BPKIHS Internal Assessment, May 2000 - MULTIPLE CHOICE QUESTIONS, CNS Paper IIIB

(B-98)                                                                                            
                                                                     8th May 2000
B.P. KOIRALA INSTITUTE OF HEALTH SCIENCES, DHARAN, NEPAL

2nd Year MBBS Unit-5
Internal Assessment, May 2000
Paper - III B
(CNS)
MULTIPLE CHOICE QUESTIONS

Time: 1 hour                                                                                       
                     Maximum Marks: 75

Anatomy:
SECTION 'A'


1.   Which of the following fibers do not enter the cerebellum via inferior cerebellar peduncle?
a.    Anterior spinocerebellar tract
b.   Posterior spinocerebellar tract
c.    Olivocerebellar tract
d.    Reticulocerebellar fibres                                                                   
             Key: (a)

2.   The only one noncortical structure to receive efferents from thalamus is:
a.    Neostriatum
b.   Cerebellum
c.    Spinal cord
d.    Pons                                                                                         
                        Key: (a)

3.   Largest afferent fiber bundle that ends in the hypothalamus is:
a.    Medial forebrain bundle
b.    Fornix
c.    Stria terminalis
d.    Dorsal longitudinal fasciculus                                                               
          Key: (b)

4.   Occlusion of which area of the circle of Willis will result in total unilateral blindness?
a.    Anterior cerebral artery
b.   Ophthalmic artery
c.    Anterior choroidal artery
d.    Posterior communicating artery                                                               
       Key: (b)

5.   The fourth ventricle of the brain communicates superiorly with third ventricle through the:
a.    Cerebral aqueduct
b.   Foramen of Magendi
c.    Foramen of Luschka
d.    Central canal of medulla oblongata                                                           
     Key: (a)

6.   In which region of spinal cord lie the preganglionic neurons of the sympathetic nervous
system?
a.    Cervical
b.    Thoracic
c.    Sacral
d.    Coccygeal                                                                                   
                    Key: (b)

7.   Which of the following structures has unipolar neurons ?
a.    Anterior horn of spinal cord
b.   Sympathetic ganglion
c.    Dorsal root ganglion of spinal nerve
d.    Posterior horn of spinal cord                                                               
           Key: (c)

8.   The habenular nucleus receives the nerve fibers from:
a.    Stria medullaris thalami
b.   Ansa lenticularis
c.    Medial longitudinal fasciculus
d.    Lateral lemniscus                                                                             
                Key: (a)

9.   Linea splendens is a:
a.    Groove in the Insula
b.   Oblique ridge in the thyroid cartilage
c.    Covering of thalamus
d.    Thickened band of pia mater                                                                   
         Key: (d)

Physiology
10. Brain region primarily involved in aggressive behaviour is:
a.    Hippocampus
b.   Amygdala
c.    Hypothalamus
d.    Thalamus                                                                                      
                    Key: (b)

11. The neural mechanisms involved in motor planning for expression of words are located in:
a.    Wernicke’s area
b.    Brocas area
c.    Visual association cortex
d.    Prefrontal cortex                                                                             
                  Key: (b)

12. Which of the following substances pass through blood brain barrier with greatest ease:
a.    H+ ions
b.   Polypeptides
c.    CO2 and O2
d.    Glucose                                                                                       
                      Key: (c)

13. Desynchronized EEG may be associated with:
a.    Awake relaxed state
b.    REM sleep
c.    Slow wave sleep
d.    Unconscious state                                                                             
                Key: (b)

14. Lesion in the primary motor cortex is most likely to produce all of the following EXCEPT:
a.    Hypotonia
b.   Loss of localized movements
c.    Loss of fine movements
d.    Babinski negative                                                                             
                Key: (d)

15. The sensory pathway passing through non specific thalamic nuclei is mainly responsible for:
a.    Conscious perception of stimuli
b.   Some reflex responses
c.    General arousal
d.    Physical orientation                                                                          
                Key: (c)

16. All of the following facts regarding synaptic transmission are true EXCEPT:
a.    Presynaptic Ca++ influx occurs through voltage gated channels
b.   Postsynaptic reaction of neurotransmitter results in increased Na+ influx
c.    Magnitude of EPSP depends on the amount of neurotransmitter released
d.   Action potential apperaing at presynaptic terminal passes to postsynaptic terminal unmodified.
Key: (d)


