WorksheetsGEM 8.01
Total questions: 220
Worksheet time: 4hrs 40mins
Name
Class
Date
1.
Which layer encloses an entire peripheral nerve?
a)
Endoneurium
b)
Perineurium
c)
Epineurium
d)
Myelin sheath
e)
Basal lamina
2.
A typical location of a pseudo-unipolar neuron is the:
a)
Ventral horn
b)
Lateral geniculate nucleus
c)
Dorsal root ganglion
d)
Anterior pituitary
e)
Cerebellar cortex
3.
Which neurotransmitter is classically inhibitory in the CNS?
a)
Glutamate
b)
Dopamine
c)
Serotonin
d)
GABA
e)
Acetylcholine
4.
A competitive antagonist occupies post-synaptic receptors. What follows?
a)
No transmitter release
b)
Transmitter accumulates then reuptaken/broken down
c)
Axonal conduction halts
d)
Vesicle docking is blocked
e)
Initial segment channels inactivate
5.
Interneurons chiefly:
a)
Carry touch from skin
b)
Activate muscle
c)
Link sensory and motor neurons in CNS
d)
Convey visceral pain
e)
Form PNS myelin
6.
In the cerebrum "rostral" refers to:
a)
Toward feet
b)
Toward occiput
c)
Toward nose/beak
d)
Toward vertex
e)
Toward spinal cord
7.
Main role of the corpus callosum:
a)
Endocrine regulation
b)
CSF filtration
c)
Inter-hemispheric communication
d)
CSF production
e)
Pontocerebellar relay
8.
Initial imaging in suspected intracranial haemorrhage in A&E?
a)
MRI
b)
PET
c)
Ultrasound
d)
CT head
e)
SPECT
9.
Which lobe is central to personality/executive function?
a)
Occipital
b)
Parietal
c)
Temporal
d)
Insula
e)
Frontal
10.
Why are lips/hands large in sensory homunculus?
a)
Greater muscle bulk
b)
Greater afferent receptor density
c)
Shorter reflex arcs
d)
Smaller cortical fields
e)
Higher basal firing rate
11.
Which structure allows communication between equivalent cortical areas of the left and right cerebral hemispheres?
a)
Internal capsule
b)
Corpus callosum
c)
Anterior commissure
d)
Superior longitudinal fasciculus
e)
Cingulate gyrus
12.
A lesion at the pterion most likely risks rupture of which vessel?
a)
Middle cerebral artery
b)
Middle meningeal artery
c)
Superior sagittal sinus
d)
Internal carotid artery
e)
Superficial temporal vein
13.
Which of the following cortical areas is primarily responsible for comprehension of language?
a)
Broca's area
b)
Primary auditory cortex
c)
Wernicke's area
d)
Prefrontal cortex
e)
Angular gyrus
14.
A patient understands language but speaks with great effort and poor articulation. The most likely site of lesion is:
a)
Wernicke's area
b)
Broca's area
c)
Primary motor cortex
d)
Precentral gyrus (lower limb region)
e)
Corpus callosum
15.
The homunculus described by Wilder Penfield demonstrated that:
a)
The same cortical region controls both sensory and motor function
b)
The cortical representation of the body is proportional to size
c)
Contralateral body parts are represented in the cortex
d)
Sensory input and motor output are ipsilateral
e)
Facial motor representation lies in the medial hemisphere
16.
Which lobe of the brain is primarily involved in integrating sensory information from various modalities?
a)
Frontal
b)
Parietal
c)
Occipital
d)
Temporal
e)
Insular
17.
The insular cortex is primarily located:
a)
Within the central sulcus
b)
Deep to the lateral sulcus
c)
Posterior to the occipital pole
d)
Inferior to the corpus callosum
e)
Between the caudate and putamen
18.
Which of the following best describes the primary motor cortex?
a)
Located on the postcentral gyrus and initiates voluntary movement
b)
Located on the precentral gyrus and initiates voluntary movement
c)
Located in the temporal lobe and controls balance
d)
Located in the cerebellum and coordinates emotion
e)
Located in the parietal lobe and regulates autonomic function
19.
Which of the following statements regarding the basal ganglia is TRUE?
a)
They consist entirely of white matter
b)
They directly innervate skeletal muscles
c)
They regulate initiation and quality of movement
d)
They are part of the cerebellum
e)
They have no role in posture control
20.
During a CT scan of the head, which of the following planes corresponds to a section parallel to the ground when the patient is supine?
a)
Sagittal
b)
Coronal
c)
Axial
d)
Oblique sagittal
e)
Parasagittal
21.
A patient presents with spastic paralysis of the right arm and leg following a left-sided cerebrovascular accident. Which cortical area is most likely affected?
a)
Postcentral gyrus
b)
Precentral gyrus
c)
Supplementary motor area
d)
Premotor cortex
e)
Prefrontal cortex
22.
Damage to which area of the brain causes receptive aphasia?
a)
Broca's area
b)
Wernicke's area
c)
Arcuate fasciculus
d)
Primary auditory cortex
e)
Angular gyrus
23.
A 65-year-old woman neglects the left side of her plate when eating. Which region is most likely damaged?
a)
Left parietal lobe
b)
Right parietal lobe
c)
Left temporal lobe
d)
Right frontal lobe
e)
Occipital lobe
24.
A patient can describe visual features of a face but cannot recognise familiar people, even family members. What is the most likely diagnosis?
a)
Apperceptive agnosia
b)
Visual hallucination
c)
Cortical blindness
d)
Prosopagnosia
e)
Visual field defect
25.
Lesions of the prefrontal cortex are most likely to result in which clinical feature?
a)
Visual field loss
b)
Spastic paralysis
c)
Disinhibition and personality change
d)
Expressive aphasia
e)
Loss of touch sensation
26.
Which brain region integrates sensory input with emotional and memory components for perception?
a)
Occipital lobe
b)
Hippocampus
c)
Parietal multimodal association area
d)
Precentral gyrus
e)
Cerebellum
27.
Damage to which area causes difficulty identifying an object by touch alone, despite intact sensation?
a)
Primary somatosensory cortex
b)
Somatosensory association cortex
c)
Premotor cortex
d)
Visual association cortex
e)
Prefrontal cortex
28.
A 58-year-old man with a left inferior frontal gyrus lesion speaks slowly and with effort but understands language. What is the diagnosis?
a)
Wernicke's aphasia
b)
Broca's aphasia
c)
Conduction aphasia
d)
Global aphasia
e)
Transcortical sensory aphasia
29.
Which statement about hemispheric specialisation is correct?
a)
Both hemispheres equally handle spatial attention
b)
Left hemisphere controls prosody of speech
c)
Right hemisphere is dominant for face recognition
d)
Right hemisphere controls language in all people
e)
Left hemisphere controls visuospatial awareness
30.
Unilateral lesion of the supplementary motor area typically causes:
a)
Inability to initiate voluntary movement on the opposite side
b)
Loss of proprioception
c)
Bilateral cortical blindness
d)
Receptive aphasia
e)
Visual neglect
31.
A 62-year-old right-handed man has fluent but nonsensical speech. He cannot follow simple verbal commands but has normal articulation. MRI shows a lesion in the dominant superior temporal gyrus. What is the most likely diagnosis?
a)
Broca's aphasia
b)
Wernicke's aphasia
c)
Conduction aphasia
d)
Global aphasia
e)
Transcortical motor aphasia
32.
