico?


b) Trichinosis

c) Baylisascaris procyonis (Raccoon Roundworm)

d) Angiostrongylus cantonensis (Rat Lungworm)

e) Toxoplasmosis

Neuro #6 – Microbiology: Infections Of The Eye (Chapter 25)

1) What is the major cause of blepharitis and styes?

a) Staphylococcus aureus

b) Staphylococcus epidermidis

c) Staphylococcus saprophyticus

d) Neisseria gonorrhoeae

e) Escherichia coli

2) The presence of eosinophils in a conjunctivitis culture would indicate the cause is:

a) Viral

b) Bacterial

c) Fungal

d) Parasitic

3) A grade-school boy presents with bilateral conjunctivitis with ocular secretions, fever,

and sore throat. Symptoms began within a day of a swimming-pool trip. A rapid group A

strep test is negative. Which of the following is the most likely cause?

a) Parvovirus

b) Papovavirus

c) Herpesvirus

d) Adenovirus serotypes 3, 4, 7

e) Adenovirus serotypes 8. 19. 37

4) A neonate presents with conjunctival injection and watery discharge. Culture reveals

multinucleated giant cells. Acyclovir is prescribed. Which of the following is the most

likely cause?

a) Adenovirus

b) Herpesvirus



e) Cytomegalovirus

5) An AIDS patient presents with retinitis. Culture reveals Owl’s-eye inclusions.

Gancyclovir is prescribed. Which of the following is the most likely cause?

a) Adenovirus

b) Herpesvirus

c) Neisseria gonorrhoeae

d) Chlamydia trachomatis

e) Cytomegalovirus

6) Trachoma (Chlamydia trachomatis) is considered the most important eye infection

worldwide due to its associated incidence of blindness. Which of the following is NOT a

common method of spreading this disease?



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



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?


b) Fusarium 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:


b) Fusarium 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



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

Neuro #7 – Microbiology: Viral Infections of the CNS

1) Enteroviruses (e.g. coxackie, poliovirus), a major cause of viral meningitis, is spread

through what route of transmission?

a) Droplet contact

b) Direct physical contact

c) Airborn transmission

d) Fecal-oral transmission

e) Vector borne transmission

2) A patient presents with fever, headache, and vomitting. Lumbar puncture shows

protein at 30 mg/dL and glucose at 70 mg/dL with very few cells. Which of the following

is most likely?


b) Viral meningitis

c) Fungal meningitis

d) Aseptic meningitis

e) Normal CSF

3) Which of the following is true of echovirus as well as coxsackie A and B viruses?

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

4) Arboviruses (e.g. Japanese B, St. Louis Encephalitis), a major cause of viral

encephalitis, is spread through what route of transmission?

a) Droplet contact

b) Direct physical contact

c) Airborn transmission

d) Fecal-oral transmission

e) Vector borne transmission

5) A patient presents with viral meningitis after a camping trip in Louisiana. Which of the


a) Japanese B Encephalitis

b) St. Louis Encephalitis

c) West Nile Encephalitis

d) Eastern Equine Encephalitis (EEE)

e) Western Equine Encephalitis (WEE)

6) Which Arbovirus is the most common worldwide?

a) Japanese B Encephalitis

b) St. Louis Encephalitis



c) West Nile Encephalitis

d) Eastern Equine Encephalitis (EEE)

e) Western Equine Encephalitis (WEE)

7) An 18-year-old male presents with bilateral parotitis and orchitis. Which of the

following is most likely?

a) Enterovirus

b) Arbovirus

c) Herpes virus

d) Mumps

e) Rabies

8) A neonate presents with classic signs of meningitis. Lumbar puncture is clear and

shows increased lymphocytes, slightly increased protein, and normal glucose. Which of

the following is most likely?


b) Echerichia coli

c) Listeria monocytogenes

d) HSV-1

e) HSV-2

9) Which of the following causes of viral encephalitis can be treated with IV acyclovir?

a) Measles

b) Mumps

c) Rabies

d) Herpes

e) Enterovirus

f) West Nile virus

10) Which of the following is “bullet” shaped and causes acute, progressive, incurable

encephalitis?

a) Measles

b) Mumps

c) Rabies

d) Herpes

e) Enterovirus

11) Which of the following is the most likely cause of viral encephalitis in an adult, often

causing temporal lobe encephalitis?

a) HSV-1

b) HSV-2

c) Enterovirus

d) Arbovirus

e) Mumps

12) Which of the following is the most common cause of rabies worldwide, and the least

common in the United States?

a) Raccoons

b) Bats

c) Dogs

d) Foxes

e) Skunks



13) Hydrophobia is a neurological symptom of which of the following infections?

