CCMP 2020 Batch – Mission 100% Regular Hard Work, Dedication, Study with No Stress.

20 MCQs in one Set. No Negative Marking. Time allowed 30 minutes.

CCMP Study Group @ RCSM GMC Kolhapur
MCQS in Autonomic Nervous System_Answers 02
01. You are in the eye OPD and wish to use a topical beta blocker in a patient. The chosen drug by you should
have all the following properties except:
(a) Strong local anaesthetic activity
(b) High lipophilicity
(c) High ocular capture
(d) Low systemic activity
01. Ans. (a) Strong local anaesthetic activity (Ref: KDT 6/e p144)
Timolol and betaxolol are the preferred β-blockers for the treatment of glaucoma because they lack local
anaesthetic activity. Drugs possessing this property increase the risk of corneal ulcers.

02. Which of the following is the longest acting ocular beta blocker?
(a) Timolol
(b) Betaxolol
(c) Cartiolol
(d) Metoprolol
02. Ans. (b) Betaxolol (Ref: KDT 6/e p145)
Betaxolol is a cardioselective β-block useful in glaucoma. It is longer acting than timolol. Another non-
selective β-blocker used topically for the treatment of glaucoma is levobunolol.

03. Several children at a summer camp were hospitalized with symptoms thought to be due to ingestion of
food containing botulinum toxin. The effects of botulinum toxin are likely to include:
(a) Bronchospasm
(b) Cycloplegia
(c) Diarrhea
(d) Skeletal muscle spasms
03. Ans. (b) Cycloplegia (Ref: KDT 6/e p93)
Botulinum toxin interferes with the release of ACh and thus acts as a parasympatholytic agent. Bronchospasm
and diarrhoea are the symptoms of muscarinic stimulation whereas muscle spasms may be seen on nicotinic
stimulation. Cholinergic drugs cause cyclospasm whereas anticholinergics result in cycloplegia.

04. A direct acting cholinomimetic that is lipid soluble and has been used in the treatment of glaucoma is:
(a) Acetylcholine
(b) Physostigmine
(c) Pilocarpine
(d) Neostigmine
04. Ans. (c) Pilocarpine (Ref: KDT 6/e p98)
Pilocarpine is a directly acting and physostigmine is an indirectly acting cholinomimetic useful for glaucoma.

05. Drug of choice for treatment of acute organophosphate poisoning is:

(a) Atropine
(b) Pralidoxime
(c) Neostigmine
(d) d- Tubocurarine
05. Ans. (a) Atropine (Ref: KDT 6/e p104)
06. Kondiba, 28 year old farmer is found convulsing in the farm. Heart rate is 100/min and blood pressure is
180/110 mm Hg. Diarrhea, sweating and urination are apparent. Pupils are pin point. Drug poisoning is
suspected. Most probable cause is:
(a) Acetaminophen overdose
(b) Amphetamine toxicity
(c) Organophosphate poisoning
(d) Atropine poisoning
06. Ans. (c) Organophosphate poisoning (Ref. KDT 6/e p104, 105)
All the symptoms are of anticholinesterase poisoning except raised blood pressure and heart rate. At high
doses, ACh can stimulate NN and NM receptors. These symptoms may occur due to the nicotinic actions of
ACh.

07. Shamrao, a farmer comes to you in the emergency in comatose state. Patient had profuse sweating and
lacrimation. Diarrhea and urination were apparent. On examination pupil was constricted and BP of the
farmer was 80/60 mm Hg. You make a diagnosis of anticholinesterase poisoning. You decide to administer
him atropine. All of the following actions will be reversed by atropine except:
(a) Hypotension
(b) Central excitation
(c) Muscle paralysis
(d) Bronchoconstriction
07. Ans. (c) Muscle paralysis (Ref. KDT 6/e p104, 105)
Atropine is a non-selective antagonist at muscarinic receptors. It can penetrate blood brain barrier and
reverse the muscarinic action in the CNS. It can also reverse hypertension and bronchoconstiction caused due
to stimulation of muscarinic receptors.
However, muscle paralysis is due to Nicotinic (NN) action on which it has no activity.

08. Lalita, a 28 yr old woman has been treated with several autonomic drugs for about a month. Which of the
following signs would distinguish between an overdose of a muscarinic blocker and a ganglionic blocker?
(a) Blurred vision
(b) Dry mouth, constipation
(c) Mydriasis
(d) Postural hypotension
08. Ans. (d) Postural hypotension (Ref. KDT 6/e p115)
Postural hypotension is due to blockade of sympathetic system. Ganglion blockers inhibit the transmission
through both sympathetic as well as parasympathetic ganglia whereas muscarinic blockers inhibit only
parasympathetic activity.

