MCQ's on Autonomic Nervous System for Staff Nurses and Medical Exams [Objective]

1. In the autonomic regulation of blood pressure
(A) Cardiac output is maintained constant at the expense of other hemodynamic variables
(B) Elevation of blood pressure results in elevated aldosterone secretion
(C) Baroreceptor nerve fibers docrease firing rate when arterial pressure increases
(D) Stroke volume and mean arterial blood pressure are the primary direct determinants of cardiac output
(E) A condition that reduces the sensitivity of the sensory baroreceptor nerve endings might cause an increase in sympathetic discharge

2. The autonomic nervous system is also known as
(A) Visceral
(B) Vegetative
(C) Involuntary nervous system
(D) All of the above

3. Full activation of the sympathetic nervous system, as in maximal exercise, can produce all of the following responses except
(A) Bronchial relaxation
(B) Decreases intestinal motility
(C) Increased renal blood flow
(D) Mydriasis
(E) Increased heart rate (tachycardia)

4. Several children at a summer camp were hospitalized with symptoms thought to be due to ingestion of food containing botulinum toxins. The effects of botulinum toxin are likely to include
(A) Bronchospasm
(B) Cycloplegia
(C) Diarrhea
(D) Skeletal muscle spasms
(E) Hyperventilation

5. The neurotransmitter agent that is normally released in the sinoatrial node of the heart in response to a blood pressure increase is
(A) Acetylcholine
(B) Dopamine
(C) Epinephrine
(D) Glutamate
(E) Norepinephrine

6. A direct-acting cholinomimetic that is lipid-soluble and often used in the treatment of glaucoma is
(A) Acetylcholine
(B) Bethanechol
(C) Physostigmine
(D) Pilocarpine
(E) Neostigmine

7. Which of the following agents is a prodrug that is much less toxic in mammals than in insects ?
(A) Acetylcholine
(B) Bethanechol
(C) Physostigmine
(D) Pilocarpine
(E) Neostigmine

8. Atropine overdose may cause which one of the following
(A) Gastrointestinal smooth muscle crampine
(B) Increased cardiac rate
(C) Increased gastric secretion
(D) Pupillary constriction
(E) Urinary frequency

9. The synaptic pre-ganglionic neurons have their cell bodies in the lateral horn of the grey matter of the
(A) Thoracic segment only
(B) Lumbar segment only
(C) Both (A) and (B)
(D) None of the above

10. Which one of the following can be blocked by atropine?
(A) Decreased blood pressure caused by hexamethonium
(B) Increased blood pressure caused by nicotine
(C) Increased skeleton muscle strength caused by neostigmine
(D) Tachycardia caused by exercise
(E) Tachycardia caused by infusion of acetylcholine

11. Which of the following best describes the mechanism of action of scopolamine ?
(A) Irreversible antagonist at nicotinic receptors
(B) Irreversible antagonist at muscarinic receptors
(C) Physiologic antagonist at muscarinic receptors
(D) Reversible antagonist at muscarinic receptors
(E) Reversible antagonist at nicotinic receptors

12. Accepted therapeutic indications for the use of antimuscarinic drugs include all of the following except
(A) Hypertension
(B) Motion sickness
(C) Parkinson’s disease
(D) Postoperative bladder spasm
(E) Traveler’s diarrhea

13. In male sex organs _______ system is responsible for erection.
(A) Sympathetic
(B) Parasympathetic
(C) Norepinephrine
(D) None of the above

14. A 7-years-old boy has a significant bedwetting problem. A long-acting indirect sympathomimetic agent sometimes used by the oral route for this and other indications is
(A) Dobutamine
(B) Ephedrine
(C) Epinephrine
(D) Isoproterenol
(E) Phenylephrine

15. When pupillary dilation-but not cycloplegia-is desired, a good choice is
(A) Homatropine
(B) Isoproterenol
(C) Phenylephrine
(D) Pilocarpine
(E) Tropicamide

