WorksheetsGEM 8.04
Total questions: 260
Worksheet time: 4hrs 20mins
Name
Class
Date
1.
Which structure forms the ventral (anterior) part of the midbrain containing corticospinal fibres?
a)
Tectum
b)
Tegmentum
c)
Crus cerebri
d)
Superior colliculus
e)
Substantia nigra
2.
The decussation of the pyramids occurs at which level of the brainstem?
a)
Midbrain
b)
Rostral pons
c)
Caudal medulla
d)
Rostral medulla
e)
Diencephalon
3.
Which cranial nerve uniquely emerges from the dorsal aspect of the brainstem?
a)
Oculomotor (III)
b)
Trochlear (IV)
c)
Abducens (VI)
d)
Facial (VII)
e)
Glossopharyngeal (IX)
4.
A lesion of the Edinger–Westphal nucleus causes loss of which function?
a)
Accommodation and pupillary light reflex
b)
Facial motor function
c)
Extraocular abduction
d)
Hearing acuity
e)
Taste sensation
5.
The superior colliculus is primarily associated with:
a)
Hearing reflexes
b)
Visual tracking and saccadic eye movements
c)
Pain and temperature sensation from the face
d)
Autonomic reflexes
e)
Balance control
6.
The red nucleus gives rise to which descending motor tract?
a)
Corticospinal
b)
Rubrospinal
c)
Reticulospinal
d)
Vestibulospinal
e)
Tectospinal
7.
Damage to the abducens nucleus causes which deficit?
a)
Ipsilateral ptosis
b)
Contralateral loss of adduction
c)
Ipsilateral loss of abduction
d)
Contralateral facial weakness
e)
Loss of upward gaze
8.
Which nucleus receives visceral afferents from the vagus and glossopharyngeal nerves?
a)
Hypoglossal nucleus
b)
Dorsal motor nucleus of vagus
c)
Nucleus ambiguus
d)
Nucleus tractus solitarius (NTS)
e)
Inferior olivary nucleus
9.
Which structure forms the 'roof' of the midbrain above the cerebral aqueduct?
a)
Tegmentum
b)
Tectum
c)
Crus cerebri
d)
Substantia nigra
e)
Red nucleus
10.
A lesion of the substantia nigra is most characteristically seen in:
a)
Huntington's disease
b)
Multiple sclerosis
c)
Parkinson's disease
d)
Motor neurone disease
e)
Myasthenia gravis
11.
A patient with a brainstem stroke presents with ipsilateral oculomotor nerve palsy (ptosis, "down and out" eye, dilated pupil) and contralateral hemiparesis. Which artery is most likely occluded?
a)
Posterior cerebral artery (PCA)
b)
Basilar artery
c)
Anterior inferior cerebellar artery (AICA)
d)
Posterior inferior cerebellar artery (PICA)
e)
Superior cerebellar artery (SCA)
12.
A 65-year-old man presents with contralateral hemiparesis, contralateral loss of vibration/proprioception, and ipsilateral medial rectus weakness (cannot adduct eye). The lesion is at which level?
a)
Midbrain (oculomotor fascicle)
b)
Pons (abducens fascicle)
c)
Medulla (hypoglossal fascicle)
d)
Cervical spinal cord
e)
Internal capsule
13.
A patient with a brainstem lesion cannot move the eyes upward or converge, and has pupillary light–near dissociation. The lesion is most likely in:
a)
Dorsal midbrain (pretectal and posterior commissure region)
b)
Ventral midbrain (cerebral peduncle)
c)
Pons (facial colliculus)
d)
Medulla (inferior olive)
e)
Internal capsule
14.
Bilateral lesions of the medial longitudinal fasciculus (MLF) produce which characteristic eye movement disorder?
a)
Bilateral internuclear ophthalmoplegia
b)
Bilateral abducens palsy
c)
Complete oculomotor palsy
d)
One-and-a-half syndrome
e)
Vertical gaze palsy
15.
Damage to the lateral medulla produces all of the following EXCEPT:
a)
Loss of pain and temperature on ipsilateral face
b)
Contralateral loss of body pain and temperature
c)
Dysphagia and hoarseness
d)
Ipsilateral loss of proprioception and vibration
e)
Ataxia and vertigo
16.
Which structure within the pons is the origin of the corticopontine fibres projecting to the cerebellum via the middle cerebellar peduncle?
a)
Pontine nuclei
b)
Reticular formation
c)
Red nucleus
d)
Inferior olivary nucleus
e)
Substantia nigra
17.
A lesion affecting the facial colliculus would result in which combination of findings?
a)
Ipsilateral facial paralysis and ipsilateral horizontal gaze palsy
b)
Bilateral facial paralysis
c)
Contralateral facial paralysis only
d)
Ipsilateral tongue deviation
e)
Ipsilateral ptosis with dilated pupil
18.
The mesencephalic nucleus of the trigeminal nerve is unique because it:
a)
Contains primary sensory neuron cell bodies within the CNS
b)
Mediates taste from anterior two-thirds of tongue
c)
Provides LMN fibres to muscles of mastication
d)
Relays temperature sensation from the face
e)
Connects directly to the cerebellar dentate nucleus
19.
A lesion in the inferior colliculus would most directly impair which function?
a)
Auditory processing and reflexes to sound
b)
Visual saccades and head turning to light
c)
Pupil constriction to light
d)
Motor coordination of gait
e)
Facial motor control
20.
The dorsal motor nucleus of the vagus supplies parasympathetic fibres to which of the following?
a)
Thoracic and abdominal viscera up to the splenic flexure
b)
Lacrimal and nasal glands
c)
Parotid gland
d)
Pupil constrictor muscles
e)
Submandibular gland
21.
Which cranial nerve nucleus lesion produces contralateral eye movement deficit?
a)
Oculomotor nucleus
b)
Trochlear nucleus
c)
Abducens nucleus
d)
Facial motor nucleus
e)
Hypoglossal nucleus
22.
Which cranial nerve carries branchial efferent fibres to muscles of facial expression?
a)
Oculomotor nerve
b)
Trigeminal nerve (mandibular division)
c)
Facial nerve
d)
Glossopharyngeal nerve
e)
Hypoglossal nerve
23.
Which of the following cranial nerves contains general visceral efferent fibres to the parotid gland?
a)
Facial nerve
b)
Glossopharyngeal nerve
c)
Vagus nerve
d)
Oculomotor nerve
e)
Trigeminal nerve
24.
Loss of pain and temperature sensation over the face would most likely result from damage to which nucleus?
a)
Chief sensory nucleus of V
b)
Mesencephalic nucleus of V
c)
Spinal trigeminal nucleus
d)
Nucleus tractus solitarius (NTS)
e)
Facial motor nucleus
25.
A lesion of the hypoglossal nucleus results in which clinical sign?
a)
Tongue deviates away from the lesion
b)
Tongue deviates toward the lesion
c)
Bilateral tongue paralysis
d)
Contralateral facial weakness
e)
Loss of taste on posterior third of tongue
26.
Which nucleus receives afferent input from baroreceptors in the carotid sinus?
a)
Spinal trigeminal nucleus
b)
Nucleus ambiguus
c)
Dorsal motor nucleus of vagus
d)
Nucleus tractus solitarius (NTS)
e)
Inferior salivatory nucleus
27.
The Edinger–Westphal nucleus provides preganglionic fibres that synapse in which ganglion?
a)
Ciliary ganglion
b)
Otic ganglion
c)
Pterygopalatine ganglion
d)
Submandibular ganglion
e)
Geniculate ganglion
28.
Damage to the nucleus ambiguus would most likely result in which clinical finding?
a)
Loss of taste from anterior two-thirds of tongue
b)
Loss of sensation from the external ear
c)
Weakness of pharyngeal and laryngeal muscles
d)
Impaired pupillary light reflex
e)
Deviation of the tongue toward the unaffected side
29.
Which cranial nerve contains the highest proportion of visceral afferent fibres?
a)
Facial
b)
Glossopharyngeal
c)
Vagus
d)
Trigeminal
e)
Hypoglossal
30.
Which of the following best describes general somatic efferent fibres?
a)
Motor fibres to muscles derived from pharyngeal arches
b)
Parasympathetic preganglionic fibres
c)
Sensory fibres from mucosal linings of viscera
d)
Motor fibres to somite-derived skeletal muscle
e)
Sensory fibres from the retina and cochlea
31.
A 62-year-old man presents with vertical diplopia, worse when descending stairs. Examination reveals the affected eye cannot depress when adducted. The lesion is localised to the left midbrain. Which structure is most likely affected?
a)
Right trochlear nucleus
b)
Left trochlear nerve
c)
Right trochlear nerve
d)
Left oculomotor nucleus
e)
Right abducens nucleus
32.
Lesion of which nucleus would cause impaired gag reflex and uvular deviation to the opposite side?
a)
Nucleus ambiguus
b)
Spinal trigeminal nucleus
c)
Dorsal motor nucleus of vagus
d)
Nucleus tractus solitarius
e)
Facial motor nucleus
33.
A 35-year-old woman has loss of lacrimation and salivation from submandibular glands. Which nucleus is most likely affected?
a)
Superior salivatory nucleus
b)
Inferior salivatory nucleus
c)
Edinger–Westphal nucleus
d)
Dorsal motor nucleus of vagus
e)
Nucleus ambiguus
34.
A lesion in the right nucleus tractus solitarius (NTS) would most likely cause which deficit?
a)
Loss of proprioception from the face
b)
Loss of taste from the right posterior third of the tongue
c)
Loss of corneal reflex on the left
d)
Contralateral hemiparesis
e)
Deviation of the tongue to the left
35.