17. Representation of different body parts in the somatosensory cortex is proportional to:
a.    Importance of the body part in sensory perception
b.    The size of the body part
c.    Mobility of the body part
d.    Degree of usage of the body part                                                              
       Key: (a)


18. Loss of consciousness produced by general anaesthetic involves:
a.    Reticular activating system
b.   Raphe magnus
c.    Nor-epinephrine
d.    Serotonin                                                                                     
                     Key: (a)

19. A strong electric shock passing through the brain will:
a.    Impair remote memory
b.   Impair recent memory
c.    Impair all memories equally
d.    Not effect memory                                                                             
              Key: (b)

Biochemistry
20. Phenylalanine is the precursor of:
a.    Catecholamines
b.   Thyroid hormone
c.    Steroid
d.    Acetyl choline                                                                                
                  Key: (a)

21. All the following events occur during visual cycle EXCEPT:
a.    Activation of transducin
b.   Separation of α - subunit from  -  subunit of G protein
c.    Conversion of cyclic AMP to 5 ‘ AMP
d.    Closure of sodium channel                                                                     
          Key: (c)

22. All the statements regarding the polyol pathway are correct EXCEPT:
a.    the pathway occurs in liver
b.   the pathway deals with the formation of fructose from glucose
c.    both NADPH and NAD are required for the pathway
d.    inhibition of aldose reductase blocks the pathway                            Key: (a)

Pathology
23. All of the following microscopic features are seen in Alzheimer’s disease EXCEPT:
a.    Neurofibrillary tangles
b.    Pick bodies
c.    Neuritic plaques
d.    Amyloid angiopathy                                                                            
             Key: (b)

24.  Negri bodies are seen in which of the following diseases ?
a.    Alzheimer’s disease
b.    Rabies
c.    Herpes simplex infection
d.    HIV infection                                                                                 
                  Key: (b)

25. All the following are childhood CNS tumors EXCEPT:
a.    Medulloblastoma
b.   Ependymoma
c.    Primitive neuroectodermal tumor
d.    Oligodendroglioma                                                                             
             Key: (d)

26. All the following tumors of CNS arise in posterior fossa of brain EXCEPT:
a.    Medulloblastoma
b.   Ependymoma
c.    Meningioma
d.    Pilocytic astrocytoma                                                                         
              Key: (c)

Microbiology
27. The following test is used for diagnosis of Japanese encephalitis in a patient:
a.    IgG detection in a single serum sample
b.   IgM capture ELISA in a single serum sample
c.    Raised protein level in CSF
d.    Low glucose level in CSF                                                                      
          Key: (b)

28. Which of the following species act as amplifying hosts of Japanese Encephalitis (JE) virus:
a.    Water birds and man
b.    Pigs and man
c.    Water birds and pigs
d.    Cows and goats                                                                                
                Key: (c)

29. In acute bacterial meningitis important CSF findings are:
a.    Lmphocytic pleocytosis and reduced protein content
b.   Predominantly polymorphonuclear cells and reduced glucose content
c.    Mixed cellular reaction with normal protein and glucose levels
d.    Clear CSF with occasional macrophages                                          Key: (b)

Pharmacology
30. Which one of the following drugs is used for prophylaxis of manic depressive illness ?
a.    Lithium
b.   Chlorpromazine
c.    Imipramine
d.    Fluoxetine                                                                                    
                     Key: (a)

31. Which of the following drugs is used in the treatment of chronic addiction to morphine:
a.    Naloxone
b.   Diazepam
c.    Methadone
d.    Phenobarbitone                                                                                
                Key: (c)

32. Which one of the following drugs is often combined with a potent narcotic analgesic such as 
fentanyl to produce neuroleptanalgesia ?
a.    Haloperidol
b.   Droperidol
c.    Chlorpromazine
d.    Trifluoperazine                                                                               
                  Key: (b)

Forensic Medicine
33. Brain stem death has been legally accepted in Nepal since: 
a.    2050
b.    2052
c.    2055
d.    2057                                                                                          
                        Key: (c)

Psychiatry
34. Which one of the following functions is true for ability to compare between an airplane and a 
bird:
a.  Abstraction
b.  Intelligence
c.  Judgement
d.  Memory                                                                                          
                   Key: (a)