16. ‘Fight or flight’ state can be described as
(A) Sympathetic active; para-sympathetic quiescent
(B) Sympathetic active; para-sympathetic active
(C) Sympathetic quiescent; para-sympathetic active

17. Your patient is to receive a selective ß2 stimulant drug ß2 selective stimulant are often effective in
(A) Angina due to coronary insufficiency
(B) Asthma
(C) Chronic heart failure
(D) Delayed or insufficiently strong labor
(E) All of the above

18. Which of the following drugs is the drug of choice in anaphylaxis associated with bronchospasm and hypotension ?
(A) Cortisone
(B) Epinephrine
(C) Isoproterenol
(D) Norepinephrine
(E) Phenylephrine

19. Which of the following effects of epinephrine would be blocked by phentolamine but not by metoprolol ?
(A) Cardiac stimulation
(B) Contractionof radial smooth muscle in the iris
(C) Increase of camp in fat
(D) Relaxation of bronchial smooth muscle
(E) Relaxation of the uterus

20. Propranolol is useful in all of the following except
(A) Angina
(B) Familial tremor
(C) Hypertension
(D) Idiopathic hypertrophic subaortic cardiomyopathy
(E) Partial atrioverntricular heart block

21. ‘Rest and digest’ state can be described as
(A) Sympathetic active; para-sympathetic quiescent
(B) Sympathetic active; para-sympathetic active
(C) Sympathetic quiescent; para-sympathetic active

22. A friend has very severe hypertension and asks about a drug her doctor wishes to prescribe. Her physician has explained that this drug is associated with tachycardia and fluid retention (which may be marked) and increased hair growth. Which of the following is most likely to produce the effects that your friend has described?
(A) Captopril
(B) Guanethidine
(C) Minoxidil
(D) Prazosin
(E) Propranolol

23. Which one of the following is characteristic of captopril and enalapril ?
(A) Competitively blocks angiotensim II at its receptor
(B) Decreases angiotensin II concentration in the blood
(C) Decreases rennin concentration in the blood
(D) Increases sodium and decreases potassium in the blood
(E) Decreases sodium and increases potassium in the urine

24. Postural hypotension is a common adverse effect of which one of the following types of drugs ?
(A) ACE inhibitors
(B) Alpha-receptor blockers
(C) Arteriolar dilators
(D) ß1 – selective receptor blockers
(E) Nonselective ß - blockers

25. A visitor from another city comes to your office complaining of incessant cough. He has diabetes and hypertension and has recently started taking a different antihypertensive medication. The most likely cause of his cough is
(A) Enalapril
(B) Losartan
(C) Minoxidil
(D) Propranolol
(E) Verapamil

26. Reserprine, an alkaloid derived from the root of Rauwolfia serpentina
(A) Can be used to control hyperglycemia
(B) Can cause severe depression of mood
(C) Can decrease gastrointestinal secretion and motility
(D) Has no cardiac effects
(E) A spare receptor agonist

27. Nitroglycerin, either directly or through reflexes, results in which one of the following effects
(A) Decreased heart rate
(B) Decreased venous capacitance
(C) Increased afterload
(D) Increased cardiac force
(E) Increased diastolic intramyocardial fiber tension

28. The antianginal effect of propranolol may be attributed to which one of the following
(A) Block of exercise – induced tachycardia
(B) Decreased end – diastolic ventricular volume
(C) Dilation of consticted coronary vessels
(D) Increased cardiac force
(E) Increased resting heart rate

29. The major common determinant of myocardial oxygen consumption is
(A) Blood volume
(B) Cardiac output
(C) Diastolic blood pressure
(D) Heart rate
(E) Myocardial fiber tension

30. Choose the incorrect statement from the following
(A) Sympathetic system increases rate of SA node
(B) Sympathetic system causes constriction of coronary arteries
(C) Sympathetic system causes increased motility of GIT smooth muscles
(D) Sympathetic system causes constriction of sphincter in GIT

31. Denervation super-sensitivity includes
(A) Proliferation of receptors
(B) Loss of mechanism for transmitter removal
(C) Increased post-junctional responsiveness
(D) All of the above

