WorksheetsGEM 8.02
Total questions: 170
Worksheet time: 3hrs 50mins
Name
Class
Date
1.
Which artery primarily supplies the medial surface of the cerebral hemisphere, including the motor and sensory areas of the lower limb?
a)
Middle cerebral artery
b)
Anterior cerebral artery
c)
Posterior cerebral artery
d)
Anterior choroidal artery
e)
Superior cerebellar artery
2.
Occlusion of the middle cerebral artery (MCA) in the dominant hemisphere most commonly causes:
a)
Contralateral leg weakness
b)
Contralateral arm and face weakness with aphasia
c)
Ipsilateral facial weakness
d)
Bilateral leg paralysis
e)
Contralateral visual neglect
3.
The posterior cerebral artery (PCA) is a direct branch of which artery?
a)
Internal carotid artery
b)
Basilar artery
c)
Vertebral artery
d)
Middle cerebral artery
e)
Posterior communicating artery
4.
Which of the following arteries supplies the choroid plexus of the lateral ventricle?
a)
Posterior cerebral artery
b)
Anterior choroidal artery
c)
Posterior inferior cerebellar artery
d)
Anterior communicating artery
e)
Superior cerebellar artery
5.
A lesion of the posterior cerebral artery typically produces which visual defect?
a)
Bitemporal hemianopia
b)
Contralateral homonymous hemianopia with macular sparing
c)
Contralateral superior quadrantanopia
d)
Ipsilateral monocular blindness
e)
Tunnel vision
6.
Occlusion of the posterior inferior cerebellar artery (PICA) most likely results in:
a)
Lateral medullary (Wallenberg) syndrome
b)
Medial medullary syndrome
c)
Locked-in syndrome
d)
Weber's syndrome
e)
Pure motor stroke
7.
The circle of Willis provides collateral circulation between which two arterial systems?
a)
External and internal carotid systems
b)
Vertebral and basilar systems
c)
Internal carotid and vertebrobasilar systems
d)
Subclavian and carotid systems
e)
Middle and posterior cerebral systems only
8.
Occlusion of the anterior spinal artery typically causes:
a)
Loss of vibration and proprioception bilaterally
b)
Ipsilateral loss of pain and temperature
c)
Bilateral motor paralysis with loss of pain and temperature
d)
Contralateral hemiplegia only
e)
Sensory ataxia without motor weakness
9.
Which artery most commonly contributes to the anterior spinal artery below the T8 level?
a)
Posterior spinal artery
b)
Great anterior radiculomedullary artery (of Adamkiewicz)
c)
Lumbar artery
d)
Anterior inferior cerebellar artery
e)
Vertebral artery
10.
A saccular aneurysm at the junction of the posterior communicating artery and internal carotid artery most likely compresses which cranial nerve?
a)
Optic nerve (CN II)
b)
Oculomotor nerve (CN III)
c)
Trochlear nerve (CN IV)
d)
Abducens nerve (CN VI)
e)
Trigeminal nerve (CN V)
11.
The internal carotid artery passes through all the following structures EXCEPT:
a)
Carotid canal
b)
Cavernous sinus
c)
Foramen lacerum
d)
Petrous part of temporal bone
e)
Foramen ovale
12.
Occlusion of the anterior choroidal artery most likely causes which deficit pattern?
a)
Contralateral lower limb paralysis only
b)
Contralateral hemiplegia, hemianesthesia, and homonymous hemianopia
c)
Ipsilateral facial paralysis and hearing loss
d)
Bilateral limb ataxia
e)
Contralateral loss of proprioception only
13.
Which artery's occlusion would most likely produce pure motor lacunar stroke?
a)
Lateral striate arteries
b)
Anterior spinal artery
c)
Posterior cerebral artery
d)
Anterior inferior cerebellar artery
e)
Anterior cerebral artery
14.
A patient presents with left-sided facial paralysis and hearing loss with vertigo. The lesion is most likely due to occlusion of which artery?
a)
Anterior inferior cerebellar artery
b)
Posterior inferior cerebellar artery
c)
Superior cerebellar artery
d)
Posterior cerebral artery
e)
Basilar artery
15.
The most common site of berry aneurysm formation in the circle of Willis is:
a)
Junction of anterior communicating and anterior cerebral arteries
b)
Junction of posterior communicating and internal carotid arteries
c)
Bifurcation of the basilar artery
d)
Origin of the middle cerebral artery
e)
Junction of vertebral and basilar arteries
16.
The posterior spinal arteries typically arise from which source?
a)
Vertebral artery or posterior inferior cerebellar artery
b)
Basilar artery
c)
Anterior spinal artery
d)
Internal carotid artery
e)
Middle meningeal artery
17.
A right PCA infarct involving the fusiform gyrus most likely results in:
a)
Left homonymous hemianopia with macular sparing
b)
Prosopagnosia (inability to recognise faces)
c)
Alexia without agraphia
d)
Akinetopsia (motion blindness)
e)
Visual neglect
18.
Which artery supplies the inferior surface of the cerebellum and the dorsolateral medulla?
a)
Posterior inferior cerebellar artery
b)
Anterior inferior cerebellar artery
c)
Superior cerebellar artery
d)
Basilar artery
e)
Labyrinthine artery
19.
Which statement best describes the function of the posterior communicating artery?
a)
Connects anterior cerebral arteries
b)
Connects internal carotid and posterior cerebral arteries
c)
Connects vertebral arteries
d)
Connects basilar artery and anterior spinal artery
e)
Connects middle cerebral arteries
20.
A patient presents with sudden bilateral loss of proprioception and vibration sense but preserved motor power. Which vessel is most likely affected?
a)
Posterior spinal arteries
b)
Anterior spinal artery
c)
Vertebral arteries
d)
Basilar artery
e)
Radicular arteries
21.