A patient can describe the shape and colour of a fork but cannot name it or describe its function. Vision and language comprehension are intact. Which cortical area is most likely damaged?
a)
Area 17 (Primary visual cortex)
b)
Area 18 (Visual association cortex)
c)
Area 19 (Visual association cortex -- ventral stream)
d)
Parietal multimodal association cortex
e)
Frontal eye field
33.
Following a left middle cerebral artery (MCA) stroke, a patient cannot repeat sentences despite good comprehension and fluent speech. Which structure is most likely affected?
a)
Broca's area
b)
Wernicke's area
c)
Arcuate fasciculus
d)
Angular gyrus
e)
Insula cortex
34.
A right-handed patient presents with left visual field loss and left-sided neglect. The lesion is most likely in the:
a)
Left occipital lobe
b)
Right parietal lobe
c)
Left parietal lobe
d)
Right occipital lobe
e)
Right temporal lobe
35.
A 45-year-old man has difficulty initiating voluntary movements on his left side but normal muscle strength. Which lesion best explains this finding?
a)
Right supplementary motor area
b)
Left primary motor cortex
c)
Left cerebellar hemisphere
d)
Right parietal association cortex
e)
Right premotor cortex
36.
A 60-year-old woman has personality changes, impulsivity, and poor social judgement after a head injury. Which structure is most affected?
a)
Premotor cortex
b)
Supplementary motor area
c)
Prefrontal cortex
d)
Primary motor cortex
e)
Temporal pole
37.
A patient with a lesion to the right fusiform gyrus is unable to recognise familiar faces but can identify voices. What condition does this describe?
a)
Apperceptive agnosia
b)
Prosopagnosia
c)
Auditory agnosia
d)
Visual field loss
e)
Anosognosia
38.
A patient with a stroke shows spastic paralysis of the left leg and loss of inhibition of the Babinski reflex. Which Brodmann area is affected?
a)
Area 4
b)
Area 6
c)
Area 17
d)
Area 22
e)
Area 5
39.
A patient demonstrates intact comprehension and fluency but produces irrelevant, disorganised speech, unable to inhibit inappropriate comments. The lesion most likely involves:
a)
Premotor cortex
b)
Broca's area
c)
Wernicke's area
d)
Prefrontal cortex
e)
Angular gyrus
40.
A patient fails to respond to objects in the left visual field despite normal visual pathways and acuity. They also ignore the left half of their own body. The most likely diagnosis is:
a)
Left occipital lesion
b)
Left parietal lesion
c)
Right occipital lesion
d)
Right parietal lesion
e)
Bilateral temporal lesion
41.
Which layer of the cornea is responsible for maintaining its dehydration and transparency through active ion transport?
a)
Bowman's layer
b)
Dua's layer
c)
Stroma
d)
Endothelium
e)
Epithelium
42.
The cornea receives its sensory innervation from which cranial nerve division?
a)
Maxillary division of trigeminal nerve
b)
Ophthalmic division of trigeminal nerve
c)
Facial nerve
d)
Oculomotor nerve
e)
Glossopharyngeal nerve
43.
Contraction of the ciliary muscle causes:
a)
Flattening of the lens for distance vision
b)
Relaxation of zonular fibers and increased lens curvature
c)
Pupil dilation (mydriasis)
d)
Decreased refractive power of the lens
e)
Constriction of sphincter pupillae
44.
Which of the following refractive errors is due to light focusing in front of the retina?
a)
Emmetropia
b)
Hypermetropia
c)
Myopia
d)
Presbyopia
e)
Astigmatism
45.
Vitamin A deficiency primarily affects which type of photoreceptor and visual function?
a)
Cones and color vision
b)
Rods and night vision
c)
Cones and peripheral vision
d)
Ganglion cells and motion detection
e)
Bipolar cells and light-dark adaptation
46.
Which structure forms the main blood supply to the outer retina?
a)
Central retinal artery
b)
Ciliary body
c)
Choroid
d)
Sclera
e)
Ophthalmic vein
47.
Loss of the corneal reflex could result from a lesion in which nerve?
a)
Optic nerve
b)
Oculomotor nerve
c)
Trigeminal nerve
d)
Abducens nerve
e)
Accessory nerve
48.
Which muscle is responsible for eyelid elevation and innervated by the oculomotor nerve?
a)
Orbicularis oculi
b)
Levator palpebrae superioris
c)
Muller's muscle
d)
Superior rectus
e)
Frontalis
49.
Papilloedema occurs due to raised intracranial pressure because the optic nerve sheath is continuous with:
a)
Choroid
b)
Ciliary body
c)
Dura mater
d)
Retina
e)
Sclera
50.
Which combination correctly describes the pathway of parasympathetic innervation to the lacrimal gland?
a)
Oculomotor → ciliary ganglion → lacrimal gland
b)
Trigeminal → pterygopalatine ganglion → lacrimal gland
c)
Facial → greater petrosal → pterygopalatine ganglion → zygomatic nerve → lacrimal nerve → lacrimal gland
d)
Glossopharyngeal → otic ganglion → lacrimal gland
e)
Vagus → superior cervical ganglion → lacrimal gland
51.
A 70-year-old patient reports progressive blurring of vision for near objects but clear distance vision. Which of the following best explains this condition?
a)
Weakness of ciliary muscle and reduced lens elasticity
b)
Increased corneal curvature and refractive power
c)
Elongated eyeball causing image focus anterior to retina
d)
Opaque corneal endothelium with stromal oedema
e)
Increased aqueous humour production
52.
Which structure directly produces aqueous humour?
a)
Iris stroma
b)
Ciliary processes
c)
Trabecular meshwork
d)
Choroid
e)
Schlemm's canal
53.
A lesion of the sympathetic pathway to the eye would most likely cause:
a)
Mydriasis and lid retraction
b)
Miosis and partial ptosis
c)
Miosis and lid elevation
d)
Mydriasis and complete ptosis
e)
Mydriasis with loss of accommodation
54.
Which layer of the retina recycles vitamin A for photopigment regeneration?
a)
Outer nuclear layer
b)
Ganglion cell layer
c)
Retinal pigment epithelium
d)
Inner plexiform layer
e)
Photoreceptor layer
55.
During fundoscopy, a pale optic disc with well-defined margins and visible sclera is observed. Which of the following is the most likely diagnosis?
a)
Papilloedema
b)
Optic neuritis
c)
Optic atrophy
d)
Central retinal artery occlusion
e)
Retinitis pigmentosa
56.
Which of the following muscles originates from the common tendinous ring?
a)
Superior oblique
b)
Inferior oblique
c)
Levator palpebrae superioris
d)
Lateral rectus
e)
Superior tarsal muscle
57.
A 45-year-old with uncontrolled diabetes develops flame-shaped retinal haemorrhages and exudates on fundoscopy. Which layer of the retina is primarily affected?
a)
Outer plexiform layer
b)
Inner nuclear layer
c)
Nerve fibre layer
d)
Photoreceptor layer
e)
Retinal pigment epithelium
58.
The afferent limb of the corneal reflex is via which specific branch?
a)
Maxillary division (V2) of trigeminal nerve
b)
Nasociliary branch of ophthalmic nerve (V1)
c)
Frontal branch of ophthalmic nerve (V1)
d)
Zygomatic branch of facial nerve
e)
Buccal branch of facial nerve
59.