Which cranial nerve contains both branchial efferent and visceral efferent fibres?
a)
Facial nerve
b)
Trochlear nerve
c)
Trigeminal (ophthalmic) nerve
d)
Vestibulocochlear nerve
e)
Hypoglossal nerve
36.
A patient with a lesion in the inferior salivatory nucleus would most likely have which deficit?
a)
Dry mouth due to loss of submandibular secretion
b)
Dry eyes due to reduced lacrimation
c)
Reduced parotid gland secretion
d)
Loss of taste to the anterior two-thirds of tongue
e)
Impaired accommodation reflex
37.
Which cranial nerve nucleus lies adjacent to the midline in the medulla and controls tongue movements?
a)
Dorsal motor nucleus of vagus
b)
Hypoglossal nucleus
c)
Nucleus ambiguus
d)
Spinal trigeminal nucleus
e)
Nucleus tractus solitarius
38.
A patient presents with ipsilateral loss of corneal reflex and contralateral loss of pain and temperature in the body. Where is the lesion most likely located?
a)
Spinal trigeminal nucleus and tract
b)
Chief sensory trigeminal nucleus
c)
Mesencephalic nucleus of V
d)
Nucleus tractus solitarius
e)
Nucleus ambiguus
39.
Which cranial nerve nucleus provides parasympathetic innervation to thoracic and abdominal viscera (excluding the heart)?
a)
Dorsal motor nucleus of vagus
b)
Nucleus ambiguus
c)
Superior salivatory nucleus
d)
Inferior salivatory nucleus
e)
Edinger–Westphal nucleus
40.
A right-sided lesion of the facial motor nucleus would produce which finding?
a)
Weakness of the contralateral lower face only
b)
Bilateral loss of forehead wrinkling
c)
Ipsilateral paralysis of the entire face
d)
Loss of taste on contralateral anterior tongue
e)
Hyperacusis on the contralateral side
41.
The glossopharyngeal nerve exits the skull through which foramen?
a)
Foramen ovale
b)
Jugular foramen
c)
Foramen rotundum
d)
Hypoglossal canal
e)
Foramen spinosum
42.
Which of the following muscles is innervated by the glossopharyngeal nerve?
a)
Tensor veli palatini
b)
Stylopharyngeus
c)
Palatoglossus
d)
Cricothyroid
e)
Superior pharyngeal constrictor
43.
The afferent limb of the gag reflex is mediated by which cranial nerve?
a)
Vagus nerve
b)
Trigeminal nerve
c)
Facial nerve
d)
Glossopharyngeal nerve
e)
Hypoglossal nerve
44.
Which nucleus gives rise to the preganglionic parasympathetic fibres of the glossopharyngeal nerve?
a)
Dorsal motor nucleus of vagus
b)
Nucleus ambiguus
c)
Inferior salivatory nucleus
d)
Solitary nucleus (NTS)
e)
Edinger–Westphal nucleus
45.
Damage to the right vagus nerve would cause which clinical sign?
a)
Uvula deviates to the right
b)
Tongue deviates to the right
c)
Uvula deviates to the left
d)
Shoulder droop on right side
e)
Loss of taste on anterior tongue
46.
The recurrent laryngeal nerve is a branch of which cranial nerve?
a)
Accessory nerve
b)
Glossopharyngeal nerve
c)
Trigeminal nerve
d)
Vagus nerve
e)
Hypoglossal nerve
47.
Which nerve is tested by asking a patient to shrug their shoulders and turn their head against resistance?
a)
Vagus nerve
b)
Hypoglossal nerve
c)
Accessory nerve
d)
Glossopharyngeal nerve
e)
Facial nerve
48.
A lesion of the right hypoglossal nerve will cause the tongue to:
a)
Deviate to the left on protrusion
b)
Deviate to the right on protrusion
c)
Remain midline
d)
Deviate to the left with atrophy on left side
e)
Deviate to the right with atrophy on left side
49.
Which cranial nerves pass through the jugular foramen?
a)
IX, X, XI
b)
IX, X, XII
c)
VII, VIII, IX
d)
X, XI, XII
e)
VIII, IX, X
50.
Bulbar palsy is characterised by which of the following?
a)
Bilateral upper motor neurone lesion
b)
Bilateral lower motor neurone lesion
c)
Unilateral lower motor neurone lesion
d)
Damage to corticospinal tract only
e)
Spastic paralysis with brisk jaw jerk
51.
A lesion of the nucleus ambiguus would most likely result in which of the following deficits?
a)
Dysphagia and hoarse voice
b)
Loss of taste from anterior two-thirds of tongue
c)
Loss of general sensation from the face
d)
Diplopia on downward gaze
e)
Inability to shrug the shoulders
52.
Fibres conveying baroreceptor information from the carotid sinus terminate in which brainstem nucleus?
a)
Inferior salivatory nucleus
b)
Nucleus tractus solitarius (NTS)
c)
Nucleus ambiguus
d)
Dorsal motor nucleus of vagus
e)
Spinal trigeminal nucleus
53.
During carotid endarterectomy, inadvertent injury to the hypoglossal nerve would produce which clinical sign?
a)
Uvula deviation to ipsilateral side
b)
Loss of gag reflex
c)
Tongue deviation to side of lesion on protrusion
d)
Shoulder droop
e)
Loss of taste posterior third of tongue
54.
The auricular branch of the vagus nerve carries sensory fibres to which region?
a)
Tympanic membrane (internal surface)
b)
Posterior third of tongue
c)
Posterior pharyngeal wall
d)
External ear and ear canal
e)
Epiglottic vallecula
55.
The spinal accessory nucleus is located at which spinal cord levels?
a)
C1–C2 only
b)
C3–C7
c)
C5–T1
d)
Medulla oblongata only
e)
C1–C5
56.
Which cranial nerve provides parasympathetic innervation to the parotid gland?
a)
Glossopharyngeal nerve
b)
Facial nerve
c)
Trigeminal nerve (V3)
d)
Vagus nerve
e)
Hypoglossal nerve
57.
A patient presents with dysphonia and dysphagia following thyroid surgery. Which nerve was most likely injured?
a)
Superior laryngeal nerve (external branch)
b)
Recurrent laryngeal nerve
c)
Glossopharyngeal nerve
d)
Accessory nerve
e)
Hypoglossal nerve
58.
Which statement about bulbar and pseudobulbar palsy is correct?
a)
Bulbar palsy is an upper motor neurone lesion
b)
Pseudobulbar palsy has flaccid paralysis and fasciculations
c)
Bulbar palsy involves lower motor neurone nuclei of CN IX–XII
d)
Pseudobulbar palsy causes absent jaw jerk reflex
e)
Bulbar palsy is more common than pseudobulbar palsy
59.
During neck dissection, which vessel-nerve relationship is correct for identifying the accessory nerve?
a)
Crosses superficial to external jugular vein
b)
Lies deep to levator scapulae muscle
c)
Emerges anterior to the sternocleidomastoid
d)
Passes between internal jugular vein and internal carotid artery
e)
Runs parallel to the hypoglossal nerve in carotid sheath
60.
Taste fibres from the epiglottis are carried by which nerve to the nucleus tractus solitarius?
a)
Glossopharyngeal nerve
b)
Facial nerve
c)
Trigeminal nerve
d)
Hypoglossal nerve
e)
Vagus nerve
61.
A 45-year-old woman presents with numbness of her forehead and loss of corneal reflex on the right. Which foramen is most likely affected?
a)
Foramen ovale
b)
Foramen rotundum
c)
Superior orbital fissure
d)
Stylomastoid foramen
e)
Internal acoustic meatus
62.
The cell bodies of the first-order sensory neurons for touch and pressure from the face are located in which structure?
a)
Spinal trigeminal nucleus
b)
Trigeminal motor nucleus
c)
Trigeminal ganglion
d)
Mesencephalic nucleus
e)
VPM nucleus of thalamus
63.
Which muscle is innervated by the mandibular division of the trigeminal nerve?
a)
Buccinator
b)
Masseter
c)
Orbicularis oculi
d)
Posterior belly of digastric
e)
Stylohyoid
64.
A patient's jaw deviates to the right on mouth opening following cranial trauma. Which side's trigeminal motor root is affected?
a)
Left
b)
Right
c)
Bilateral
d)
None — normal finding
e)
Unrelated to trigeminal nerve
65.
The afferent limb of the corneal reflex is supplied by which nerve?
a)
Facial nerve
b)
Oculomotor nerve
c)
Ophthalmic division of trigeminal nerve
d)
Maxillary division of trigeminal nerve
e)
Glossopharyngeal nerve
66.
Which of the following carries parasympathetic postganglionic fibres but has no parasympathetic nucleus of its own?
a)
Glossopharyngeal nerve
b)
Facial nerve
c)
Trigeminal nerve
d)
Oculomotor nerve
e)
Vagus nerve
67.
In the jaw-jerk reflex, where are the cell bodies of the first-order proprioceptive neurons located?
a)
Trigeminal ganglion
b)
Mesencephalic nucleus
c)
Spinal trigeminal nucleus
d)
Chief sensory nucleus
e)
Motor cortex
68.
A dentist performing a mental nerve block should inject anaesthetic near which anatomical structure?
a)
Supraorbital foramen
b)
Infraorbital foramen
c)
Mental foramen
d)
Foramen ovale
e)
Foramen rotundum
69.
The second-order neurons of the trigeminal pain and temperature pathway are located in which nucleus?
a)
Chief sensory nucleus
b)
Spinal trigeminal nucleus
c)
Trigeminal ganglion
d)
Mesencephalic nucleus
e)
VPM nucleus
70.
