import React, { useState, useEffect, useMemo } from 'react'; import { Clock, BookOpen, Trophy, BarChart3, CheckCircle, XCircle, Home, Play, ArrowLeft, ChevronRight, Download, Flag, Eye, TrendingUp, Pause } from 'lucide-react'; // Subjects organized by lecture const subjectsByLecture = { "Lecture 1": [ "Anatomy and Physiology", "College English and Computer Skills", "Dental Anatomy", "Dental Hygiene Clinic I", "Dental Hygiene Theory I", "Histology and Embryology", "Infection Control", "Introduction to Professionalism", "Introduction to Psychology", "Introduction to Statistics and Research", "Microbiology" ], "Lecture 2": [ "Dental Hygiene Clinic II", "Dental Hygiene Theory II", "Dental Materials Theory", "Dental Radiography Interpretation", "Dental Radiography Lab", "Dental Radiography Theory", "Head and Neck Anatomy", "Oral Health Education", "Pathophysiology", "Periodontology I", "Pharmacology", "Medical Emergencies" ], "Lecture 3": [ "Community Dental Health I", "Dental Hygiene Clinic III", "Dental Hygiene Theory III", "Dental Materials Lab", "Ethics and Jurisprudence", "Gerontology", "Nutrition for Living", "Oral Health Promotion", "Oral Pathology", "Periodontology II" ], "Lecture 4": [ "Business Practice", "Community Dental Health II", "Consolidated Learning", "Dental Hygiene Clinic IV", "Dental Hygiene Theory IV" ] }; // Subjects with sub-topics const subjectsWithSubtopics = { "Lecture 1": [ "Anatomy and Physiology", "College English and Computer Skills", "Dental Anatomy", "Dental Hygiene Clinic I", "Dental Hygiene Theory I", "Histology and Embryology", "Infection Control", "Introduction to Professionalism", "Introduction to Psychology", "Introduction to Statistics and Research", "Microbiology" ], "Lecture 2": [ "Dental Hygiene Clinic II", "Dental Hygiene Theory II", "Dental Materials Theory", "Dental Radiography Interpretation", "Dental Radiography Lab", "Dental Radiography Theory", "Head and Neck Anatomy", "Oral Health Education", "Pathophysiology", "Periodontology I", "Pharmacology", "Medical Emergencies" ], "Lecture 3": [ "Community Dental Health I", "Dental Hygiene Clinic III", "Dental Hygiene Theory III", "Dental Materials Lab", "Ethics and Jurisprudence", "Gerontology", "Nutrition for Living", "Oral Health Promotion", "Oral Pathology", "Periodontology II" ], "Lecture 4": [ "Business Practice", "Community Dental Health II", "Consolidated Learning", "Dental Hygiene Clinic IV", "Dental Hygiene Theory IV" ], "Pathophysiology": [ "Inflammation and Healing", "Immunity and infection (part 1)", "Immunity and infection (part 2)", "Nervous System Disorders", "Stress and Associated problems", "Blood and circulatory system disorders" ] }; // Question bank - ready for questions to be added const questionBank = { "Inflammation and Healing": [ { id: 101, question: "Which of the following belongs to the first line of defense?", options: ["Neutrophils", "Intact skin and mucous membranes", "T lymphocytes", "Antibodies"], correct: 1 }, { id: 102, question: "Which lines of defense are considered non-specific?", options: ["First line only", "First and second lines", "Second and third lines", "Third line only"], correct: 1 }, { id: 103, question: "Which is part of the second line of defense?", options: ["Skin", "Antibodies", "Inflammation", "Mucus"], correct: 2 }, { id: 104, question: "Interferons are mainly activated against:", options: ["Bacteria", "Fungi", "Viruses and tumors", "Helminths"], correct: 2 }, { id: 105, question: "Humoral immunity is mainly controlled by:", options: ["T lymphocytes", "Macrophages", "B lymphocytes and antibodies", "Neutrophils"], correct: 2 }, { id: 106, question: "Which suffix is commonly used in disease names to indicate inflammation?", options: ["-osis", "-emia", "-itis", "-oma"], correct: 2 }, { id: 107, question: "Which statement is TRUE about inflammation vs infection?", options: ["They are the same process.", "Infection is always caused by inflammation.", "Inflammation is always caused by infection.", "Infection can be one cause of inflammation."], correct: 3 }, { id: 108, question: "Which of the following is a common cause of inflammation?", options: ["Mild exercise", "Direct physical damage like a cut or sprain", "High protein diet", "Normal body temperature"], correct: 1 }, { id: 109, question: "What is the first step when tissue/capillary is injured in acute inflammation?", options: ["Histamine release", "Bradykinin release", "Neutrophil migration", "Macrophage activation"], correct: 1 }, { id: 110, question: "Histamine is mainly released from which cells in the tissue?", options: ["Neutrophils", "Mast cells", "Eosinophils", "Platelets"], correct: 1 }, { id: 111, question: "Bradykinin and histamine together cause which important vascular change?", options: ["Vasoconstriction", "Vasodilation of capillaries", "Decreased permeability", "Reduced blood flow (ischemia)"], correct: 1 }, { id: 112, question: "Which cells are the two major phagocytic cells in inflammation?", options: ["B cells and T cells", "Neutrophils and macrophages", "Basophils and eosinophils", "Platelets and RBCs"], correct: 1 }, { id: 113, question: "The main functional difference between neutrophils and macrophages is:", options: ["Only neutrophils can phagocytose", "They work in different locations", "Macrophages are not part of the immune system", "Neutrophils are not in blood"], correct: 1 }, { id: 114, question: "Which local signs are typical of acute inflammation?", options: ["Fever and headache", "Redness, warmth, swelling, pain", "Malaise and anorexia", "Tachycardia and hypotension"], correct: 1 }, { id: 115, question: "Which of the following is a systemic manifestation of acute inflammation?", options: ["Blister", "Mild fever", "Local redness", "Local edema"], correct: 1 }, { id: 116, question: "Which type of exudate is described as watery, with few proteins and cells?", options: ["Fibrinous", "Purulent", "Serous", "Hemorrhagic"], correct: 2 }, { id: 117, question: "Which exudate is thick and sticky, with high fibrin and WBCs?", options: ["Serous", "Fibrinous", "Purulent", "Serosanguinous"], correct: 1 }, { id: 118, question: "Purulent exudate is best described as:", options: ["Clear and watery", "Yellow-green