Which meningeal layer is tightly adherent to the surface of the brain?
a)
Dura mater
b)
Arachnoid mater
c)
Pia mater
d)
Periosteal layer
e)
Falx cerebri
22.
The potential space between dura mater and arachnoid mater is called the:
a)
Subarachnoid space
b)
Subdural space
c)
Epidural space
d)
Arachnoid villi
e)
Periosteal cavity
23.
Cerebrospinal fluid (CSF) is produced mainly by the:
a)
Pia mater alone
b)
Arachnoid granulations
c)
Choroid plexus
d)
Dural venous sinuses
e)
Central canal
24.
The lateral ventricles communicate with the third ventricle via the:
a)
Foramen of Luschka
b)
Cerebral aqueduct
c)
Foramen of Monro
d)
Foramen of Magendie
e)
Interpeduncular cistern
25.
The fourth ventricle is located between which two structures?
a)
Thalamus and hypothalamus
b)
Cerebrum and cerebellum
c)
Pons/medulla and cerebellum
d)
Corpus callosum and midbrain
e)
Pituitary gland and pons
26.
Cerebrospinal fluid is reabsorbed into the venous circulation via:
a)
Cerebral aqueduct
b)
Foramen of Magendie
c)
Arachnoid granulations
d)
Central canal
e)
Superior sagittal artery
27.
The falx cerebri is formed by which meningeal layer?
a)
Periosteal layer of dura
b)
Meningeal layer of dura
c)
Arachnoid mater
d)
Pia mater
e)
Aponeurotic layer of scalp
28.
Which vessel is most commonly injured in an extradural (epidural) hematoma?
a)
Middle meningeal artery
b)
Superior sagittal sinus
c)
Bridging veins
d)
Posterior cerebral artery
e)
Internal carotid artery
29.
Which of the following statements about the cavernous sinus is TRUE?
a)
It contains the optic nerve
b)
It is an air-filled sinus
c)
It drains into the vertebral venous plexus only
d)
It contains the internal carotid artery and cranial nerves III, IV, V1, V2, VI
e)
It lies posterior to the occipital bone
30.
Which type of intracranial hemorrhage typically shows a crescent (concave) shape on CT?
a)
Extradural hematoma
b)
Subdural hematoma
c)
Subarachnoid hemorrhage
d)
Intracerebral hemorrhage
e)
Epidural hematoma
31.
Which statement best explains why pain from meningitis can be referred to the scalp or face?
a)
The dura mater is supplied by branches of the trigeminal nerve
b)
The pia mater contains pain-sensitive nociceptors
c)
The arachnoid mater receives sensory fibres from C1
d)
The falx cerebri is innervated by the facial nerve
e)
The tentorium cerebelli has autonomic innervation
32.
In the spinal meninges, the denticulate ligaments are formed by which structure?
a)
Pia mater
b)
Arachnoid mater
c)
Dura mater
d)
Filum terminale externum
e)
Ligamentum flavum
33.
A lesion occluding the cerebral aqueduct would most likely cause dilation of which ventricles?
a)
Lateral and third ventricles
b)
Only the fourth ventricle
c)
Only the third ventricle
d)
Third and fourth ventricles
e)
Lateral and fourth ventricles
34.
The foramen of Luschka directly connects the fourth ventricle with:
a)
Lateral subarachnoid cisterns
b)
Central canal
c)
Superior sagittal sinus
d)
Interpeduncular cistern
e)
Third ventricle
35.
Which dural venous sinus lies at the junction of the falx cerebri and tentorium cerebelli?
a)
Straight sinus
b)
Inferior sagittal sinus
c)
Transverse sinus
d)
Occipital sinus
e)
Cavernous sinus
36.
The confluence of sinuses typically receives blood from all of the following EXCEPT:
a)
Superior sagittal sinus
b)
Straight sinus
c)
Occipital sinus
d)
Cavernous sinus
e)
Inferior sagittal sinus
37.
Which feature most accurately differentiates subarachnoid haemorrhage from subdural haemorrhage on CT?
a)
Subarachnoid blood conforms to sulci and cisterns
b)
Subarachnoid blood appears lentiform (biconvex)
c)
Subdural blood is restricted by suture lines
d)
Subdural haemorrhage fills basal cisterns
e)
Subarachnoid haemorrhage shows midline shift early
38.
The tentorium cerebelli separates:
a)
Cerebellum from occipital bone
b)
Cerebellum from cerebrum
c)
Right and left cerebral hemispheres
d)
Pituitary gland from hypothalamus
e)
Midbrain from pons
39.
A fracture at the pterion risks injury to which artery, potentially causing an epidural haematoma?
a)
Middle meningeal artery
b)
Anterior cerebral artery
c)
Posterior communicating artery
d)
Superior cerebellar artery
e)
Inferior sagittal sinus
40.
Which cranial nerve is most likely affected first in cavernous sinus thrombosis?
a)
Abducens nerve (CN VI)
b)
Optic nerve (CN II)
c)
Trochlear nerve (CN IV)
d)
Maxillary nerve (CN V2)
e)
Oculomotor nerve (CN III)
41.
Which of the following correctly lists the layers of the scalp from superficial to deep?
a)
Skin → Loose connective tissue → Aponeurosis → Dense connective tissue → Pericranium
b)
Skin → Dense connective tissue → Aponeurosis → Loose connective tissue → Pericranium
c)
Skin → Pericranium → Loose connective tissue → Aponeurosis → Dense connective tissue
d)
Dense connective tissue → Skin → Aponeurosis → Pericranium → Loose connective tissue
e)
Skin → Aponeurosis → Dense connective tissue → Loose connective tissue → Pericranium
42.