A patient presents with severe unilateral facial pain triggered by light touch over the cheek and upper lip. Which foramen is the likely access point for a therapeutic block of the affected division?
a)
Foramen ovale
b)
Foramen rotundum
c)
Superior orbital fissure
d)
Jugular foramen
e)
Stylomastoid foramen
71.
A 58-year-old man presents with left-sided facial weakness. He cannot close his left eye, but his forehead wrinkling is preserved. Where is the lesion most likely located?
a)
Right motor cortex
b)
Left facial nucleus
c)
Left stylomastoid foramen
d)
Internal acoustic meatus
e)
Parotid gland
72.
A patient's jaw deviates to the right on mouth opening following cranial trauma. Which side's trigeminal motor root is affected?
a)
Left
b)
Right
c)
Bilateral
d)
None — normal finding
e)
Unrelated to trigeminal nerve
73.
Which lesion produces hyperacusis, loss of lacrimation, and loss of taste to the anterior two-thirds of the tongue?
a)
Facial nerve lesion proximal to the geniculate ganglion
b)
Lesion distal to chorda tympani origin
c)
Lesion at stylomastoid foramen
d)
Damage to mandibular division of trigeminal nerve
e)
Isolated greater petrosal nerve lesion
74.
A lesion in the facial canal distal to the geniculate ganglion but proximal to the chorda tympani would result in which combination?
a)
Facial paralysis and loss of taste anterior 2/3
b)
Facial paralysis and hyperacusis
c)
Hyperacusis and loss of lacrimation
d)
Loss of lacrimation and taste
e)
Loss of taste only
75.
During parotid surgery, the marginal mandibular branch of the facial nerve is injured. Which function is most affected?
a)
Elevation of upper lip
b)
Depression of lower lip
c)
Puffing of cheeks
d)
Closing of eyelids
e)
Frowning of forehead
76.
A lesion of the facial nucleus in the pons would most likely be associated with which additional neurological sign?
a)
Contralateral hemiparesis
b)
Loss of taste anterior 2/3 tongue
c)
Loss of corneal reflex (afferent limb)
d)
Hyperacusis
e)
Dysphonia
77.
A 35-year-old man has right facial droop and loss of taste on the right anterior tongue. He also has hyperacusis. The lesion is most likely located:
a)
In the internal acoustic meatus
b)
At stylomastoid foramen
c)
In the parotid gland
d)
Within the cortex
e)
Distal to chorda tympani
78.
A lesion of the spinal trigeminal nucleus would most likely cause which deficit?
a)
Ipsilateral loss of pain and temperature from the face
b)
Contralateral loss of touch from face
c)
Ipsilateral loss of proprioception from jaw
d)
Bilateral jaw weakness
e)
Contralateral facial paralysis
79.
Following a cerebellopontine angle tumour, a patient develops facial paralysis and loss of hearing. Which structure is most likely compressed?
a)
Internal acoustic meatus
b)
Stylomastoid foramen
c)
Foramen ovale
d)
Foramen rotundum
e)
Jugular foramen
80.
A patient presents with loss of corneal reflex (efferent limb), inability to smile, and drooling. Which branch of the facial nerve is likely affected?
a)
Buccal branch
b)
Temporal branch
c)
Zygomatic branch
d)
Marginal mandibular branch
e)
Cervical branch
81.
The facial nerve emerges from the brainstem at which location?
a)
Midbrain
b)
Pontomedullary junction
c)
Medullary pyramids
d)
Cerebellopontine angle only
e)
Inferior olive
82.
The facial nerve passes through which skull opening before branching in the parotid gland?
a)
Foramen ovale
b)
Foramen rotundum
c)
Stylomastoid foramen
d)
Foramen spinosum
e)
Jugular foramen
83.
Which pharyngeal arch does the facial nerve innervate muscles derived from?
a)
First
b)
Second
c)
Third
d)
Fourth
e)
Sixth
84.
Which muscle is responsible for dampening loud sounds?
a)
Tensor tympani
b)
Stapedius
c)
Buccinator
d)
Orbicularis oculi
e)
Zygomaticus major
85.
Chorda tympani supplies taste to which region?
a)
Posterior third of tongue
b)
Soft palate only
c)
Epiglottis
d)
Anterior two thirds of tongue
e)
Dorsum of tongue via glossopharyngeal
86.
The geniculate ganglion contains cell bodies of which fibres?
a)
Motor fibres to facial expression
b)
Taste and somatic sensory fibres
c)
Parasympathetic fibres to lacrimal gland
d)
Upper motor neurones
e)
Spinal motor neurones
87.
Which branch of the facial nerve supplies orbicularis oculi?
a)
Cervical
b)
Buccal
c)
Temporal
d)
Mandibular
e)
Zygomatic
88.
Which clinical sign suggests an upper motor neurone facial palsy?
a)
Complete ipsilateral facial paralysis
b)
Inability to close eyelid on affected side
c)
Forehead muscle sparing
d)
Vesicles in ear canal
e)
Loss of taste in anterior tongue
89.
Which condition most commonly causes lower motor neurone facial palsy?
a)
Stroke affecting internal capsule
b)
Acoustic neuroma
c)
Multiple sclerosis
d)
Bell's palsy
e)
Posterior cerebral artery infarct
90.
Hyperacusis in facial nerve palsy occurs due to dysfunction of which nucleus or muscle?
a)
Hypoglossal nucleus
b)
Nucleus ambiguus
c)
Stapedius muscle
d)
Tensor veli palatini
e)
Superior salivatory nucleus
91.
A patient presents with sudden onset weakness of all muscles on the left side of the face including inability to close the left eye, loss of taste from the anterior two-thirds of the tongue on the left, and hyperacusis on the left. The most likely lesion location is:
a)
Left facial nerve in the facial canal (proximal to chorda tympani & stapedius branches)
b)
Left primary motor cortex (upper motor neurone) supplying facial area
c)
Left stylomastoid foramen (distal facial nerve)
d)
Right upper motor neurone to lower face only
e)
Left geniculate ganglion only
92.
Which nucleus contains the preganglionic parasympathetic cell bodies that provide secretomotor fibres to the submandibular and sublingual glands via the chorda tympani?
a)
Inferior salivatory nucleus
b)
Superior salivatory nucleus
c)
Dorsal motor nucleus of vagus
d)
Facial motor nucleus
e)
Solitary nucleus
93.
A unilateral cortical stroke affecting the left corticobulbar fibres to the face would most classically cause:
a)
Left facial paralysis of both upper and lower face
b)
Ipsilateral hyperacusis and loss of corneal reflex
c)
Right lower-face weakness with preserved forehead movement
d)
Complete right facial paralysis including orbicularis oculi
e)
Ipsilateral loss of taste from the anterior two-thirds
94.
Damage limited to the stylomastoid foramen (facial nerve as it exits skull) most consistently produces which pattern?
a)
Loss of lacrimation and salivation with preserved facial movement
b)
Ipsilateral hyperacusis with preserved taste from anterior two-thirds
c)
Contralateral lower-face weakness only
d)
Ipsilateral paralysis of muscles of facial expression with preserved taste and stapedius function
e)
Loss of corneal reflex afferent limb only
95.
A patient with vesicular rash of the external ear followed by an ipsilateral facial palsy most likely has:
a)
Bell's palsy (idiopathic LMN lesion limited to stylomastoid exit)
b)
Isolated lesion of the buccal branch in the parotid gland
c)
A stroke in the internal capsule affecting corticobulbar fibres
d)
Lesion of the hypoglossal nerve nucleus
e)
Ramsay Hunt syndrome due to herpes zoster reactivation in geniculate ganglion
96.
Which statement about corticobulbar control of facial nucleus is true?
a)
Upper-face LMNs receive bilateral cortical input; lower-face LMNs receive primarily contralateral input.
b)
Both upper- and lower-face LMNs receive strictly contralateral cortical input.
c)
Upper-face receives contralateral input only; lower-face bilateral input.
d)
Corticobulbar fibres to facial nucleus travel in the dorsal columns.
e)
Corticobulbar lesions never affect facial movement
97.
Which clinical sign would best help you distinguish an UMN supranuclear facial palsy from a LMN intranuclear/infranuclear palsy?
a)
Presence of ipsilateral hyperacusis
b)
Preservation of forehead wrinkling on the affected side
c)
Loss of taste from anterior two-thirds on the affected side
d)
Ipsilateral corneal reflex absent when trigeminal afferent intact
e)
Muscle fasciculations and marked muscular atrophy within days
98.
The chorda tympani:
a)
Carries preganglionic parasympathetic fibres to the parotid gland
b)
Is a branch of the glossopharyngeal nerve
c)
Conveys taste from the anterior two-thirds and carries parasympathetic secretomotor fibres to submandibular/sublingual glands
d)
Joins the greater petrosal nerve to supply lacrimation
e)
Is purely motor to stapedius
99.
A lesion that interrupts the facial nerve proximal to the geniculate ganglion would most likely produce which combination?
a)
Isolated paralysis of platysma with spared corneal reflex
b)
Contralateral lower-face weakness only and hyperreflexia elsewhere
c)
Purely sensory loss from external auditory meatus with intact motor function
d)
Facial paralysis, loss of taste from anterior two-thirds, and decreased lacrimation (depending on exact level)
e)
Isolated loss of salivation to parotid gland
100.
Which of the following muscle actions is NOT primarily supplied by the facial nerve motor root?
a)
Squeezing eyelids shut (orbicularis oculi)
b)
Smiling by elevating angle of mouth (zygomaticus major)
c)
Retracting tongue (styloglossus/hypoglossal innervation)
d)
Pursing the lips (orbicularis oris)
e)
Tensing neck skin and depressing angle of mouth (platysma)
101.