A patient presents with ptosis, dilated pupil, and loss of accommodation. Which nerve is most likely affected?
a)
Abducens nerve
b)
Facial nerve
c)
Trochlear nerve
d)
Oculomotor nerve
e)
Ophthalmic division of trigeminal nerve
60.
A neonate presents with persistent tearing and recurrent conjunctivitis due to a congenital obstruction of the valve of Hasner. This valve is located at the distal end of which structure?
a)
Lacrimal canaliculus
b)
Lacrimal sac
c)
Nasolacrimal duct
d)
Punctum
e)
Conjunctival fornix
61.
A 65-year-old man presents with sudden, painless loss of vision in his right eye. Fundoscopy shows a pale retina with a cherry-red spot at the macula. Which artery is most likely occluded?
a)
Central retinal artery
b)
Posterior cerebral artery
c)
Middle cerebral artery
d)
Anterior choroidal artery
e)
Posterior communicating artery
62.
Compression of the central part of the optic chiasm by a pituitary adenoma typically causes which visual defect?
a)
Bitemporal hemianopia
b)
Binasal hemianopia
c)
Right homonymous hemianopia
d)
Left superior quadrantanopia
e)
Monocular blindness
63.
A lesion in the left optic tract results in which type of visual field defect?
a)
Right homonymous hemianopia
b)
Left homonymous hemianopia
c)
Right superior quadrantanopia
d)
Left inferior quadrantanopia
e)
Bitemporal hemianopia
64.
A temporal lobe lesion affecting Meyer's loop will cause which visual defect?
a)
Contralateral superior quadrantanopia
b)
Contralateral inferior quadrantanopia
c)
Ipsilateral superior quadrantanopia
d)
Contralateral homonymous hemianopia
e)
Central scotoma
65.
A patient with infarction of the posterior cerebral artery presents with a contralateral homonymous hemianopia but the central vision is preserved. What explains this finding?
a)
Macular dual blood supply from PCA and MCA
b)
Redundancy of optic chiasm fibers
c)
Preservation of the optic tract
d)
Extra blood flow from anterior choroidal artery
e)
Collateral supply via ophthalmic artery
66.
A patient develops a right Horner's syndrome following a stroke affecting the lateral medulla. Which of the following structures carries the damaged sympathetic fibers?
a)
Descending hypothalamospinal tract
b)
Oculomotor nerve
c)
Facial nerve
d)
Optic tract
e)
Ciliary ganglion
67.
Which of the following reflex pathways involves bilateral stimulation of the Edinger--Westphal nuclei after a unilateral light stimulus?
a)
Pupillary light reflex
b)
Accommodation reflex
c)
Corneal reflex
d)
Blink reflex
e)
Ciliospinal reflex
68.
Which of the following is true about the optic nerve?
a)
Myelinated by oligodendrocytes
b)
Surrounded by epineurium and perineurium
c)
Regenerates after injury
d)
Part of the peripheral nervous system
e)
Formed by bipolar cells of retina
69.
A lesion of the parietal lobe optic radiations will cause which defect?
a)
Contralateral inferior quadrantanopia
b)
Contralateral superior quadrantanopia
c)
Central scotoma
d)
Bitemporal hemianopia
e)
Monocular blindness
70.
Aneurysm of the posterior communicating artery is most likely to compress which structure to cause a contralateral homonymous hemianopia?
a)
Optic tract
b)
Optic chiasm
c)
Lateral geniculate nucleus
d)
Optic nerve
e)
Visual cortex
71.
A 45-year-old man has sudden onset of right inferior quadrantanopia. MRI shows a small infarct in the left temporal lobe. Which structure is most likely affected?
a)
Meyer's loop
b)
Superior optic radiation
c)
Optic tract
d)
Optic chiasm
e)
Visual cortex
72.
A 32-year-old woman has a left afferent pupillary defect (Marcus Gunn pupil). When a light is shone in the left eye, both pupils constrict weakly; when shone in the right eye, both constrict normally. Which structure is affected?
a)
Left optic nerve
b)
Left oculomotor nerve
c)
Right optic nerve
d)
Right Edinger--Westphal nucleus
e)
Left oculomotor nucleus
73.
A 70-year-old with atherosclerosis develops a left homonymous hemianopia with macular sparing. Which artery is most likely occluded?
a)
Right posterior cerebral artery
b)
Left posterior cerebral artery
c)
Right middle cerebral artery
d)
Left anterior cerebral artery
e)
Right anterior choroidal artery
74.
Injury to which artery would most likely cause contralateral homonymous hemianopia without macular sparing?
a)
Anterior choroidal artery
b)
Posterior cerebral artery
c)
Middle cerebral artery
d)
Posterior communicating artery
e)
Anterior cerebral artery
75.
A 50-year-old woman has a pituitary macroadenoma resected. Postoperatively, she complains of loss of vision in the nasal fields of both eyes. Which structure was likely damaged during surgery?
a)
Lateral part of optic chiasm
b)
Medial part of optic chiasm
c)
Right optic tract
d)
Left optic nerve
e)
Optic radiations
76.
A 28-year-old patient has an upper visual field defect in both eyes. MRI shows a lesion in the lower lip of the calcarine fissure. Which fibers terminate here?
a)
Inferior retinal fibers
b)
Superior retinal fibers
c)
Macular fibers
d)
Nasal retinal fibers only
e)
Temporal retinal fibers only
77.
A 40-year-old man with trauma to the neck develops right-sided ptosis, miosis, and anhidrosis. Where is the most likely lesion?
a)
Right sympathetic chain near the apex of the lung
b)
Right oculomotor nerve
c)
Left hypothalamus
d)
Right optic tract
e)
Left superior cervical ganglion
78.
A patient with trauma develops right oculomotor nerve palsy. Which of the following findings would still be intact?
a)
Pupillary constriction in response to light
b)
Accommodation reflex
c)
Lateral gaze of the right eye
d)
Elevation of right eyelid
e)
Convergence of both eyes
79.
A lesion in the left parietal lobe causes visual symptoms. Which defect is most likely?
a)
Right inferior quadrantanopia
b)
Right superior quadrantanopia
c)
Left inferior quadrantanopia
d)
Left homonymous hemianopia
e)
Bilateral central scotoma
80.
A 55-year-old woman has an aneurysm compressing the right posterior communicating artery. She develops a visual field defect and mild ptosis. Which combination best describes the findings?
a)
Left homonymous hemianopia and right ptosis
b)
Right homonymous hemianopia and left ptosis
c)
Bitemporal hemianopia and right ptosis
d)
Right monocular blindness and right ptosis
e)
Left inferior quadrantanopia and right ptosis
81.
Which extraocular muscle is supplied by the trochlear nerve (CN IV)?
a)
Inferior rectus
b)
Medial rectus
c)
Superior oblique
d)
Lateral rectus
e)
Inferior oblique
82.
The primary action of the superior rectus muscle is:
a)
Depression
b)
Elevation
c)
Intorsion
d)
Abduction
e)
Extorsion
83.
In testing the inferior rectus muscle, the eye should first be:
a)
Abducted
b)
Adducted
c)
Elevated
d)
Depressed
e)
In the primary position
84.
A lesion of the right abducent nerve (CN VI) will most likely cause:
a)
Esotropia of the right eye
b)
Exotropia of the right eye
c)
Hypertropia of the right eye
d)
Ptosis of the right eye
e)
Dilated pupil on the right
85.