with many leukocytes, microbes, and cell debris", "Thin with only plasma", "Only fibrin"], correct: 1 }, { id: 119, question: "Which is TRUE for chronic inflammation compared to acute?", options: ["More swelling and exudate", "Less immune cells", "More lymphocytes, macrophages, fibroblasts", "No tissue destruction occurs"], correct: 2 }, { id: 120, question: "Which definition best describes granulation tissue?", options: ["Dead tissue inside a wound", "New connective tissue and capillaries on wound surface", "A collection of pus", "Old scar tissue"], correct: 1 }, { id: 121, question: "The main complication of chronic inflammation emphasized by the professor is:", options: ["Edema", "Deep ulceration", "Keloid formation", "Bone fracture"], correct: 1 }, { id: 122, question: "Which type of healing is seen in mild sunburn that disappears in 3–4 days without scarring?", options: ["Resolution", "Regeneration", "Replacement", "Chronic inflammation"], correct: 0 }, { id: 123, question: "Regeneration means:", options: ["Functional tissue replaced by scar", "Damaged tissue replaced by non-functional cells", "Damaged tissue replaced by functional cells of the same type", "No cells are replaced"], correct: 2 }, { id: 124, question: "Replacement (in healing) is MOST common in which system?", options: ["Muscular system", "Nervous system", "Digestive system", "Endocrine system"], correct: 1 }, { id: 125, question: "Healing by first intention usually involves:", options: ["Large contaminated wound", "Clean wound with small gap and minimal tissue loss", "Massive tissue destruction", "Always infected tissue"], correct: 1 }, { id: 126, question: "Healing by second intention is characterized by:", options: ["Minimal inflammation", "Clean straight surgical incision", "Larger wound, more inflammation, more granulation, large scar", "No scar formation"], correct: 2 }, { id: 127, question: "Which term describes bands of scar tissue that join surfaces that were previously separate?", options: ["Keloid", "Ulcer", "Adhesion", "Contracture"], correct: 2 }, { id: 128, question: "Hypertrophic scar tissue / keloid is best described as:", options: ["Loss of epithelium only", "Overgrowth of fibrous tissue forming a thick, raised scar", "Only superficial redness", "Ulcer with necrosis"], correct: 1 }, { id: 129, question: "Ulceration around a scar is mainly due to:", options: ["Excess melanin production", "Impaired blood supply to the area", "Increased nerve endings", "High protein diet"], correct: 1 }, { id: 130, question: "Which combination correctly matches burn depth?", options: ["1st & 2nd degree – full-thickness", "3rd & 4th degree – partial-thickness", "1st & 2nd degree – partial-thickness", "2nd & 3rd degree – full-thickness"], correct: 2 }, { id: 131, question: "Which layers are involved in a deep partial-thickness (2nd degree) burn?", options: ["Epidermis only", "Epidermis and dermis", "Dermis and hypodermis only", "Hypodermis only"], correct: 1 }, { id: 132, question: "Which is a typical sign of a second-degree burn?", options: ["No pain", "Blisters", "Only redness", "Involvement of bone"], correct: 1 }, { id: 133, question: "A third-degree burn involves:", options: ["Only epidermis", "Only epidermis and dermis", "All three skin layers, but not muscle or bone", "Bone and muscle only"], correct: 2 }, { id: 134, question: "What makes a burn fourth-degree rather than third-degree?", options: ["Presence of blisters", "Only superficial redness", "Involvement of muscle and/or bone", "Infection with bacteria"], correct: 2 }, { id: 135, question: "Which of the following is a common serious complication of burn injury?", options: ["Hyperglycemia only", "Dehydration, shock, infection", "Increased hair growth", "Extra skin thickness"], correct: 1 }, { id: 136, question: "The blue-green discoloration around a burn wound is typically caused by:", options: ["Staphylococcus aureus", "Pseudomonas infection", "E. coli", "Candida"], correct: 1 }, { id: 137, question: "Why is immediate covering of a clean burn wound important?", options: ["To prevent scar formation", "To prevent further infection", "To stop granulation tissue", "To increase exudate"], correct: 1 }, { id: 138, question: "Which is NOT part of the first line of defense?", options: ["Tears", "Skin", "Gastric acid", "Antibodies"], correct: 3 }, { id: 139, question: "Which describes the second line of defense?", options: ["Mechanical barriers", "Inflammation and phagocytosis", "Antibody production", "Memory response"], correct: 1 }, { id: 140, question: "Which is part of the third line of defense?", options: ["Interferons", "Neutrophils", "T lymphocytes", "Skin pH"], correct: 2 }, { id: 141, question: "Interferons primarily defend against:", options: ["Parasites", "Viruses", "Fungi", "Allergens"], correct: 1 }, { id: 142, question: "Which cell produces antibodies?", options: ["T-helper cells", "Plasma cells (from B cells)", "Macrophages", "NK cells"], correct: 1 }, { id: 143, question: "Which line of defense is nonspecific and includes fever?", options: ["First", "Second", "Third", "None"], correct: 1 }, { id: 144, question: "Which immune component is both a protein and part of 2nd line?", options: ["Histamine", "Complement", "Dopamine", "Prostaglandin"], correct: 1 }, { id: 145, question: "Which best describes humoral immunity?", options: ["Phagocytosis", "Antibody-mediated response", "Skin barrier", "Fever"], correct: 1 }, { id: 146, question: "Which cells activate B lymphocytes?", options: ["NK cells", "T-helper cells", "Neutrophils", "Basophils"], correct: 1 }, { id: 147, question: "Which example represents passive natural immunity?", options: ["Vaccination", "Getting sick from flu", "Breast milk IgA", "Injection of antivenom"], correct: 2 }, { id: 148, question: "Which is NOT a typical cause of inflammation?", options: ["Ischemia", "Infection", "Foreign bodies", "Normal metabolism"], correct: 3 }, { id: 149, question: "Inflammation begins when damaged cells release:", options: ["Histamine", "Bradykinin", "IL-2", "Complement"], correct: 1 }, { id: 150, question: "Histamine is released by:", options: ["Neutrophils", "Mast cells", "RBCs", "NK cells"], correct: 1 }, { id: 151, question: "Bradykinin directly causes:", options: ["WBC activation", "Fever", "Pain", "Antibody production"], correct: 2 }, { id: 152, question: "Vasodilation during inflammation results in:", options: ["Pale skin", "Hyperemia", "Necrosis", "Hypoxia"], correct: 1 }, { id: 153, question: "Increased capillary permeability causes:", options: ["Fever", "Tachycardia", "Edema", "Hemorrhage"], correct: 2 }, { id: 154, question: "Neutrophils are recruited primarily during:", options: ["Chronic infection", "Acute inflammation", "Viral infection only", "Allergy"], correct: 1 }, { id: 155, question: "Which is the MOST abundant WBC in acute inflammation?", options: ["Eosinophils", "Basophils", "Neutrophils", "Lymphocytes"], correct: 2 }, { id: 156, question: "Macrophages are dominant in:", options: ["Early inflammation", "Chronic inflammation", "Allergic reactions", "Antibody production"], correct: 1 }, { id: 157, question: "The term 'chemotaxis' refers to:", options: ["WBC movement toward injury", "RBC rupture", "Vasodilation", "Pain sensation"], correct: 0 }, { id: 158, question: "Redness and warmth are due to:", options: ["Fever", "Vasodilation", "Platelet activation", "Scar formation"], correct: 1 }, { id: 159, question: "Swelling is mainly caused by:", options: ["RBC destruction", "Fluid shift into tissues", "Fever", "Tissue regeneration"], correct: 1 }, { id: 160, question: "Purulent exudate contains:", options: ["Water only", "Fibrin only", "Pus: leukocytes + bacteria + debris", "Plasma only"], correct: 2 }, { id: 161, question: "Serous exudate usually indicates:", options: ["Severe infection", "Mild inflammation", "Chronic inflammation", "Hemorrhage"], correct: 1 }, { id: 162, question: "Fibrinous exudate is characteristic of:", options: ["Mild allergy", "Severe inflammation", "Viral infection", "Burns only"], correct: 1 }, { id: 163, question: "Systemic effects of inflammation do NOT include:", options: ["Mild fever", "Fatigue", "Leukocytosis", "Local necrosis only"], correct: 3 }, { id: 164, question: "Fever is triggered by:", options: ["Histamine", "Bradykinin", "Pyrogens", "Serotonin"], correct: 2 }, { id: 165, question: "Leukocytosis means:", options: ["Low RBC", "High WBC", "Low WBC", "High platelets"], correct: 1 }, { id: 166, question: "A shift to the left (blood test) indicates:", options: ["Increase in immature neutrophils", "RBC deficiency", "Eosinophil dominance", "Platelet loss"], correct: 0 }, { id: 167, question: "Chronic inflammation is characterized by:", options: ["More exudate", "More swelling", "More lymphocytes & macrophages", "No tissue destruction"], correct: 2 }, { id: 168, question: "Resolution occurs when:", options: ["Tissue damage is severe", "Tissue is destroyed completely", "Mild injury returns to normal", "Scar replaces tissue"], correct: 2 }, { id: 169, question: "Regeneration requires:", options: ["Mitotic cells", "Non-dividing cells", "RBCs", "Neurons"], correct: 0 }, { id: 170, question: "Which tissue heals by replacement?", options: ["Liver", "Skin epithelium", "Nervous tissue", "Bone marrow"], correct: 2 }, { id: 171, question: "Granulation tissue consists of:", options: ["Neurons and cartilage", "Connective tissue + new capillaries", "Scar tissue only", "Necrotic cells"], correct: 1 }, { id: 172, question: "A deep ulcer forms mainly due to:", options: ["Excess epithelial growth", "Poor blood supply", "High RBC count", "Strong immune response"], correct: 1 }, { id: 173, question: "A keloid is:", options: ["A shallow ulcer", "Overgrown fibrous scar tissue", "Early granulation tissue", "A wound infection"], correct: 1 }, { id: 174, question: "Adhesions occur when:", options: ["Bone tissue forms", "Scar tissue connects separate structures", "RBCs accumulate", "Ulcers heal"], correct: 1 }, { id: 175, question: "Contracture refers to:", options: ["Muscle paralysis", "Shortening of scar tissue", "Excessive bleeding", "Wound reopening"], correct: 1 }, { id: 176, question: "First intention healing involves:", options: ["Large wound", "Infection", "Minimal tissue loss", "Heavy scarring"], correct: 2 }, { id: 177, question: "Second intention healing involves:", options: ["Small, clean wound", "No granulation tissue", "Large scar formation", "No inflammation"], correct: 2 }, { id: 178, question: "First-degree burns affect:", options: ["Epidermis only", "Dermis only", "All 3 skin layers", "Muscle"], correct: 0 }, { id: 179, question: "Which burn type includes blisters?", options: ["First degree", "Superficial partial-thickness", "Full-thickness", "Fourth degree"], correct: 1 }, { id: 180, question: "Deep partial-thickness burns involve:", options: ["Epidermis only", "Epidermis & dermis", "Dermis & hypodermis", "All layers including bone"], correct: 1 }, { id: 181, question: "Full-thickness burns involve:", options: ["Epidermis", "Dermis", "Hypodermis", "All of the above"], correct: 3 }, { id: 182, question: "Fourth-degree burns involve:", options: ["Skin only", "Skin + muscle/bone", "Epidermis only", "Dermis only"], correct: 1 }, { id: 183, question: "Which burn type usually requires skin grafting?", options: ["First-degree", "Second-degree", "Third-degree", "Superficial"], correct: 2 }, { id: 184, question: "Major complication of burns due to fluid loss:", options: ["Hypertension", "Shock", "Hypoglycemia", "Fever only"], correct: 1 }, { id: 185, question: "A blue-green burn wound suggests:", options: ["S. aureus", "Pseudomonas", "Candida", "HPV"], correct: 1 }, { id: 186, question: "Why do burn patients develop infection easily?", options: ["Temperature drop", "Skin barrier lost", "High RBC count", "Increased immunity"], correct: 1 }, { id: 187, question: "Immediate covering of a burn wound is essential to:", options: ["Reduce scarring", "Prevent infection", "Increase exudate", "Stop pain completely"], correct: 1 }, { id: 188, question: "A 25-year-old woman cuts her hand while cooking. Minutes later, the area becomes red, warm, and swollen. Which mediator caused the initial pain and triggered the inflammatory cascade?", options: ["Histamine", "Bradykinin", "Prostaglandin", "Interferon"], correct: 1 }, { id: 189, question: "A 40-year-old man develops cellulitis on his leg. The area is warm