Which statement best defines pain according to the International Association for the Study of Pain?
a)
A sensory response to actual tissue damage
b)
A conscious experience only triggered by nociceptor activation
c)
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
d)
An automatic withdrawal reflex in response to noxious stimuli
e)
A nociceptive signal transmitted via A-delta and C fibres
102.
What term refers specifically to the sensory process that provides signals that may trigger pain?
a)
Pain perception
b)
Nociception
c)
Somatosensation
d)
Central sensitisation
e)
Hyperalgesia
103.
Which of the following best describes acute pain?
a)
Pain that persists beyond 3 months
b)
Pain occurring without any stimulus
c)
Pain only due to neuropathic injury
d)
Pain caused by noxious stimuli acting as a protective mechanism
e)
Pain associated with learned emotional responses
104.
Which feature differentiates pain from nociception?
a)
Presence of C fibres
b)
Involvement of emotional processing
c)
Peripheral activation of free nerve endings
d)
Activation of mechanoreceptors
e)
Release of glutamate at the dorsal horn
105.
A patient with complete spinal cord transection experiences nociceptor activation in the foot but does not report pain. Which concept does this illustrate?
a)
Hyperalgesia
b)
Pain without nociception
c)
Nociception without pain
d)
Allodynia
e)
Secondary sensitisation
106.
Prostaglandins contribute to pain by:
a)
Blocking sodium channels in nociceptors
b)
Increasing the activation threshold of nociceptors
c)
Lowering the activation threshold of nociceptors
d)
Inhibiting substance P release
e)
Preventing peripheral inflammation
107.
NSAIDs provide analgesia primarily by:
a)
Blocking voltage-gated calcium channels
b)
Inhibiting COX enzymes and reducing prostaglandin synthesis
c)
Directly inhibiting C-fibre transmission
d)
Increasing endogenous opioid release
e)
Enhancing descending inhibitory pathways
108.
Which nociceptor-associated fibre type is responsible for the first, sharp pain sensation?
a)
C fibres
b)
A-delta fibres
c)
A-beta fibres
d)
Preganglionic sympathetic fibres
e)
Dorsal column fibres
109.
In the dorsal horn, C-fibres primarily terminate in which region?
a)
Rexed laminae IV and V
b)
Ventral horn
c)
Substantia gelatinosa (laminae I and II)
d)
Lateral corticospinal tract
e)
Clarke's column
110.
Lissauer's tract allows nociceptive fibres to:
a)
Synapse directly in the thalamus
b)
Ascend or descend several segments before synapsing
c)
Cross immediately upon entering the spinal cord
d)
Synapse in the ventral horn
e)
Terminate directly in the somatosensory cortex
111.
A patient describes a "sharp, stabbing pain" immediately after injuring their foot, followed seconds later by a prolonged dull ache. Which fibre type is responsible for the immediate pain?
a)
A-delta fibres
b)
C fibres
c)
A-beta fibres
d)
Preganglionic sympathetic fibres
e)
Spinocerebellar fibres
112.
Which scenario represents nociception without pain?
a)
Neuropathic burning pain without peripheral injury
b)
A patient with complete spinal cord transection who has nociceptor activation in the foot but perceives no pain
c)
Pain from abdominal inflammation
d)
Mechanical pain from a bone fracture
e)
Burning pain from chilli exposure
113.
Which best explains why NSAIDs reduce hyperalgesia?
a)
They inhibit COX enzymes, reducing prostaglandin-mediated nociceptor sensitisation
b)
They block NMDA receptors in the dorsal horn
c)
They increase endogenous endorphin release
d)
They prevent A-delta fibre conduction
e)
They block all C-fibre signaling centrally
114.
A lesion selectively damaging the substantia gelatinosa would most impair:
a)
Proprioception
b)
Light touch
c)
Transmission of C-fibre pain signals
d)
Motor control
e)
Auditory relay pathways
115.
A patient reports severe, sharp epigastric pain during myocardial infarction. This is an example of:
a)
Neuropathic pain
b)
Referred pain
c)
Primary hyperalgesia
d)
Psychogenic pain
e)
Allodynia
116.
Which term describes increased pain sensitivity at the site of inflamed tissue?
a)
Primary hyperalgesia
b)
Secondary hyperalgesia
c)
Allodynia
d)
Central sensitisation
e)
Paresthesia
117.
Which neurotransmitter is particularly associated with slow, prolonged nociceptive signalling from C-fibres?
a)
Glutamate
b)
Substance P
c)
Serotonin
d)
Glycine
e)
Acetylcholine
118.
A spinal lesion causes pain and temperature loss beginning several segments below the lesion, while touch is preserved. Which pathway explains this pattern?
a)
Corticospinal tract
b)
Dorsal column pathway
c)
Spinothalamic tract with Lissauer's tract involvement
d)
Rubrospinal tract
e)
Vestibulospinal tract
119.
Which best explains central sensitisation in chronic pain?
a)
Increased nociceptor density at the injury site
b)
Loss of substantia gelatinosa neurons
c)
Increased prostaglandin synthesis
d)
Increased excitability of dorsal horn neurons
e)
Reduced spinothalamic tract conduction
120.
Visceral nociception typically produces:
a)
Fast, sharp pain
b)
Pain localised to skin regions
c)
Pain unaffected by emotional state
d)
Pain abolished by reflex withdrawal
e)
Dull, poorly localised pain
121.
Where are the cell bodies of the general sensory afferents of the trigeminal nerve located?
a)
Dorsal root ganglia
b)
Trigeminal ganglion
c)
Ciliary ganglion
d)
Otic ganglion
e)
Geniculate ganglion
122.
Which division of the trigeminal nerve supplies sensory information to the forehead and upper eyelid?
a)
Mandibular division
b)
Maxillary division
c)
Ophthalmic division
d)
Facial nerve
e)
Glossopharyngeal nerve
123.
Which trigeminal division has both sensory and motor components?
a)
Ophthalmic division
b)
Maxillary division
c)
Mandibular division
d)
All three divisions
e)
None of the divisions
124.
Sensory fibres mediating pain and temperature from the face synapse primarily in which nucleus?
a)
Main (principal) sensory nucleus of CN V
b)
Mesencephalic nucleus of CN V
c)
Spinal nucleus of CN V
d)
Nucleus ambiguus
e)
Solitary nucleus
125.
Fine touch sensation from the face synapses first at which structure?
a)
Spinal nucleus of CN V
b)
Main (principal) sensory nucleus of CN V
c)
Mesencephalic nucleus
d)
Dorsal horn of the spinal cord
e)
Red nucleus
126.
After synapsing in the main sensory nucleus of CN V, second-order neurons:
a)
Remain ipsilateral up to the cortex
b)
Decussate and join the trigeminothalamic tract
c)
Descend into the spinal cord
d)
Synapse directly in the cerebellum
e)
Travel to the vestibular nuclei
127.
Which thalamic nucleus receives sensory information from the trigeminothalamic tract?
a)
Ventral posterior nucleus
b)
Lateral geniculate nucleus
c)
Medial geniculate nucleus
d)
Pulvinar
e)
Anterior nucleus
128.
Which pathway carries unconscious proprioceptive information from jaw muscle spindles?
a)
Trigeminothalamic tract
b)
Corticobulbar tract
c)
Mesencephalic trigeminal pathway
d)
Spinothalamic tract
e)
Dorsal column tract
129.
The mesencephalic nucleus is unusual because:
a)
It sends motor fibres to mastication muscles
b)
It contains first-order sensory neuron cell bodies within the CNS
c)
It receives only pain input
d)
It is located in the spinal cord
e)
It has no clinical significance
130.
Sensory information from the face ultimately projects to which cortical area?
a)
Primary motor cortex
b)
Visual cortex
c)
Face area of the primary somatosensory cortex
d)
Auditory cortex
e)
Olfactory cortex
131.
A lesion selectively destroying the spinal trigeminal nucleus (caudal part) on the left will most likely cause which of the following deficits?
a)
Loss of discriminative touch from left face
b)
Loss of pain and temperature from left face
c)
Loss of proprioception from left jaw muscles (unconscious)
d)
Contralateral loss of face pain and temperature
e)
Loss of corneal blink motor response on the left
132.
Which statement about the mesencephalic nucleus of CN V is correct?
a)
It contains cell bodies analogous to dorsal root ganglia but located within the CNS.
b)
It mediates conscious proprioception of the face.
c)
Its primary afferents synapse in Meckel's cave.
d)
It projects directly to the somatosensory cortex without thalamic relay.
e)
It is the site where second-order neurons for face pain decussate.
133.
A patient has loss of fine touch from the right side of the face but preserved pain/temperature. Where is the lesion most likely located?
a)
Right trigeminal (Gasserian) ganglion
b)
Left principal (main) sensory nucleus of V
c)
Right principal (main) sensory nucleus of V
d)
Left spinal trigeminal nucleus (caudal)
e)
Right mesencephalic nucleus
134.
Through which thalamic relay do trigeminal lemniscus fibers conveying face sensation ascend to reach primary somatosensory cortex?
a)
Ventral posterolateral nucleus (VPL)
b)
Lateral geniculate nucleus (LGN)
c)
Ventral posteromedial nucleus (VPM)
d)
Medial dorsal nucleus (MD)
e)
Pulvinar
135.
