DRUGS ACTING ON CENTRAL NERVOUS SYSTEM

GENERAL ANAESTHETICS  


1. The minimal alveolar concentration of an inhalational anaesthetic is a measure of its:
A. Potency
B. Therapeutic index
C. Diffusibility
D. Oil: water partition coefficient
ANSWER:  [  A  ]

2. The primary mechanism by which general anaesthetics produce their action is:
A. Affecting receptor operated ion channels in cerebral neurones
B. Blocking voltage sensitive Na+ channels in neuronal membrane
C. Depressing metabolic activity of cerebral neurones
D. Blocking production of high energy phosphates in the brain
ANSWER:  [  A  ]

3. General anaesthetics produce immobility in response to painful surgical stimuli by acting primarily at the:
A. Motor cortex
B. Basal ganglia
C. Thalamus
D. Spinal cord
ANSWER:  [  D  ]

4. Which general anaesthetic selectively inhibits excitatory NMDA receptors:
A. Thiopentone
B. Halothane
C. Desflurane
D. Ketamine
ANSWER:  [  D  ]

5. If a patient being anaesthetised with ether is unconscious, has regular respiration, blood pressure and heart rate are normal, corneal reflex is present and eyeballs are roving, the patient is in:
A. Stage II
B. Stage III plane 1
C. Stage III plane 2
D. Stage III plane 3
ANSWER:  [  B  ]

6 No surgical operation should be performed during the following stage of anaesthesia:
A. Stage I
B. Stage II
C. Stage III, plane 1
D. Stage III, plane 3
ANSWER:  [  B  ]

7. Which of the following is a sign of deep anaesthesia:
A. Appearance of tears in eyes
B. Resistance to passive inflation of lungs
C. Fall in blood pressure
D. Patient makes swallowing movements
ANSWER:  [  C  ]

8. The following factor delays induction with an inhaled general anaesthetic:
A. Alveolar perfusion-ventilation mismatch
B. Hyperventilation
C. Low blood:gas partition coefficient of the anaesthetic
D. Inclusion of 5% carbon dioxide in the inhaled gas mixture
ANSWER:  [  A  ]

9. ‘Second gas effect’ is exerted by the following gas when coadministered with halothane:
A. Nitrous oxide
B. Cyclopropane
C. Nitrogen
D. Helium 
ANSWER:  [  A  ]

10. 'Diffusion hypoxia’ is likely to occur only after use of nitrous oxide because it:
A. Is a respiratory depressant
B. Has low blood solubility and is used in high concentration
C. Is a very potent anaesthetic
D. Interferes with diffusion of oxygen into the tissues
ANSWER:  [  B  ]

11. Select the inhalational general anaesthetic which is metabolized in the body to a significant extent:
A. Sevoflurane
B. Isoflurane
C. Ether
D. Halothane
ANSWER:  [  D  ]

12. The following anaesthetic can be used by the open drop method:
A. Ether
B. Desflurane
C. Halothane
D. Isoflurane
ANSWER:  [  A  ]

13. The minimal alveolar concentration (MAC) of halothane is:
A. 75%
B. 25%
C. 7.5%
D. 0.75%
ANSWER:  [  D  ]

14. The following general anaesthetic has poor muscle relaxant action:
A. Ether
B. Nitrous oxide
C. Halothane
D. Isoflurane
ANSWER:  [  B  ]

15. Select the correct statement about nitrous oxide:
A. It irritates the respiratory mucosa
B. It has poor analgesic action
C. It is primarily used as a carrier and adjuvant to other anaesthetics
D. It frequently induces post anaesthetic nausea and retching
ANSWER:  [  C  ]

16. Ether is still used as a general anaesthetic in India, specially in peripheral hospitals because:
A. It is nonexplosive
B. It is pleasant smelling and nonirritating
C. It induces anaesthesia rapidly
D. It is cheap and can be administered without anaesthetic machine
ANSWER:  [  D  ]

17. As a general anaesthetic, halothane has the following advantages except:
A. Very good analgesic action
B. Noninflammable and nonexplosive
C. Reasonably rapid induction of anaesthesia
D. Pleasant and nonirritating
ANSWER:  [  A  ]