The loose connective tissue layer of the scalp is clinically important because:
a)
It contains sebaceous glands
b)
It provides attachment for muscles
c)
It is a potential space for spread of infection
d)
It contains periosteal arteries
e)
It contains hair follicles
43.
The superior sagittal sinus lies within which dural reflection?
a)
Falx cerebri
b)
Tentorium cerebelli
c)
Falx cerebelli
d)
Diaphragma sellae
e)
Straight sinus
44.
The meningeal and periosteal layers of the dura mater separate to form:
a)
Subdural space
b)
Dural venous sinuses
c)
Subarachnoid space
d)
Epidural space
e)
Arachnoid villi
45.
Which sinus receives venous blood from the superior sagittal, straight, and occipital sinuses?
a)
Cavernous sinus
b)
Sigmoid sinus
c)
Confluence of sinuses
d)
Transverse sinus
e)
Inferior sagittal sinus
46.
Which cranial nerve is most commonly affected in cavernous sinus thrombosis?
a)
CN II
b)
CN III
c)
CN IV
d)
CN VI
e)
CN V3
47.
The emissary veins are clinically significant because they:
a)
Contain valves preventing retrograde flow
b)
Drain CSF from arachnoid villi
c)
Connect extracranial and intracranial venous systems
d)
Supply the dura mater
e)
Drain into vertebral venous plexus only
48.
An extradural (epidural) haematoma is most commonly due to rupture of which vessel?
a)
Middle meningeal artery
b)
Superior sagittal sinus
c)
Bridging veins
d)
Anterior cerebral artery
e)
Internal carotid artery
49.
Which type of intracranial haemorrhage typically shows midline shift due to venous bleeding between dura and arachnoid?
a)
Extradural
b)
Subdural
c)
Subarachnoid
d)
Intracerebral
e)
Intraventricular
50.
The tentorium cerebelli separates:
a)
Two cerebral hemispheres
b)
Cerebrum from cerebellum
c)
Pituitary gland from cerebrum
d)
Cerebellum from brainstem
e)
Frontal from parietal lobes
51.
A 22-year-old man sustains a temporal bone fracture. A CT scan shows a biconvex hyperdensity that does not cross suture lines. Which vessel is most likely injured?
a)
Middle meningeal artery
b)
Bridging veins
c)
Superior sagittal sinus
d)
Internal carotid artery
e)
Middle cerebral artery
52.
Which of the following dural reflections covers the pituitary gland within the sella turcica?
a)
Falx cerebri
b)
Diaphragma sellae
c)
Tentorium cerebelli
d)
Falx cerebelli
e)
Confluence of sinuses
53.
A patient with facial infection in the "danger triangle" develops ophthalmoplegia and proptosis. Which structure most likely transmits the infection intracranially?
a)
Middle meningeal artery
b)
Anterior cerebral vein
c)
Ophthalmic veins
d)
Diploic veins
e)
Internal carotid artery
54.
Which cranial nerves pass through the lateral wall of the cavernous sinus?
a)
II, III, VI
b)
III, IV, VI
c)
V1, V2, VI
d)
III, IV, V1, V2
e)
III, IV, V3, VI
55.
Which venous sinus directly drains into the internal jugular vein through the jugular foramen?
a)
Transverse sinus
b)
Confluence of sinuses
c)
Cavernous sinus
d)
Straight sinus
e)
Sigmoid sinus
56.
Which space is a potential space in the healthy individual but may contain blood following rupture of bridging veins?
a)
Subdural space
b)
Epidural space
c)
Subarachnoid space
d)
Intracerebral space
e)
Ventricular space
57.
Increased CSF within the ventricles due to impaired absorption by arachnoid granulations leads to:
a)
Intracerebral haemorrhage
b)
Communicating hydrocephalus
c)
Non-communicating hydrocephalus
d)
Subdural haematoma
e)
Raised intracranial pressure from mass lesion
58.
The falx cerebri attaches inferiorly to which of the following structures?
a)
Tentorium cerebelli
b)
Foramen magnum
c)
Crista galli
d)
Tentorium cerebelli and internal occipital crest
e)
Diaphragma sellae
59.
A patient with a subarachnoid haemorrhage most likely has bleeding located between:
a)
Dura mater and skull
b)
Dura mater and arachnoid mater
c)
Arachnoid mater and pia mater
d)
Pia mater and brain tissue
e)
Periosteum and bone
60.
Which feature best distinguishes a venous dural sinus from systemic veins?
a)
Possesses muscular walls
b)
Contains valves to prevent backflow
c)
Lined by endocardium
d)
Lies within subarachnoid space
e)
Lacks valves and muscular tissue
61.
Which of the following scientists is correctly associated with first introducing the term "blood-brain barrier"?
a)
Paul Ehrlich
b)
Lina Stern
c)
Rudolf Virchow
d)
Carl Weigert
e)
Hans Berger
62.
Paul Ehrlich's experiments with trypan blue dye demonstrated what about the brain?
a)
The brain tissue avidly absorbed blue dye
b)
Brain and spinal cord stained more intensely than other tissues
c)
Brain tissue was impermeable to the dye
d)
Trypan blue selectively bound to neuronal membranes
e)
Brain capillaries contained fenestrations
63.
Which of the following structural features is unique to brain capillaries compared to systemic capillaries?
a)
Presence of fenestrations
b)
Extensive transcytosis
c)
Tight junctions between endothelial cells
d)
High permeability to charged molecules
e)
Absence of basement membrane
64.
Which cell type contributes "end-feet" processes that enclose brain capillaries?
a)
Oligodendrocytes
b)
Microglia
c)
Astrocytes
d)
Neurons
e)
Ependymal cells
65.
Which of the following substances crosses the blood-brain barrier most easily under normal conditions?
a)
Glucose
b)
Potassium ions
c)
Albumin
d)
Oxygen
e)
Dopamine
66.
