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Neuroscience – Part 3

14Mar2009

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:

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Neuroscience – Part 3

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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

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Neuroscience – Part 3

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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-omethyltransferase (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?

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Neuroscience – Part 3

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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

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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

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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

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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

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Neuroscience – Part 3

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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

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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

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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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Neuroscience – Part 3

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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 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

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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) 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 Nmethyl-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 d) Myasthenia Gravis e) Alcoholism 31) Which of the following is used immediately after diagnosis to help dissolve clots in stroke patients?

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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% 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

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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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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

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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 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 bloodbrain 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?

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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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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? a) Streptococcus agalactiae b) Echerichia coli c) Neisseria meningitidis d) Listeria monocytogenes 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? a) Streptococcus agalactiae b) Echerichia coli c) Neisseria meningitidis d) Listeria monocytogenes e) Staphylococcus saprophyticus 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:

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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 Gramnegative 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 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 c) Staphylococcus aureus d) Neisseria gonorrhoeae 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?

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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 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? a) Bacterial meningitis 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 following is the most likely? 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

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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? a) Streptococcus agalactiae 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

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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? a) Huntington disease b) Parkinson disease c) Alzheimer disease d) Myasthenia Gravis e) Creutzfelt-Jacob disease

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5) Which of the following involves individual neurons shriveling and becoming hyperchromatic with eccentric nuclei? a) Huntington disease b) Parkinson disease c) Alzheimer disease d) Myasthenia Gravis 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 c) Staphylococcus aureus d) Neisseria gonorrhoeae e) Cytomegalovirus 9) A CT scan of a 72-year-old patient shows a single tumor in the cerebrum. Which of the following is the most likely? a) Lymphoma b) Ependymoma c) Glioblastoma multiforme d) Oligodendroglioma 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

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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

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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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Neuroscience – Part 3

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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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Neuroscience – Part 3

14Mar2009

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

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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 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

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Neuroscience – Part 3

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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. Which of the following is the most likely? a) Huntington disease b) Parkinson disease c) Alzheimer disease d) Myasthenia Gravis 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? a) Huntington disease b) Parkinson disease c) Multiple Sclerosis d) Myasthenia Gravis e) Amyotrophic lateral sclerosis 5) Which of the following has a high risk of suicide after genetic screening returns positive results? a) Huntington disease b) Parkinson disease c) Multiple Sclerosis d) Myasthenia Gravis e) Amyotrophic lateral sclerosis 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? a) Huntington disease b) Parkinson disease c) Alzheimer disease d) Multiple Sclerosis

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Neuroscience – Part 3

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e) Amyotrophic lateral 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 c) Multiple Sclerosis 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. Which of the following is the most likely? 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

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Neuroscience – Part 3

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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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Neuroscience – Part 3 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

14Mar2009 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

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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

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Neuroscience – Part 3 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

14Mar2009 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

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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

18) C 19) B 20) A 21) C

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

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