18. The general anaesthetic having significant cardiodepressant property is:
A. Halothane
B. Enflurane
C. Ether
D. Nitrous oxide
ANSWER:  [  A  ]

19. Select the general anaesthetic having the most marked uterine relaxant action:
A. Propofol
B. Halothane
C. Nitrous oxide
D. Ether
ANSWER:  [  B  ]

20. Malignant hyperthermia is a rare complication of use of the following anaesthetic:
A. Ketamine
B. Thiopentone sodium
C. Halothane
D. Ether
ANSWER:  [  C  ]

21. Select the general anaesthetic that is particularly suitable for outpatient surgery because of quick recovery and short-lived post-anaesthetic psychomotor impairment:
A. Ether
B. Halothane
C. Enflurane
D. Desflurane
ANSWER:  [  D  ]

22. The following is true of sevoflurane except:
A. It induces anaesthesia rapidly
B. It is nonpungent
C. It produces prolonged postanaesthetic psychomotor impairment
D. It is less potent than halothane
ANSWER:  [  C  ]

23. The drug/drugs used mainly for induction of general anaesthesia is/are:
A. Thiopentone sodium
B. Fentanyl + droperidol
C. Ketamine
D. All of the above
ANSWER:  [  A  ]

24. Residual CNS depression is least marked after the use of the following anaesthetic:
A. Diazepam
B. Thiopentone sodium
C. Lorazepam
D. Propofol
ANSWER:  [  D  ]

25. The anaesthetic action of thiopentone sodium is characterised by:
A. Good muscle relaxation
B. Poor analgesia
C. Sensitization of heart to adrenaline
D. No postoperative residual CNS depression
ANSWER:  [  B  ]

26. Induction of anaesthesia with propofol is often attended by:
A. Transient apnoea
B. Sharp short lasting fall in blood pressure
C. Pain in the injected vein
D. All of the above
ANSWER:  [  D  ]

27. ‘Dissociative anaesthesia’ is produced by:
A. Ketamine
B. Fentanyl
C. Propofol
D. Both ‘A’ and ‘B’ are correct
ANSWER:  [  A  ]

28. Ketamine is the preferred anaesthetic for the following except:
A. Hypertensives
B. Trauma cases who have bled significantly
C. Burn dressing
D. Short operations on asthmatics
ANSWER:  [  A  ]

29. Select the anaesthetic that increases cardiac output and blood pressure:
A. Halothane
B. Fentanyl
C. Ketamine
D. Diazepam
ANSWER:  [  C  ]

30. Intravenous fentanyl is used in balanced anaesthesia to afford:
A. Relaxation of chest muscles
B. Analgesia
C. Unconsciousness
D. Suppression of gastric acid secretion
ANSWER:  [  B  ]

31. Use of morphine in preanaesthetic medication:
A. Is routine except in the presence of contraindications
B. Is restricted to patients being anaesthetised with ether
C. Should be made only in combination with atropine
D. Is restricted mostly to patients in pain preoperatively
ANSWER:  [  D  ]

32. Use of glycopyrrolate in preanaesthetic medication serves the following purposes except:
A. Prevents respiratory secretions during anaesthesia
B. Guards against reflex vagal bradycardia during surgery
C. Produces amnesia for perioperative events
D. Reduces the probability of occurrence of laryngospasm
ANSWER:  [  C  ]

33. The following drug is routinely used in preanaesthetic medication for prolonged operations:
A. Atropine
B. Morphine
C. Promethazine
D. Ranitidine
ANSWER:  [  C  ]

ETHYL & METHYL ALCOHOLS

1. The following is true about actions of ethylalcohol:
A. It exerts anticonvulsant action followed by lowering of seizure threshold
B. It lowers pain threshold
C. It increases confidence and reduces number of errors
D. It increases heat production and helps to keep warm in cold weather
ANSWER:  [  A  ]

2. Effect of alcohol on sleep has the following feature:
A. It is a dependable hypnotic but is not prescribed because of abuse potential
B. It consistently improves the quality of sleep
C. It can disorganise sleep architecture
D. It suppresses sleep apnoea
ANSWER:  [  C  ]