a) Measles

b) Mumps

c) Rabies

d) Herpes

e) Enterovirus

14) Which of the following is used to treat rabies?

a) Immunoglobulin + vaccine

b) Acyclovir + gancyclovir

c) Zidovudine (AZT)

d) Interferon alpha

e) Plasma replacement therapy

15) A child undergoes routine vaccinations and develops subacute sclerosing pan

encephalitis (SSPE) ten years later. Which of the following vaccines is the most likely

cause?

a) Measles

b) Mumps

c) Rabies

d) Herpes

e) Enterovirus

Neuro #8 – Pathology: Central Nervous System

1) Which of the following is considered malignant?

a) Osteoma

b) Glioma

c) Oligodendroma

d) Chondroma

e) Pituitary adenoma

2) Which of the following cells is the most sensitive to hypoxia?

a) Glial cells

b) Neurons

c) Myocytes

d) Osteocytes

e) Chondrocytes

3) Which area of the brain is extremely sensitive to hypoxia?

a) Amygdala

b) Substantia nigra

c) Caudate nucleus

d) Raphi nucleus

e) Hippocampus

4) Which of the following is associated with diffuse cortical atrophy in the elderly?





e) Creutzfelt-Jacob disease



5) Which of the following involves individual neurons shriveling and becoming

hyperchromatic with eccentric nuclei?





e) Creutzfelt-Jacob disease

6) A 40-year-old patient complaining of neck pain undergoes a CT scan, revealing a

tumor in the medullary region of the brain. Which of the following is the most likely?

a) Lymphoma

b) Ependymoma

c) Glioblastoma multiforme

d) Oligodendroglioma

e) Teratoma

7) Which of the following is histologically associated with rabies encephalitis?

a) Lewy bodies

b) Negri bodies

c) Spongiform changes

d) Halo inclusions

e) Owl’s eye inclusion

f) Cowdry bodies

8) Which of the following shows histological inclusions with prominent clear “halos?”

a) Adenovirus

b) Herpesvirus



e) Cytomegalovirus

9) A CT scan of a 72-year-old patient shows a single tumor in the cerebrum. Which of the


a) Lymphoma

b) Ependymoma

c) Glioblastoma multiforme


e) Teratoma

10) A portion of the brain is stained with Glial Fibrillary Acidic Protein (GFAP)

revealing red color, gliosis, and thus CNS injury. Which of the following cells would

show hypertrophy and hyperplasia on the slide?

a) Oligodendrocytes

b) Ependymal cells

c) Radial glia

d) Gemistocytes

e) Schwann cells

11) Which of the following is a complication associated with astrocytes that can occur in

patients who have been treated for meningitis?

a) Cerebral stroke

b) Increased Cowdry bodies



c) Increased risk of HIV

d) Decreased risk of viral meningitis

e) Hydrocephalus

12) Which of the following cell types is responsible for neurophagia?

a) Astrocytes

b) Oligodendrocytes

c) Schwann cells

d) Microglial cells

e) Ependymal cells

13) Which of the following structures most impedes the escape of protein bound

molecules from the blood vessels to the central nervous system?

a) Pre-capillary astrocytic foot plates

b) Glial limitans

c) Capillary endothelium

d) Capillary microglia

e) Ionic currents

14) Which of the following is NOT associated with astrocyte function?

a) Associated with blood-brain barrier

b) Takes up aspartate

c) Takes up glucose

d) Shows hyperplasia in response to injury

e) Involved in neuronal signal transmission

15) Loss of consciousness, such as seen in a knockout punch by a boxer, is most

commonly caused by a dysfunction of the:

a) Blood flow in the brain

b) Amygdala and hippocampus

c) Vestibulocochlear nucleus

d) Lentiform nucleus

e) Brainstem reticular formation

Neuro #9 – Pathology: Congenital Malformations & Cerebral Edema

1) It is recommended that women of childbearing age take folate supplements, as these

supplements can help prevent ____ defects, which occur shortly after conception and

possibly even before the mother knows she is pregnant.

a) Heart and respiratory

b) Extremity

c) Brain and spinal cord

d) Ocular and vestibular

e) Abdominal organ

2) During examination of a newborn, a small tuft of hair is found in the lumbosacral

region. Which of the following should the clinician be concerned about?

a) Spina bifida occulta

b) Spina bifida cystic (myelomeningocele)

c) Meningocele

d) Rashischisis

e) Arnold-Chiari Syndrome



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


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


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



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?