Which feature best distinguishes fibers terminating in the principal sensory nucleus from those terminating in the spinal trigeminal nucleus?
a)
Principal nucleus receives primarily nociceptive input; spinal nucleus receives touch.
b)
Principal nucleus processes discriminative touch and proprioception; spinal nucleus processes pain/temperature.
c)
Only spinal nucleus axons cross the midline; principal nucleus axons remain ipsilateral.
d)
Principal nucleus contains first-order neuron cell bodies.
e)
Spinal nucleus is located in the midbrain.
136.
Stimulation of the cornea elicits a blink. The sensory limb of this reflex is carried by which branch/nucleus of CN V?
a)
Mandibular division (V3) to principal nucleus
b)
Maxillary division (V2) to mesencephalic nucleus
c)
Ophthalmic division (V1) to spinal trigeminal nucleus and principal nucleus for reflex processing
d)
Glossopharyngeal nerve via nucleus ambiguus
e)
Facial nerve sensory root to VPM
137.
A focal lesion in Meckel's cave most likely interrupts which of the following?
a)
Cell bodies of mesencephalic nucleus
b)
Trigeminal (Gasserian) ganglion — first-order somatosensory cell bodies
c)
Facial motor nucleus
d)
Spinal trigeminal tract only
e)
VPM thalamic relay
138.
Which ascending pathway name is commonly used for second-order fibers carrying trigeminal sensory information to the thalamus?
a)
Dorsal columns
b)
Spinothalamic tract
c)
Trigeminothalamic tract (also trigeminal lemniscus)
d)
Corticospinal tract
e)
Medial lemniscus of the midbrain only for body
139.
Damage limited to the right trigeminal (Gasserian) ganglion would produce which sensory pattern?
a)
Ipsilateral loss of all modalities (touch, pain, temperature) across V1-V3 on the right face
b)
Contralateral loss of pain and temperature only from the left face
c)
Isolated loss of jaw-jerk reflex only
d)
Loss of taste from anterior two-thirds of tongue
e)
Bilateral loss of facial discriminative touch
140.
Which clinical finding best localizes a lesion to the principal sensory nucleus of CN V (at the pontine level) on the left?
a)
Left facial anesthesia to light touch with normal jaw jerk and preserved thermal/pain sensation
b)
Loss of corneal reflex afferent on the left with facial motor paresis on the left
c)
Ipsilateral tongue deviation on protrusion
d)
Loss of vibration and proprioception in the right arm
e)
Bilateral loss of unconscious jaw proprioception
141.
Which structure is a key site involved in initiating descending endogenous analgesic pathways?
a)
Substantia nigra
b)
Periaqueductal grey
c)
Hippocampus
d)
Primary motor cortex
e)
Cerebellar vermis
142.
The gate control theory of pain involves the activation of which type of fibres to reduce nociceptive input?
a)
C fibres
b)
Aδ fibres
c)
Aβ mechanoreceptive fibres
d)
Gamma motor fibres
e)
Preganglionic autonomic fibres
143.
A TENS machine primarily provides pain relief through:
a)
Increasing C-fibre firing
b)
Enhancing spinal NK1 receptor expression
c)
Activating Aβ mechanoreceptors to inhibit pain pathways
d)
Reducing serotonin release from the raphe nuclei
e)
Blocking sodium channels in nociceptors
144.
Which descending brainstem region is a major source of serotonin in pain modulation?
a)
Locus coeruleus
b)
Rostral ventral medulla (raphe nuclei)
c)
Hypothalamus lateral zone
d)
Hippocampus CA3 region
e)
Amygdala central nucleus
145.
The locus coeruleus contributes to descending pain control via release of:
a)
Serotonin
b)
Dopamine
c)
Noradrenaline
d)
GABA
e)
Acetylcholine
146.
Noradrenaline acting on α2 receptors in the spinal cord results in:
a)
Increased nociception
b)
Decreased nociception
c)
Muscle contraction
d)
Facilitation of C-fibre signalling
e)
No effect on pain signalling
147.
Opioid analgesia at the spinal cord primarily occurs by:
a)
Enhancing C-fibre release of substance P
b)
Activating inhibitory interneurons containing enkephalins
c)
Increasing second-order neuron firing rates
d)
Blocking Aβ fibre activation
e)
Increasing activity of pronociceptive ON-cells in RVM
148.
Activation of OFF-cells in the rostral ventral medulla leads to:
a)
Increased pain perception
b)
Reduced pain perception
c)
No effect on pain perception
d)
Sympathetic activation
e)
Muscle spasticity
149.
Which best explains why pain perception varies between individuals and contexts?
a)
Pain is solely dependent on nociceptive stimulus strength
b)
Pain has emotional and cognitive components
c)
C-fibres always fire at a fixed intensity
d)
The spinal cord cannot alter pain signalling
e)
Descending modulation does not occur in humans
150.
Intrathecal α2-agonists may be used clinically because they:
a)
Increase blood pressure and pain sensitivity
b)
Enhance nociceptive neurotransmission
c)
Inhibit transmission at the spinal cord dorsal horn
d)
Block all peripheral nerve conduction
e)
Prevent serotonin reuptake in the brain
151.
Which observation from animal and human studies most directly supports the existence of descending endogenous analgesic systems?
a)
Abdominal surgery performed without anaesthesia while electrically stimulating midbrain/pons produced no behavioural signs of pain.
b)
TENS use reduces labour pain by local skin anaesthesia.
c)
Small children rub a sore knee and therefore have reduced nociception due to local inflammation.
d)
Systemic serotonin administration reliably abolishes acute pain in humans.
e)
Athletes never report pain during high-intensity competition.
152.
Which mechanism best explains how TENS (transcutaneous electrical nerve stimulation) might relieve pain?
a)
Selective blockade of C-fibre sodium channels only.
b)
Activation of large-diameter mechanoreceptive afferents and/or stimulation of descending inhibitory pathways.
c)
Increasing peripheral inflammation to reduce nociceptor sensitivity.
d)
Directly increasing spinal serotonergic on-cell firing to produce analgesia.
e)
Systemically raising plasma opioid levels sufficient to cause spinal analgesia.
153.
Which statement about RVM (rostral ventromedial medulla) cell types is correct?
a)
"On" cells produce anti-nociception when activated.
b)
"Off" cells are inhibited by opioids and thus mediate pronociception.
c)
"On" cells are pronociceptive; opioids inhibit them, contributing to analgesia.
d)
RVM contains only serotonergic neurons and no influence on spinal nociception.
e)
RVM output affects only supraspinal perception, not spinal second-order neurons.
154.
Which brainstem nucleus is correctly paired with its principal descending neurotransmitter implicated in spinal analgesia?
a)
Periaqueductal grey — dopamine
b)
Rostral ventral medulla — noradrenaline only
c)
Hypothalamus — GABA exclusively
d)
Locus coeruleus — noradrenaline (with descending projections producing analgesia via α2 receptors)
e)
Raphe nuclei — acetylcholine
155.
Which pharmacological action at spinal α-adrenoceptors produces analgesia?
a)
α1 receptor activation → inhibitory analgesic effect
b)
Blocking α2 receptors → analgesia
c)
Activating α1 receptors → analgesia via hyperpolarisation of second-order neurons
d)
α2 receptor activation → pro-nociceptive effect
e)
α2 receptor activation → inhibitory (analgesic) effect
156.
Opioid analgesia with fewer systemic side effects when delivered intrathecally is best explained by which mechanism?
a)
Local spinal application targets opioid receptors on primary afferent terminals and second-order neurons, reducing required systemic dose.
b)
Intrathecal opioids preferentially activate serotonin reuptake in the bloodstream.
c)
Systemic opioid injection never reaches the central nervous system.
d)
Intrathecal delivery antagonises endogenous enkephalin interneurons.
e)
Intrathecal opioids increase peripheral nociceptor firing to produce tolerance.
157.
Which statement is MOST consistent with the transcript's account of serotonin (5-HT) in descending pain control?
a)
5-HT is the primary clinically effective analgesic given systemically for acute pain.
b)
Raphe nuclei are a serotonergic source implicated in descending modulation, but robust clinical demonstration of 5-HT analgesia in humans is limited.
c)
Serotonin exclusively produces pronociception in all contexts.
d)
Human trials show intrathecal 5-HT administration is first-line for chronic pain.
e)
5-HT acts only in the forebrain and never at spinal levels.
158.
Which scenario best illustrates the gate control mechanism described in the transcript?
a)
Local anaesthetic block of a peripheral nerve entirely abolishes pain by preventing central descending facilitation.
b)
Increasing C-fibre firing alone reduces pain because of central inhibition.
c)
Rubbing a stubbed toe activates large-diameter mechanoreceptors that inhibit second-order neurons receiving C-fibre input, reducing perceived pain.
d)
Systemic noradrenaline infusion activates peripheral α2 receptors causing immediate analgesia.
e)
On-cell activation in RVM reduces spinal nociceptive transmission.
159.
Which clinical observation best illustrates survival value of endogenous descending analgesia described in the transcript?
a)
Chronic neuropathic pain improving spontaneously without injury.
b)
TENS applied during childbirth eliminates the need for analgesia in all women.
c)
Serotonin supplements curing fibromyalgia in randomised trials.
d)
Battlefield or athletic situations where individuals sustain severe injury but report little pain and can continue activity.
e)
Local lidocaine patch reducing phantom limb pain via descending pathways.
160.
Which combination of cellular effects in the spinal cord is most consistent with how descending opioidergic pathways reduce pain?
a)
Activation of spinal α1 receptors on interneurons and increased glutamate release from primary afferents.
b)
Inhibition of enkephalinergic interneurons and facilitation of on-cell RVM pronociceptive output.
c)
Activation of NMDA receptors on second-order neurons to dampen transmission.
d)
Increased release of substance P in dorsal horn to produce analgesia.
e)
Activation of opioid receptors on primary afferent central terminals and on second-order neurons (and activation of opioid interneurons), reducing transmitter release and neuronal excitability.