and erythematous. What is the physiological cause?", options: ["Leukocytosis", "Vasodilation", "Platelet activation", "Fibrin formation"], correct: 1 }, { id: 190, question: "A child is stung by a bee. The skin around the sting becomes swollen. Which process is responsible?", options: ["RBC leakage", "Increased capillary permeability", "Decreased blood flow", "Antibody production"], correct: 1 }, { id: 191, question: "A 60-year-old patient has long-standing inflammation in his joints due to rheumatoid arthritis. Which cell type predominates?", options: ["Neutrophils", "NK cells", "Macrophages & lymphocytes", "Basophils"], correct: 2 }, { id: 192, question: "A wound has thick yellow pus. Which best describes this exudate?", options: ["Serous", "Purulent", "Fibrinous", "Hemorrhagic"], correct: 1 }, { id: 193, question: "A patient with pneumonia has a temperature of 38.9°C. What caused the fever?", options: ["Bradykinin", "Pyrogens", "Complement", "Antibodies"], correct: 1 }, { id: 194, question: "Lab results show elevated WBCs and many immature neutrophils (bands). What does this indicate?", options: ["Viral infection", "Bacterial acute inflammation", "Chronic immune disorder", "Hemorrhage"], correct: 1 }, { id: 195, question: "A shallow scrape on the skin heals completely with no scar. Which healing process occurred?", options: ["Replacement", "Regeneration", "Fibrosis", "Second intention"], correct: 1 }, { id: 196, question: "A deep wound on the leg heals, but the new tissue cannot perform normal functions. Which best describes the healing?", options: ["Resolution", "Regeneration", "Replacement with scar tissue", "First intention"], correct: 2 }, { id: 197, question: "A patient develops a large raised scar extending beyond the original wound edge. This is:", options: ["Ulcer", "Contracture", "Keloid", "Granulation tissue"], correct: 2 }, { id: 198, question: "A woman develops abdominal pain months after surgery. Imaging shows scar tissue connecting bowel loops. What is this called?", options: ["Contracture", "Adhesion", "Keloid", "Fistula"], correct: 1 }, { id: 199, question: "A patient has a burn with blisters, redness, and severe pain. What type of burn is this?", options: ["First degree", "Superficial partial-thickness", "Full-thickness", "Fourth degree"], correct: 1 }, { id: 200, question: "A burn wound is white and charred, and the patient feels no pain. Why?", options: ["Too much exudate", "Nerves destroyed", "Excess histamine", "Severe edema"], correct: 1 }, { id: 201, question: "A burn wound becomes blue-green and foul-smelling after several days. Which organism is most likely?", options: ["S. aureus", "Pseudomonas", "Candida", "Streptococcus"], correct: 1 }, { id: 202, question: "A patient with extensive burns has low blood pressure and rapid pulse. The cause is:", options: ["Infection", "Fluid and electrolyte loss", "Hyperglycemia", "Fever"], correct: 1 }, { id: 203, question: "A surgical incision with neatly approximated edges heals with minimal scarring. What type of healing is this?", options: ["First intention", "Second intention", "Replacement", "Chronic repair"], correct: 0 }, { id: 204, question: "A bedridden patient develops an open sore on the back of his heel due to poor blood supply. What complication occurred?", options: ["Keloid", "Ulcer", "Fibrinous exudate", "Hyperplasia"], correct: 1 }, { id: 205, question: "A patient using glucocorticoids for months develops slow wound healing. What explains this?", options: ["Increased WBC activity", "Inhibited immune and inflammatory responses", "Increased collagen formation", "Excess granulation tissue"], correct: 1 }, { id: 206, question: "A patient with pneumonia develops a fibrinous exudate in the lungs. This indicates:", options: ["Mild inflammation", "Severe inflammation", "Viral infection", "Full tissue regeneration"], correct: 1 }, { id: 207, question: "A patient's burn extends through epidermis, dermis, and subcutaneous tissue. Eschar is present. Which treatment is MOST likely required?", options: ["Ice packs", "Antibiotics only", "Skin graft", "NSAIDs only"], correct: 2 } ], "Immunity and infection (part 1)": [ { id: 201, question: "Which of the following is a nonspecific immune response?", options: ["Antibody production", "Cell-mediated immunity", "Inflammation", "IgE synthesis"], correct: 2 }, { id: 202, question: "Which immune response is mediated by B-lymphocytes?", options: ["Cell-mediated immunity", "Humoral immunity", "Nonspecific immunity", "Delayed hypersensitivity"], correct: 1 }, { id: 203, question: "Where do T-lymphocytes mature?", options: ["Bone marrow", "Thymus", "Spleen", "Lymph nodes"], correct: 1 }, { id: 204, question: "Which cell type performs phagocytosis?", options: ["B-cells", "T-helper cells", "Macrophages", "Plasma cells"], correct: 2 }, { id: 205, question: "Which of the following is an exogenous antigen?", options: ["Cell surface protein", "Viral particle entering the body", "Self-antigen on RBCs", "MHC class I protein"], correct: 1 }, { id: 206, question: "Which antibody is the first to increase during an immune response?", options: ["IgA", "IgG", "IgM", "IgE"], correct: 2 }, { id: 207, question: "Which immunoglobulin is found in body secretions such as saliva and tears?", options: ["IgG", "IgM", "IgA", "IgD"], correct: 2 }, { id: 208, question: "Which antibody can cross the placenta?", options: ["IgA", "IgD", "IgE", "IgG"], correct: 3 }, { id: 209, question: "Which immunoglobulin is responsible for allergic reactions?", options: ["IgM", "IgA", "IgE", "IgG"], correct: 2 }, { id: 210, question: "Which immune cell is involved in cell-mediated immunity?", options: ["B-cells", "Plasma cells", "T-lymphocytes", "Mast cells"], correct: 2 }, { id: 211, question: "Which of the following is a lymphoid structure involved in immune function?", options: ["Pancreas", "Thymus", "Kidney", "Thyroid"], correct: 1 }, { id: 212, question: "Which immune cell originates AND matures in the bone marrow?", options: ["T lymphocyte", "B lymphocyte", "NK cell", "Eosinophil"], correct: 1 }, { id: 213, question: "Which chemical mediator is involved in allergic reactions?", options: ["Serotonin", "Histamine", "Complement C5a", "Interferon"], correct: 