3. Patients treated with the following drug should be cautioned not to consume alcoholic beverages:
A. Mebendazole
B. Metronidazole
C. Methimazole
D. Metamizol
ANSWER:  [  B  ]

4. Regular low-to-moderate alcohol consumption is associated with:
A. Lower incidence of coronary artery disease
B. Myocardial depression
C. Physical dependence
D. Wernicke's encephalopathy
ANSWER:  [  A  ]

5. Moderate amounts of alcohol produce the following effects except:
A. Flushing
B. Tachycardia
C. Diuresis
D. Rise in body temperature
ANSWER:  [  D  ]

6. Consumption of alcoholic beverages in moderate amounts can be allowed for the following category of subjects:
A. Epileptics
B. Patients with history of myocardial infarction
C. Gastroesophageal reflux patients
D. Pregnant women
ANSWER:  [  B  ]

7. Safe limit of daily alcohol consumption is:
A. Same for men and women
B. Relatively lower for women than for men
C. Relatively higher for women than for men
D. Less than half for women than for men
ANSWER:  [  B  ]

8. What is considered to be the safe limit of daily alcohol consumption by an adult man in the absence of contraindications and interacting drugs:
 A. 20-40 ml of whisky
B. 50-100 ml of whisky
C. 120-180 ml of whisky
D. 200-300 ml of whisky
ANSWER:  [  B  ]
9. Which of the following motivating factors is the least important for the alcohol drinking habit:
A. Physical dependence on alcohol
B. Pleasurable feelings induced by alcohol
C. Attitude to relate drinking with enjoyment
D. Social belief that alcohol intoxicated subject is unmindful of his actions
ANSWER:  [  A  ]

10. Select the drug that has been found to reduce alcohol craving and chances of resumed heavy drinking by alcoholics after they have undergone a detoxification programme:
A. Chlordiazepoxide
B. Chlorpromazine
C. Methadone
D. Naltrexone
ANSWER:  [  D  ]

11. Disulfiram is used for the treatment of:
A. Acute alcoholic intoxication
B. Both physically and psychologically dependent alcoholics
C. Alcoholics psychologically but not physically dependent on alcohol
D. Both ‘A’ and ‘B’ are correct
ANSWER:  [  C  ]

12. Ethanol is used in methanol poisoning because it:
A. Antagonises the actions of methanol
B. Stimulates the metabolism of methanol and reduces its blood level
C. Inhibits the metabolism of methanol and generation of toxic metabolite
D. Replenishes the folate stores depleted by methanol
ANSWER:  [  C  ]

13. Which of the following is a specific inhibitor of the enzyme alcohol dehydrogenase and is useful in the treatment of methanol poisoning:
A. Disulfiram
B. Ethylene glycol
C. Calcium leucovorin
D. Fomepizole
ANSWER:  [  D  ]

SEDATIVES-HYPNOTICS

1. Barbiturates exert the following actions except:
A. Anticonvulsant
B. Analgesic
C. Antianxiety
D. Respiratory depressant
ANSWER:  [  B  ]

2. The mechanism of action of barbiturates differs from that of benzodiazepines in that they:
A. Do not affect the GABA-benzodiazepine receptor-chloride channel complex
B. Act as inverse agonists at the benzodiazepine receptor
C. Increase the frequency of chloride channel opening without affecting its life time
D. Have both GABA-facilitatory as well as GABA-mimetic actions
ANSWER:  [  D  ]

3. Which of the following processes plays the major role in terminating the action of phenobarbitone:
A. Biliary excretion
B. Renal excretion
C. Hepatic metabolism
D. Redistribution
ANSWER:  [  B  ]

4. Currently barbiturates are primarily used as:
A. Hypnotic
B. Sedative
C. Antiepileptic
D. Preanaesthetic medicant
ANSWER:  [  C  ]

5. Benzodiazepines differ from barbiturates in the following aspects except:
A. They have a steeper dose response curve
B. They have higher therapeutic index
C. They have lower abuse liability
D. They do not induce microsomal drug metabolizing enzymes
ANSWER:  [  A  ]