Which of the following brain regions lacks a complete blood-brain barrier?
a)
Primary motor cortex
b)
Hippocampus
c)
Area postrema
d)
Cerebellar cortex
e)
Thalamus
67.
The chemoreceptor trigger zone (CTZ) is clinically significant because:
a)
It mediates the blood–CSF barrier
b)
It allows hormones to cross into systemic circulation
c)
It detects circulating emetogenic substances
d)
It regulates cerebral blood flow
e)
It maintains the ionic composition of brain ECF
68.
Which of the following best describes the main function of the blood-brain barrier?
a)
Facilitates unrestricted nutrient exchange
b)
Allows free passage of all neurotransmitters
c)
Maintains stable extracellular environment for neurons
d)
Increases brain perfusion pressure
e)
Promotes immune cell entry into CNS
69.
Which statement about the ionic regulation by the blood-brain barrier is correct?
a)
Brain extracellular K⁺ fluctuates widely with plasma levels
b)
The BBB maintains tighter control of Na⁺ and K⁺ than systemic capillaries
c)
Astrocytes are not involved in ion regulation
d)
Glutamate and GABA freely diffuse across the BBB
e)
BBB permeability increases during normal neuronal activity
70.
Which of the following changes is most likely to disrupt the blood-brain barrier?
a)
Increased CO₂ in blood
b)
Sleep
c)
Systemic infection and inflammation
d)
Normal ageing
e)
Exercise
71.
Which of the following mechanisms primarily limits paracellular diffusion across the blood–brain barrier?
a)
Tight junctions between endothelial cells
b)
Astrocyte end-foot processes
c)
Pericyte contractility
d)
Thickened basement membrane
e)
Pinocytotic vesicle reduction
72.
Which of the following transport mechanisms is most responsible for glucose entry into the brain?
a)
GLUT1-mediated facilitated diffusion
b)
Na⁺-glucose cotransporter (SGLT1)
c)
Simple diffusion through lipid bilayer
d)
Active transport via ATPase
e)
Endocytosis followed by vesicular release
73.
A lipid-soluble drug is observed to rapidly cross the BBB. Which property most likely accounts for this?
a)
High molecular weight
b)
Ionized at physiological pH
c)
High lipid solubility
d)
Protein binding in plasma
e)
Polar hydroxyl groups
74.
Damage to the blood–brain barrier is most likely to result in which physiological consequence?
a)
Cerebral oedema due to plasma protein leakage
b)
Reduced intracranial pressure
c)
Increased oxygen diffusion into brain
d)
Decreased CSF production
e)
Enhanced glucose uptake
75.
Which of the following correctly matches a circumventricular organ with its physiological role?
a)
Subfornical organ -- osmotic regulation and thirst
b)
Pineal gland -- motor coordination
c)
Median eminence -- vision
d)
Area postrema -- circadian rhythm regulation
e)
Posterior pituitary -- immune surveillance
76.
During meningitis, increased BBB permeability occurs due to:
a)
Cytokine-mediated disruption of tight junctions
b)
Reduced astrocyte activity
c)
Increased expression of GLUT1
d)
Enhanced lipid solubility of bacterial toxins
e)
Increased oxygen consumption by neurons
77.
Which of the following neuropharmacological properties is most important for a drug targeting central dopamine receptors?
a)
Ability to cross BBB via passive diffusion
b)
High plasma protein binding
c)
Strong affinity for P-glycoprotein efflux transporter
d)
Ionized at physiological pH
e)
Metabolized by peripheral monoamine oxidase
78.
Which of the following statements about astrocytes in the BBB is true?
a)
They form tight junctions between endothelial cells
b)
They regulate endothelial permeability via paracrine signals
c)
They actively transport glucose into neurons
d)
They synthesize basement membrane proteins exclusively
e)
They produce cerebrospinal fluid directly
79.
Which of the following would increase drug delivery across the BBB without damaging its structure?
a)
Using a lipid-soluble prodrug
b)
Inducing local inflammation
c)
Hyperosmotic mannitol infusion
d)
Inhibiting astrocyte metabolism
e)
Disrupting tight junction proteins
80.
In the context of the BBB, P-glycoprotein (P-gp) functions primarily to:
a)
Efflux lipophilic xenobiotics from endothelial cells
b)
Transport glucose into the brain
c)
Facilitate water movement
d)
Mediate receptor endocytosis
e)
Transport amino acids into neurons
81.
Which structural feature of cerebral capillaries chiefly prevents paracellular passage of hydrophilic drugs?
a)
Fenestrations
b)
Gap junctions
c)
Tight junctions
d)
Caveolae
e)
Pinocytotic vesicles
82.
Primary route for water movement across BBB endothelium?
a)
Passive diffusion through membrane
b)
Aquaporin channels
c)
Vesicular transcytosis
d)
Gap junctions
e)
Paracellular flow
83.
Which gas-linked parameter do central chemoreceptors actually detect?
a)
Arterial PCO₂ directly
b)
Arterial PO₂ directly
c)
CSF pH changes
d)
Plasma HCO₃⁻
e)
Mixed venous CO₂
84.
Which drug property most favours passive diffusion across BBB?
a)
Large MW and hydrophilic
b)
Strongly ionised at pH 7.4
c)
High lipid solubility
d)
P-gp substrate
e)
Substrate of MAO
85.
Why does heroin enter brain faster than morphine?
a)
Smaller molecular mass
b)
Greater lipophilicity
c)
P-gp inhibition
d)
Uses System L
e)
Ion trapping in CSF
86.
Why is gentamicin poor for CNS in intact BBB?
a)
Strong P-gp substrate
b)
Highly lipophilic
c)
Hydrophilic and excluded
d)
Eliminated by liver first-pass
e)
Vesicular transcytosis only
87.
