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🧠Nervous System (Central)
Anatomy
1. Which of the following is correct regarding spinal nerve rami?
Anterior ramus innervates trunk and limbs, posterior ramus innervates the back
Posterior ramus innervates limbs and anterior ramus innervates the back
2. At birth, conus medullaris lies at the level of:
L1–L2
L2–L3
S2–S3
T12–L1
3. Which of the following is correct regarding dura mater?
The two layers are fused except where brain veins are located
Periosteal and meningeal layers are continuous with spinal cord
Only the periosteal layer is continuous with spinal cord
Only the meningeal layer is continuous with spinal cord
4. The anatomical location of interventricular foramen lies in:
Between anterior horn and body of lateral ventricle
Between posterior and inferior horn
5. What does a lesion in postcentral gyrus cause?
Contralateral motor and sensory dysfunction
Contralateral sensory disturbances
Ipsilateral motor dysfunction
6. Fibers from cortex to ventral gray column are:
Commissural fibers
Association fibers
Corticopetal fibers
Projection fibers
7. Cortico-hypothalamic fibers originate from:
Temporal lobe
Parietal lobe
Frontal lobe
Insular lobe
8. Which of the following is correct regarding the straight sinus?
Located at junction of falx cerebri and tentorium cerebelli
Drains directly into cavernous sinus
9. How do segmental spinal arteries supply the spinal cord?
Directly through anterior median fissure
Via radicular arteries accompanying nerve roots
10. Trochlear nucleus lies at the level of:
Medulla oblongata
Pons
Superior colliculi
Inferior colliculi
11. Internal arcuate fibers come from:
Lateral spinothalamic tract
Medial lemniscus
Contralateral cuneate nucleus
Ipsilateral cuneate nucleus
12. Which of the following is NOT part of discriminative touch pathway?
Cuneate nucleus
Gracile nucleus
VPL nucleus of thalamus
Lateral spinothalamic tract
13. Hypokinesia includes:
Dysmetria
Masked facial expressions
14. Descending hypothalamic tracts controlling ANS terminate at:
Medial lemniscus
Reticular formation
Nucleus ambiguus
Inferior olive
15. Cranial nerves that do NOT provide bilateral innervation to the face:
Facial nerve (lower face) and hypoglossal nerve
Trigeminal and facial nerves
16. Parallel fibers in molecular layer of cerebellum are:
Axons of granule cells
Dendrites of Purkinje cells
17. Posterior spinocerebellar tract synapses with:
Contralateral Clarke’s column
Ipsilateral Clarke’s column
18. Fourth somite results from:
Neural folds fusion
Neural crest migration
19. Thalamostriate fibers originate from:
Intralaminar nucleus
Ventral lateral nucleus
Ventral anterior nucleus
Ventral posterior nucleus
20. Thalamic nucleus involved in cerebellar pathway regulation:
Ventral lateral nucleus
Intralaminar nucleus
Ventral posterior nucleus
Ventral anterior nucleus
21. Astereognosis is due to lesion in:
Superior parietal lobule
Inferior parietal lobule
Middle temporal gyrus
22. Sympathetic fibers are located at:
S2–S4
T1–L2
C8–L4
All of the above
23. Area most affected by middle cerebral artery lesion:
Lateral frontal, parietal and temporal lobes
Entire medial surface of brain
Occipital lobe
24. Which of the following site is most affected by lesion in middle cerebral artery?
Lateral part of frontal, parietal and temporal lobes
Entire medial surface of the brain
Occipital lobe only
25. Which of the following best describes the internal cerebral vein?
Drains directly into cavernous sinus
Runs over the surface of cerebrum
Merges with great cerebral vein beneath splenium to form straight sinus
Drains into superior sagittal sinus
26. The decussation of superior cerebellar peduncles is located in:
Upper pons
Caudal midbrain
Rostral midbrain
Medulla oblongata
27. Medial lemniscus is formed from:
Ipsilateral cuneate nucleus
Ipsilateral gracile nucleus
Contralateral cuneate nucleus
28. The root of facial nerve wraps around abducent nucleus to produce:
Facial colliculus
Inferior colliculus
29. Which of the following is NOT associated with pain and temperature pathway?
Cuneate nucleus
Posterolateral tract of Lissauer
Thalamus
Dorsal gray column of spinal cord
30. Mossy fibers synapse with:
Dendrites of granule cells
Dendrites of Purkinje cells
Axons of Purkinje cells
Axons of granule cells
31. Which of the following is correct?
Cerebellar output is carried by inhibitory axons of Purkinje cells
Granule cells receive inhibitory input from mossy fibers
Climbing fibers form parallel fibers
32. Which of the following is a hyperkinetic disorder?
Chorea
Bradykinesia
Dysmetria
33. Anterior spinocerebellar tract enters cerebellum via:
Contralateral superior cerebellar peduncle
Ipsilateral inferior cerebellar peduncle
Ipsilateral superior cerebellar peduncle
Both contralateral and ipsilateral superior cerebellar peduncles
34. Which structure forms the boundary between telencephalon and diencephalon?
Optic vesicles
Lamina terminalis
35. Which of the following is correct regarding corticospinal tract?
Lateral corticospinal tract descends in lateral funiculus and terminates in anterior horn
Terminates in posterior horn only
36. Which of the following is correct regarding lamina terminalis?
Most rostral part of neural tube and gives rise to commissural fibers
Forms floor of fourth ventricle
37. Which of the following is correct regarding spinal cord tracts?
Ascending tracts are in all columns while descending tracts are in ventral and lateral columns
Descending tracts only in anterior column
Motor and sensory tracts are evenly distributed in all columns
38. In which part of internal capsule do corticospinal tracts pass?
Posterior limb
Anterior limb
Genu
Physiology
1. Which of the following is correct about aphasia?
Wernicke’s aphasia results from lesion in posterior part of superior temporal gyrus