6. Hypnotic benzodiazepines increase the period of time spent in the following stage of sleep:
A. Stage II
B. Stage III
C. Stage IV
D. REM stage
ANSWER:  [  A  ]

7. Select the correct statement about benzodiazepines (BZDs):
A. All BZDs facilitate GABA mediated Cl¯ influx into neurones
B. Different BZDs exert the same degrees of hypnotic, anxiolytic and anticonvulsant actions
C. The BZD receptor is homogeneous at all neuronal sites
D. The muscle relaxant action of BZDs is nnoott nnoott not blocked by flumazenil 
ANSWER:  [  A  ]

8. Hypnotic dose of diazepam produces the following action:
A. Tachycardia
B. Constipation
C. Hyperalgesia
D. Decreased nocturnal gastric secretion
ANSWER:  [  D  ]

9. The primary mechanism of action of benzodiazepines is:
A. Dopamine antagonism
B. Adenosine antagonism
C. Opening of neuronal chloride channels
D. Facilitation of GABA-mediated chloride influx
ANSWER:  [  D  ]

10. Select the drug that antagonises diazepam action noncompetitively:
A. Adenosine
B. Flumazenil
C. Bicuculline
D. Valproic acid
ANSWER:  [  C  ]

11. The following drugs exert their action through the GABAA-benzodiazepine–receptor Cl¯ channel complex except:
A. Baclofen
B. Zolpidem
C. Bicuculline
D. Phenobarbitone
ANSWER:  [  A  ]

12. At a single hypnotic dose, the pharmacokinetics of diazepam is characterised by:
A. Slow elimination and little redistribution
B. Slow elimination with marked redistribution
C. Rapid elimination and marked redistribution
D. Ultra rapid elimination
ANSWER:  [  B  ]

13. The following is a very potent and short acting benzodiazepine whose use as hypnotic has been noted to cause psychiatric disturbances in some cases:
A. Flurazepam
B. Nitrazepam
C. Temazepam
D. Triazolam
ANSWER:  [  D  ]

14. Which of the following statements is not true of zopiclone:
A. It is a nonbenzodiazepine hypnotic with efficacy and safety similar to benzodiazepines
B. It does not produce rebound sleep disturbances on discontinuation
C. It does not act by potentiating GABA
D. It is used to wean off insomniacs from regular benzodiazepine use
ANSWER:  [  C  ]

15. Choose the drug that has been found to be more selective for the ω 1 subtype of BZD receptor, and produces hypnotic action but little antianxiety, muscle relaxant or anticonvulsant actions:
A. Zopiclone
B. Zolpidem
C. Flumazenil
D. Melatonin
ANSWER:  [  B  ]

16. Zolpidem differs from diazepam in that:
A. It is safer in overdose than diazepam
B. Its hypnotic action shows little fading on repeated nightly use
C. It causes more marked suppression of REM sleep
D. It has more potent muscle relaxant action
ANSWER:  [  B  ]

17. Diazepam is indicated in the following conditions except:
A. Generalized tonic-clonic (grand mal) epilepsy
B. Tetanus
C. Febrile convulsions
D. Cardiac catheterization
ANSWER:  [  A  ]

18. The following drug is used to reverse the CNS depression produced by diazepam:
A. Dexamphetamine
B. Doxapram
C. Physostigmine
D. Flumazenil
ANSWER:  [  D  ]

19. Select the correct statement about flumazenil:
A. It is a CNS stimulant used as an antidote for benzodiazepine poisoning
B. It is a CNS depressant but blocks the action of diazepam
C. It has no CNS effect of its own but blocks the depressant effects of benzodiazepines as well as barbiturates
D. It has no CNS effect of its own but blocks the depressant effect of diazepam as well as stimulant effect of beta carbolines
ANSWER:  [  D  ]

20. The general principles in the use of hypnotics include the following except:
A. A hypnotic may be used intermittently for upto 2-3 weeks in short-term insomnia due to emotional stress
B. In patients with chronic insomnia a hypnotic should be used regularly
C. All hypnotics aggravate sleep apnoea
D. A hypnotic with slow elimination is preferred in patients with early morning awakening 
ANSWER:  [  B  ]