161.
Which definition best describes chronic pain?
a)
Pain lasting less than 2 weeks
b)
Pain only associated with ongoing tissue damage
c)
Pain persisting beyond 3–6 months or after healing
d)
Pain relieved entirely by NSAIDs
e)
Pain only caused by nerve injury
162.
A patient describes severe pain from lightly touching their skin. This is an example of:
a)
Hyperalgesia
b)
Allodynia
c)
Phantom pain
d)
Visceral pain
e)
Psychogenic pain
163.
Phantom limb pain is likely due to:
a)
Inflammation in the amputated limb tissue
b)
Persistent nociceptor stimulation in the absent limb
c)
Maladaptive neural activity in the CNS
d)
Psychosomatic fabrication
e)
Excess production of prostaglandins
164.
Mirror box therapy primarily works by:
a)
Increasing opioid release from the spinal cord
b)
Restoring sensory feedback and cortical representation
c)
Blocking nociceptors in the residual limb
d)
Reducing inflammation around the stump
e)
Stimulating the thalamus directly
165.
Which type of chronic pain is classically poorly localised and often difficult to treat?
a)
Neuropathic pain
b)
Cutaneous pain
c)
Visceral pain
d)
Somatic pain
e)
Referred pain
166.
Damage to descending analgesic pathways may result in:
a)
Reduced pain sensitivity
b)
Balanced inhibition and facilitation of pain
c)
Enhanced pro-nociceptive signalling
d)
Increased endogenous opioid activity
e)
Improved pain tolerance
167.
Thalamic stroke can result in chronic pain because:
a)
It increases prostaglandin synthesis
b)
It disrupts nociceptor function
c)
It alters central pain relay and processing
d)
It enhances spinal reflexes
e)
It damages peripheral nerves
168.
Which medication class is recommended first-line for neuropathic pain according to NICE?
a)
NSAIDs
b)
Paracetamol
c)
Opioids
d)
Certain anticonvulsants
e)
Beta blockers
169.
Transcutaneous electrical nerve stimulation (TENS) is thought to work by:
a)
Directly blocking nociceptors
b)
Enhancing descending inhibitory pathways
c)
Increasing histamine release
d)
Causing end-organ muscle paralysis
e)
Destroying peripheral nerves
170.
Psychological pain management strategies primarily aim to:
a)
Eliminate chronic pain completely
b)
Reframe the perception and coping with pain
c)
Replace pharmacological therapy
d)
Cure underlying neurological damage
e)
Diagnose the source of pain
171.
Chronic pain is best characterised by which physiological change?
a)
Increased spontaneous firing of second-order neurons
b)
Complete loss of nociceptor input
c)
Enhanced recruitment of A-beta fibres to nociceptive pathways
d)
Reduced central sensitisation
e)
Sustained activation of inflammatory mediators only
172.
A patient experiences increased pain from a painful stimulus after spinal cord injury. This is:
a)
Allodynia
b)
Hyperalgesia
c)
Neuroma formation
d)
Visceral sensitisation
e)
Gate control failure
173.
In phantom limb pain, mirror therapy primarily reduces pain by:
a)
Increasing spinal opioid interneuron activity
b)
Facilitating GABA release in the thalamus
c)
Normalising mismatched visual-proprioceptive representation
d)
Decreasing glutamate release at dorsal horn synapses
e)
Interrupting C-fibre conduction in the residual limb
174.
Which brain region is key in descending inhibition of pain?
a)
Hypothalamus
b)
Periaqueductal grey
c)
Hippocampus
d)
Caudate nucleus
e)
Amygdala
175.
Damage to the thalamus may lead to central pain syndrome because:
a)
It prevents peripheral nociceptor activation
b)
It increases efferent sympathetic outflow
c)
It disrupts relay and modulation of pain signals to cortex
d)
It enhances C-fibre myelination
e)
It reduces glutamate receptor density in the cortex
176.
Which feature most strongly differentiates neuropathic pain from nociceptive pain?
a)
It improves significantly with NSAIDs
b)
It arises from direct nerve injury or dysfunction
c)
It is typically sharp and well localised
d)
It is mediated only by C-fibres
e)
It always follows a clear trauma
177.
First-line agent for diabetic neuropathy per NICE:
a)
Morphine
b)
Gabapentin or pregabalin
c)
Paracetamol
d)
Ibuprofen
e)
Tramadol
178.
TENS (Transcutaneous Electrical Nerve Stimulation) likely reduces pain via:
a)
Direct inhibition of nociceptors
b)
Activation of A-beta fibres that engage inhibitory interneurons
c)
Causing local muscle fatigue
d)
Increasing release of substance P
e)
Destroying peripheral nerve endings
179.
Which analgesic approach is most appropriate when chronic pain persists despite adequate tissue healing and no identifiable structural pathology?
a)
Escalating opioid dosage
b)
Early referral to specialist pain management including CBT
c)
Surgical decompression of the suspected region
d)
Long-term NSAID therapy
e)
Routine nerve ablation
180.
Which finding most strongly supports central sensitisation rather than persistent peripheral injury?
a)
Pain only during mechanical pressure at the injury site
b)
Pain improves significantly with local anaesthetic block
c)
Pain is sharp and dermatome-specific
d)
Pain worsens only during inflammation
e)
Pain persists despite complete peripheral nerve block
181.
The inner ear is located within which part of the temporal bone?
a)
Squamous part
b)
Mastoid part
c)
Petrous part
d)
Tympanic part
e)
Styloid process
182.
The scala vestibuli and scala tympani are filled with:
a)
Endolymph
b)
Cerebrospinal fluid
c)
Perilymph
d)
Synovial fluid
e)
Aqueous humour
183.
The organ of Corti rests upon which membrane?
a)
Reissner's membrane
b)
Basilar membrane
c)
Tectorial membrane
d)
Tympanic membrane
e)
Vestibular membrane
184.
Vibration of the stapes at the oval window produces pressure waves in which space?
a)
Scala tympani
b)
Scala vestibuli
c)
Cochlear duct
d)
Utricle
e)
Saccule
185.
High-frequency sounds cause maximal displacement of the basilar membrane:
a)
Near the apex of the cochlea
b)
At the helicotrema
c)
Near the round window
d)
Near the oval window
e)
Uniformly along the cochlea
186.
The superior olivary nucleus receives input from:
a)
Ipsilateral cochlear nucleus only
b)
Contralateral cochlear nucleus only
c)
Both ipsilateral and contralateral cochlear nuclei
d)
Medial geniculate nucleus
e)
Inferior colliculus
187.
Which structure connects the scala tympani to the subarachnoid space?
a)
Cochlear aqueduct (canaliculus)
b)
Vestibular aqueduct
c)
Round window
d)
Oval window
e)
Endolymphatic duct
188.
In Rinne's test, a patient hears the tuning fork better on bone than through air. This indicates:
a)
Normal hearing
b)
Bilateral sensorineural loss
c)
Unilateral conductive hearing loss
d)
Bilateral conductive hearing loss
e)
Unilateral sensorineural hearing loss
189.
Unilateral sensorineural hearing loss causes sound on Weber's test to lateralise to:
a)
The affected ear
b)
The unaffected ear
c)
Midline
d)
Both ears equally
e)
The side with conductive loss
190.
The primary auditory cortex is located in which region?
a)
Inferior temporal gyrus
b)
Middle temporal gyrus
c)
Superior temporal gyrus
d)
Angular gyrus
e)
Supramarginal gyrus
191.
A 62-year-old patient complains of difficulty hearing high-pitched sounds (speech is muffled, low-pitch sounds preserved). Which cochlear location is most likely primarily damaged?
a)
Base of the cochlea
b)
Apex of the cochlea
c)
Helicotrema
d)
Scala media near apex
e)
Basilar membrane mid-turn
192.
A lesion of the cochlear nucleus at the rostral medulla will most likely cause which of the following hearing findings?
a)
Complete bilateral deafness
b)
Ipsilateral impairment with preserved contralateral input to cortex
c)
Pure conductive hearing loss
d)
Loss of bone conduction only
e)
Isolated loss of speech perception with preserved pure tone thresholds
193.
A patient has a focal infarct limited to the superior olivary complex on one side. The most likely clinical deficit is:
a)
Complete ipsilateral deafness
b)
Loss of middle ear reflex bilaterally
c)
Impaired horizontal sound localisation (interaural time/intensity differences)
d)
Loss of tonotopic organisation in primary auditory cortex
e)
Deafness for low-frequency sounds only
194.
A patient with a small lesion restricted to the inferior colliculus on the right side is most likely to present with:
a)
Total right-sided deafness
b)
Bilateral loss of air-bone gap on tuning fork tests
c)
Loss of vestibular function on the right
d)
Contralateral decrease in auditory reflexes and altered frequency mapping (partial)
e)
Purely ipsilateral peripheral tinnitus
195.
Paralysis of the stapedius muscle due to a facial nerve (VII) lesion would most likely result in:
a)
Improved hearing in a noisy environment
b)
Conductive hearing loss on audiometry only at low frequencies
c)
No change in tinnitus perception
d)
Loss of vestibulo-ocular reflex
e)
Hyperacusis (increased sensitivity to sound) on the affected side
196.
Which of the following best explains why presbycusis typically affects high frequencies first?
a)
Age-related degeneration preferentially affects the basal turn hair cells and stria vascularis
b)
Progressive narrowing of the cochlear aqueduct with age reduces low-frequency transmission
c)
Eustachian tube dysfunction selectively damages high-frequency perception over time
d)
Ageing causes ossicular chain stiffening that attenuates low frequencies first
e)
Loss of superior olivary nucleus neurons reduces high-frequency encoding
197.