1 }, { id: 214, question: "Which of the following best describes the function of antigens?", options: ["They destroy bacteria directly", "They stimulate the immune system to produce antibodies", "They activate complement without antibodies", "They neutralize pathogens directly"], correct: 1 }, { id: 215, question: "Which type of immunity depends on T-lymphocytes?", options: ["Humoral immunity", "Nonspecific immunity", "Cell-mediated immunity", "Innate immunity"], correct: 2 }, { id: 216, question: "Which antibody is MOST abundant in the blood?", options: ["IgA", "IgE", "IgG", "IgM"], correct: 2 }, { id: 217, question: "Which immunoglobulin plays a major role in parasitic infections such as malaria?", options: ["IgG", "IgM", "IgE", "IgD"], correct: 2 }, { id: 218, question: "Which immune cell secretes cytokines and presents antigens?", options: ["Neutrophil", "Macrophage", "B plasma cell", "Basophil"], correct: 1 }, { id: 219, question: "Which of the following is a component AND an element of the immune system (in both lists)?", options: ["Antigen", "Complement", "Lymphocytes", "Antibodies"], correct: 2 }, { id: 220, question: "Which immunoglobulin exists as a pentamer?", options: ["IgG", "IgA", "IgM", "IgD"], correct: 2 }, { id: 221, question: "Which line(s) of defense are considered nonspecific?", options: ["First line only", "First and second lines", "Second and third lines", "Third line only"], correct: 1 }, { id: 222, question: "Which is an example of the first line of defense?", options: ["Antibody production", "Unbroken skin and mucous membranes", "Phagocytosis by neutrophils", "T-cell activation"], correct: 1 }, { id: 223, question: "Tears and gastric juice are classified as which type of defense?", options: ["Mechanical barrier", "Chemical barrier", "Cellular immunity", "Humoral immunity"], correct: 1 }, { id: 224, question: "Which of the following belongs to the second line of defense?", options: ["Skin", "Antibodies", "Inflammation", "Cell-mediated immunity"], correct: 2 }, { id: 225, question: "Which of the following is a component of specific immunity?", options: ["Phagocytosis", "Interferon", "Antibody production", "Intact skin"], correct: 2 }, { id: 226, question: "Which of the following is a lymphoid structure found in the small intestine?", options: ["Thymus", "Bone marrow", "Intestinal lymphoid tissue", "Hypothalamus"], correct: 2 }, { id: 227, question: "Which statement about cell-surface antigens is TRUE?", options: ["They are identical in all humans", "They are unique to each individual except identical twins", "They exist only on microbes", "They are found only on red blood cells"], correct: 1 }, { id: 228, question: "Which best describes an endogenous antigen?", options: ["Bacterial toxin entering the body", "Viral protein on a virus surface", "Self cell-surface marker recognized as antigen", "Pollen from the environment"], correct: 2 }, { id: 229, question: "Which of the following is MOST commonly the chemical nature of antigens?", options: ["Lipids", "Proteins", "Nucleic acids", "Simple sugars"], correct: 1 }, { id: 230, question: "Glycoproteins are composed of:", options: ["Lipids and proteins", "Carbohydrates and proteins", "Nucleic acids and proteins", "Carbohydrates and lipids"], correct: 1 }, { id: 231, question: "Which group is correctly matched as immune cells?", options: ["Neurons and fibroblasts", "Lymphocytes and macrophages", "Keratinocytes and chondrocytes", "Osteocytes and adipocytes"], correct: 1 }, { id: 232, question: "Macrophages belong to which system?", options: ["Central nervous system", "Musculoskeletal system", "Mononuclear phagocytic system", "Endocrine system"], correct: 2 }, { id: 233, question: "Which cell type is primarily responsible for humoral immunity?", options: ["T-cells", "Macrophages", "B-cells", "NK cells"], correct: 2 }, { id: 234, question: "Which cell type directly kills virus-infected or abnormal cells in cell-mediated immunity?", options: ["B lymphocytes", "Cytotoxic T cells", "Neutrophils", "Eosinophils"], correct: 1 }, { id: 235, question: "What is the basic structure of an antibody (immunoglobulin)?", options: ["Spherical", "Spiral", "Y-shaped", "Ring-shaped"], correct: 2 }, { id: 236, question: "What is the main function of antibodies?", options: ["Produce cytokines", "Neutralize antigens", "Phagocytose bacteria", "Activate bone marrow"], correct: 1 }, { id: 237, question: "Which immunoglobulin is the largest in size?", options: ["IgA", "IgE", "IgG", "IgM"], correct: 3 }, { id: 238, question: "Which statement about IgA is TRUE?", options: ["It is a pentamer", "It is mainly found in body secretions", "It crosses the placenta", "It is the main antibody in blood"], correct: 1 }, { id: 239, question: "Which immunoglobulin helps activate B lymphocytes to produce more antibodies?", options: ["IgD", "IgM", "IgE", "IgA"], correct: 0 }, { id: 240, question: "Which of the following is correctly paired?", options: ["IgE – main antibody in blood", "IgG – found mainly in secretions", "IgM – first antibody to increase in immune response", "IgA – crosses the placenta"], correct: 2 }, { id: 241, question: "Which immunoglobulins are the main prerequisites for complement activation?", options: ["IgA and IgE", "IgG and IgM", "IgD and IgE", "IgA and IgD"], correct: 1 }, { id: 242, question: "How many proteins are in the complement system (C1–C__)?", options: ["C1–C5", "C1–C7", "C1–C8", "C1–C9"], correct: 3 }, { id: 243, question: "Which of the following is NOT a protein?", options: ["Histamine", "Cytokines", "Prostaglandin", "Dopamine"], correct: 0 }, { id: 244, question: "Natural immunity is:", options: ["Immunity you get from vaccines", "Immunity you are born with", "Immunity from injected antibodies", "Immunity from organ transplant"], correct: 1 }, { id: 245, question: "Which of the following is the best example of active natural immunity?", options: ["Receiving tetanus antitoxin after an animal bite", "Getting chickenpox and recovering", "Receiving a hepatitis B vaccine", "IgG from mother via placenta"], correct: 1 }, { id: 246, question: "Which statement about IgG in pregnancy is TRUE?", options: ["IgG cannot cross the placenta", "All antibodies