Neurology
Q1. A 7-month-old boy presents with macrocephaly, irritability, and
developmental delay. CT shows enlarged lateral and third ventricles but a
normal fourth ventricle. What is the most likely cause?
A. Communicating hydrocephalus
B. Aqueductal stenosis
C. Chiari malformation
D. Dandy-Walker malformation
Q2. A 66-year-old man presents with sudden right-sided weakness and
difficulty speaking. Exam shows contralateral hemiparesis affecting the face
and arm > leg, and expressive aphasia. Which vessel is most likely
7occluded?
A. Anterior cerebral artery
B. Posterior cerebral artery
C. Middle cerebral artery
D. Vertebral artery
Q3. A 70-year-old man presents with a resting tremor, rigidity, and
bradykinesia. Which symptom is not part of the Parkinson’s TRAP acronym?
A. Tremor
B. Rigidity
C. Aphasia
D. Postural instability
Q4. A 23-year-old man sustains a head injury in a motorcycle crash. He
initially loses consciousness but regains it. Hours later, he deteriorates
rapidly. CT shows a lens-shaped hematoma. Which vessel is most likely
injured?
A. Bridging veins
B. Middle meningeal artery
C. Superior sagittal sinus
D. Internal carotid artery
Q5. A patient with a Chiari I malformation develops a fluid-filled cyst in the
spinal cord. He presents with bilateral loss of pain and temperature sensation
in a cape-like distribution, but touch and vibration are preserved. What is the
diagnosis?
A. Multiple sclerosis
B. Syringomyelia
C. ALS
D. Tabes dorsalis
Q6. A pregnant woman’s ultrasound shows absent cranial vault and brain
tissue in the fetus. Polyhydramnios is present. Which deficiency is strongly
associated?
A. Vitamin B12
B. Folate
C. Vitamin D
D. Iron
Q7. A newborn develops meningitis. Blood culture grows Gram-positive cocci.
Which organism is the most common cause?
A. Streptococcus pneumoniae
B. Listeria monocytogenes
C. Escherichia coli
D. Group B Streptococcus
Q8. A 2-year-old boy presents with a loud pansystolic murmur at the lower
left sternal border. Echocardiogram confirms an abnormal opening between
ventricles. Which is the most likely defect?
A. Tetralogy of Fallot
B. Ventricular septal defect
C. Atrial septal defect
D. Patent ductus arteriosus
Q9. A 4-year-old child presents with fever, rash, conjunctivitis, cervical
lymphadenopathy, and a red “strawberry tongue.” What is the diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Rheumatic fever
Q10. A renal biopsy in a 40-year-old man shows “spike and dome”
appearance on electron microscopy. Which condition does this represent?
A. Minimal change disease
B. FSGS
C. Membranous nephropathy
D. MPGN
Q11. A biopsy shows dilated renal tubules with eosinophilic casts resembling
thyroid tissue. Which condition is this classic for?
A. Acute tubular necrosis
B. Chronic pyelonephritis
C. Goodpasture’s syndrome
D. IgA nephropathy
Q12. A renal biopsy shows crescents in the glomeruli. Immunofluorescence
shows linear IgG along the basement membrane. Which diagnosis is most
likely?
A. Minimal change disease
B. IgA nephropathy
C. Anti-GBM disease
D. Amyloidosis
Q13. A 50-year-old man has hematuria and frothy urine. Labs show
proteinuria >3.5 g/day, hypoalbuminemia, and edema. What is the
syndrome?
A. Nephritic syndrome
B. Nephrotic syndrome
C. RPGN
D. Pyelonephritis
Q14. A renal biopsy shows “tram-track” appearance of the GBM. Which
diagnosis is most consistent?
A. Minimal change disease
B. MPGN
C. FSGS
D. Lupus nephritis
Q15. A patient presents with decreased urine output. Urinalysis shows
muddy brown casts. What is the most likely diagnosis?