Clinical findings: Left Rinne negative (BC>AC) and Weber lateralises to the right. Best interpretation:
a)
Left severe sensorineural loss
b)
Left conductive hearing loss
c)
Right conductive hearing loss
d)
Bilateral symmetrical sensorineural loss
e)
Left central auditory pathway lesion
198.
Within the inferior colliculus, frequency mapping is arranged such that the ventral portion receives projections primarily from:
a)
Utricle (vestibular low-frequency motion)
b)
Dorsal cochlear nucleus low-frequency neurons
c)
Ventral cochlear nucleus high-frequency neurons
d)
Contralateral inferior olive motor fibres
e)
Facial nerve motor nucleus
199.
A cochlear implant electrode array is intended primarily to stimulate which structure to restore auditory perception?
a)
Inner hair cell stereocilia directly
b)
Tectorial membrane mechanically
c)
Basilar membrane motion via fluid displacement
d)
Spiral ganglion / cochlear nerve fibres in the modiolus
e)
Utricular macula hair cells
200.
Activation of the medial olivocochlear efferent system primarily results in:
a)
Increased afferent firing from inner hair cells
b)
Enhanced cochlear blood flow via the cochlear aqueduct
c)
Mechanical stiffening of the ossicular chain
d)
Strengthening of the middle ear reflex to low-frequency noise
e)
Suppression of outer hair cell electromotility and reduced otoacoustic emissions
201.
Which of the following is a key component of the "Triad of General Anaesthesia"?
a)
Muscle tone
b)
Unconsciousness
c)
Reflex preservation
d)
Hyperalgesia
e)
Hypotension
202.
Which intravenous anaesthetic agent provides both airway and cardiovascular stability?
a)
Propofol
b)
Thiopentone
c)
Etomidate
d)
Ketamine
e)
Midazolam
203.
Which volatile anaesthetic agent is known for being pungent and unsuitable for inhalational induction?
a)
Sevoflurane
b)
Isoflurane
c)
Desflurane
d)
Halothane
e)
Nitrous oxide
204.
Which statement about thiopentone is TRUE?
a)
It increases cerebral blood flow
b)
It has a short elimination half-life (~1.5 h)
c)
It is metabolised renally
d)
It decreases blood pressure and increases heart rate
e)
It causes adrenal suppression
205.
Which local anaesthetic agent is most cardiotoxic?
a)
Lidocaine
b)
Bupivacaine
c)
Ropivacaine
d)
Prilocaine
e)
Amethocaine
206.
What is the mechanism of action of local anaesthetics?
a)
Block calcium channels
b)
Block sodium channels
c)
Stimulate GABA receptors
d)
Block potassium channels
e)
Inhibit acetylcholine release
207.
Which of the following is a depolarising neuromuscular blocker?
a)
Rocuronium
b)
Atracurium
c)
Vecuronium
d)
Suxamethonium
e)
Pancuronium
208.
A 70-year-old man on warfarin is listed for TURP. What is the main anaesthetic concern?
a)
Risk of bronchospasm
b)
Difficult airway
c)
Risk of bleeding and spinal haematoma
d)
Hypoglycaemia
e)
Reduced renal excretion of drugs
209.
In a patient with poorly controlled asthma requiring urgent laparotomy, which anaesthetic management is MOST appropriate preoperatively?
a)
Immediate induction with thiopentone
b)
Nebulised salbutamol and oxygen therapy
c)
Withhold steroids to avoid stress response
d)
Administer large-volume IV fluids
e)
Avoid beta-agonists due to tachycardia
210.
Which of the following statements regarding spinal anaesthesia is TRUE?
a)
It allows continuous infusion via catheter
b)
It has a less dense block than epidural
c)
It has a clear endpoint upon CSF return
d)
It is suitable for prolonged postoperative analgesia
e)
It cannot be used for lower limb surgery
211.
During induction with etomidate, which adverse effect is of most clinical concern in critically ill patients?
a)
Adrenocortical suppression
b)
Bronchospasm
c)
Malignant hyperthermia
d)
Hyperkalaemia
e)
Reflex bradycardia
212.
Which volatile anaesthetic has the lowest blood/gas partition coefficient, allowing for the fastest onset and recovery?
a)
Halothane
b)
Desflurane
c)
Isoflurane
d)
Sevoflurane
e)
Nitrous oxide
213.
A patient under general anaesthesia suddenly develops masseter muscle rigidity and rising end-tidal CO₂. The most likely diagnosis is:
a)
Hypoventilation
b)
Anaphylaxis
c)
Malignant hyperthermia
d)
Suxamethonium apnoea
e)
Bronchospasm
214.
Which intravenous agent acts as an NMDA receptor antagonist rather than via GABA?
a)
Propofol
b)
Thiopentone
c)
Etomidate
d)
Ketamine
e)
Midazolam
215.
A patient with a BMI of 50 requires general anaesthesia. Which preoperative strategy is most appropriate?
a)
Delay surgery for six weeks of weight loss
b)
Omit preoxygenation to avoid gastric insufflation
c)
Use Trendelenburg position for induction
d)
Use a small dose of thiopentone to reduce hypotension
e)
Preoxygenate in a 25–30° head-up position
216.
Which statement best explains the effect of propofol on cerebral physiology?
a)
Reduces cerebral blood flow and intracranial pressure
b)
Increases cerebral perfusion pressure
c)
Increases intracranial pressure
d)
Has no effect on cerebral metabolism
e)
Causes cerebral vasodilation
217.
A 26-year-old woman in labour with a partial epidural block requires emergency C-section. What is the most appropriate anaesthetic approach?
a)
General anaesthesia with halothane
b)
Top up existing epidural with local anaesthetic
c)
Wait until spontaneous delivery
d)
Proceed with spinal anaesthesia at a higher dose
e)
Give sedation with midazolam only
218.
Which of the following correctly describes atracurium's metabolism?
a)
Hepatic metabolism
b)
Renal excretion unchanged
c)
Pseudocholinesterase degradation
d)
Hofmann elimination and ester hydrolysis
e)
CYP3A4 metabolism
219.
A 70-year-old man is planned for TURP under spinal anaesthesia. Which physiological effect is MOST likely?
a)
Tachycardia due to vagal blockade
b)
Hypertension due to vasoconstriction
c)
Hypotension from sympathetic blockade
d)
Hyperventilation due to diaphragmatic paralysis
e)
Respiratory depression from local anaesthetic toxicity
220.
In a patient with severe asthma requiring emergency laparotomy, which induction agent is most appropriate?
a)
Thiopentone
b)
Etomidate
c)
Midazolam
d)
Propofol
e)
Ketamine
221.
A patient stands with feet together and eyes closed. He begins to sway and falls. Which sensory system is most likely affected?
a)
Visual system
b)
Cerebellum
c)
Vestibular system
d)
Motor cortex
e)
Proprioceptive system
222.
Which structure detects vertical acceleration?
a)
Utricular macula
b)
Saccular macula
c)
Superior semicircular canal
d)
Posterior semicircular canal
e)
Lateral semicircular canal
223.
Which statement best describes the lateral vestibulospinal tract?
a)
Projects bilaterally to cervical cord
b)
Crosses in the medulla
c)
Controls contralateral limb flexors
d)
Descends ipsilaterally to all cord levels
e)
Mediates head rotation
224.
Which function is mediated by the medial longitudinal fasciculus (MLF)?
a)
Conjugate eye and head movements
b)
Voluntary saccades
c)
Visual fixation
d)
Vestibulospinal reflex
e)
Accommodation
225.
A patient with a left frontal lobe stroke cannot voluntarily look to the right. Which structure is affected?
a)
Left PPRF
b)
Right PPRF
c)
Left frontal eye field
d)
Right frontal eye field
e)
Left superior colliculus
226.
In left vestibular nucleus damage, which direction will the fast phase of nystagmus be?
a)
To the left
b)
To the right
c)
Upward
d)
Downward
e)
Absent
227.
Cold water is instilled into the left ear of a conscious patient. Which is the normal response?
a)
Eyes drift right, fast phase left
b)
Eyes drift left, fast phase right
c)
Eyes drift right, fast phase right
d)
Eyes drift left, fast phase left
e)
No eye movement
228.
Benign Paroxysmal Positional Vertigo (BPPV) is most commonly caused by:
a)
Viral inflammation of vestibular nerve
b)
Ischaemia of labyrinthine artery
c)
Displacement of otoconia
d)
Increased endolymph pressure
e)
Acoustic neuroma
229.
Which statement best describes the vestibulo-ocular reflex (VOR)?
a)
Prevents image blurring during head movement
b)
Initiates voluntary eye movement
c)
Detects retinal slip
d)
Mediates accommodation reflex
e)
Controls pupil diameter
230.
Afferents from the semicircular canals project primarily to which vestibular nuclei?
a)
Lateral vestibular nucleus
b)
Inferior vestibular nucleus
c)
Superior and medial vestibular nuclei
d)
Posterior vestibular nucleus
e)
Cerebellar flocculus
231.
A 45-year-old man presents with acute vertigo, vomiting, and vertical nystagmus that changes direction on gaze. There is no hearing loss. Which of the following best localises the lesion?
a)
Brainstem or cerebellum
b)
Vestibular nerve
c)
Semicircular canals
d)
Utricle and saccule
e)
Middle ear
232.
During caloric testing in a comatose patient, cold water is irrigated into the left ear. No eye movement occurs. What does this indicate?
a)
Brainstem death
b)
Left vestibular neuritis
c)
Bilateral cortical blindness
d)
Normal reflex
e)
Right MLF lesion
233.