A patient with right superior oblique palsy will most likely complain of:
a)
Horizontal diplopia
b)
Vertical diplopia
c)
Monocular diplopia
d)
Loss of convergence
e)
Nystagmus
86.
In dextroversion (looking right), which pair of muscles act as yoke muscles?
a)
Right medial rectus & left lateral rectus
b)
Right lateral rectus & left medial rectus
c)
Right inferior rectus & left superior oblique
d)
Right superior rectus & left inferior oblique
e)
Left superior rectus & right inferior oblique
87.
Which of the following features is typical of an oculomotor (CN III) nerve palsy?
a)
Miosis and ptosis
b)
Ptosis and dilated pupil
c)
Intorsion of the eye
d)
Abduction of the affected eye
e)
Pure vertical diplopia
88.
Which condition can produce a 'false localising sign' of sixth nerve palsy?
a)
Diabetes mellitus
b)
Cavernous sinus thrombosis
c)
Raised intracranial pressure
d)
Posterior communicating artery aneurysm
e)
Orbital floor fracture
89.
The nucleus of the abducent nerve (CN VI) is located in which part of the brainstem?
a)
Midbrain at the level of superior colliculus
b)
Midbrain at the level of inferior colliculus
c)
Pons beneath the facial colliculus
d)
Medulla oblongata near the olive
e)
Cerebellopontine angle
90.
In testing extraocular movements using the 'H-pattern,' the superior oblique muscle is best assessed when the eye is:
a)
Abducted and elevated
b)
Abducted and depressed
c)
Adducted and elevated
d)
Adducted and depressed
e)
In primary position
91.
A patient presents with diplopia that worsens when looking down stairs and reading. The right eye shows hypertropia and extorsion in the primary position. Which nerve is most likely affected?
a)
Oculomotor nerve (right)
b)
Abducent nerve (right)
c)
Trochlear nerve (right)
d)
Oculomotor nerve (left)
e)
Abducent nerve (left)
92.
During eye movement testing, the right eye fails to adduct when looking left, but convergence is intact. Where is the lesion?
a)
Right oculomotor nucleus
b)
Left abducent nerve
c)
Right medial longitudinal fasciculus
d)
Left oculomotor nerve
e)
Right abducent nucleus
93.
A diabetic patient presents with a "down and out" eye but a normal pupillary response. What is the most likely underlying cause?
a)
Posterior communicating artery aneurysm
b)
Cavernous sinus thrombosis
c)
Ischaemic microangiopathy of CN III
d)
Uncal herniation
e)
Orbital apex fracture
94.
The superior oblique muscle originates near the orbital apex but changes direction via a trochlea. Its tendon finally inserts:
a)
Below the equator on the inferolateral sclera
b)
Above the equator on the superomedial sclera
c)
Below the equator on the inferomedial sclera
d)
Above the equator on the superolateral sclera
e)
Into the common tendinous ring
95.
A lesion of the right oculomotor nucleus in the midbrain will produce:
a)
Ipsilateral ptosis and contralateral superior rectus weakness
b)
Ipsilateral ptosis and superior oblique paralysis
c)
Bilateral ptosis with pupillary constriction
d)
Contralateral ptosis and ipsilateral abduction deficit
e)
Isolated ipsilateral mydriasis
96.
In which position is the inferior oblique muscle's vertical action (elevation) best tested?
a)
Eye adducted
b)
Eye abducted
c)
Eye in primary position
d)
Eye depressed
e)
Eye elevated
97.
A patient has right eye ptosis, dilated pupil, and eye deviated "down and out." The lesion most likely lies:
a)
Midbrain between posterior cerebral and superior cerebellar arteries
b)
Pons beneath the facial colliculus
c)
Medulla near the olive
d)
Cavernous sinus lateral wall
e)
Orbital floor
98.
Which combination of muscles is tested when examining for dextroelevation (up and right gaze)?
a)
Right superior rectus & left inferior oblique
b)
Right inferior rectus & left superior oblique
c)
Left superior rectus & right inferior oblique
d)
Right lateral rectus & left medial rectus
e)
Left lateral rectus & right medial rectus
99.
In a patient with left sixth nerve palsy due to Foville syndrome, which additional sign is most likely present?
a)
Ipsilateral facial weakness
b)
Contralateral facial weakness
c)
Ipsilateral ptosis
d)
Contralateral miosis
e)
Ipsilateral tongue deviation
100.
A patient with esotropia and failure of abduction in the right eye also has contralateral hemiparesis. The lesion is in:
a)
Midbrain -- Weber syndrome
b)
Midbrain -- Benedict syndrome
c)
Pons -- Millard-Gubler syndrome
d)
Pons -- Foville syndrome
e)
Medulla -- Dejerine syndrome
101.
A seizure is best defined as which of the following?
a)
A chronic disorder causing recurrent unprovoked fits
b)
Abnormal, paroxysmal neuronal discharge causing altered function
c)
Sudden increase in cerebral blood flow
d)
Loss of consciousness due to reduced cerebral perfusion
e)
A sudden increase in intracranial pressure
102.
Epilepsy is defined as:
a)
Any single seizure lasting more than 30 seconds
b)
A transient loss of consciousness with postural tone
c)
Recurrent unprovoked seizures due to an enduring brain predisposition
d)
Abnormal cortical discharges secondary to metabolic imbalance
e)
A febrile seizure in a child
103.
Which of the following best characterises primary generalised seizures?
a)
Focal onset in one hemisphere
b)
Consciousness preserved at onset
c)
Bilateral synchronous onset with immediate loss of consciousness
d)
Begins as focal and spreads bilaterally
e)
Occurs only during sleep
104.
Which of the following features differentiates a complex partial seizure from a simple partial seizure?
a)
Presence of aura
b)
Motor involvement
c)
Alteration or impairment of consciousness
d)
Secondary generalisation
e)
Duration >5 minutes
105.
Todd's paralysis refers to:
a)
Postictal hemiparesis following focal seizures
b)
Preictal aura of motor weakness
c)
Seizure-induced aphasia that persists for weeks
d)
Sudden loss of muscle tone causing falls
e)
Syncope due to cerebral hypoperfusion
106.
Status epilepticus is defined as:
a)
Seizures lasting >30 minutes
b)
Recurrent seizures with full recovery between
c)
Continuous seizure activity lasting >5 minutes
d)
Two or more seizures within 24 hours
e)
Seizure occurring during sleep
107.
Which finding is most specific for non-epileptic seizures (NES)?
a)
Lateral tongue bite
b)
Weeping with eyes closed during episode
c)
Urinary incontinence
d)
Postictal confusion
e)
Prolactin elevation post-event
108.
Which of the following is the most common global cause of secondary epilepsy?
a)
Vascular lesions
b)
Alcohol withdrawal
c)
Infection
d)
Head trauma
e)
Tumour
109.
Which of the following statements about mesial temporal sclerosis (MTS) is TRUE?
a)
It is the least common cause of focal epilepsy
b)
It rarely responds to surgery
c)
It is the commonest cause of intractable temporal lobe epilepsy
d)
It mainly causes generalised seizures
e)
It usually resolves spontaneously
110.
Which patient is most suitable for surgical evaluation?
a)
Seizures controlled with one AED
b)
First-time generalised seizure
c)
Persistent seizures despite ≥3 AEDs
d)
Pseudo-seizures with normal EEG
e)
Febrile seizures in childhood
111.