A. Nephrotic syndrome
B. Acute tubular necrosis
C. Chronic interstitial nephritis
D. Post-strep GN
Q16. A pregnant woman with a history of folate deficiency delivers an infant
with no forebrain or cerebum. The amniotic fluid is excessive. What is the
most likely diagnosis?
A. Encephalocele
B. Anencephaly
C. Spina bifida occulta
D. Microcephaly
Q17. A man presents with painless hematemesis. He has a history of
cirrhosis. Which is the most likely cause?
A. Gastric ulcer
B. Esophageal varices
C. Mallory-Weiss tear
D. Gastritis
Q18. A barium enema shows an “apple-core” lesion. Which condition is most
likely?
A. Ulcerative colitis
B. Crohn’s disease
C. Colon cancer
D. Diverticulosis
Q19. Colonoscopy in a patient with long-standing bloody diarrhea shows
continuous inflammation and “lead-pipe” colon. Which is the diagnosis?
A. Crohn’s disease
B. Ulcerative colitis
C. Ischemic colitis
D. Celiac disease
Q20. A patient with abdominal pain and distension has CT showing twisting
of mesentery (“whirl sign”). Which diagnosis fits?
A. Volvulus / closed-loop obstruction
B. Intussusception
C. Diverticulitis
D. Appendicitis
Q21. A woman presents with upper GI bleeding and vomits dark, granular
material resembling coffee grounds. What does this represent?
A. Lower GI bleed
B. Old digested blood in stomach
C. Hemorrhoids
D. Bile vomiting
Q22. A man with a history of alcohol abuse presents with severe epigastric
pain radiating to the back. CT shows peripancreatic hemorrhage with
ecchymosis of the flanks (“Grey-Turner’s sign”). What is the diagnosis?
A. Acute cholecystitis
B. Acute pancreatitis (hemorrhagic)
C. Perforated ulcer
D. Splenic rupture
Q23. A patient presents with severe watery diarrhea described as “rice-water
stools.” Which pathogen is responsible?
A. Salmonella
B. Vibrio cholerae
C. Shigella
D. Giardia
Q24. A 65-year-old alcoholic presents with pneumonia and cough producing
thick, red, “currant jelly” sputum. Which organism is likely?
A. Streptococcus pneumoniae
B. Klebsiella pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
Q25. A patient with suspected pneumonia has rust-colored sputum. Which
organism is the most common cause of CAP?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Klebsiella
D. Legionella
Q26. A woman presents with thick, white, “cottage cheese-like” vaginal
discharge and itching. What is the diagnosis?
A. Bacterial vaginosis
B. Trichomoniasis
C. Candidiasis
D. Chlamydia
Q27. A young man presents with dysuria and pyuria, but urine culture is
negative. Which organism is most likely?
A. Neisseria gonorrhoeae
B. E. coli
C. Chlamydia trachomatis
D. Staphylococcus saprophyticus
Q28. A 25-year-old man presents with a painless testicular mass. Β-hCG is
mildly elevated, AFP is normal. Which is most likely?
A. Teratoma
B. Seminoma
C. Yolk sac tumor
D. Embryonal carcinoma
Q29. A 70-year-old man presents with a unilateral testicular mass. Which
malignancy is most likely?
A. Seminoma
B. Yolk sac tumor
C. Lymphoma
D. Choriocarcinoma
Q30. A woman presents with abdominal distension and elevated CA-125.
Which diagnosis is most likely?
A. Ovarian cancer
B. Uterine fibroid
C. Endometriosis
D. PID
Q31. A prostate biopsy shows Gleason score 9 (4+5). How is this classified?
A. Low risk
B. Intermediate risk
C. High risk
D. Benign
Q32. A 62-year-old smoker presents with painless hematuria. Which
diagnosis must be ruled out?
A. UTI
B. Kidney stones
C. Bladder cancer
D. Prostatitis
Q33. A bipolar patient presents with rapid, continuous speech that is difficult
to interrupt. Which term describes this?