Why must L-dopa be given instead of dopamine in Parkinson's?
a)
Dopamine causes seizures
b)
Dopamine cannot enter brain
c)
L-dopa inhibits MAO in CNS
d)
L-dopa is hydrophilic
e)
Dopamine effluxed by albumin
88.
System L transporter at BBB carries which drug family?
a)
β-lactam antibiotics
b)
HIV protease inhibitors
c)
GABA analogues (e.g. gabapentin)
d)
P-gp substrates
e)
Haloperidol
89.
Which describes P-glycoprotein at BBB?
a)
Na⁺-driven symporter
b)
Facilitated diffusion carrier
c)
Vesicular transporter
d)
ATP-dependent efflux pump
e)
Tight junction protein
90.
In meningitis tight junctions open. Which consequence is most relevant clinically?
a)
Raised CSF Na⁺
b)
Higher antibiotic CNS penetration
c)
Lower CSF pH
d)
Reduced drug efflux
e)
Impaired transcytosis
91.
In the context of CNS drug delivery, the dominant advantage of using L-dopa rather than a dopamine agonist is:
a)
It exploits an endogenous nutrient transporter
b)
It is not a P-gp substrate
c)
It directly inhibits MAO inside endothelium
d)
It is fully unionised at physiological pH
e)
It avoids first-pass metabolism
92.
Which situation most likely increases CNS accumulation of a lipophilic drug that is a P-gp substrate?
a)
Systemic P-gp inhibition
b)
Protein binding in blood increases
c)
Hepatic enzyme induction
d)
Efflux transporter polymorphism → gain of function
e)
Acute rise in CSF pH
93.
Which specific transport class does the glucose transporter across the BBB belong to?
a)
SLC --- facilitative carrier
b)
ABC --- ATP-driven pump
c)
Ionotropic channel
d)
Caveolar endocytosis
e)
Tight junction complex
94.
Which best explains why loperamide has no central opioid effect?
a)
Strong P-gp efflux from endothelium
b)
It is fully ionised in blood
c)
It is hydrolysed by MAO in endothelium
d)
It is excluded by tight junction size filter
e)
It cannot cross enterocytes
95.
Which mechanism is used by insulin to cross the BBB?
a)
Receptor-mediated transcytosis
b)
Paracellular aqueous leak
c)
SLC superfamily influx
d)
Simple diffusion
e)
ABC efflux
96.
Which class best describes P-glycoprotein?
a)
ABC transporter
b)
SLC transporter
c)
Gap-junction channel
d)
Clathrin adaptor
e)
Carbonic anhydrase cofactor
97.
A highly lipophilic drug reaches the endothelium and diffuses in, but is rapidly returned to blood. Which is the key named phenomenon limiting brain exposure?
a)
ABC efflux
b)
Enhanced caveolar transcytosis
c)
Tight-junction restriction
d)
Pericyte contraction
e)
Aquaporin competition
98.
Which factor best explains patient-to-patient loss of anticonvulsant efficacy with chronic therapy despite unchanged dosing?
a)
Induction of efflux pumps in BBB
b)
Reduced hepatic extraction ratio
c)
Higher albumin affinity develops
d)
System L saturation
e)
Glymphatic clearance increase
99.
Which correctly matches family → energetic coupling?
a)
SLC --- secondary active / facilitative
b)
ABC --- facilitative only
c)
Aquaporin --- primary active
d)
System L --- directly ATP-driven
e)
Glut transporter --- primary active
100.
After bacterial meningitis, a patient receives high-dose IV gentamicin. Mechanism permitting CNS entry in the acute phase?
a)
Inflammation-induced tight-junction failure
b)
P-gp blockade by cytokines
c)
Caveolar up-regulation
d)
Enhanced System L flux
e)
Carbonic anhydrase activation
101.
Which cranial nerve carries sensory information from the olfactory epithelium to the brain?
a)
Optic nerve (CN II)
b)
Olfactory nerve (CN I)
c)
Trigeminal nerve (CN V)
d)
Facial nerve (CN VII)
e)
Glossopharyngeal nerve (CN IX)
102.
Where is the olfactory epithelium located?
a)
Frontal sinus
b)
Nasopharynx
c)
Inferior nasal concha
d)
Roof of the nasal cavity beneath the cribriform plate
e)
Maxillary sinus
103.
Which type of cell in the olfactory epithelium is capable of regenerating olfactory sensory neurones?
a)
Supporting cells
b)
Basal cells
c)
Mitral cells
d)
Periglomerular cells
e)
Granule cells
104.
Which structure contains perforations allowing passage of olfactory nerve fibres?
a)
Cribriform plate of the ethmoid bone
b)
Foramen ovale
c)
Foramen rotundum
d)
Jugular foramen
e)
Internal acoustic meatus
105.
Which statement best describes olfaction as a sensory modality?
a)
It is a mechanoreceptive sense.
b)
It is a thermoreceptive sense.
c)
It is a chemoreceptive sense.
d)
It is a photoreceptive sense.
e)
It is a proprioceptive sense.
106.
Which cells in the olfactory bulb receive direct input from olfactory sensory neurones?
a)
Granule cells
b)
Mitral cells
c)
Basal cells
d)
Supporting cells
e)
Periglomerular cells
107.
Which of the following best explains why smell can evoke strong emotional memories?
a)
Direct projection to the hypothalamus
b)
Direct connections with the limbic system
c)
Pathway through the thalamus before cortical processing
d)
Activation of the cerebellum
e)
Processing in the visual cortex
108.
A lesion of the posterior cerebral artery typically produces which visual defect?
a)
Bitemporal hemianopia
b)
Contralateral homonymous hemianopia with macular sparing
c)
Contralateral superior quadrantanopia
d)
Ipsilateral monocular blindness
e)
Tunnel vision
109.