A 27-year-old man presents with focal seizures that occasionally generalise. Which best describes the underlying mechanism?
a)
Abnormal synchronous depolarisation of cortical neurons
b)
Reduced cerebral perfusion to the occipital cortex
c)
Enhanced parasympathetic activity during REM sleep
d)
Increased production of cerebrospinal fluid
e)
Structural hypoplasia of the basal ganglia
112.
A patient has sudden loss of tone causing a fall but no postictal confusion. EEG shows generalised slow spike-and-wave discharges. What seizure type is this?
a)
Myoclonic
b)
Atonic
c)
Absence
d)
Clonic
e)
Complex partial
113.
A 36-year-old woman has right arm weakness lasting 30 minutes after a left-temporal seizure. What explains this?
a)
Todd's aphasia
b)
Post-ictal migraine
c)
Todd's paresis due to neuronal exhaustion
d)
Cortical haemorrhage
e)
Frontal lobe tumour
114.
A 29-year-old woman presents with "fits" during stress. During one episode, her eyes remain tightly closed and she resists eye opening. What does this most strongly suggest?
a)
Frontal lobe seizure
b)
Complex partial seizure
c)
Absence seizure
d)
Non-epileptic (psychogenic) seizure
e)
Generalised tonic--clonic seizure
115.
A man is suspected to have temporal lobe epilepsy. Which investigation provides the best correlation of clinical behaviour with electrical activity during seizures?
a)
Routine EEG
b)
MRI brain
c)
PET scan
d)
SPECT scan
e)
Continuous video-EEG monitoring
116.
A 40-year-old woman has ongoing tonic--clonic seizures for 8 minutes. IV lorazepam is given with no effect. What is the next step?
a)
Load with IV levetiracetam or phenytoin
b)
Give IM midazolam again
c)
Administer IV valproate and observe
d)
Proceed directly to intubation
e)
Administer phenothiazine
117.
A 31-year-old with intractable temporal lobe epilepsy fails 3 AEDs. Imaging shows hippocampal atrophy. Which surgery offers the highest chance of seizure freedom?
a)
Hemispherectomy
b)
Temporal lobectomy with amygdalohippocampectomy
c)
Corpus callosotomy
d)
Vagus nerve stimulation
e)
Cortical excision of motor cortex
118.
EEG shows a classic 3 Hz spike-and-wave pattern during a brief episode of unresponsiveness in a 9-year-old girl. Which is the likely diagnosis?
a)
Juvenile myoclonic epilepsy
b)
Temporal lobe epilepsy
c)
Absence epilepsy
d)
Psychogenic non-epileptic seizure
e)
Atonic seizure
119.
After anterior corpus callosotomy for drop attacks, a patient develops apathy and difficulty coordinating actions between both hands. What is this complication called?
a)
Todd's paralysis
b)
Gerstmann syndrome
c)
Post-ictal confusion
d)
Disconnection syndrome
e)
Kluver--Bucy syndrome
120.
A 24-year-old woman with generalised epilepsy seeks pregnancy advice. Which statement is most appropriate?
a)
Phenytoin is safe in all trimesters
b)
Carbamazepine causes severe hepatotoxicity in pregnancy
c)
Levetiracetam is absolutely contraindicated
d)
Valproate is teratogenic and should be avoided
e)
Phenobarbital is preferred in women of child-bearing age
121.
Which of the following drugs acts primarily by blocking voltage-gated sodium channels?
a)
Ethosuximide
b)
Vigabatrin
c)
Phenytoin
d)
Tiagabine
e)
Perampanel
122.
Which of the following drugs is most appropriate for absence seizures?
a)
Phenytoin
b)
Carbamazepine
c)
Ethosuximide
d)
Lamotrigine
e)
Phenobarbital
123.
Which statement best describes valproate's mechanism of action?
a)
Inhibits NMDA receptors
b)
Blocks both sodium and T-type calcium channels
c)
Enhances GABA reuptake
d)
Blocks potassium channels
e)
Selectively inhibits AMPA receptors
124.
Which of the following antiepileptics is most associated with enzyme induction via CYP450?
a)
Phenytoin
b)
Valproate
c)
Tiagabine
d)
Ethosuximide
e)
Clonazepam
125.
Which drug is contraindicated in pregnancy due to teratogenicity?
a)
Valproate
b)
Ethosuximide
c)
Carbamazepine
d)
Phenytoin
e)
Vigabatrin
126.
Which of the following drugs is used as an add-on therapy for partial seizures and acts by inhibiting GABA reuptake?
a)
Vigabatrin
b)
Tiagabine
c)
Lamotrigine
d)
Perampanel
e)
Phenobarbital
127.
Which drug causes irreversible visual field defects as a serious side effect?
a)
Phenytoin
b)
Tiagabine
c)
Vigabatrin
d)
Valproate
e)
Lamotrigine
128.
Which of the following drugs acts as a negative allosteric modulator of AMPA receptors?
a)
Lamotrigine
b)
Topiramate
c)
Perampanel
d)
Phenytoin
e)
Ethosuximide
129.
A patient with frequent tonic-clonic seizures is prescribed benzodiazepines for acute control. Which statement is correct?
a)
They act slowly but last long, ideal for maintenance therapy
b)
They enhance the action of GABA at GABA_A receptors
c)
They block NMDA receptors to reduce excitation
d)
They inhibit T-type calcium channels
e)
They irreversibly inhibit GABA transaminase
130.
Which of the following historical treatments for epilepsy is still used in veterinary medicine?
a)
Valproate
b)
Phenobarbital
c)
Potassium bromide
d)
Phenytoin
e)
Ethosuximide
131.
A 35-year-old woman with generalised tonic--clonic seizures is started on an antiepileptic that induces hepatic CYP450 enzymes, leading to failure of her oral contraceptive pill. Which drug is most likely responsible?
a)
Carbamazepine
b)
Valproate
c)
Lamotrigine
d)
Ethosuximide
e)
Levetiracetam
132.
A patient treated for epilepsy develops ataxia, diplopia, and nystagmus. Serum levels are found to be just above the therapeutic range due to saturation kinetics of elimination. Which drug is most likely?
a)
Phenytoin
b)
Phenobarbital
c)
Valproate
d)
Carbamazepine
e)
Tiagabine
133.
A 26-year-old woman with both absence and tonic--clonic seizures requires monotherapy. Which single agent would cover both seizure types?
a)
Valproate
b)
Phenytoin
c)
Ethosuximide
d)
Carbamazepine
e)
Vigabatrin
134.
Which antiepileptic's mechanism involves irreversible inhibition of GABA transaminase?
a)
Vigabatrin
b)
Tiagabine
c)
Perampanel
d)
Phenobarbital
e)
Topiramate
135.
A child with absence seizures worsens after starting a new antiepileptic. Which of the following drugs is most likely to exacerbate absence seizures?
a)
Carbamazepine
b)
Ethosuximide
c)
Valproate
d)
Lamotrigine
e)
Clobazam
136.
Which antiepileptic is most appropriate for acute termination of status epilepticus when intravenous access is unavailable?
a)
Midazolam (buccal)
b)
Carbamazepine (oral)
c)
Valproate (IV)
d)
Tiagabine (oral)
e)
Lamotrigine (sublingual)
137.
A patient on long-term phenobarbital shows increased metabolism of warfarin. This interaction occurs because phenobarbital:
a)
Induces hepatic cytochrome P450 enzymes
b)
Inhibits hepatic cytochrome P450 enzymes
c)
Competes for renal tubular secretion
d)
Inhibits glucuronidation of warfarin
e)
Displaces warfarin from plasma protein binding
138.
