Q.1 Which scale is most commonly used to assess a patient’s level of consciousness in neurological critical care?
APACHE II Score
Glasgow Coma Scale (GCS)
Richmond Agitation-Sedation Scale
SOFA Score
Explanation - The Glasgow Coma Scale (GCS) is the standard tool to assess level of consciousness based on eye, verbal, and motor responses.
Correct answer is: Glasgow Coma Scale (GCS)
Q.2 Increased intracranial pressure (ICP) is defined as sustained pressure above:
5 mmHg
10 mmHg
15 mmHg
20 mmHg
Explanation - Sustained ICP greater than 20 mmHg is considered abnormal and requires intervention.
Correct answer is: 20 mmHg
Q.3 Which of the following is a classic sign of increased ICP?
Bradycardia, hypertension, irregular respiration
Tachycardia, hypotension, hyperthermia
Hyperventilation, sweating, tachypnea
Hypothermia, bradypnea, low BP
Explanation - Cushing’s triad (bradycardia, hypertension, irregular respirations) indicates increased ICP and impending herniation.
Correct answer is: Bradycardia, hypertension, irregular respiration
Q.4 What is the normal cerebral perfusion pressure (CPP) range in adults?
30–40 mmHg
50–70 mmHg
70–90 mmHg
100–120 mmHg
Explanation - CPP should be maintained between 70–90 mmHg to ensure adequate brain perfusion.
Correct answer is: 70–90 mmHg
Q.5 Which type of brain herniation involves displacement of the cerebellar tonsils through the foramen magnum?
Uncal herniation
Subfalcine herniation
Tonsillar herniation
Central herniation
Explanation - Tonsillar herniation occurs when cerebellar tonsils push into the foramen magnum, compressing the brainstem.
Correct answer is: Tonsillar herniation
Q.6 What is the most reliable method to monitor ICP directly?
MRI scan
CT scan
Ventriculostomy catheter
Transcranial Doppler
Explanation - A ventriculostomy allows direct measurement of ICP and drainage of cerebrospinal fluid (CSF).
Correct answer is: Ventriculostomy catheter
Q.7 Which medication is most commonly used as an osmotic diuretic in raised ICP?
Furosemide
Mannitol
Spironolactone
Acetazolamide
Explanation - Mannitol reduces intracranial pressure by creating an osmotic gradient that draws water out of brain tissue.
Correct answer is: Mannitol
Q.8 Hyperventilation lowers ICP primarily by:
Decreasing cerebral blood flow
Increasing CSF absorption
Enhancing venous return
Raising blood pressure
Explanation - Hyperventilation causes vasoconstriction and decreases cerebral blood flow, lowering ICP temporarily.
Correct answer is: Decreasing cerebral blood flow
Q.9 Which cranial nerve is assessed by checking pupil size and reactivity?
CN II (Optic)
CN III (Oculomotor)
CN IV (Trochlear)
CN VI (Abducens)
Explanation - The oculomotor nerve controls pupil constriction and is tested by checking pupillary reflexes.
Correct answer is: CN III (Oculomotor)
Q.10 In neurological ICU, continuous EEG monitoring is primarily used for:
Detecting hypoxia
Monitoring seizures
Assessing ICP
Measuring perfusion
Explanation - Continuous EEG helps detect both clinical and subclinical seizures in critically ill patients.
Correct answer is: Monitoring seizures
Q.11 The earliest sign of deterioration in a patient with traumatic brain injury is usually:
Pupil dilation
Change in level of consciousness
Seizures
Cushing’s triad
Explanation - LOC changes are often the earliest indication of worsening neurological status.
Correct answer is: Change in level of consciousness
Q.12 What is the primary purpose of using sedation in patients with raised ICP?
To reduce anxiety
To prevent aspiration
To decrease cerebral metabolic demand
To increase BP
Explanation - Sedation lowers brain metabolism, reducing cerebral blood flow and ICP.