A patient reports that pleasant smells now seem unpleasant. What is the most likely term for this condition?
a)
Anosmia
b)
Hyposmia
c)
Phantosmia
d)
Dysosmia
e)
Hyperosmia
110.
Which condition commonly presents with hyperosmia?
a)
Parkinson's disease
b)
Alzheimer's disease
c)
Pregnancy
d)
Head trauma
e)
Temporal lobe epilepsy
111.
Which of the following is not one of the five recognised primary tastes?
a)
Umami
b)
Bitter
c)
Metallic
d)
Sour
e)
Sweet
112.
Which papillae are found on the posterior aspect of the tongue and contain numerous taste buds?
a)
Filiform
b)
Fungiform
c)
Circumvallate
d)
Foliate
e)
Palatine
113.
Which statement best describes the taste receptor cells within a taste bud?
a)
They are true neurones with axons projecting to the brainstem.
b)
They regenerate every 6 months.
c)
They synapse with gustatory afferent axons at their base.
d)
They are primarily located in filiform papillae.
e)
They respond only to one specific taste.
114.
Which cranial nerve carries special sensory taste fibres from the anterior two-thirds of the tongue?
a)
Trigeminal nerve (CN V)
b)
Glossopharyngeal nerve (CN IX)
c)
Facial nerve (CN VII)
d)
Vagus nerve (CN X)
e)
Hypoglossal nerve (CN XII)
115.
Which cranial nerve provides general sensory (touch, temperature, pain) innervation to the anterior two-thirds of the tongue?
a)
Facial (VII)
b)
Glossopharyngeal (IX)
c)
Vagus (X)
d)
Lingual branch of trigeminal (V3)
e)
Hypoglossal (XII)
116.
The first-order neurones carrying taste information have their cell bodies located in which structure?
a)
Nucleus of the solitary tract
b)
Thalamus
c)
Gustatory cortex
d)
Peripheral ganglia of cranial nerves VII, IX, and X
e)
Lingual papillae
117.
Where do second-order neurones of the gustatory pathway project to after synapsing in the nucleus of the solitary tract?
a)
Gustatory cortex
b)
Hypothalamus
c)
Thalamus
d)
Amygdala
e)
Cerebellum
118.
The primary gustatory cortex is located in which brain region?
a)
Postcentral gyrus
b)
Precentral gyrus
c)
Anterior insula and frontal operculum
d)
Hippocampus
e)
Temporal pole
119.
Which mechanism best explains how taste information is encoded in the gustatory system?
a)
Specific receptor coding -- one cell per tastant
b)
Population coding -- combined activity of broadly tuned neurones
c)
Frequency coding -- intensity of stimulus determines firing rate only
d)
Anatomical labelling -- each pathway uniquely labelled for a tastant
e)
Temporal summation coding -- time intervals between spikes encode flavour
120.
A lesion in which of the following structures is most likely to result in loss of taste sensation on the posterior third of the tongue?
a)
Facial nerve
b)
Glossopharyngeal nerve
c)
Vagus nerve
d)
Trigeminal nerve
e)
Hypoglossal nerve
121.
During week 4 of embryonic development, the notochord induces the overlying ectoderm to form which structure?
a)
Neural tube
b)
Notochordal plate
c)
Neural crest
d)
Surface ectoderm
e)
Somites
122.
Failure of the anterior neuropore to close during week 4 most likely results in:
a)
Spina bifida
b)
Anencephaly
c)
Encephalocele
d)
Syringomyelia
e)
Meningocele
123.
Neural crest cells are derived from which embryonic germ layer?
a)
Endoderm
b)
Mesoderm
c)
Neuroectoderm
d)
Surface ectoderm
e)
Intermediate mesoderm
124.
Which of the following bones is primarily derived from neural crest cells?
a)
Parietal bone
b)
Occipital bone
c)
Frontal bone
d)
Petrous part of temporal bone
e)
Sphenoid greater wing
125.
The dorsal root ganglia arise from which embryonic cell population?
a)
Neural tube
b)
Neural crest
c)
Paraxial mesoderm
d)
Surface ectoderm
e)
Endoderm
126.
Which of the following is NOT a derivative of neural crest cells?
a)
Schwann cells
b)
Chromaffin cells of the adrenal medulla
c)
Melanocytes
d)
Motor neurons of the spinal cord
e)
Sensory neurons of cranial nerves
127.
Which embryonic structure induces the overlying ectoderm to become neuroectoderm?
a)
Primitive streak
b)
Paraxial mesoderm
c)
Notochord
d)
Amnion
e)
Neural crest
128.
Cranial neural crest cells migrate into the pharyngeal arches to contribute to which of the following?
a)
Vertebral column
b)
Facial skeleton
c)
Heart chambers
d)
Kidneys
e)
Diaphragm
129.
Which of the following structures of the autonomic nervous system is derived from neural crest cells?
a)
Spinal cord grey matter
b)
Sympathetic chain ganglia
c)
Adrenal cortex
d)
Dorsal horn neurons
e)
Thalamus
130.
Which of the following best describes the potential of neural crest cells?
a)
Totipotent
b)
Pluripotent
c)
Multipotent
d)
Unipotent
e)
Bipotent
131.
A 21-year-old student presents with fever, headache, neck stiffness, and a purpuric rash. Which of the following is the most likely causative organism?
a)
Streptococcus pneumoniae
b)
Listeria monocytogenes
c)
Neisseria meningitidis
d)
Mycobacterium tuberculosis
e)
Haemophilus influenzae type b
132.
Which of the following is a contraindication to immediate lumbar puncture in suspected meningitis?
a)
Fever and headache
b)
Photophobia
c)
Neck stiffness
d)
Focal neurological deficit
e)
Positive Kernig's sign
133.