35. All of the following are true for cognition EXCEPT:
a.  Memory
b.  Complex use of symbols
c.  Planning
d.  Special sensations                                                                              
                Key: (d)

36.  A child goes to toilet instead of soiling the clothes to avoid a 'time out'. This is an 
example of learning:
a.  Operant conditioning
b.  Pavlovian (classical) conditioning
c.  Social learning
d.  None of the above                                                                               
               Key: (a)

37. Amnesia due to hysteria occurs because of :
a.  Loss of neurons
b.  Loss of neurotransmitters
c.  Repression of unacceptable feelings or thoughts
d.  Conscious avoidance of the event                                                                
     Key: (c)

Section 'B'
Anatomy
38. Archicerebellum is made up of:
1.    Pyramid
2.    Lingula
3.    Uvula
4.    Flocculonodular lobe                                                                          
             Key: (c)

Biochemistry
39. Inhibitory neurotransmitters are:
1.    GABA
2.   Acetylcholine
3.   Dopamine
4.    Serotonin                                                                                     
                     Key: B

Pharmacology
40. Therapeutic drug monitoring is essential for which of the following drugs:
1.    Diazepam
2.   Lithium carbonate
3.   Chlorpromazine
4.    Phenytoin                                                                                     
                     Key: (c)

41. Which of the following statements about nitrous oxide (N2 O) are true:
1.    It is a non-inflammable gas
2.   Potent anaesthetic
3.   Good analgesic
4.    Good muscle relaxant                                                                          
             Key: (b)

Forensic Medicine
42.  In brain stem death:
1.    Spontaneous respiration continues
2.   Spontaneous cardiac action continues
3.   Gag reflex is present
4.    EEG is flat and isoelectric                                                                   
             Key: (C)

SECTION 'C'
Biochemistry

43. A:  Neurotransmitter has shorter duration of action than neuromodulator.
R:   Neuromodulater has longer latent period.                                                       
        Key: (A)

Microbiology
44. A:  Serological detection of Gr B meningococcal meningitis is difficult.
R:   The polysaccharide capsule of Gr B meningococci is a poor immunogen.            
Key: (A)


Pharmacology
45. A:  Benzodiazepines are preferred over barbiturates as sedative hypnotics.
R:   Benzodiazepines act through Benzodiazepines receptor and are facilitatory to GABA.
Key: (b)




SECTION 'D'
Anatomy


46. A 50 year old male who came with a complaint of muscular rigidity, slow tremor, mask-like face, 
and shuffling gait was diagnosed as a case of Parkinson’s disease.

Parkinson’s disease is caused by destruction of which part of the brain:
a.    Motor cortex
b.   Dentate nucleus
c.    Reticular formation
d.    Substantia nigra                                                                              
                  Key (d)

47. A 40 year old man visited his physician because of muscular hypotonia, scanning speech and 
dysdiadochokinesia.

Dysdiadochokinesia is defined as:
a.    Rhythmical oscillation of eyes
b.   Inability to perform alternating movements regularly and rapidly
c.    Loss of resilience of muscles to palpation
d.    Movement produced by tendon reflexes are prolonged                                   Key: (b)

48. A patient consulted a doctor with a complaint of double vision, which he developed after 
sustaining a head injury in an accident. On examination, the doctor found that the patient had 
squint and was unable to move his right eye laterally.

Which nerve is likely to be involved ?
a.    Oculomotor
b.   Trochlear
c.    Abducent
d.    Nasociliary                                                                                   
                    Key: (c)

49. A patient who had loss of taste sensation on posterior one third of the tongue, paralysis of 
one half of the tongue, and difficulty in swallowing was diagnosed as a case of brain tumor.

The most likely site for the presence of the tumor would be:
a.    Internal capsule
b.   Cerebellum
c.    Mid brain
d.    Medulla oblongata                                                                             
               Key: (d)
Physiology
50. A 25 year old motorcyclist was brought to the emergency with an accident involving severe 
injury at the sacral level. On examination, his legs were found to be dangling passively & were not 
responding to neurological examination.