Which of the following drugs decreases glutamate release and also acts as a sodium channel blocker?
a)
Lamotrigine
b)
Perampanel
c)
Tiagabine
d)
Ethosuximide
e)
Diazepam
139.
Which of the following mechanisms explains use-dependent sodium channel block seen with phenytoin?
a)
Drug binds preferentially to inactivated sodium channels during repetitive firing
b)
Drug binds equally to resting and inactivated sodium channels
c)
Drug blocks potassium channels during depolarisation
d)
Drug activates GABA_A receptors during hyperpolarisation
e)
Drug inhibits calcium influx into presynaptic terminals
140.
A 29-year-old woman with focal epilepsy is considering pregnancy. Which antiepileptic below is least teratogenic and often preferred in this context?
a)
Lamotrigine
b)
Valproate
c)
Phenytoin
d)
Carbamazepine
e)
Phenobarbital
141.
Which of the following is the most common primary malignant brain tumour in adults?
a)
Meningioma
b)
Medulloblastoma
c)
Glioblastoma
d)
Oligodendroglioma
e)
Ependymoma
142.
Which tumour is most commonly infratentorial in children?
a)
Glioblastoma
b)
Meningioma
c)
Pilocytic astrocytoma
d)
Oligodendroglioma
e)
Lymphoma
143.
Which of the following features is characteristic of glioblastoma histology?
a)
Rosenthal fibres
b)
Perivascular pseudorosettes
c)
Pseudopalisading necrosis
d)
Homer Wright rosettes
e)
Schiller-Duval bodies
144.
Which brain tumour is most likely to be extrinsic to brain parenchyma?
a)
Meningioma
b)
Astrocytoma
c)
Glioblastoma
d)
Medulloblastoma
e)
Oligodendroglioma
145.
Which pair of symptoms best suggests raised intracranial pressure (ICP)?
a)
Diplopia and vertigo
b)
Headache and papilloedema
c)
Aphasia and hemiparesis
d)
Tremor and rigidity
e)
Facial palsy and deafness
146.
Which of the following metastatic cancers most commonly spreads to the brain?
a)
Prostate
b)
Lung
c)
Colon
d)
Thyroid
e)
Bladder
147.
Which WHO grade corresponds to anaplastic astrocytoma?
a)
Grade 1
b)
Grade 2
c)
Grade 3
d)
Grade 4
e)
Grade 5
148.
What is the approximate median survival for glioblastoma despite optimal therapy?
a)
3 months
b)
6 months
c)
12 months
d)
15 months
e)
24 months
149.
Which tumour is most likely benign and slow-growing?
a)
Glioblastoma
b)
Oligodendroglioma
c)
Medulloblastoma
d)
Meningioma
e)
Ependymoma
150.
Which molecular factor predicts better response to temozolomide in glioblastoma?
a)
TP53 mutation
b)
IDH1 mutation
c)
MGMT promoter methylation
d)
EGFR amplification
e)
PTEN deletion
151.
A 62-year-old woman presents with progressive headache, seizures, and left-sided weakness. MRI shows a solitary enhancing mass at the grey--white junction. Which diagnosis is most likely?
a)
Metastasis
b)
Glioblastoma
c)
Oligodendroglioma
d)
Meningioma
e)
Abscess
152.
Which of the following histological features defines high-grade astrocytoma (Grade 4, glioblastoma)?
a)
Cellular pleomorphism only
b)
Necrosis and microvascular proliferation
c)
Rosenthal fibres
d)
Homer-Wright rosettes
e)
Perivascular pseudorosettes
153.
A 10-year-old boy presents with unsteady gait and vomiting. MRI reveals a midline cerebellar mass. Which tumour is most likely?
a)
Medulloblastoma
b)
Craniopharyngioma
c)
Pilocytic astrocytoma
d)
Meningioma
e)
Ependymoma
154.
Which primary cancer most frequently metastasises to the brain?
a)
Lung carcinoma
b)
Breast carcinoma
c)
Melanoma
d)
Renal cell carcinoma
e)
Colorectal carcinoma
155.
A 45-year-old man has seizures. MRI shows a cortical tumour with "fried-egg" appearing cells and calcifications. Which tumour is most likely?
a)
Oligodendroglioma
b)
Astrocytoma
c)
Glioblastoma
d)
Meningioma
e)
Ependymoma
156.
Which WHO grade corresponds to a curable tumour by surgery alone?
a)
Grade 1
b)
Grade 2
c)
Grade 3
d)
Grade 4
e)
Grade 0
157.
Which factor best predicts improved survival in patients with glioblastoma treated with temozolomide?
a)
EGFR amplification
b)
MGMT promoter methylation
c)
IDH1 wild-type status
d)
TP53 mutation
e)
Loss of chromosome 1p/19q
158.
A tumour arising from arachnoid cap cells with calcification and high vascularity most likely is:
a)
Meningioma
b)
Schwannoma
c)
Astrocytoma
d)
Ependymoma
e)
Glioblastoma
159.
Which of the following statements regarding brain metastases is TRUE?
a)
They are less common than primary brain tumours
b)
Usually occur in the brainstem
c)
Often multiple and at the grey--white matter junction
d)
Rarely originate from the lung
e)
Treated primarily with curative surgery
160.
A 68-year-old woman is found to have a supratentorial, dural-based tumour incidentally on MRI. She is asymptomatic. What is the most appropriate next step?
a)
Conservative monitoring with interval MRI
b)
Immediate surgical resection
c)
Whole-brain radiotherapy
d)
Stereotactic radiosurgery
e)
Chemotherapy with temozolomide
161.
Which enzyme catalyses the conversion of dopamine to noradrenaline?
a)
Tyrosine hydroxylase
b)
DOPA decarboxylase
c)
Monoamine oxidase
d)
Dopamine β-hydroxylase
e)
Catechol-O-methyltransferase
162.
Which of the following mechanisms primarily terminates noradrenaline signalling?
a)
Enzymatic degradation in the synaptic cleft
b)
Diffusion away from the synapse
c)
Reuptake into the presynaptic neurone
d)
Uptake into astrocytes
e)
Conversion into adrenaline
163.
What is the main function of presynaptic α₂-adrenergic receptors?
a)
Stimulate vesicle exocytosis
b)
Inhibit further noradrenaline release
c)
Increase postsynaptic receptor sensitivity
d)
Facilitate dopamine reuptake
e)
Promote tyrosine hydroxylation
164.
Which transporter is responsible for high-affinity neuronal uptake of noradrenaline?
a)
DAT
b)
SERT
c)
NET
d)
EMT
e)
VMAT
165.
Which drug inhibits the neuronal uptake of noradrenaline via NET?
a)
Phenylephrine
b)
Cocaine
c)
Clonidine
d)
Doxazosin
e)
Nebivolol
166.
Which enzyme is inhibited by monoamine oxidase inhibitors (MAOIs)?
a)
COMT
b)
Dopamine β-hydroxylase
c)
Monoamine oxidase
d)
Tyrosine hydroxylase
e)
DOPA decarboxylase
167.
Which of the following correctly matches receptor subtype and its major physiological effect?
a)
α₁ -- Bronchodilation
b)
α₂ -- Vasoconstriction
c)
β₁ -- Increased heart rate and contractility
d)
β₂ -- Decreased cardiac output
e)
β₃ -- Increased gastric acid secretion
168.