32. Which of the following is approved for the treatment of hemorrhagic stroke ?
(A) Amyl nitrite
(B) Hydralazine
(C) Isosorbide moninitrate
(D) Nifedipine
(E) Nimodipine

33. Which of the following drugs used for the treatment of angina by inhalation has a very rapid onset and a brief duration of effect ?
(A) Amyl nitrite
(B) Hydralazine
(C) Isosorbide mononitrate
(D) Nifedipine
(E) Nimodipine

34. Which of the following is a vasodilator drug used for hypertension that lacks a direct effect on autonomic receptors but may provoke anginal attacks?
(A) Amyl nitrite
(B) Hydralazine
(C) Isosorbide mononitrate
(D) Nifedipine
(E) Nimodipine

35. The biochemical mechanism of action of digitalis is associated with
(A) A decrease in calcium uptake by the sarcoplasmic reticulum
(B) An increase in ATP synthesis
(C) A modification of the actin molecule
(D) An increase in systolic intracellular calcium levels
(E) A block of sodium/calcium exchange

36. A patient has been taking digoxin for several years for chronic heart failure is about to receive atropine for another condition. A common effect of digoxin (at therapeutic blood levels) that can be almost entirely blocked by atropine is
(A) Decreased appetite
(B) Increased atrial contractility
(C) Increased PR interval on the ECG
(D) Headaches
(E) Tachycardia

37. In a patient given a cardiac glycoside, important effects of the drug on the heart include which of the following?
(A) Decreased atrioventricular conduction velocity
(B) Decreased ejection time
(C) Increased ectopic automaticity
(D) Increased ectopic automaticity
(E) All of the above

38. Which of the following situations constitutes an added risk of digoxin toxicity ?
(A) Starting administration of captopril
(B) Starting administration of quinidine
(C) Hyperkalemia
(D) Hypermagnesemia
(E) Hypocalcemia

39. At rest, the interior of the typical mammalian neuronal axon potential is approximately ________ mV
(A) 0
(B) –70
(C) –100
(D) –20

40. Following enzyme is involved in the synthesis of actylcholine
(A) Choline acetyl transferase
(B) Acetyl cholinesterase
(C) Both (A) and (B)
(D) None of the above

41. Which of the following has been shown to prolong life in patient with chronic congestive failure but has a negative inotropic effect on cardiac contractility?
(A) Carvedilol
(B) Digitoxin
(C) Digoxin
(D) Dobutamine
(E) Enalapril

42. Which of the following is the drug of choice in treating suicidal overdose of digitoxin ?
(A) Digoxin antibodies
(B) Lidocaine
(C) Magnesium
(D) Potassium
(E) Quinidine

43. When used as an antiarrhythmic drug, Lidocaine typically
(A) Increases action potential duration
(B) Increases contractility
(C) Increses PR interval
(D) Reduces abnormal automaticity
(E) Reduces resting potential

44. A 16-year-old-girl is found to have paroxysmal attacks of rapid heart rate. The antiarrhythmic of choice in most cases of acute AV nodal tachycardia is
(A) Adenosine
(B) Amiodarone
(C) Flecainide
(D) Propranolol
(E) Quinidine

45. Recognized adverse effects of quinidine include which one of the following?
(A) Cinchonism
(B) Constipation
(C) Lupus erythematosus
(D) Increase in digoxin clearance
(E) Precipitation of hyperthyroidism

46. Following is an antagonist of ganglion type nicotinic receptors
(A) Tubercurarine
(B) a-bungarotoxin
(C) Trimethaphan
(D) All of the above

47. Which of the following is an orally active drug that blocks sodium channels and decreases action potential duration?
(A) Adenosine
(B) Amiodarone
(C) Disopyramide
(D) Esmolol
(E) Mexiletine

48. Which of the following has the longest half-life of all antiarrhythmic drugs?
(A) Adenosine
(B) Amiodarone
(C) Disopyramide
(D) Esmolol
(E) Flecainide