cross the placenta equally", "IgG is the only antibody that crosses the placenta", "IgM is the only antibody that crosses the placenta"], correct: 2 }, { id: 247, question: "Which of the following describes passive artificial immunity?", options: ["Getting infected with influenza", "Receiving a live attenuated vaccine", "IgG crossing the placenta", "Injection of preformed antibodies made in a company"], correct: 3 }, { id: 248, question: "In the primary immune response, significant antibody levels usually appear after:", options: ["1–2 days", "1–2 weeks", "1–2 months", "Immediately"], correct: 1 }, { id: 249, question: "In the secondary immune response, compared to the primary response:", options: ["Antibodies appear later and are lower", "Antibodies appear faster and are 3–4 times higher", "There is no antibody production", "Antibody production is the same as primary"], correct: 1 }, { id: 250, question: "Which drug name do you specifically need to know for the exam as an immunosuppressant in transplant rejection?", options: ["Prednisone", "Azathioprine", "Cyclosporine", "Methotrexate"], correct: 2 }, { id: 251, question: "Which type of hypersensitivity is IgE-mediated, involving mast cells and histamine release?", options: ["Type I", "Type II", "Type III", "Type IV"], correct: 0 }, { id: 252, question: "Which of the following is the most dangerous, life-threatening Type I reaction?", options: ["Hay fever", "Food allergy", "Eczema", "Anaphylactic shock"], correct: 3 }, { id: 253, question: "Which is the best treatment combination for severe anaphylactic shock?", options: ["Antibiotics only", "Epinephrine, glucocorticoids, antihistamines, and oxygen", "NSAIDs and rest", "Only antihistamines"], correct: 1 }, { id: 254, question: "In Type II hypersensitivity, the key feature is:", options: ["Immune complex deposition", "Sensitized T cells", "Antigen on the cell surface attacked by antibodies", "IgE bound to mast cells"], correct: 2 }, { id: 255, question: "Which of the following is a classic example of Type II hypersensitivity?", options: ["Anaphylactic shock from peanuts", "Contact dermatitis from nickel", "Mismatched ABO blood transfusion", "Tuberculin skin test"], correct: 2 }, { id: 256, question: "Natural immunity refers to:", options: ["Immunity from vaccines", "Immunity present at birth", "Immunity from antibody injection", "Immunity after transplant"], correct: 1 }, { id: 257, question: "Acquired (adaptive) immunity is obtained by:", options: ["Genetic factors", "Exposure to antigens", "Placental transfer", "Medicine"], correct: 1 }, { id: 258, question: "Example of active natural immunity:", options: ["Antitoxin injection", "Infection (ex: chickenpox)", "Vaccine", "IgG via placenta"], correct: 1 }, { id: 259, question: "Which antibody crosses the placenta?", options: ["IgA", "IgM", "IgG", "IgE"], correct: 2 }, { id: 260, question: "Passive artificial immunity includes:", options: ["Vaccine", "Infection", "Injection of pre-made antibodies", "Natural recovery"], correct: 2 }, { id: 261, question: "Primary immune response usually takes:", options: ["1–2 days", "3–5 days", "1–2 weeks", "1–2 months"], correct: 2 }, { id: 262, question: "Secondary immune response typically occurs in:", options: ["Minutes", "1–3 days", "1–2 weeks", "1 month"], correct: 1 }, { id: 263, question: "Secondary response produces antibodies that are:", options: ["Lower", "Same", "3–4 times higher", "Much lower"], correct: 2 }, { id: 264, question: "Which peak is the primary immune response?", options: ["First small peak", "Second large peak", "Both", "Neither"], correct: 0 }, { id: 265, question: "Hyperacute transplant rejection occurs:", options: ["Months later", "Years later", "Immediately (hours–days)", "Weeks later"], correct: 2 }, { id: 266, question: "Acute rejection usually occurs:", options: ["Immediately", "After weeks", "Months/years later", "Only in autoimmune disease"], correct: 1 }, { id: 267, question: "The only immunosuppressant required for exam:", options: ["Prednisone", "Methotrexate", "Cyclosporine", "Azathioprine"], correct: 2 }, { id: 268, question: "Major risk of immunosuppressive therapy:", options: ["Stronger immunity", "Autoimmune disease", "Opportunistic infections", "High antibody production"], correct: 2 }, { id: 269, question: "Type I hypersensitivity is mediated by:", options: ["IgG", "IgM", "IgE", "T-cells"], correct: 2 }, { id: 270, question: "Which cells release histamine in Type I?", options: ["Neutrophils", "Mast cells & Basophils", "Macrophages", "NK cells"], correct: 1 }, { id: 271, question: "Most dangerous Type I reaction:", options: ["Asthma", "Hay fever", "Eczema", "Anaphylactic shock"], correct: 3 }, { id: 272, question: "Best immediate treatment for anaphylaxis:", options: ["Antibiotics", "Epinephrine", "NSAIDs", "Antivirals"], correct: 1 }, { id: 273, question: "Type II hypersensitivity involves:", options: ["IgE + mast cell", "T-cells", "Antibody attack on cell-surface antigens", "Immune complex deposition"], correct: 2 }, { id: 274, question: "Classic example of Type II hypersensitivity:", options: ["Contact dermatitis", "Allergic asthma", "Mismatched blood transfusion", "TB skin test"], correct: 2 }, { id: 275, question: "In mismatched transfusion, what destroys RBCs?", options: ["Histamine", "Complement activation", "T-cell activation", "Autoantibody suppression"], correct: 1 }, { id: 276, question: "Type III hypersensitivity is triggered by:", options: ["Allergens", "Cell-surface antigens", "Immune complexes", "Sensitized T-cells"], correct: 2 }, { id: 277, question: "An immune complex is best defined as:", options: ["Antigen + complement", "Antigen + antibody bound together", "Antibody + cytokine", "T-cell + macrophage"], correct: 1 }, { id: 278, question: "In Type III hypersensitivity, immune complexes mainly cause injury by activating:", options: ["Histamine release", "NK cells", "Complement system", "Platelets"], correct: 2 }, { id: 279, question: "Final steps shared by most hypersensitivity reactions include:", options: ["Viral replication", "Complement activation → inflammation → phagocytosis → tissue damage", "T-cell killing", "Autoantibody formation"], correct: 1 }, { id: 