Which of the following β-agonists is used in asthma management?
a)
Dobutamine
b)
Salbutamol
c)
Metoprolol
d)
Nebivolol
e)
Phenylephrine
169.
Which receptor subtype is targeted by mirabegron in the treatment of overactive bladder?
a)
α₁
b)
α₂
c)
β₁
d)
β₂
e)
β₃
170.
Which statement best describes the extra-neuronal monoamine transporter (EMT)?
a)
High affinity, low capacity
b)
Low affinity, high capacity
c)
Inhibited by tricyclic antidepressants
d)
Exclusively transports dopamine
e)
Located on presynaptic neurones
171.
Inhibition of vesicular monoamine transporter (VMAT) would most directly lead to which effect on noradrenaline transmission?
a)
Decreased storage of noradrenaline in vesicles
b)
Increased release of noradrenaline
c)
Enhanced activation of α₂ autoreceptors
d)
Increased postsynaptic receptor sensitivity
e)
Increased reuptake via NET
172.
Which statement best explains why monoamine oxidase inhibitors (MAOIs) can cause hypertensive crises when combined with tyramine-rich foods?
a)
Tyramine displaces noradrenaline from vesicles
b)
Tyramine increases tyrosine hydroxylase activity
c)
Tyramine inhibits noradrenaline reuptake
d)
Tyramine blocks α₂ autoreceptors
e)
Tyramine stimulates β₃ receptors
173.
A patient is taking a tricyclic antidepressant (TCA). Which mechanism best explains potential cardiovascular side effects?
a)
Inhibition of NET leading to increased synaptic noradrenaline
b)
Blockade of β₁ receptors decreasing cardiac contractility
c)
Activation of α₁ receptors causing vasodilation
d)
Stimulation of β₂ receptors leading to hypotension
e)
Inhibition of MAO leading to catecholamine accumulation
174.
Which adrenergic receptor subtype primarily mediates smooth muscle relaxation in the bladder detrusor muscle?
a)
β₃
b)
β₂
c)
α₁
d)
α₂
e)
β₁
175.
Which of the following drugs acts as a selective α₁-adrenoceptor antagonist used for benign prostatic hyperplasia?
a)
Tamsulosin
b)
Clonidine
c)
Phenylephrine
d)
Nebivolol
e)
Salbutamol
176.
Which of the following correctly describes the pharmacological property of the extra-neuronal monoamine transporter (EMT)?
a)
Low affinity and high capacity
b)
High affinity and low capacity
c)
Inhibited by tricyclic antidepressants
d)
Transports acetylcholine preferentially
e)
Located on presynaptic vesicles
177.
A patient taking clonidine for hypertension experiences rebound hypertension after abrupt withdrawal. What is the most likely cause?
a)
Upregulation of α₁ receptors during therapy
b)
Depletion of noradrenaline stores
c)
Downregulation of β₁ receptors
d)
Accumulation of dopamine in vesicles
e)
Inhibition of MAO
178.
Which of the following best explains why chronic cocaine use can lead to cardiomyopathy?
a)
Excessive β₁ stimulation causing myocardial toxicity
b)
Blockade of α₁ receptors causing ischaemia
c)
Stimulation of β₂ receptors increasing oxygen delivery
d)
Inhibition of DOPA decarboxylase
e)
Activation of α₂ autoreceptors
179.
Which enzyme is predominantly responsible for catecholamine degradation in the periphery rather than the CNS?
a)
Catechol-O-methyltransferase (COMT)
b)
Monoamine oxidase (MAO)
c)
Tyrosine hydroxylase
d)
DOPA decarboxylase
e)
Dopamine β-hydroxylase
180.
During sympathetic activation, which of the following receptor actions contributes most to increased peripheral vascular resistance?
a)
α₁ receptor activation causing vasoconstriction
b)
β₁ receptor activation increasing heart rate
c)
β₂ receptor activation causing vasodilation
d)
α₂ receptor activation inhibiting transmitter release
e)
β₃ receptor activation relaxing detrusor muscle
181.
Which of the following is the main excitatory neurotransmitter in the CNS?
a)
GABA
b)
Glycine
c)
Glutamate
d)
Dopamine
e)
Acetylcholine
182.
Which enzyme converts glutamate to GABA?
a)
Glutaminase
b)
Glutamine synthase
c)
Glutamic acid decarboxylase (GAD)
d)
GABA transaminase
e)
Tyrosine hydroxylase
183.
Which of the following correctly describes NMDA receptor activation?
a)
Requires only glutamate binding
b)
Requires removal of Mg²⁺ block and glycine binding
c)
Activated solely by AMPA receptor activity
d)
Conducts only sodium ions
e)
Blocked by benzodiazepines
184.
Which drug inhibits GABA transaminase?
a)
Tiagabine
b)
Vigabatrin
c)
Baclofen
d)
Perampanel
e)
Ketamine
185.
Which statement best describes the function of GABA_A receptors?
a)
G protein-coupled receptors that increase cAMP
b)
Ligand-gated Cl⁻ channels causing hyperpolarization
c)
Ligand-gated Na⁺ channels causing depolarization
d)
G protein-coupled receptors activating GIRK channels
e)
Ionotropic receptors that increase Ca²⁺ influx
186.
Which of the following acts as an NMDA receptor channel blocker and is used in Alzheimer's disease?
a)
Baclofen
b)
Memantine
c)
Vigabatrin
d)
Muscimol
e)
Flunitrazepam
187.
Which drug increases GABA activity by blocking GABA reuptake transporters (GAT)?
a)
Vigabatrin
b)
Tiagabine
c)
Baclofen
d)
Perampanel
e)
Ketamine
188.
What is the main difference between benzodiazepines and barbiturates in their GABA_A receptor action?
a)
Benzodiazepines act even in absence of GABA
b)
Barbiturates act only when GABA is present
c)
Benzodiazepines only modulate GABA effect; barbiturates can directly activate channel
d)
Both act as inverse agonists at the benzodiazepine site
e)
Barbiturates act on GABA_B receptors
189.
Which of the following statements regarding excitotoxicity is correct?
a)
Caused by excessive GABA release
b)
Involves increased Ca²⁺ influx via NMDA receptors
c)
Mediated by GABA_B receptor activation
d)
Prevented by activation of AMPA receptors
e)
Always reversible
190.
Baclofen acts as:
a)
GABA_A receptor agonist used for insomnia
b)
GABA_B receptor agonist used for spasticity
c)
GABA reuptake inhibitor used for epilepsy
d)
NMDA receptor blocker used in depression
e)
AMPA receptor antagonist used for stroke
191.
Which of the following best explains why NMDA receptors are described as "coincidence detectors"?
a)
They require both ligand binding and postsynaptic depolarisation to activate
b)
They activate in the absence of glutamate if glycine is present
c)
They open whenever AMPA receptors are active
d)
They remain open once magnesium enters the channel
e)
They require ATP to phosphorylate the receptor subunits
192.
Which transporter is responsible for clearing extracellular glutamate from the synaptic cleft?
a)
GAT1
b)
EAAT (Excitatory Amino Acid Transporter)
c)
VMAT2
d)
NET
e)
DAT
193.
Which of the following correctly matches a receptor with its pharmacological modulator?
a)
NMDA receptor -- Tiagabine
b)
GABA_B receptor -- Flunitrazepam
c)
AMPA receptor -- Perampanel
d)
GABA_A receptor -- Memantine
e)
mGluR -- Vigabatrin
194.