A 68-year-old man is admitted with meningitis. Why is amoxicillin added to his empirical antibiotic regimen?
a)
To cover Haemophilus influenzae
b)
To cover Listeria monocytogenes
c)
To provide synergistic activity with ceftriaxone
d)
To treat possible tuberculosis
e)
To prevent antibiotic resistance
134.
Which of the following cerebrospinal fluid (CSF) findings is most typical of bacterial meningitis?
a)
Normal glucose, low protein, lymphocytic predominance
b)
Low glucose, high protein, neutrophilic predominance
c)
Low glucose, low protein, lymphocytic predominance
d)
High glucose, low protein, neutrophilic predominance
e)
Normal glucose, normal protein, mixed cells
135.
A 55-year-old woman presents with headache, fever, and gradual confusion over 3 weeks. CSF shows lymphocytosis, raised protein, and low glucose. What is the most likely diagnosis?
a)
Viral meningitis
b)
Tuberculous meningitis
c)
Listeria meningitis
d)
Meningococcal meningitis
e)
Cryptococcal meningitis
136.
Which of the following best describes the role of corticosteroids in bacterial meningitis?
a)
Contraindicated due to increased risk of sepsis
b)
Used only in viral meningitis
c)
Reduces mortality and neurological sequelae in pneumococcal meningitis
d)
Should be given after antibiotics
e)
Used routinely for all bacterial meningitis including TB
137.
Which of the following is most characteristic of pneumococcal meningitis?
a)
Common in young adults living in halls
b)
Associated with a purpuric rash
c)
Often follows pneumonia or otitis media
d)
Resistant to penicillin
e)
Rare in alcoholics
138.
Which of the following vaccination programmes has most reduced the incidence of bacterial meningitis in the UK?
a)
MMR
b)
HPV
c)
MenC
d)
Influenza
e)
BCG
139.
A 19-year-old university student presents with headache and photophobia. There is no rash. You suspect meningitis. What is the next best step?
a)
Wait for LP before starting antibiotics
b)
Give dexamethasone and IV ceftriaxone immediately
c)
Give oral penicillin and discharge
d)
Perform CT scan in all suspected cases
e)
Start antivirals first
140.
Which of the following defines meningism?
a)
Presence of purpuric rash with sepsis
b)
Inflammation of brain parenchyma
c)
Headache, photophobia, and neck stiffness
d)
Reduced consciousness and seizures
e)
Inflammation of meninges
141.
Which of the following best defines health according to the World Health Organization (WHO)?
a)
Absence of disease and infirmity
b)
Ability to perform normal daily activities
c)
State of complete physical, mental and social well-being
d)
Achievement of optimal physical performance
e)
Maintenance of biochemical homeostasis
142.
What does the term "Health-Related Quality of Life (HRQoL)" primarily measure?
a)
Financial cost of illness
b)
Number of hospital visits per year
c)
Both quantity and quality of life
d)
Only psychological well-being
e)
Mortality rate in a population
143.
Which of the following instruments is an example of a general health profile?
a)
EQ-5D
b)
Dialysis Symptom Index
c)
Asthma Quality of Life Questionnaire
d)
Minnesota Living with Heart Failure Questionnaire
e)
St George's Respiratory Questionnaire
144.
A key advantage of a general HRQoL measure such as EQ-5D is:
a)
It is more responsive to small clinical changes
b)
It is highly specific to one disease
c)
It allows comparison across diseases and interventions
d)
It is only valid in hospital-based studies
e)
It is more relevant to patients' personal experiences
145.
Which of the following best describes a disease-specific HRQoL measure?
a)
Allows national comparison of disease burden
b)
Is more responsive to individual patient changes
c)
Is less relevant to clinical practice
d)
Cannot be used in economic evaluation
e)
Is less accurate than general measures
146.
In economic evaluation, the Quality-Adjusted Life Year (QALY) combines:
a)
Mortality and hospital cost
b)
Life expectancy and disease incidence
c)
Quantity and quality of life
d)
Mortality and morbidity rates
e)
Disability and prevalence
147.
A patient with a utility score of 0.7 living for 10 years would have a total of:
a)
3 QALYs
b)
5 QALYs
c)
7 QALYs
d)
10 QALYs
e)
14 QALYs
148.
Which criticism of QALYs was highlighted by the ECHOUTCOME study (2013)?
a)
They are based on objective biological measures
b)
They assume constant proportional trade-off, which people often break
c)
They overvalue rare diseases
d)
They ignore social equity and fairness
e)
They are independent of individual bias
149.
Which of the following is a major advantage of using QALYs in policy decision-making?
a)
They remove all subjectivity from measurement
b)
They only apply to life-extending treatments
c)
They allow comparison across diseases and interventions
d)
They focus solely on physical health
e)
They are calculated independently of patient preferences
150.
Which of the following statements about utility in HRQoL measurement is correct?
a)
Higher utility values indicate poorer health states
b)
Utility reflects individual preference for a health state
c)
Utility scores are measured in pounds (£)
d)
Utility cannot be expressed numerically
e)
Utility values are always fixed for each disease
151.
Under the Mental Capacity Act (2005), which of the following is not a key principle?
a)
Every adult is presumed to have capacity unless proven otherwise
b)
Individuals have the right to make unwise decisions
c)
All decisions for those lacking capacity must be made in their best interests
d)
Capacity should be judged based on a person's age and appearance
e)
Actions taken should be the least restrictive of rights and freedoms
152.
Which of the following is not required for a patient to have capacity under the MCA (2005)?
a)
Ability to understand relevant information
b)
Ability to retain that information
c)
Ability to use or weigh that information
d)
Ability to express their decision verbally
e)
Ability to communicate the decision in any form
153.