A. Tangential speech
B. Pressured speech
C. Mutism
D. Echolalia
Q34. A patient with recurrent mood swings has hypomanic episodes and
major depression but no full mania. Which diagnosis is correct?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymia
D. Major depression
Q35. A patient with bipolar disorder on lithium develops nausea, tremor,
muscle rigidity, and hyperreflexia. Which complication is this?
A. Serotonin syndrome
B. Lithium toxicity
C. Neuroleptic malignant syndrome
D. Alcohol withdrawal
Q36. A woman with severe PMS symptoms (mood swings, irritability,
depression) is diagnosed with PMDD. Which is first-line treatment?
A. Benzodiazepines
B. SSRIs
C. OCPs
D. Antipsychotics
Q37. A man presents with recurrent kidney stones. Calcium is high,
phosphate is low. Which diagnosis is most likely?
A. Secondary hyperparathyroidism
B. Primary hyperparathyroidism
C. Vitamin D deficiency
D. Renal tubular acidosis
Q38. A woman presents with fatigue, weight gain, and goiter. She is from a
region with poor access to iodized salt. Which deficiency is most likely?
A. Selenium
B. Iodine
C. Vitamin D
D. Calcium
Q39. A patient with diabetes presents with polyuria, polydipsia, and
hyperglycemia, but no ketones are present. Which condition is most likely?
A. Type 1 DM
B. Type 2 DM
C. DKA
D. HHS
Q40. A patient with chest pain and shortness of breath undergoes CT
pulmonary angiogram. A clot is seen in the pulmonary artery. What is the
diagnosis?
A. COPD
B. Pneumonia
C. Pulmonary embolism
D. CHF
Q41. A patient with pericardial effusion develops hypotension, muffled heart
sounds, and JVD. Which sign is characteristic?
A. Pulsus paradoxus
B. Water-hammer pulse
C. Kussmaul’s sign
D. Corrigan’s sign
Q42. A patient with hyperthyroidism develops irregular pulse. Which
arrhythmia is most likely?
A. SVT
B. Atrial flutter
C. Atrial fibrillation
D. Ventricular tachycardia
Q43. A 68-year-old patient with COPD dies suddenly. What is the most
common cause of death?
A. Lung cancer
B. CAD
C. Pneumonia
D. Respiratory failure
Q44. A patient with suspected CHF shows increased JVP when pressure is
applied over the abdomen. Which sign is this?
A. Kussmaul’s sign
B. Murphy’s sign
C. Hepatojugular reflux
D. Cullen’s sign
Q45. A patient with endometriosis presents with chronic pelvic pain. First-line
therapy includes:
A. Surgery
B. NSAIDs + OCPs
C. Hysterectomy
D. Radiation
Q46. A patient develops painful, red target-shaped skin lesions after HSV
infection. What is this called?
A. Stevens-Johnson syndrome
B. Erythema nodosum
C. Erythema multiforme
D. Pemphigus vulgaris
Q47. A patient with bipolar disorder is on lithium. What is the therapeutic
serum level range for acute mania?
A. 0.2–0.6 mEq/L
B. 0.6–1.2 mEq/L
C. 1.5–2.0 mEq/L
D. >2.5 mEq/L
Q48. A patient presents with acute gout. Which is the most appropriate first-
line therapy?
A. Allopurinol
B. NSAIDs
C. Steroids
D. Colchicine
Q49. A patient with hypertensive emergency is started on an IV drug that
blocks both alpha- and beta-receptors. Which drug is this?
A. Metoprolol
B. Atenolol
C. Labetalol
D. Esmolol
Q50. A patient presents with ascites, spider angiomas, and asterixis. Which is
the underlying pathology?
A. Acute hepatitis
B. Cirrhosis
C. Budd-Chiari syndrome
D. Wilson’s disease
Q51. A diabetic patient with obesity presents with hepatomegaly and
asterixis. Biopsy shows fatty liver progressing to cirrhosis. Which is the
diagnosis?
A. Alcoholic cirrhosis
B. Viral hepatitis
C. NASH cirrhosis
D. Hemochromatosis