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



d) PMN cells in the CSF

16) A patient is struck on the side of the head with a blunt object. CT scan shows the thin

temporal bone is fractured and an “olive shaped” hematoma is present. What vessels are

most likely involved?

a) Anterior meningeal arteries

b) Middle meningeal arteries

c) Posterior meningeal arteries

d) Internal carotid arteries

e) Cerebral bridging veins

17) A patient presents with an epidural hematoma causing increased intracranial pressure.

If the pressure became greater than venous pressure, the veins in the brain would collapse

and thus stop cerebral blood flow. Which of the following occurs as a result of the

Cushing Reflex to help prevent this fatal situation?

a) Decreased heart rate, decreased blood pressure, decreased heart contractility

b) Increased heart rate, decreased blood pressure, increased heart contractility

c) Decreased heart rate, decreased blood pressure, increased heart contractility

d) Increased heart rate, increased blood pressure, increased heart contractility

e) Decreased heart rate, increased blood pressure, increased heart contractility

18) A patient presents a week after falling on their head on the ice. They complain of

some difficulty with motor tasks and feel like they have been acting “strangely.” CT scan

shows a subdural hematoma. Which of the following clinical sequelae is life threatening?

a) Migraine headaches

b) Subfalcine (cingulate) herniation

c) Transtentorial (uncal) herniation

d) Intracranial calcification

e) Loss of associated bridging veins

19) A patient with pre-existing aneurysms presents with a traumatic head injury. They

have rapidly developed an extremely severe headache and vomiting. Spinal tap shows

blood in the CSF. Which of the following is the most likely?

a) Epideral hematoma

b) Subdural hematoma

c) Subarachnoid hemorrhage

d) Coup cerebral contusion

e) Contrecoup cerebral contusion

20) Which of the following can be given to patients with spinal cord injuries to help

prevent paraplegia due to immunologic response?

a) NSAIDs

b) MAOIs

c) Narcotics

d) Steroids

e) Beta-blockers

21) Which of the following is typically seen in the cerebral cortex and can present with

seizures and intracranial (subarachnoid) hemorrhages in the 2nd and 3rd decades of life?

a) Arterial venous malformations

b) Cavernous angiomas

c) Telangiectasias



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

Neuro #10 – Pathology: Demyelinating Diseases & Tumors

1) Which of the following is NOT a demyelinating disease?

a) Metachromatic leukodysrophy (MLD)

b) Fabry disease

c) Krabbe disease

d) Adrenoleukodysrophy (ADL)

e) Alexander disease



2) A 35-year-old female presents with bitemporal hemianopsia. She complains of

relapsing and remitting numbness of her left leg. Demyelinating plaques are found.






e) Multiple Sclerosis

3) A 30-year-old alcoholic presents with electrolyte imbalances. The Emergency Room

clinician rapidly corrects the condition, but the patient soon develops quadriplegia.

Which of the following most likely occurred?

a) Acute necrotizing hemorrhagic encephalitis

b) Acute disseminated encephalomyelitis

c) Acute multiple sclerosis (Marburg form)

d) Central pontine myelinolysis

e) Marchifava (Bignami disease)

4) A construction work presents with complaints of painful cramps and difficulty using a

hammer with his right hand. Upon examination, bilateral weakness of the upper

extremities if found. Although genetic testing does not show a defective gene on

chromosome 21, which of the following does this patient most likely have?



c) Multiple Sclerosis


e) Amyotrophic lateral sclerosis

5) Which of the following has a high risk of suicide after genetic screening returns

positive results?






6) A patient presents with combined coordination problems of both the upper and lower

limbs. Upon examination, scoliosis is found. Genetic testing reveals an abnormality on

chromosome 9 with triplet (GAA) expansion. Which of the following is the most likely?

a) Tabes dorsalis

b) Friedreich ataxia

c) Subacute combined degeneration

d) Amyotrophic lateral schlerosis

e) Multiple Sclerosis

7) A 70-year-old patient’s tissue sample shows cerebral blood vessels that stain with

Congo red stain (Congophilic angiopathy). Which of the following did the patient have?




d) Multiple Sclerosis




8) A 50-year-old presents with hypersexuality, drastically increased alcohol intake, and

lack of inhibition. CT scan shows frontotemporal “knife-blade” cortical atrophy. Which

of the following is the most likely?

a) Pick disease

b) Alzheimer disease


d) Parkinson disease

e) Huntington disease

9) Which of the following involves a lesion in the white matter of the brain?

a) Fibrillary astrocytoma

b) Glioblastoma multiforme

c) Pilocytic astrocytoma

d) Pleomorphic xanthoastrocytoma

e) Oligodendroglioma

10) What is the most common location of ependymomas in children?