49. Which of the following diuretics would be most useful in a patient with cerebral edema?
(A) Acetazolamide
(B) Amiloride
(C) Ethacrynic acid
(D) Furosemide
(E) Mannitol

50. Which of the following therapies would be most useful in the management of severe hypercalcemia?
(A) Amiloride plus saline infusion
(B) Furosemide plus saline infusion
(C) Hydrochlorothiazide plus saline infusion
(D) Mannitol plus saline infusion
(E) Spironolactone plus saline infusion

51. A 55-year-old patient with severe posthepatitis cirrhosis is started on a diuretic for another condition. Two days later he is found in a coma. The drug most likely to cause coma in a patient with cirrhosis is
(A) Acetazolamide
(B) Amiloride
(C) Furosemide
(D) Hydrochlorothiazide
(E) Spironolactone

52. Oxytremorine is a selective agonist of muscarinic _______ receptors
(A) M1
(B) M2
(C) M3
(D) M4

53. A drug that is useful in glaucoma and high-altitude sickness is
(A) Acetazolamide
(B) Amiloride
(C) Demeclocycline
(D) Desmopressin
(E) Ethacrynic acid

54. Cromolyn has as its major action
(A) Block of calcium channels in lymphocytes
(B) Block of mediator release from mast cells
(C) Block of phosphodiesterase in mast cells and basophils
(D) Smooth muscle relaxation in the bronchi
(E) Stimulation of cortisol release by the adrenals

55. Following events occur in the cytoplasm and not inside storage vesicles, except
(A) Conversion of tyrosine to dopa
(B) Conversion of dopa to dopamine
(C) Conversion of dopamine to norepinephrine
(D) Conversion of dopamine to 3,4 dihydroxy phenyl acetic acid

56. Which one of the following is lest likely to be useful in the therapy of hypercalcemia?
(A) Calcitonin
(B) Glucocorticoids
(C) Plicamycin
(D) Parenteral infusion of phosphate
(E) Thiazide diuretics

57. Characteristics of Vitamin D and its metabolites include which one of the following?
(A) Act to decrease serum levels of calcium
(B) Activation of their Vitamin D receptors increases cellular CAMP
(C) Calcitriol is the major derivative responsible for increasing intestinal absorption of phosphate
(D) Metabolites of Vitamin D increase renal excretion of calcium
(E) Vitamin D deficiency results in Pager’s disease

58. Which of the following conditions is an indication for the use of calcitonin?
(A) Chronic renal failure
(B) Hypoparathyroidism
(C) Intestinal osteodystrophy
(D) Pager’s disease
(E) Rickets

59. Clinical uses of Vitamin D do not include
(A) Chronic renal failure
(B) Hyperparathyroidism
(C) Intestinal osteodystrophy
(D) Nutritional rickets
(E) Osteoporosis

60. Which one of the following drugs, when used chronically, is associated with the development of bone pain and mineralization defects such as osteomalacia?
(A) Calcitonin
(B) Dihydrotachysterol
(C) Ergocalciferol
(D) Etidronate
(E) Norgestrel

61. A 70-year-old man has severe urinary hesitancy associated with benign prostatic hyperplasia. He has tried alpha blockers with little relief. His physician recommends a drug that blocks 5a - reductase in the prostate and writes a prescription for
(A) Atropine
(B) Clonidine
(C) Hydralazine
(D) Neostigmine
(E) Propranolol

62. Action of norepinephrine and epinephrine are terminated by
(A) Reuptake into nerve terminal
(B) Dilution by diffusion and uptake at extraneuronal site
(C) Metabolic transformation
(D) All of the above

63. Typical results of beta-receptor activation include which one of the following?
(A) Hypoglycemia
(B) Lipolysis
(C) Glycogen synthesis
(D) Decreased skeletal muscle tremor
(E) Decreased rennin secretion