A 45-year-old man with schizophrenia refuses medication but can explain his reasoning and understands the risks. According to the MCA, what should be assumed?
a)
He lacks capacity due to his diagnosis
b)
He has capacity because he understands and reasons
c)
His capacity must be determined by a psychiatrist
d)
Capacity cannot be assumed in mental illness
e)
He should be detained under the Mental Health Act
154.
Which of the following best defines informed consent?
a)
Patient signs a written form for treatment
b)
Patient agrees verbally to any procedure
c)
Voluntary agreement to treatment with sufficient understanding and capacity
d)
Consent obtained from a family member when patient is unconscious
e)
Agreement implied by attending a hospital
155.
Which of the following situations does not justify breaching patient confidentiality?
a)
Risk of serious harm to others
b)
Reporting a notifiable infectious disease
c)
Patient incapacity where disclosure is in best interests
d)
Patient's refusal to allow disclosure of a minor administrative error
e)
Reporting gunshot wounds to police
156.
A 15-year-old requests oral contraceptives. Which of the following best describes when treatment can proceed without parental consent?
a)
If the patient is Gillick competent and meets Fraser guidelines
b)
If the GP believes it's in the best interests alone
c)
If the patient's parents give retrospective consent
d)
If the patient signs a written statement
e)
Never, as parental consent is always required under 16
157.
Under the Mental Capacity Act, which two-stage test must be applied first?
a)
Assess the patient's ability to communicate
b)
Determine if there is an impairment of the mind or brain
c)
Judge if the decision is unwise
d)
Evaluate best interests
e)
Consult family members
158.
Which of the following is not considered when determining a patient's best interests under s.4(6) MCA?
a)
Patient's past and present wishes
b)
Religious or cultural beliefs
c)
Family members' financial interests
d)
Values likely to influence their decision
e)
Views of those involved in their care
159.
A 17-year-old with capacity refuses life-saving surgery. Which statement is correct?
a)
Parents can overrule the refusal
b)
The refusal is legally binding
c)
The refusal can be overridden by the court in some circumstances
d)
The refusal must always be respected
e)
The MCA 2005 does not apply to 16–17-year-olds
160.
Which of the following is a Liberty Protection Safeguard (LPS) replacing the Deprivation of Liberty Safeguard (DoLS)?
a)
Allows deprivation of liberty under 14 years
b)
Applies to England only
c)
Simplifies authorisation for deprivation of liberty in hospitals and care homes
d)
Removes requirement to act in best interests
e)
Applies only to those detained under the Mental Health Act
161.
A 70-year-old man with dementia can understand and retain information but is unable to weigh the pros and cons of surgery. What is the correct conclusion under the MCA (2005)?
a)
He lacks capacity for this specific decision
b)
He has global incapacity
c)
His next of kin automatically gains decision-making authority
d)
The decision should be delayed until he regains full understanding
e)
He can still provide valid consent if he is calm and agreeable
162.
A patient with severe depression refuses ECT. He understands the procedure and risks but feels "life isn't worth living." What is the correct action?
a)
Respect his decision as he has capacity
b)
Treat under the Mental Capacity Act
c)
Treat under the Mental Health Act
d)
Seek court authorisation for treatment
e)
Override refusal due to suicide risk
163.
Which of the following statements regarding advance decisions (advance directives) is correct under the MCA (2005)?
a)
They must be written, signed, and witnessed if they refuse life-sustaining treatment
b)
They can be overruled by family members
c)
They apply only to those aged 21 or above
d)
They expire after five years
e)
They can include financial instructions
164.
Which of the following best describes the role of the Court of Protection?
a)
To make financial and welfare decisions for people lacking capacity
b)
To provide psychiatric detention under the Mental Health Act
c)
To review criminal responsibility of mentally ill offenders
d)
To authorise compulsory treatment under DoLS
e)
To appoint guardians for minors
165.
A 30-year-old man refuses blood transfusion due to religious belief. He is alert, understands the risks, and refuses life-saving treatment. What should you do?
a)
Respect his decision
b)
Override and transfuse under "best interests"
c)
Apply to court to compel treatment
d)
Seek consent from next of kin
e)
Detain under the Mental Health Act
166.
A nurse discloses a patient's HIV status to the patient's partner without consent. When is this legally and ethically permissible?
a)
When there is a serious risk of harm to an identifiable individual
b)
When the nurse suspects unfaithfulness
c)
When the patient has previously been dishonest
d)
Only if the police request it
e)
Never under any circumstances
167.
A 14-year-old requests termination of pregnancy and refuses parental involvement. Which is the most appropriate action?
a)
Proceed if Gillick competent
b)
Inform parents regardless
c)
Refuse until parental consent obtained
d)
Refer to social services automatically
e)
Inform head teacher for safeguarding
168.
Under the Liberty Protection Safeguards (LPS), which statement is correct?
a)
They apply in hospitals, care homes, and the community
b)
They can only be authorised by the Court of Protection
c)
They apply only to those with mental illness
d)
They remove the need for capacity assessment
e)
They require three independent professionals to authorise
169.
Which of the following best illustrates the principle of "least restrictive option" under the MCA?
a)
Allowing a patient with mild dementia to manage finances with supervision
b)
Detaining a patient under the Mental Health Act for convenience
c)
Giving sedative medication to prevent wandering
d)
Denying access to relatives due to confusion
e)
Restricting meals to ensure compliance with care plans
170.
Which of the following scenarios correctly represents a valid implied consent situation?
a)
A patient extends their arm for a blood test
b)
A relative gives verbal consent for a CT scan
c)
A patient is sedated and does not resist an injection
d)
A nurse assumes consent for photography of a wound
e)
A consultant continues treatment despite patient objection
100 %