09. Mr. Vishwasrao has just been diagnosed with myasthenia gravis. You are his physician and are considering
different therapies for his disease. Neostigmine and pyridostigmine may cause which one of the following?
(a) Bronchodilation
(b) Diarrhea
(c) Cycloplegia
(d) Irreversible inhibition of acetylcholinesterase
09. Ans. (b) Diarrhea (Ref. KDT 6/e p101)
Neostigmine and pyridostigmine are reversible cholinesterase inhibitors that can cause cholinergic adverse
effects like diarrhoea and increased secretions.

10. A patient complains of muscle weakness. It was reversed on administration of

neostigmine, because:
(a) It blocks action of acetylcholine
(b) It interferes with the action of mono amine oxidase
(c) It interferes with the action of carbonic anhydrase
(d) It interferes with the action of acetylcholine esterase.
10. Ans. (d) It interferes with the action of acetyl cholinesterase
Neostigmine acts by inhibiting the enzyme acetylcholinesterase. This enzyme is involved in degradation of
ACh, consequently neostigmine increases the synaptic level of ACh.
Muscle weakness can be improved by stimulation of NM receptors at muscle end plate due to increased ACh.

11. How would a drug that competes with ACh for receptors at the motor end plate affect skeletal muscle? It
would:
(a) Produce uncontrolled muscle spasms
(b) Cause the muscles to contract and be unable to relax
(c) Cause muscles to relax and be unable to contract
(d) Make the muscles more excitable
11. Ans. (c) Cause muscles to relax and be unable to contract (Ref: KDT 6/e p340)
Drugs competing with Ach at neuromuscular junction are competitive or non-depolarizing neuromuscular
blockers. These drugs are used as muscle relaxants. In contrast to depolarizing muscle relaxants, these do not
cause initial fasciculations.

12. All are cholinergic agents EXCEPT:

(a) Gallantamine
(b) Donepezil
(c) Tacrine
(d) Memantine
12. Ans. (d) Memantine (Ref: KDT 6/e p472, 473)
• Donepezil, rivastigmine, gallantamine and tacrine are cholinergic (due to inhibition of cholinesterase
enzyme) drugs useful for Alzheimer’s disease.
• Memantine is an NMDA blocker, used for Alzheimer’s disease.

13. Which of the following provides the best explanation for neostigmine being preferred over physostigmine
for treating myasthenia gravis?
(a) It is better absorbed orally
(b) It has longer duration of action
(c) It has additional direct agonistic action on nicotinic receptors at the muscle end plate
(d) It penetrates blood brain barrier
13. Ans. (c) It has additional direct agonistic action on nicotinic receptors at muscle end plate (Ref: KDT 6/e
p103)
Neostigmine is a quaternary ammonium derivative and is lipid insoluble. Its absorption from GIT and
penetration in the brain and cornea is much less than physostigmine. It produces additional action on NM
receptors.

14. Which of the following properties make pyridostigmine different from neostigmine?
(a) It is more potent
(b) It is longer acting
(c) It produces less muscarinic side effects
(d) It does not have any direct action on NM receptors
14. Ans. (b) It is longer acting (Ref: KDT 7/e p108)
• Pyridostigmine acts for 3-6 hours as compared to 0.5-2 hour duration of action of neostigmine.
• It is less potent than neostigmine.
• Rest of the properties are similar to neostigmine.
15. Dr Sunil used edrophonium for differentiating myasthenic crisis from cholinergic crisis. He preferred it
over other anticholinesterase agents because of its:
(a) Shorter duration of action
(b) Longer duration of action
(c) Direct action on muscle end plate
(d) Selective inhibition of true cholinesterase
15. Ans. (a) Shorter duration of action (Ref: KDT 6/e p101)

16. Agonistic action at which of the following adrenergic receptors results in the reduction of aqueous
secretion?
(a) β1 receptor
(b) β2 receptor
(c) M2 receptor
(d) α2 receptor
16. Ans. (d) α2 Receptors (Ref: KDT 6/e p146)
Stimulation of α2 receptors located on ciliary epithelium reduces secretion of aqueous humor.

17. Pin-point pupil suggests poisoning with:

(a) DDT
(b) Opiates
(c) Belladonna
(d) Barbiturates
17. Ans. (b) Opiates (Ref: KDT 6/e p102, 456)
Causes of Pin-Point Pupil
• Opioids Poisoning
• Organophosphate Poisoning
• Carbamate Poisoning
• Carbolic acid Poisoning
• Pontine Hemorrhage

18. Drug of choice in treatment of myasthenia gravis is:

(a) d-Tubocurarine
(b) Hexamethonium
(c) Neostigmine
(d) Gallamine
18. Ans. (c) Neostigmine (Ref: KDT 6/e p103)

19. Which of the following does not cross the blood brain barrier?
(a) Pralidoxime
(b) Obidoxime
(c) Diacetyl-monoxime
(d) Physostigmine
19. Ans. (a) Pralidoxime

20. Anti-cholinesterases are ineffective against:

(a) Belladona poisoning
(b) Carbamate poisoning
(c) Postoperative ileus
(d) Cobra bite
20. Ans. (b) Carbamate poisoning