64. A patient is admitted to the emergency room with orthostatic hypotension and evidence of marked GI bleeding. Which of the following most accurately describes the probable autonomic response to this bleeding?
(A) Slow heart rate, dilated pupils, damp skin
(B) Rapid heart rate, dilated pupils, damp skin
(C) Slow heart rate, dry skin, increased bowel sounds
(D) Rapid heart rate, constricted pupils, increased bowel sounds
(E) Rapid heart rate, constricted pupils, warm skin

65. Drugs that block the a receptor on effector cells at adrenergic nerve endings
(A) Antagonize the effects of isoproterenol on the heart rate
(B) Antagonize some of the effects of epinephrine on the blood pressure
(C) Antagonize the effects of epinephrine on adenylyl cyclase
(D) Cause mydriasis
(E) Decreases blood glucose levels

66. Yohimbine is an antagonist of ______ receptors.
(A) a1
(B) a2
(C) both (A) and (B)
(D) None of the above

67. Which of the following organs is innervated only by parasympathetic nerves ?
(A) Iris muscles
(B) Ciliary muscle
(C) Sweat glands
(D) Splenic capsule

68. Muscarinic cholinergic receptors
(A) Are located only on parasympathetically innervated effector cells
(B) Mediate responses by opening an instrinsic Na+ ion channel
(C) Are present on vascular endothelium which has no cholinergic nerve supply
(D) Predominate in the autonomic ganglia

69. The cardiac muscarinic receptors
(A) Are of the M1 subtype
(B) Are of the M2 subtype
(C) Are selectively blocked by pirenzepine
(D) Function through the PIP2 ? IP3/DAG pathway

70. Atropine does not exert relaxant/ antispasmodic effect on the following muscle
(A) Intestinal
(B) Ureteric
(C) Bronchial
(D) Layngeal

71. a1 – receptors are coupled with _______ G protein.
(A) Gs
(B) Gi
(C) Gq
(D) Go

72. Hyoscine differs from atropine in that it
(A) Exerts depressant effects on the CNS at relatively low doses
(B) Exerts more potent effects on the heart than on the eye
(C) Is longer acting
(D) Has weaker antimotion sickness activity

73. Which of the following anticholinergic drugs is primarily used in preanaesthetic medication and during surgery
(A) Glycopyrrolate
(B) Pipenzolate methyl bromide
(C) Isopropamide
(D) Dicyclomine

74. Glycopyrrolate is the preferred antimuscannic drug for use before and during surgery because
(A) It is potent and fast acting
(B) It has no central action
(C) It has antisecretory and vagolytic actions
(D) All of the above

75. Which of the following mydriatics has the fastest and briefest action ?
(A) Atropine
(B) Homatropine
(C) Tropicamide
(D) Cyclopentolate

76. The most suitable mydratic for a patient of corneal ulcer is
(A) Atropine sulfate
(B) Homatropine
(C) Cyclopentolate
(D) Tropicamide

77. The most effective antidote for belladonna poisoning is
(A) Neostigmine
(B) Physostigmine
(C) Pilocarpine
(D) Methacholine

78. Atropine is contraindicated in
(A) Cyclic AMP
(B) Inositol trisphosphate
(C) Diacyl glycerols
(D) G protein

79. Select the correct statement from the following about a1 – adrenergic receptor agonists
(A) Isoproterenol > epinephrine = norepinephrine
(B) Epinephrine > isoproterenol > norepinephrine
(C) Isoproterenol = epinephrine = norepinephrine
(D) Epinephrine = norepinephrine > isoproterenol

80. The most efficacious inhibitor of catecholamine synthesis in the body is
(A) a - methyl – p - tyrosine
(B) a - methyldopa
(C) a - methyl - norepinephrine
(D) Pyrogallol

81. Tyramine induces release of noradrenaline from adrenergic nerve endings
(A) By depolarizing the axonal membrane
(B) By mobilizing Ca2+
(C) By a nonexocytotic process
(D) Only in the presence of MAO inhibitors