21. Which of the following is not a CNS depressant but increases the tendency to fall asleep at night:
A. Pyridoxine
B. Diphenhydramine
C. Melatonin
D. Ethanol
ANSWER:  [  C  ]

ANTICONVULSANTS
1. The barbiturate having higher anticonvulsant: sedative activity ratio is:
A. Pentobarbitone
B. Phenobarbitone
C. Butabarbitone
D. Thiopentone
ANSWER:  [  B  ]

2. The most probable mechanism of anticonvulsant action of phenytoin is:
A. Facilitation of GABAergic inhibitory transmission
B. Hyperpolarization of neurones
C. Interaction with Ca2+ channels to promote Ca2+ influx
D. Prolongation of voltage sensitive neuronal Na+ channel inactivation
ANSWER:  [  D  ]

3. The following antiepileptic drug is most likely to impair learning and memory, and produce behavioral abnormalities in children:
A. Valproic acid
B. Phenobarbitone
C. Phenytoin
D. Ethosuximide
ANSWER:  [  B  ]

4. Phenytoin appears to derive its anticonvulsant action from:
A. Selective inhibition of high frequency neuronal discharges
B. Selective inhibition of epileptic focus
C. Selective inhibition T-type Ca2+ current in brain cells
D. Selective enhancement of inhibitory transmission in the brain
ANSWER:  [  A  ]

5. The characteristic feature of phenytoin pharmacokinetics is:
A. High first pass metabolism
B. Nonsaturation kinetics of metabolism
C. Capacity limited metabolism saturating at higher therapeutic concentration range
D. Extrahepatic metabolism
ANSWER:  [  C  ]

6. The following adverse effect(s) of phenytoin is/are related to high plasma drug concentration:
A. Ataxia
B. Hirsutism
C. Gum hyperplasia
D. All of the above
ANSWER:  [  A  ]

7. The following drug displaces plasma protein bound phenytoin as well as decreases its metabolism:
A. Carbamazepine
B. Sodium valproate
C. Cimetidine
D. Chloramphenicol
ANSWER:  [  B  ]

8. Carbamazepine possesses the following property not shared by phenytoin:
A. Modification of maximal electroshock seizures
B. Raising threshold for pentylenetetrazol convulsions
C. Suppression of complex partial seizures
D. Amelioration of trigeminal neuralgia
ANSWER:  [  B  ]

9. Select the antiepileptic drug that is effective in manicdepressive illness as well:
A. Ethosuccimide
B. Primidone
C. Phenobarbitone
D. Carbamazepine
ANSWER:  [  D  ]

10. The following antiepileptic drug is likely to cause hyponatremia as a side effect, especially in elderly patients:
A. Primidone
B. Carbamazepine
C. Phenytoin
D. Sodium valproate
ANSWER:  [  B  ]

11. The drug of choice for trigeminal neuralgia is:
A. Aspirin
B. Imipramine
C. Carbamazepine
D. Valproic acid
ANSWER:  [  C  ]

12. The following statement is  not  true of carbamazepine:
A. It generates an active metabolite
B. Its plasma half life decreases to nearly half of the original value after chronic use
C. It is being used in mania
D. It is not effective in complex partial seizures
ANSWER:  [  D  ]

13. The following antiepileptic drug raises pentylene tetrazol seizure threshold but does not modify maximal electroshock seizures:
A. Ethosuximide
B. Carbamazepine
C. Primidone
D. Phenobarbitone
ANSWER:  [  A  ]

14. The antiepileptic drug which suppresses maximal electroshock as well as kindled seizures, raises pentylenetetrazol threshold and is effective in both generalized tonic-clonic as well as absence seizures is:
A. Phenytoin
B. Carbamazepine
C. Sodium valproate
D. Ethosuximide
ANSWER:  [  C  ]

15. Select the drug having a narrow spectrum antiepileptic activity restricted to absence seizures:
A. Lamotrigine
B. Ethosuccimide
C. Sodium valproate
D. Primidone
ANSWER:  [  B  ]