Broca’s aphasia results from lesion in occipital lobe
2. Which of the following best describes the mechanism of habituation?
Closure of presynaptic calcium channels
Increased postsynaptic receptor sensitivity
3. Choose the correct statement about composition of CSF compared to plasma:
Plasma has significantly lower sodium than CSF
CSF has higher concentration of chloride ions
CSF has higher protein concentration
4. Choose the correct statement about sleep:
Anti-adrenergic neurons are activated in REM sleep
Cholinergic neurons are activated in REM sleep
GABA levels are highest during wakefulness
5. Choose the correct statement about pain pathway:
WDR neurons are activated by noxious and non-noxious stimuli
WDR neurons respond only to noxious stimuli
NS neurons respond to non-noxious stimuli only
6. Which of the following is correct about pain?
Inflammatory mediators released at injury site facilitate pain pathway
Pain transmission is inhibited by inflammatory mediators
7. Which correctly describes a component of the direct pathway of basal ganglia?
Disinhibition of subthalamic nucleus
Excitation of globus pallidus
Disinhibition of the thalamus
8. Which of the following is correct regarding input to the cerebellum?
Mossy and climbing fibers inhibit Purkinje cells
Mossy fibers directly excite Purkinje cells
Climbing fibers project to and excite Purkinje cells
9. Which of the following is correct regarding the indirect pathway of basal ganglia?
It inhibits the thalamus leading to suppression of movement
It activates globus pallidus externa
Dopamine activates subthalamic nucleus
It inhibits the striatum
10. Which of the following is the correct function of mirror neurons?
Aid in learning new skills by imitation and observation
Control autonomic nervous system responses
11. Which of the following is correct regarding neurochemical mechanism of sleep and arousal?
High levels of norepinephrine and histamine lead to wakefulness
Low histamine levels cause wakefulness
12. Which of the following is correct regarding EEG?
High frequency beta rhythm is seen during wakefulness
Sleep spindles are seen in REM sleep
K-complexes are smallest EEG events
Theta waves dominate deep sleep
13. Which best describes the role of astrocytes in regulating cerebral blood flow?
Nitric oxide causes vasodilation
Adenosine causes vasoconstriction
Neuropeptide Y causes vasodilation
14. Which best describes the difference between plasma and CSF composition?
Sodium is higher in plasma
Magnesium is higher in CSF than plasma
Calcium is higher in CSF
Chloride is lower in CSF
15. Which of the following is correct regarding pain neurotransmitters?
Glycine enhances pain transmission
Both Aδ and C fibers use GABA
Substance P is the main neurotransmitter of C fibers
Serotonin is the main excitatory neurotransmitter
Pharmacology
1. Which of the following drug(s) is/are used for neuropathic pain?
Morphine
Tricyclic antidepressants
Serotonin/norepinephrine reuptake inhibitors
Two of the listed are correct
2. Which of the following drug(s) is/are used for neuropathic pain?
Morphine
Tricyclic antidepressants
Serotonin/norepinephrine reuptake inhibitors
Two of the listed are correct
3. Which of the following is INCORRECT about first-generation antiepileptic drugs?
They are considered first-line treatment for epilepsy
They are efficacious
They have complex pharmacokinetics
They have multiple drug interactions
4. Which of the following is correct regarding hypotheses of schizophrenia?
All of the listed
Mescaline is a 5-HT2A agonist producing hallucinations
Only 5-HT2C receptors modulate dopamine release
5. Which of the following is NOT used as a pre-anesthetic drug?
Fentanyl
Antimuscarinic drugs
Metoclopramide
Diphenhydramine
Propofol
6. Which of the following is FALSE about anti-seizure medications?
Pregabalin is used for epilepsy and neuropathy
Loading dose of lamotrigine and carbamazepine is required
Some can cause skin rash and hepatotoxicity