82. Choose the correct statement from the following about a1 – adrenergic receptor agonists
(A) Norepinephrine > isoproterenol > epinephrine
(B) Norepinephrine < epinephrine > isoproterenol
(C) Epinephrine = norepinephrine >> isoproterenol
(D) Epinephrine > isoproterenol > norepinephrine

83. A sympathomimetic amine that acts almost exclusively by releasing noradrenaline from the nerve endings is
(A) Ephedrine
(B) Dopamine
(C) Isoprenaline
(D) Tyramine

84. Low doses of adrenaline dilate the following vascular bed
(A) Cutaneous
(B) Mucosal
(C) Renal
(D) Skeletal muscle

85. a2–adrenergic receptors are associated with following except
(A) Increase in phospholipase C activity
(B) Increase in potassium channel conductance
(C) Decrease in calcium channel conductance
(D) Increase in adenylyl cyclase activity

86. Adrenaline raises blood glucose level by the following actions except
(A) Inducing hepatic glycogenolysis
(B) Inhibiting insulin secretion from pancreatic ß cells
(C) Augmenting glucagons secretion from pancreatic a cells
(D) Inhibiting peripheral glucose utilization

87. Noradrenaline is administered by
(A) Subcutaneous injection
(B) Intramuscular injection
(C) Slow intravenous infusion
(D) All of the above routes

88. Dobutamine differs from dopamine in that
(A) It does not activate peripheral dopaminergic receptors
(B) It does not activate adrenergic ß receptors
(C) It causes pronounced tachycardia
(D) It has good blood-brain barrier penetrability

89. Ephedrine is similar to adrenaline in the following feature
(A) Potency
(B) Inability to penetrate blood-brain barrier
(C) Duration of action
(D) Producing both a and ß adrenergic effects

90. Continuous exposure of ctecholaminesensitive cells and tissues to adrenergic agonists causes a progressive diminition in their capacity to respond, this phenomenon is called as
(A) Refractoriness
(B) Desensitization
(C) Tachyphylaxis
(D) All of the above

91. While undergoing a surgical procedure a patient develops hypotension. Which of the following drugs can be injected intramuscularly to raise his BP
(A) Noradrenaline
(B) Isoprenaline
(C) Mephentermine
(D) Isoxsuprine

92. Vasoconstrictors should not be used in
(A) Neurogenic shock
(B) Haemorrhagic shock
(C) Secondary shock
(D) Hypotension due to spinal anaesthesia

93. Guanethidine inhibits
(A) Synthesis of transmitter
(B) Metabolism of transmitter
(C) Release of transmitter
(D) Displacement of transmitter from axonal terminal

94. The drug which produces vasoconstriction despite being an a adrenergic blocker is
(A) Phenoxybenzamine
(B) Ergotamine
(C) Dihydroergotoxine
(D) Tolazoline

95. Prazosin is an effective antihypertensive while nonselective a adrenergic blockers are not because
(A) It is the only orally active a blocker
(B) It improves plasma lipid profile
(C) It does not concurrently enhance noradrenaline release
(D) It improves urine flow in males with prostatic hypertrophy

96. Which of the following is true of sildenafil
(A) It enhances sexul enjoyment in normal men
(B) It delays ejaculation
(C) It is indicated only for treatment of erectile dysfunction in men
(D) It blocks cavernosal a2 adrenoceptors

97. The ß-adrenergic blocker which possesses both ß1 selectivity as well as intrinsic sympathomimetic activity is
(A) Alprenolol
(B) Atenolol
(C) Acebutolol
(D) Metoprolol

98. Propanolol can be used to allay anxiety associated with
(A) Chronic neurotic disorer
(B) Schizopherenia
(C) Short-term stressful situation
(D) Endogenous depression

99. Propranolol does not block the following action of adrenaline
(A) Bronchodilation
(B) Lipolysis
(C) Muscle tremor
(D) Mydriasis

100. Phenylephrine
(A) Mimics the transmitter at post-synaptic receptors
(B) Displaces transmitter from axonal terminal
(C) Inhibits synthesis of transmitter
(D) None of the above

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