16. Sodium valproate has been shown to:
A. Prolong neuronal Na+ channel inactivation
B. Attenuate ‘T’ type Ca2+ current in neurones
C. Inhibit degradation of GABA by GABA-transaminase
D. All of the above
ANSWER:  [  D  ]

17. Sodium valproate should be used with caution in young children because they are particularly at risk of developing the following adverse effect:
A. Hepatitis
B. Loss of hair
C. Anorexia
D. Tremor
ANSWER:  [  A  ]
18. The preferred drug for suppressing febrile convulsions is:
A. Intramuscular phenobarbitone
B. Intravenous phenytoin
C. Rectal diazepam
D. Oral sodium valproate
ANSWER:  [  C  ]

19. Despite having anticonvulsant action, diazepam is not used in the treatment of epilepsy because:
A. It is not effective orally
B. It causes sedation
C. Its anticonvulsant action wanes off with chronic use
D. Both ‘B’ and ‘C’ are correct
ANSWER:  [  D  ]

20. Clobazam is a benzodiazepine used as:
A. Hypnotic
B. Muscle relaxant
C. Anxiolytic
D. Antiepileptic
ANSWER:  [  D  ]

21. Choose the correct statement about lamotrigine:
A. It is a dopaminergic agonist used in parkinsonism
B. It acts by blocking NMDA-type of glutamate receptors
C. It is a broad spectrum antiepileptic drug
D. It suppresses tonic-clonic seizures, but worsens absence seizures
ANSWER:  [  C  ]

22. Select the antiepileptic drug that in addition is a preferred treatment for post herpetic neuralgia and pain due to diabetic neuropathy:
A. Carbamazepine
B. Gabapentin
C. Lamotrigine
D. Primidone
ANSWER:  [  B  ]

23. Gabapentin acts:
A. As GABAA agonist
B. As precursor of GABA
C. By enhancing GABA release
D. By GABA independent mechanism
ANSWER:  [  C  ]

24. Select the anticonvulsant drug that acts as a GABAtransaminase inhibitor:
A. Gabapentin
B. Vigabatrin
C. Lamotrigine
D. Clobazam
ANSWER:  [  B  ]

25. The following is true of topiramate except:
A. It is a broad spectrum antiepileptic drug
B. It inhibits the enzyme carbonic anhydrase
C. It is used as add-on therapy in refractory partial seizures
D. It is not effective in generalized tonic-clonic seizures
ANSWER:  [  D  ]

26. The following is true in the treatment of epilepsy except:
A. The choice of drug depends on the cause of epilepsy and not on the seizure type
B. Treatment should be instituted as early as possible
C. Treatment is generally started with a single drug and the other drug is added or substituted according to response
D. Withdrawal of drug can be attempted if no seizures have occurred for 3-5 years
ANSWER:  [  A  ]

27. A combination of two or more antiepileptic drugs is used:
A. Routinely in all types of epilepsy
B. In all cases of complex partial seizures
C. In all cases of secondarily generalized seizures
D. Only when monotherapy with first/second choice drugs fails
ANSWER:  [  D  ]

28. Select the factor which indicates that withdrawal of the successfully used antiepileptic medication is likely to result in recurrence of seizures:
A. Childhood epilepsy
B. Partial seizures
C. Treatment started soon after seizure onset
D. Absence of EEG abnormality    
ANSWER:  [  B  ]

29. An epileptic woman controlled by phenytoin therapy conceives. Which of the following measures is most appropriate:
A. Medical termination of pregnancy
B. Withdraw phenytoin therapy
C. Gradually reduce phenytoin dose to the lowest effective level
D. Substitute phenytoin with a combination of carbamazepine and sodium valproate
ANSWER:  [  C  ]

30. Risk  of neural tube defect in the offspring can be minimised in pregnant women receiving antiepileptic drugs by supplemental therapy with:
A. Folic acid
B. Vitamin A
C. Vitamin E
D. Pyridoxine
ANSWER:  [  A  ]

31. Which of the following is the most suitable drug for a 6-year-old girl suffering from absence seizures with occasional generalized tonic-clonic seizures:
A. Ethosuccimide
B. Sodium valproate
C. Carbamazepine
D. Phenytoin
ANSWER:  [  B  ]