280, question: "In Type III hypersensitivity, the red circles in the diagram represent:", options: ["Antibodies", "Antigens", "T-cells", "Histamine granules"], correct: 1 }, { id: 281, question: "Type IV hypersensitivity is mediated by:", options: ["IgG", "IgM", "Sensitized T-lymphocytes", "Mast cells"], correct: 2 }, { id: 282, question: "In Type IV reactions, the antigen-presenting cell often involved is the:", options: ["Neutrophil", "Basophil", "Macrophage", "Platelet"], correct: 2 }, { id: 283, question: "Sensitized T-cells in Type IV hypersensitivity release:", options: ["Histamine", "Prostaglandins", "Lymphokines", "Antibodies"], correct: 2 }, { id: 284, question: "Which is the BEST example of Type IV hypersensitivity?", options: ["Mismatched blood transfusion", "Anaphylaxis", "Tuberculin (TB) skin test", "Serum sickness"], correct: 2 }, { id: 285, question: "Contact dermatitis is classified as:", options: ["Type I", "Type II", "Type III", "Type IV"], correct: 3 }, { id: 286, question: "Autoimmune diseases occur because the body produces:", options: ["IgA", "Memory cells", "Autoantibodies against its own tissues", "Complement inhibitors"], correct: 2 }, { id: 287, question: "Which autoimmune disease affects the thyroid gland?", options: ["Myasthenia gravis", "Pernicious anemia", "Scleroderma", "Hashimoto's thyroiditis"], correct: 3 }, { id: 288, question: "Myasthenia gravis primarily causes:", options: ["Liver fibrosis", "Hyperthyroidism", "Muscle weakness due to blocked neurotransmission", "Increased RBC count"], correct: 2 }, { id: 289, question: "Primary immunodeficiency is typically:", options: ["Environmental", "Drug-induced", "Infectious", "Congenital (developmental defect)"], correct: 3 }, { id: 290, question: "X-linked hypogammaglobulinemia is more symptomatic in:", options: ["Females", "Children only", "Elderly adults", "Males"], correct: 3 }, { id: 291, question: "Secondary immunodeficiency can be caused by all EXCEPT:", options: ["Splenectomy", "Malnutrition", "Chemotherapy", "Healthy diet"], correct: 3 }, { id: 292, question: "The most prominent infectious cause of secondary immunodeficiency is:", options: ["Hepatitis B", "Varicella", "HIV infection", "Influenza"], correct: 2 }, { id: 293, question: "HIV is classified as a:", options: ["DNA virus", "Bacteriophage", "Retrovirus", "Paramyxovirus"], correct: 2 }, { id: 294, question: "HIV contains which unique feature?", options: ["One DNA molecule", "One RNA molecule", "Two RNA molecules", "No nucleic acid"], correct: 2 }, { id: 295, question: "Reverse transcriptase (RT) in HIV is responsible for:", options: ["Protein synthesis", "Entering the cell", "Converting viral RNA into DNA", "Splitting T-cells"], correct: 2 }, { id: 296, question: "The MOST important step for the exam in HIV's life cycle is:", options: ["Viral budding", "Capsid formation", "Spike protein synthesis", "Integration of viral DNA into human chromosome"], correct: 3 }, { id: 297, question: "Which body fluids have the highest risk for HIV transmission?", options: ["Sweat", "Tears", "Blood, semen, vaginal secretions", "Saliva"], correct: 2 }, { id: 298, question: "Which group is at the highest risk for HIV infection?", options: ["Office workers", "Athletes", "Teenagers", "IV drug users"], correct: 3 }, { id: 299, question: "In the HIV progression graph, the red curve represents:", options: ["CD4 cells", "Antibodies", "Viral load", "T-cell memory"], correct: 2 }, { id: 300, question: "The AIDS stage is characterized by all EXCEPT:", options: ["High viral load", "Low CD4 count", "Opportunistic infections", "High antibody levels"], correct: 3 }, { id: 301, question: "The infection shown as Picture A (PCP) is most commonly associated with:", options: ["Healthy young adults", "HIV/AIDS patients", "Childhood viral infections", "Autoimmune disease"], correct: 1 }, { id: 302, question: "Pneumocystis jirovecii pneumonia (PCP) primarily affects which body system?", options: ["Nervous system", "Respiratory system", "Digestive system", "Endocrine system"], correct: 1 }, { id: 303, question: "Kaposi sarcoma (Picture B) is caused by which virus?", options: ["HIV", "HPV", "HHV-8", "EBV"], correct: 2 }, { id: 304, question: "Kaposi sarcoma is especially common in which condition?", options: ["Asthma", "HIV/AIDS", "Diabetes", "Tuberculosis"], correct: 1 }, { id: 305, question: "Picture C shows severe esophageal bleeding caused by:", options: ["Streptococcus", "Candida infection", "CMV", "HSV"], correct: 1 }, { id: 306, question: "Candida esophagitis occurs most frequently in:", options: ["Healthy adults", "Patients with high immunity", "Immunocompromised individuals", "Athletes"], correct: 2 }, { id: 307, question: "Picture D shows aggressive periodontitis commonly associated with:", options: ["HIV infection", "Influenza", "Allergies", "Appendicitis"], correct: 0 }, { id: 308, question: "Which opportunistic infection is the most classic in HIV patients?", options: ["Hepatitis A", "PCP", "Salmonella", "Influenza"], correct: 1 }, { id: 309, question: "Which HIV drug class blocks the integration step of the viral life cycle?", options: ["NRTIs", "Protease inhibitors", "Fusion inhibitors", "Integrase inhibitors"], correct: 3 }, { id: 310, question: "The integration step refers to:", options: ["Viral RNA becoming protein", "Viral DNA joining host DNA", "Protein packaging", "Viral budding"], correct: 1 }, { id: 311, question: "HAART consists of how many medications?", options: ["1", "2", "3", "5"], correct: 2 }, { id: 312, question: "HAART usually combines drugs from which groups?", options: ["NRTIs + NNRTIs", "Fusion + integrase only", "Only protease inhibitors", "Antifungals"], correct: 0 }, { id: 313, question: "Which HIV drug class targets reverse transcriptase?", options: ["NRTIs", "NNRTIs", "Both A and B", "Neither"], correct: 2 }, { id: 314, question: "Which of the following is NOT part of HIV drug classes discussed?", options: ["NRTIs", "NNRTIs", "MAC inhibitors", "Integrase inhibitors"], correct: 2 }, { id: 315, question: "The alternative complement pathway is:", options: ["Antibody dependent", "Antibody independent", "RNA dependent", "IgE dependent"], correct: 1 }, { id: 316, question: "The