Injury to the spinal cord in this case might have resulted in:
a.    Upper motor neuron lesion
b.   Paresis of leg muscles
c.    Spastic paralysis of the legs
d.    Flaccid paralysis of the legs                                                                 
            Key: (d)
51. A patient with cerebellar lesion demonstrates a characteristic gait of a drunkard. The 
in-coordinated movements in such patients may be due to all of the following EXCEPT:
a.    Abnormal stretch reflex path
b.   Imperfect choice of motor units
c.    Improper duration of contraction
d.    In-coordination of agonists and antagonist                                                    
  Key: (a)

52. A patient was brought to the emergency with spinal cord injury at T1 after having run over by a 
motorcycle. He was in a state of shock. During clinical examination of reflexes, which of the 
following reflexes is likely to be elicited:
a.    Jaw Jerk
b.   Pupillary reflex


c.    Knee Jerk
d.    Babinski reflex                                                                               
                  Key: (b)

53. A patient attended medical OPD with a complaint of loss of appetite, palpitation and insomnia 
for the last one week. History revealed that he was earlier treated for addiction to alcohol.

Brain region primarily involved in his case would be:
a.    Brain stem reticular formation
b.   Amygdaloid nuclei
c.    Hypothalamus
d.    Sensory cortex                                                                                
                  Key: (c)

Biochemistry
54.  A 10 year old child came to BPKIHS emergency with history of unconsciousness and high grade 
fever. A lumber puncture for C.S.F. analysis was done and the CSF glucose was found to be 
remarkably lower than normal.

The most likely cause for the lowered CSF glucose may be due to:
a.    Meningioma
b.   Infarction
c.    Multiple sclerosis
d.    Meningitis                                                                                    
                    Key: (d)

Pathology
55. A 5 year old female patient presented to the emergency with history of fever since 4 days 
accompanied by vomiting, neck rigidity and altered consciousness. Differential count of the CSF 
showed 90% polymorphonuclear cells.

The patient most probably was suffering from:
a.    Brain abscess
b.   Subarachnoid haemorhage
c.    Acute bacterial meningitis
d.    Tuberculous meningitis                                                                        
            Key: (c)

Microbiology
56. A 30 year old male consumed two mollusc from a water source on the advice of a local faith 
healer. About 10 days after ingestion, he was admitted to the hospital with severe headache, 
retention of urine and paralysis of lower limbs. Characteristically, there was no fever, CSF showed 
pleocytosis with 75% of cells being eosinophils.  mollusc obtained from the same water source were 
inoculated into rats. Brain tissue of the rats showed acute inflammation and adult helminthic worms 
were recovered from animals.

The most likely aetiological agent of this condition could be:
a.    Trichenella spiralis
b.   Schistosoma haematobium
c.    Angiostrongylus cantonensis
d.    Echinococcus granulosus                                                                       
          Key: (c)

Pharmacology
57. A 52 year old, female patient, who had an untreatable hepatic carcinoma was to undergo foot 
surgery.

Which  of  the  following  local  anaesthetic  agents  is  safe  in  this  patient  based  on  her  
history  of carcinoma:
a.    Lidocaine
b.   Prilocaine
c.    Mepivacaine
d.    Procaine                                                                                      
                      Key: (d)

58. A 45 year old man who was injured in a car accident was brought to the emergency room. His 
blood alcohol level on admission was 275mg/dl. His wife confirm that he was drinking heavily for 
the past 3 weeks.

Which of the following drugs would offer relief to the patient during withdrawal of alcohol?
a.    Phenytoin
b.   Diazepam
c.    Disulfiram
d.    Phenobarbitone                                                                                
                Key: (b)

59. A 65 year old male patient suffering from endogenous depression developed urinary retention 
after taking amitriptyline from a private practitioner.

Which of the following antidepressant drugs would be best suited for him?
a.    Imipramine
b.   Nortriptyline
c.    Fluoxetine
d.    Amoxapine                                                                                     
                  Key: (c)

Psychiatry
60. A 20 year old college student complained that for the last couple of weeks his friends were 
gossiping among themselves against him, teasing him on the road , spreading his illness through TV 
& news agencies. He attacked some of the friends and was brought to hospital. His family didn't 
share his views.

The phenomenon described of above is a type of :
a.    Hallucination
b.    Delusion
c.    Misinterpretation
d.    abnormal emotional responses                                                                  
       Key: (b)
***


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