32. A 3-year-old boy gets seizures whenever he develops fever. Which is the most appropriate strategy so that he does not develop febrile convulsions:
A. Treat fever with paracetamol and do not give any anticonvulsant drug
B. Continuous phenobarbitone prophylaxis till the age of 10 years
C. Continuous diazepam prophylaxis for 3 years
D. Intermittent diazepam prophylaxis started at the onset of fever
ANSWER:  [  D  ]

33. The preferred drug for status epilepticus is:
A. Intravenous diazepam
B. Intravenous phenytoin sodium
C. Intramuscular phenobarbitone
D. Rectal diazepam
ANSWER:  [  A  ]

ANTIPARKINSONIAN DRUGS
1. The most effective drug in parkinsonism is:
A. Bromocriptine
B. Selegiline
C. Levodopa + carbidopa
D. Biperiden
ANSWER:  [  C  ]

2. In parkinsonian patients levodopa exerts the following effects except:
A. Reduces skeletal muscle contractility
B. Decreases muscle tone
C. Increases locomotor activity
D. Inhibits muscle tremor
ANSWER:  [  A  ]

3. The dopamine D2 receptor has the following feature:
A. It is excitatory in nature
B. It is negatively coupled to adenyl cyclase
C. It is selectively blocked by bromocriptine
D. It is not blocked by metoclopramide
ANSWER:  [  B  ]

4. The usual cardiovascular effect of levodopa is:
A. Bradycardia due to increased vagal tone
B. Rise in blood pressure due to increased noradrenaline content of adrenergic nerve endings
C. Fall in blood pressure due to decrease  in sympathetic tone
D. Both ‘A’ and ‘B’ are correct
ANSWER:  [  C  ]

5. The following drug/drugs does/do not produce any overt CNS effect in normal individuals but exert(s) clear cut therapeutic effect at the same dose in the presence of a specific neurological/psychiatric disorder:
A. Chlorpromazine
B. Levodopa
C. Imipramine
D. All of the above
ANSWER:  [  B  ]

6. Loss or alteration of taste sensation can occur a side effect of:
A. Levodopa
B. Captopril
C. Penicillamine
D. All of the above
ANSWER:  [  D  ]

7. Which of the following adverse effects of levodopa has a delayed onset and increases in severity with continued therapy:
A. Nausea and vomiting
B. Postural hypotension
C. Cardiac arrhythmia
D. Abnormal movements
ANSWER:  [  D  ]

8. The drug which abolishes the therapeutic effect of levodopa in parkinsonism, but not that of levodopacarbidopa combination is:
A. Metoclopramide
B. Pyridoxine
C. Chlorpromazine
D. Isoniazid
ANSWER:  [  B  ]

9. Use of carbidopa along with levodopa in the treatment of parkinsonism:
A. Inhibits development of involuntary movements
B. Minimises ‘on-off ’ effect’
C. Inhibits occurrence of behavioral abnormalities
D. Accentuates nausea and vomiting
ANSWER:  [  B  ]

10. The following adverse effect of levodopa is not minimised by combining it with carbidopa:
A. Involuntary movements
B. Nausea and vomiting
C. Cardiac arrhythmia
D. ‘On-off ’ effect
ANSWER:  [  A  ]

11. Though bromocriptine acts directly on dopamine receptors, it is used in parkinsonism only as a supplement to levodopa because:
A. It has low efficacy
B. It produces marked dyskinesias
C. Used alone, its effective doses produce intolerable side effects
D. Its therapeutic effect takes long time to develop
ANSWER:  [  C  ]

12. In the treatment of parkinsonism, bromocriptine differs from levodopa in the following respects except:
A. It does not need conversion to an active metabolite
B. It has a longer duration of action
C. It activates dopamine D2 receptors, with little/antagonistic action on D1 receptors
D. It does not produce behavioral/psychiatric side effects
ANSWER:  [  D  ]
13. Select the antiparkinsonian drug which directly activates dopaminergic D2 receptors in the striatum:
A. Pramipexole
B. Entacapone
C. Benserazide
D. Selegiline
ANSWER:  [  A  ]