7. Which of the following is correct regarding zolpidem?
It has few routes of administration
Flumazenil is ineffective
It has rapid onset of hypnotic action
8. Which of the following is FALSE about benzodiazepines?
Used for skeletal muscle spasm
They have no significant effect on sleep induction
Oxidation produces active metabolites
9. Which of the following is a physiological effect of depression?
Low mood
Feeling of guilt
Reduced energy
Decreased appetite
10. Which drug is BEST to treat neuropathic pain?
Anticonvulsants
Tricyclic antidepressants
SNRI
All of the above
11. Which of the following is INCORRECT about MAO inhibitors?
Tranylcypromine is MAO-B inhibitor
MAO-B metabolizes dopamine
MAO-A deactivates NE, 5-HT and dopamine
MAO-B inhibitors are used in Parkinson disease
MAO-A inhibitors are used in depression
12. Which of the following is TRUE?
Delusion is false belief without evidence
Hallucination is perception without stimulus
Psychosis involves detachment from reality
All are correct
13. Which of the following is INCORRECT about first-generation medications?
They are first-line epilepsy drugs
They are efficacious
They have complex pharmacokinetics
They have multiple interactions
14. Which of the following is INCORRECT?
Pregabalin is contraindicated in epilepsy and neuropathy
Lamotrigine is used in epilepsy and bipolar disorder
Topiramate is used in migraine and epilepsy
15. Which of the following is correct regarding hypotheses of schizophrenia?
All of the listed
Mescaline is a 5-HT2A agonist producing hallucinations
5-HT2C but not 5-HT2A modulates dopamine
16. Which of the following is NOT used as pre-anesthetic medication?
Fentanyl
Antimuscarinic drugs
Metoclopramide
Diphenhydramine
Desflurane
17. Which of the following is correct regarding ramelteon?
Used for chronic insomnia and jet lag
Causes high tolerance and dependence
Causes cognitive impairment
18. Which of the following is correct regarding barbiturates?
They have a narrow therapeutic index
They have a specific antidote
They cause no dependence
Pathology
1. Choose the INCORRECT statement about strokes:
Laminar necrosis is seen in global hypoxia
Middle cerebral artery is the most affected by thrombosis
TIA lasts from minutes up to 24 hours
Global hypoxia may be caused by hypoglycemia and cardiac arrest
2. Choose the INCORRECT statement about vascular malformations of the brain:
Gliotic brain tissue is present between vessels in cavernous hemangioma
AVM is the most common congenital vascular abnormality
They include capillary telangiectasia and cavernous hemangioma
AVM consists of abnormal artery–vein connections
3. Regarding bacterial infections of the CNS, choose the INCORRECT statement:
Toxoplasmosis can cause ring-enhancing abscess
Direct brain abscess often affects frontotemporal regions
Mucormycosis infections are usually blood-borne
Aspergillus invades vessels causing hemorrhagic infarction
4. Which of the following is NOT related to Alzheimer disease?
Apolipoprotein E4
Trisomy 21
Hypophosphorylated tau protein
Presenilin mutation
5. An 8-year-old boy with a midline cerebellar mass and beta-catenin positivity most likely has:
Medulloblastoma group 4
Medulloblastoma group 3
WNT-positive medulloblastoma
TP53-mutant medulloblastoma
6. Repeated CAG nucleotide expansion causing movement disorder affects which structure?
Putamen
Caudate nucleus
Hippocampus
7. Long-term neural deficit in closed head injury is caused by:
Demyelination of neurons
Diffuse axonal injury
8. Which of the following is correct regarding CNS tumors?
Oligodendroglioma has worse prognosis than astrocytoma
Pilocytic astrocytoma is WHO grade I, BRAF positive, IDH negative
9. Which genetic factor is most important in Alzheimer disease?
CAG repeat expansion
HLA-DR3/DR4
FMR1 mutation
Prion protein mutation
ApoE ε4 allele
10. Recurrent TIAs followed by stroke most likely result from:
Arteriovenous malformation
Cerebral atherosclerosis