a) Fourth ventricle

b) Third ventricle

c) Foramen of Magendie

d) Foramen of Luschka

e) Medullary portion of the spinal cord

11) A father brings in his child stating the child is having difficulty walking. Recently the

child presents with nausea and vomiting. A CT scan finds a tumor of the cerebellum.


a) Glioblastoma multiforme

b) Central neurocytoma

c) Craniopharyngioma

d) Medullablastoma

e) Gangliocytoma

12) An immunosuppressed patient presents with headaches. CT scan reveals lesions in

multiple sites within the central nervous system. Which of the following is the most

likely?

a) Primary CNS lymphoma

b) Germ cell tumor

c) CNS teratoma

d) Pineal parenchymal tumor

e) Meningioma

13) Which of the following tumors may infiltrate the bone of the overlying calvaria in the

brain?

a) Primary CNS lymphoma

b) Germ cell tumor

c) CNS teratoma

d) Pineal parenchymal tumor

e) Meningioma

14) What is the most common primary site for tumors that metastasize to the CNS?

a) Bone



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


d) Pernicious anemia


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


d) Pernicious anemia


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



b) Glioblastoma

c) Medulloblastoma


e) None are radiosensitive

James Lamberg



AnswerKey

Neuro #1

1) A

2) E

3) D

4) B

5) C

6) E

7) D

8.1) B

8.2) D

8.3) A

8.4) C

9) B

10) A

11) C

12) E

13) C

14) B

15) B

16) B

17) C

18) E

19) E

20) A

21) A

22) D

23) D

24) A

25) E

26) E

27) B

28) A

29) D

30) C

31) E

32) D

33) A

34) A

35) E

36) D

37) A

38) D

39) B

40) A

41) B

42) D

43) E

44) A

45) E

46) C

47) C

48) D

49) E

50) B

51) B

52) E

53) C

54) F

55) D

56) E

57) C

58) B

59) E

60) D

Neuro #2

1) C

2) A

3) B

4) E

5) B

6) C

7) C

8) D

9) D

10) C

11) C

12) A

13) E

14) B

15) A

16) C

17) D

18) B

19) E

20) A

21) B

22) D

23) C

24) E

25) D

26) C

27) E

Neuro #3

1.1) E

1.2) F

1.3) E

1.4) B

1.5) E

1.6) C

1.7) E

1.8) D

1.9) A

2) D

3) E

4) C

5) D

6) A

7) D

8) D

9) E

10) A

11) F

12) D

13) E

14) B

15) E

16) C

17) B

18) D

19) C

20) B

21) B

22) A

23) D

24) A

25) D

26) B

27) A

28) E

29) D

30) B

31) E

32) A

33) E

34) A

35) D

36) B

37) D

38) B

Neuro #4

1) B

2) B

3) D

4) E

5) B

6) B

7) C

8) E

9) C

10) A

11) A

12) E

13) D

14) B

15) C

16) D

17) B

18) D

19) D

20) C

21) C

22) B

23) C

24) A

Neuro #5

1) C

2) D

3) C

4) B

5) A

6) D

7) C

8) B

9) B

10) E

11) A

12) D

13) G

14) D



15) D

16) E

17) B

18) C

19) E

20) C

21) A

22) C

23) A

24) B

25) D

26) E

27) A

28) D

29) D

30) A

31) E

32) B

33) A

34) C

35) E

36) C

37) D

38) C

39) B

40) A

41) E

42) C

43) D

44) E

45) A

46) D

Neuro #6

1) A

2) D

3) D

4) B

5) E

6) C

7) C

8) E

9) D

10) C

11) E

12) B

13) C

14) E

15) D

16) D

17) C

18) B

19) E

20) B

Neuro #7

1) D

2) E

3) C

4) E

5) B

6) A

7) D

8) E

9) D

10) C

11) A

12) C

13) C

14) A

15) A

Neuro #8

1) B

2) B

3) E

4) C

5) E

6) B

7) B

8) E

9) C

10) D

11) E

12) D

13) C

14) B

15) E

Neuro #9

1) C

2) A

3) D

4) B

5) A

6) D

7) C

8) B

9) B

10) C

11) D

12) D

13) D

14) D

15) A

16) B

17) E

18) C

19) C

20) D

21) A

22) A

23) B

24) B

25) A

26) F

Neuro #10

1) B

2) E

3) D

4) E

5) A

6) B

7) C

8) A

9) E

10) A

11) D

12) A

13) E

14) B

15) C

16) E

17) A

18) C

19) B

20) A

21) C

Quiz Neuroscience Part 3 of 4

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