During ischemic stroke, which sequence best describes the excitotoxic cascade?
a)
AMPA inhibition → decreased Ca²⁺ → decreased ROS → apoptosis
b)
NMDA activation → decreased intracellular Na⁺ → necrosis
c)
GABA_B activation → Cl⁻ influx → membrane depolarisation
d)
Glutamate release → AMPA depolarisation → NMDA activation → Ca²⁺ influx → free radical formation
e)
Glycine depletion → NMDA inhibition → cell survival
195.
Which enzyme converts glutamate into glutamine within astrocytes?
a)
Glutaminase
b)
Glutamic acid decarboxylase
c)
GABA transaminase
d)
Glutamate dehydrogenase
e)
Glutamine synthetase
196.
Which of the following best explains why barbiturates carry a higher risk of fatal overdose than benzodiazepines?
a)
They can directly activate GABA_A receptors in absence of GABA
b)
They are irreversible GABA_A antagonists
c)
They competitively inhibit benzodiazepine binding sites
d)
They are metabolised more rapidly than benzodiazepines
e)
They are selective for GABA_B rather than GABA_A receptors
197.
Baclofen acts primarily by which of the following mechanisms?
a)
Activation of ligand-gated chloride channels
b)
Activation of G protein--coupled receptors linked to inhibition of adenylyl cyclase
c)
Inhibition of glutamate release via NMDA receptor antagonism
d)
Blocking GABA reuptake via GAT1 inhibition
e)
Activation of metabotropic glutamate receptors
198.
Which statement correctly describes the difference between ionotropic and metabotropic glutamate receptors?
a)
Both are ligand-gated ion channels but differ in selectivity
b)
Ionotropic receptors mediate slower responses than metabotropic
c)
Metabotropic receptors are GPCRs mediating slower, modulatory effects
d)
Ionotropic receptors are exclusively presynaptic
e)
Metabotropic receptors are blocked by ketamine
199.
Which of the following is an endogenous co-agonist required for NMDA receptor activation?
a)
D-aspartate
b)
Adenosine
c)
Tyrosine
d)
Glycine
e)
Dopamine
200.
Which statement best explains why benzodiazepines are considered safer than barbiturates for sedation?
a)
They bind NMDA receptors instead of GABA receptors
b)
They produce irreversible receptor activation
c)
They directly open GABA channels even without GABA
d)
They have longer half-lives and slower clearance
e)
They only enhance GABA activity in the presence of GABA
201.
Which of the following neurotransmitters is primarily synthesised from the amino acid tyrosine?
a)
Serotonin
b)
Dopamine
c)
GABA
d)
Acetylcholine
e)
Glutamate
202.
Which enzyme converts dopamine into noradrenaline?
a)
Tyrosine hydroxylase
b)
Aromatic L-amino acid decarboxylase
c)
Dopamine β-hydroxylase
d)
Monoamine oxidase
e)
Phenylethanolamine N-methyltransferase
203.
Which neurotransmitter is synthesised from tryptophan?
a)
Dopamine
b)
Noradrenaline
c)
Serotonin
d)
Adrenaline
e)
Histamine
204.
Which of the following statements about monoamine uptake is correct?
a)
Monoamines are mainly removed by enzymatic degradation.
b)
Noradrenaline uptake occurs via SERT.
c)
Dopamine uptake occurs via DAT.
d)
Serotonin uptake occurs via NET.
e)
Uptake mechanisms are unrelated to drug selectivity.
205.
Which monoamine oxidase (MAO) isoform primarily metabolises dopamine?
a)
MAO-A only
b)
MAO-B only
c)
Both MAO-A and MAO-B
d)
COMT
e)
PNMT
206.
Which dopamine receptor subtype is Gs coupled and increases cAMP?
a)
D1
b)
D2
c)
D3
d)
D4
e)
D5
207.
D2 receptor antagonism is most likely to cause which endocrine effect?
a)
Decreased prolactin secretion
b)
Increased prolactin secretion
c)
Increased cortisol release
d)
Decreased TSH release
e)
Increased growth hormone release
208.
Which serotonin receptor subtype is an ion channel rather than a GPCR?
a)
5-HT1A
b)
5-HT2A
c)
5-HT3
d)
5-HT5
e)
5-HT7
209.
Sumatriptan acts primarily as an agonist at which receptor subtype?
a)
5-HT1A
b)
5-HT1B/1D
c)
5-HT2A
d)
5-HT3
e)
5-HT4
210.
Which of the following drugs is most likely to act as a D2 receptor agonist in the treatment of Parkinson's disease?
a)
Haloperidol
b)
Clozapine
c)
Bromocriptine
d)
Fluoxetine
e)
Sumatriptan
211.
A drug that inhibits aromatic L-amino acid decarboxylase but does not cross the blood--brain barrier will have which of the following effects?
a)
Reduce peripheral dopamine synthesis but preserve central dopamine synthesis
b)
Inhibit both central and peripheral dopamine synthesis
c)
Increase peripheral noradrenaline levels
d)
Increase central serotonin synthesis
e)
Enhance conversion of tyrosine to DOPA
212.
Which of the following receptor types is found only on postsynaptic membranes?
a)
D1
b)
D2
c)
D3
d)
D4
e)
5-HT1B
213.
A patient taking a MAO-B inhibitor would show increased levels of which neurotransmitter most selectively?
a)
Dopamine
b)
Noradrenaline
c)
Serotonin
d)
Acetylcholine
e)
Glutamate
214.
An experimental drug acts as an inverse agonist at D2 receptors. Which effect is most likely?
a)
Increased cAMP levels
b)
Reduced cAMP levels
c)
Enhanced prolactin inhibition
d)
Reduced presynaptic inhibition
e)
Potentiation of dopaminergic signalling
215.
Which transporter is primarily responsible for non-neuronal uptake of monoamines such as dopamine and noradrenaline?
a)
ENT
b)
DAT
c)
NET
d)
SERT
e)
VMAT
216.
A drug that blocks 5-HT2A receptors would most likely reduce which of the following?
a)
LSD-induced hallucinations
b)
Migraine aura
c)
Chemotherapy-induced vomiting
d)
Anxiety mediated by 5-HT1A
e)
Cortisol secretion
217.
Which of the following best explains why some beta-blockers can cause depression?
a)
They cross the BBB and block central adrenergic receptors
b)
They increase serotonin reuptake
c)
They block dopamine D2 receptors
d)
They enhance GABAergic transmission
e)
They reduce noradrenaline synthesis in peripheral nerves only
218.
Which enzyme determines whether a noradrenergic neuron can also synthesise adrenaline?
a)
Phenylethanolamine N-methyltransferase
b)
Tyrosine hydroxylase
c)
Monoamine oxidase A
d)
Dopamine β-hydroxylase
e)
Aromatic L-amino acid decarboxylase
219.
A patient taking fluoxetine develops sexual dysfunction. This is most likely due to increased activation of which receptor subtype?
a)
5-HT2
b)
5-HT1A
c)
5-HT1B
d)
5-HT3
e)
5-HT4
220.
Which of the following receptor--drug pairs is correctly matched for therapeutic use?
a)
5-HT3 antagonist -- antiemetic
b)
D2 antagonist -- Parkinson's disease
c)
5-HT1B/1D antagonist -- migraine
d)
D1 agonist -- schizophrenia
e)
D4 antagonist -- ADHD
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