Astrocytoma
Subdural hematoma
11. JC virus infection causes which condition?
HSV encephalitis
CMV encephalitis
Progressive multifocal leukoencephalopathy
Rabies
12. Beta-catenin–positive medulloblastoma indicates:
Favorable prognosis
Poor prognosis
MYC overexpression
13. Which of the following is INCORRECT regarding berry aneurysm?
Most commonly occurs at posterior circulation bifurcation
Associated with Marfan syndrome
HTN is common cause of intracerebral hemorrhage
Amyloid angiopathy causes lobar hemorrhage
14. Which of the following is correct?
Diffuse axonal injury is caused by acceleration–deceleration
Epidural hematoma involves bridging veins
Countercoup injury occurs at impact site
Concussion shows structural damage
15. Which of the following is correct regarding nervous system tumors?
Oligodendroglioma shows fried-egg appearance with 1p/19q co-deletion
NF1 commonly causes meningiomas
Most CNS tumors metastasize via CSF
Pilocytic astrocytoma is usually supratentorial
16. Which statement about Parkinson disease is FALSE?
Characterized by tremor, rigidity, bradykinesia
Caused by loss of dopaminergic neurons
Lewy bodies contain α-synuclein
Death often due to infections or falls
Lewy bodies are never seen in cerebral cortex
17. Which of the following is correct regarding epidural hematoma?
Caused by bridging vein injury
Occurs between arachnoid and dura
Associated with slow venous bleeding
Usually follows low-impact trauma
Occurs between skull and dura, often due to middle meningeal artery injury
Microbiology
1. All of the following are characteristic features of lepromatous leprosy EXCEPT:
Severely depressed immunity
Extensive skin lesions
Visible nerve enlargement
High infectivity
No evidence of histopathological immune response
2. Which of the following is TRUE about tetanospasmin?
Stimulates release of inhibitory neurotransmitters
Produced by non-lysogenic strains
Stimulates release of excitatory neurotransmitters
Inhibits release of inhibitory neurotransmitters
Inhibits release of excitatory neurotransmitters
3. Which of the following is the LEAST likely cause of meningitis in a patient with a ventriculoperitoneal shunt?
Streptococcus agalactiae
Staphylococcus epidermidis
Pseudomonas aeruginosa
Staphylococcus aureus
Acinetobacter baumannii
4. All of the following are characteristic features of tuberculoid leprosy EXCEPT:
Visible nerve enlargement
Low infectivity
Localized skin lesions
Severely depressed immunity
Clear histopathological immune response
5. Which of the following causes granulomatosis infantiseptica?
Short gram-positive bacilli
Gram-positive cocci
Strongly acid-fast bacilli
Weakly acid-fast organisms
6. Which of the following toxins is produced by lysogenic conversion?
Botulinum toxin
Mycobacterium leprae toxin
Biochemistry
1. Which of the following is correct regarding neurotransmitters?
Acetylcholine is degraded by enzymatic activity
Dopamine, epinephrine and norepinephrine are derived from tryptophan
Melatonin is synthesized from norepinephrine
2. Which of the following is correct regarding brain metabolism in fasting state?
Brain uses ketone bodies from the beginning of fasting
Glucose is the main fuel in early stages of fasting
3. Which of the following is correct regarding brain metabolism?
Glucose entry into brain via GLUT-1 is insulin independent
Ketone bodies are the main energy source in fed state
Fatty acids are the main fuel for brain during fasting
Brain depends mainly on glycogen in fed state
4. Which of the following is FALSE regarding small molecular neurotransmitters?
Synthesis of norepinephrine occurs in cytoplasm of presynaptic neuron
Catecholamines are synthesized from tyrosine
Serotonin is synthesized from tryptophan
Histamine is synthesized from histidine
5. Which of the following is correct regarding brain metabolism in fasting state?
Glucose is the main source of fuel in early fasting
Triglycerides are the main energy source for the brain