A lesion of the medial longitudinal fasciculus (MLF) on the right side will cause which eye movement deficit?
a)
Failure of right eye to adduct on left gaze
b)
Failure of left eye to abduct on right gaze
c)
Failure of both eyes to converge
d)
Bilateral loss of vestibulo-ocular reflex
e)
Failure of vertical gaze
234.
Which brainstem structure receives decussated projections from the frontal eye fields?
a)
Paramedian pontine reticular formation (PPRF)
b)
Superior colliculus
c)
Vestibular nuclei
d)
Red nucleus
e)
Oculomotor nucleus
235.
Which pathological process underlies Meniere's disease?
a)
Endolymphatic hydrops
b)
Displaced otoconia
c)
Viral vestibular neuritis
d)
Cerebellar infarction
e)
Demyelination of MLF
236.
Damage to the lateral vestibular nucleus most likely results in:
a)
Impaired postural reflexes on the same side
b)
Loss of conjugate horizontal gaze
c)
Loss of contralateral limb flexion
d)
Loss of voluntary saccades
e)
Upbeat nystagmus
237.
Rotation of the head to the right primarily increases firing in which semicircular canal?
a)
Right horizontal canal
b)
Left horizontal canal
c)
Right posterior canal
d)
Left anterior canal
e)
Right saccule
238.
After unilateral vestibular loss, which mechanism allows recovery of balance over days to weeks?
a)
Central neuronal plasticity in vestibular nuclei
b)
Regeneration of hair cells
c)
Proprioceptive adaptation only
d)
Recanalisation of labyrinthine artery
e)
Increased cochlear input
239.
Which feature differentiates jerk from pendular nystagmus?
a)
Presence of a fast corrective phase
b)
Equal velocity in both directions
c)
Occurrence only in central lesions
d)
Horizontal plane only
e)
Triggered by head motion
240.
A lesion of the left vestibular nucleus causes which pattern of eye movement?
a)
Slow drift to left, fast phase to right
b)
Slow drift to right, fast phase to left
c)
Bilateral loss of conjugate gaze
d)
Vertical nystagmus
e)
No nystagmus
241.
Which of the following best defines a stroke according to the WHO?
a)
Neurological deficit resolving within 24 hours
b)
Focal neurological deficit due to vascular cause lasting >24 hours or causing death
c)
Any episode of loss of consciousness due to vascular cause
d)
Transient monocular blindness lasting <1 hour
e)
Seizure with postictal paresis
242.
A 70-year-old man has sudden expressive dysphasia and right-sided weakness. Which vessel is most likely affected?
a)
Left anterior cerebral artery
b)
Left middle cerebral artery
c)
Right posterior cerebral artery
d)
Left vertebral artery
e)
Basilar artery
243.
Which of the following is most consistent with a posterior circulation stroke?
a)
Dysphasia
b)
Neglect
c)
Ipsilateral cranial nerve palsy with contralateral weakness
d)
Homonymous hemianopia alone
e)
Facial droop and dysarthria
244.
In the Oxford Community Stroke Project (OCSP) classification, which of the following features defines a TACS?
a)
Isolated homonymous hemianopia
b)
Pure motor stroke
c)
Any two of motor, sensory, or visual signs
d)
Homonymous hemianopia + hemiparesis + higher cortical dysfunction
e)
Ataxic hemiparesis
245.
A patient with wake-up stroke shows DWI/FLAIR mismatch on MRI. What does this indicate?
a)
Completed infarct -- no treatment benefit
b)
Haemorrhagic stroke
c)
Viable penumbra -- eligible for thrombolysis
d)
Reperfusion injury
e)
Small vessel disease
246.
Thrombolysis with IV alteplase is standard up to which time window after onset of symptoms (with standard imaging)?
a)
1 hour
b)
3 hours
c)
4.5 hours
d)
6 hours
e)
9 hours
247.
Which of the following is an absolute contraindication to thrombolysis?
a)
Controlled hypertension (BP 160/90 mmHg)
b)
Platelet count 200 ×10⁹/L
c)
Recent intracerebral haemorrhage
d)
Age >85 years
e)
On aspirin therapy
248.
What is the ASPECTS score used for?
a)
Assessing stroke severity by NIHSS
b)
Evaluating collateral circulation
c)
Quantifying early CT changes in MCA stroke
d)
Measuring carotid stenosis
e)
Predicting haemorrhagic transformation
249.
A patient presents with an intracerebral haemorrhage while on warfarin. What is the most appropriate immediate management?
a)
Stop warfarin and observe
b)
Administer vitamin K only
c)
Administer prothrombin complex concentrate (PCC)
d)
Give alteplase
e)
Start aspirin
250.
A 68-year-old man with atrial fibrillation has an ischaemic stroke. What is the most appropriate long-term secondary prevention?
a)
Dual antiplatelet therapy
b)
Warfarin or DOAC anticoagulation
c)
High-dose aspirin indefinitely
d)
Carotid endarterectomy
e)
Clopidogrel monotherapy
251.
A 62-year-old presents 2.5 hours after onset with an MCA territory stroke. Non-contrast CT is normal. Which is the single best next step to maximise chance of a good functional outcome?
a)
Give IV alteplase immediately (assuming no contra-indications)
b)
Wait and perform CT perfusion before deciding
c)
Give aspirin now and re-assess at 24 h
d)
Immediate mechanical thrombectomy without IV thrombolysis
e)
Start dual antiplatelet therapy (aspirin + clopidogrel)
252.
Which ASPECTS (Alberta) CT score best predicts a large MCA infarct that would likely exclude the patient from thrombectomy or reperfusion due to extensive early infarct?
a)
9–10
b)
0–3
c)
6–8
d)
5–7
e)
8–10
253.
A patient presents with sudden vertigo, dysarthria, bilateral limb weakness and ophthalmoplegia. Which vascular territory and OCSP classification is most likely?
a)
Left MCA — PACS
b)
PCA — LACS
c)
Vertebrobasilar (posterior circulation) — POCS
d)
ACA — TACS
e)
Right MCA — LACS
254.
Which measurement/threshold on CT perfusion best matches the commonly used selection criteria for thrombectomy in extended (6–24 h) windows (e.g., DAWN/DEFUSE-3 style selection)?
a)
Ischaemic core volume > 70 ml with mismatch ratio > 1.2
b)
Penumbra:core mismatch ratio < 1.2 and core < 70 ml
c)
Core > 90 ml irrespective of mismatch
d)
Mismatch ratio > 1.2, mismatch volume > 10 ml, and core < 70 ml
e)
Any mismatch irrespective of core size
255.
A 78-year-old on apixaban presents with a lobar intracerebral haemorrhage. Which immediate step is most appropriate (assuming apixaban last dose 6 h ago)?
a)
Give PCC only if INR >1.5
b)
Give vitamin K infusion
c)
Administer alteplase reversal protocol
d)
Begin aspirin to stabilise platelets
e)
Consider specific reversal agent (andexanet alfa) or non-specific PCC per local guideline
256.
Which of the following statements about the ischaemic penumbra is MOST accurate?
a)
It is hypoperfused but potentially salvageable tissue surrounding core infarct
b)
It is permanently infarcted tissue that cannot be salvaged
c)
It corresponds to areas of intracerebral haemorrhage on CT
d)
It is identified as hyperintense on FLAIR and corresponds to completed infarct only
e)
It is irrelevant when selecting patients for thrombectomy
257.
Which of the following clinical scenarios most strongly indicates consideration of decompressive hemicraniectomy for malignant MCA infarction?
a)
NIHSS 6, alert, small cortical infarct on CT
b)
NIHSS >15 with reduced consciousness and infarct >50% MCA territory within 48 h
c)
Stable NIHSS 8 with progressive improvement over 72 hours
d)
Small lacunar infarct with isolated pure motor hemiparesis
e)
Hemorrhagic conversion of a tiny cortical infarct with minimal mass effect
258.
According to the lecture slides, which secondary prevention strategy has the greatest absolute benefit (lowest NNT) in symptomatic severe carotid stenosis when performed within 2 weeks?
a)
Carotid stenting in all patients
b)
Immediate anticoagulation with warfarin for all patients
c)
Carotid endarterectomy in symptomatic men within 2 weeks (NNT ≈ 9)
d)
Dual antiplatelet therapy indefinitely
e)
Carotid endarterectomy delayed >12 weeks (NNT ≈125)
259.
Which of the following is the most appropriate antiplatelet strategy immediately after IV thrombolysis for ischaemic stroke?
a)
Start aspirin 300 mg immediately before thrombolysis to reduce re-occlusion risk
b)
Begin dual antiplatelet therapy (aspirin + clopidogrel) within 6 h of thrombolysis
c)
Start long-term aspirin 75 mg immediately after alteplase infusion finishes
d)
Withhold antiplatelet therapy for 24 hours and perform repeat CT to exclude haemorrhage before starting aspirin 300 mg if safe
e)
Start ticagrelor immediately after thrombolysis
260.
A patient with non-valvular atrial fibrillation and recent ischaemic stroke (no ICH) is being considered for anticoagulation. Which is the best current general approach per the lecture slides?
a)
Start warfarin only — DOACs are contraindicated in stroke survivors
b)
Withhold anticoagulation indefinitely; use antiplatelets instead
c)
Start aspirin and defer anticoagulation for 6 months
d)
Use left atrial appendage occlusion device as first-line in all patients
e)
Assess CHA₂DS₂-VASc and, if appropriate, start oral anticoagulation (DOAC preferred) balancing ICH risk
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