14. Ropinirole differs from bromocriptine in the following respect:
A. It does not directly activate dopamine D2 receptors
B. It produces milder gastrointestinal side effects
C. In early cases of parkinsonism, it is less likely to need levodopa supplementation
D. Both 'B' and 'C' are correct
ANSWER:  [  D  ]

15. The following drug combination should not be used in parkinsonism:
A. Levodopa + anticholinergics
B. Levodopa + amantadine
C. Bromocriptine + levodopa
D. Amantadine + anticholinergics
ANSWER:  [  D  ]

16. The antiparkinsonian drug which acts by inhibiting the degradation of dopamine in the brain is:
A. Carbidopa
B. Amantadine
C. Selegiline
D. Bromocriptine 
ANSWER:  [  C  ]

17. Tolerance to the antiparkinsonian action develops most rapidly in the case of:
 A. Levodopa
B. Levodopa + carbidopa
C. Amantadine
D. Bromocriptine
ANSWER:  [  C  ]

18. The following drug is added to levodopa therapy of parkinsonism to attenuate ‘wearing off’ effect:
A. Selegiline
B. Trihexiphenidyl
C. Amantadine
D. Any of the above
ANSWER:  [  A  ]

19. The following is true of selegiline:
A. It does not exert antiparkinsonian action unless combined with levodopa
B. It overcomes the ‘on-off ’ effect in levodopa treated advanced parkinsonian patients
C. It retards the progression of Parkinson's disease
D. At doses used in parkinsonism it does not interfere with peripheral metabolism of dietary amines
ANSWER:  [  D  ]

20. Which of the following drugs has mild antiparkinsonian action of its own, prolongs levodopa action and allows reduction of its dose by about 25%:
A. Benserazide
B. Selegiline
C. Amantadine
D. Pyridoxine
ANSWER:  [  B  ]

21. The primary action by which entacapone and tolcapone enhance the therapeutic effect of levodopa-carbidopa in parkinsonism is:
A. Inhibition of levodopa methylation in the liver
B. Inhibition of dopamine methylation in the brain
C. Inhibition of oxidative deamination of dopamine in the brain
D. Facilitation of active transport of levodopa across brain capillaries
ANSWER:  [  A  ]

22. Entacapone differs from tolcapone in the following respect/respects:
A. It is shorter acting
B. It acts only by inhibiting peripheral metabolism of levodopa
C. It is not hepatotoxic
D. All of the above are correct
ANSWER:  [  D  ]

23. The following is true about entacapone except:
A. It acts by inhibiting degradation of dopamine in the brain
B. If prolongs the therapeutic effect of levodopacarbidopa in parkinsonism
C. It can accentuate levodopa induced dyskinesias
D. It can cause diarrhoea as a side effect
ANSWER:  [  A  ]

24. Select the drug that reversibly inhibits the enzyme COMT and is useful as an adjuvant medication in advanced parkinson's disease:
A. Pramipexole
B. Entacapone
C. Pergolide
D. Piribedil
ANSWER:  [  B  ]

25. The following drug is effective in chlorpromazine induced parkinsonism:
A. Trihexyphenidyl
B. Selegiline
C. Bromocriptine
D. Levodopa + carbidopa
ANSWER:  [  A  ]

26. The antiparkinsonian action of central anticholinergics has the following features except:
A. They control tremor more than rigidity
B. They produce a low ceiling therapeutic effect
C. They are effective in neuroleptic drug induced parkinsonism
D. They are the preferred drugs in advanced cases
ANSWER:  [  D  ]

27. The following category of drugs is not indicated in early/mild cases of Parkinson's disease:
A. Central anticholinergic
B. MAO-B inhibitor
C. COMT inhibitor
D. Nonergoline dopaminergic agonist
ANSWER:  [  C  ]

28. For majority of patients of parkinsonism the standard drug therapy is:
A. Levodopa
B. Levodopa + carbidopa
C. Levodopa + trihexiphenidyl
D. Bromocriptine
ANSWER:  [  B  ]