Correct answer is: To decrease cerebral metabolic demand
Q.13 Which positioning is recommended for patients with raised ICP?
Flat supine
Trendelenburg
30-degree head elevation
Prone position
Explanation - Head elevation at about 30° promotes venous drainage and lowers ICP.
Correct answer is: 30-degree head elevation
Q.14 Which electrolyte imbalance is a common complication of mannitol therapy?
Hyperkalemia
Hyponatremia
Hypokalemia
Hypernatremia
Explanation - Mannitol can cause dilutional hyponatremia due to osmotic shifts of water.
Correct answer is: Hyponatremia
Q.15 Decerebrate posturing indicates damage to which part of the brain?
Cerebral cortex
Midbrain
Pons
Basal ganglia
Explanation - Decerebrate posturing usually indicates brainstem (midbrain or pons) damage.
Correct answer is: Midbrain
Q.16 Which diagnostic tool is the gold standard for detecting acute intracranial hemorrhage?
MRI
Non-contrast CT scan
PET scan
EEG
Explanation - A non-contrast CT scan is the fastest and most reliable imaging for acute brain bleeds.
Correct answer is: Non-contrast CT scan
Q.17 In neurocritical care, barbiturates are sometimes used to:
Increase cerebral metabolism
Induce coma to reduce ICP
Enhance CSF production
Raise systemic BP
Explanation - Barbiturate coma lowers cerebral metabolic demand and reduces ICP in refractory cases.
Correct answer is: Induce coma to reduce ICP
Q.18 Which of the following is a noninvasive method to estimate intracranial pressure?
Fundoscopy for papilledema
Arterial blood gas analysis
Spinal tap
Jugular venous oxygen saturation
Explanation - Papilledema seen on fundoscopic exam is an indirect sign of raised ICP.
Correct answer is: Fundoscopy for papilledema
Q.19 What is the main advantage of external ventricular drainage (EVD) over intraparenchymal monitoring?
More accurate
Allows CSF drainage
Less invasive
Lower infection risk
Explanation - EVDs can both measure ICP and therapeutically drain CSF to relieve pressure.
Correct answer is: Allows CSF drainage
Q.20 Which condition is most associated with subarachnoid hemorrhage?
Hypertensive crisis
Berry aneurysm rupture
AV block
Meningitis
Explanation - Most subarachnoid hemorrhages are due to rupture of saccular (berry) aneurysms.
Correct answer is: Berry aneurysm rupture
Q.21 When assessing brain death, which reflex is checked by applying cold water into the ear canal?
Pupillary reflex
Corneal reflex
Oculocephalic reflex
Oculovestibular reflex
Explanation - The oculovestibular (caloric) reflex tests brainstem function by irrigating the ear canal with cold water.
Correct answer is: Oculovestibular reflex
Q.22 A patient with GCS of 7 is classified as having:
Mild brain injury
Moderate brain injury
Severe brain injury
Normal consciousness
Explanation - GCS ≤ 8 indicates severe traumatic brain injury.
Correct answer is: Severe brain injury
Q.23 Which monitoring technique provides information about cerebral oxygenation and metabolism?
EEG
Jugular venous oxygen saturation monitoring
Transcranial Doppler
CT perfusion
Explanation - This monitoring measures global cerebral oxygenation and metabolism.
Correct answer is: Jugular venous oxygen saturation monitoring
Q.24 Which electrolyte abnormality is most dangerous in traumatic brain injury patients?
Hypernatremia
Hyponatremia
Hyperkalemia
Hypokalemia
Explanation - Hyponatremia can worsen cerebral edema and increase ICP in TBI patients.
Correct answer is: Hyponatremia
Q.25 Which of the following is a late sign of brain herniation?
Unequal pupils
Headache
Vomiting
Restlessness
Explanation - Pupillary asymmetry is a late sign of brain herniation due to cranial nerve compression.
Correct answer is: Unequal pupils