classical complement pathway requires:", options: ["No antibodies", "IgE only", "Antibodies", "Macrophages"], correct: 2 }, { id: 317, question: "Key protein in the alternative pathway:", options: ["C1", "C2", "C3", "C9"], correct: 2 }, { id: 318, question: "Key protein in the classical pathway:", options: ["C1", "C3", "C5", "C7"], correct: 0 }, { id: 319, question: "Both complement pathways end in formation of:", options: ["Lectins", "IgE", "Membrane Attack Complex", "MHC I"], correct: 2 }, { id: 320, question: "MAC destroys cells by:", options: ["Blocking ribosomes", "Forming channels in membrane", "Stopping DNA replication", "Removing mitochondria"], correct: 1 }, { id: 321, question: "Which bacteria are more resistant to MAC?", options: ["Gram-negative", "Gram-positive", "Acid-fast", "Anaerobes"], correct: 1 }, { id: 322, question: "Which bacteria are more resistant to antibiotics?", options: ["Gram-positive", "Gram-negative", "Both equally", "Neither"], correct: 1 }, { id: 323, question: "The first step of phagocytosis is:", options: ["Digestion", "Exocytosis", "Pseudopod formation", "Lysosome fusion"], correct: 2 }, { id: 324, question: "After internalization, the antigen becomes enclosed in:", options: ["Lysosome", "Phagosome", "Ribosome", "Nucleus"], correct: 1 }, { id: 325, question: "Fusion of a phagosome with a lysosome produces:", options: ["Peroxisome", "Phagolysosome", "Megasome", "Endosome"], correct: 1 }, { id: 326, question: "Final waste material expelled from the cell is called:", options: ["Residual bodies", "Histamine granules", "Cytokines", "Myelin"], correct: 0 }, { id: 327, question: "Which cells perform phagocytosis in the bloodstream?", options: ["T cells", "B cells", "Neutrophils (PMNs)", "Platelets"], correct: 2 }, { id: 328, question: "Which cells perform phagocytosis in tissues?", options: ["Basophils", "Macrophages", "RBCs", "Mast cells"], correct: 1 }, { id: 329, question: "Which is TRUE regarding phagocytosis?", options: ["Lysosomes digest pathogens", "Phagocytosis produces IgE", "Antibodies are needed", "Only viruses are phagocytosed"], correct: 0 }, { id: 330, question: "PCP is caused by which organism?", options: ["Parasite", "Fungus-like organism", "Bacteria", "Virus"], correct: 1 }, { id: 331, question: "Which symptom is MOST typical of PCP?", options: ["Severe diarrhea", "Shortness of breath with dry cough", "Skin rash", "Jaundice"], correct: 1 }, { id: 332, question: "Kaposi sarcoma lesions are usually described as:", options: ["Yellow and crusted", "Purple or violaceous patches", "White nodules", "Transparent blisters"], correct: 1 }, { id: 333, question: "Which patient is MOST likely to develop Kaposi sarcoma?", options: ["A patient with controlled diabetes", "An immunocompetent adult", "A patient with advanced HIV", "A child with chickenpox"], correct: 2 }, { id: 334, question: "Candida esophagitis is MOST commonly associated with which symptom?", options: ["Painful swallowing", "Loss of vision", "Leg cramps", "Ear pain"], correct: 0 }, { id: 335, question: "Oral thrush and Candida esophagitis occur most often due to:", options: ["Excessive vitamin intake", "Fungal overgrowth in immunosuppression", "Autoimmune attack", "Viral replication"], correct: 1 }, { id: 336, question: "Aggressive periodontitis leads to:", options: ["Tooth enamel whitening", "Rapid periodontal tissue destruction", "Gingival calcification", "Improved oral health"], correct: 1 }, { id: 337, question: "Which finding strongly suggests HIV-associated oral disease?", options: ["Mild soreness", "Aggressive periodontal destruction", "Occasional bleeding gums", "Excessive tartar formation"], correct: 1 }, { id: 338, question: "Which HIV drug directly inhibits viral entry into the cell?", options: ["Fusion inhibitors", "NRTIs", "Integrase inhibitors", "Protease inhibitors"], correct: 0 }, { id: 339, question: "Reverse transcriptase converts:", options: ["DNA → RNA", "RNA → DNA", "Protein → RNA", "DNA → protein"], correct: 1 }, { id: 340, question: "Integrase inhibitors prevent which stage?", options: ["Viral assembly", "Viral budding", "Viral DNA insertion into host chromosome", "Viral entry"], correct: 2 }, { id: 341, question: "Without integrase, HIV cannot:", options: ["Produce antibodies", "Attach to receptors", "Become part of the host genome", "Form envelopes"], correct: 2 }, { id: 342, question: "HAART is used because HIV:", options: ["Mutates rapidly", "Does not mutate", "Is eliminated easily", "Cannot resist antibiotics"], correct: 0 }, { id: 343, question: "The main advantage of HAART is:", options: ["It cures HIV", "It suppresses viral replication", "It boosts RBC production", "It eliminates all opportunistic infections"], correct: 1 }, { id: 344, question: "A patient taking NRTIs and NNRTIs is receiving:", options: ["HIV vaccine", "HAART", "Antifungal therapy", "Antibiotics"], correct: 1 }, { id: 345, question: "The complement system is normally:", options: ["Active at all times", "Present but inactive", "Not present in healthy individuals", "Only produced during fever"], correct: 1 }, { id: 346, question: "Which statement is TRUE about the classical pathway?", options: ["It works without antibodies", "It requires antibodies", "It begins with C3 activation", "It begins in the liver"], correct: 1 }, { id: 347, question: "Which protein initiates the classical pathway?", options: ["C3", "C5", "C1", "C9"], correct: 2 }, { id: 348, question: "The alternative pathway begins with activation of:", options: ["C1", "IgM", "C3", "Histamine"], correct: 2 }, { id: 349, question: "The main function of MAC is to:", options: ["Produce cytokines", "Create pores in membranes", "Neutralize antibodies", "Trigger fever"], correct: 1 }, { id: 350, question: "MAC is part of which immune component?", options: ["Virus", "Complement system", "Antibody", "T-cell receptor"], correct: 1 }, { id: 351, question: "Gram-positive bacteria resist MAC because of:", options: ["Thick peptidoglycan layer", "Thin cell wall", "Flagella", "Toxins"], correct: 0 }, { id: 352, question: "The first physical action a phagocyte takes is:", options: ["Digesting lysosomes", "Forming pseudopods", "Expelling waste", "Releasing cytokines"], correct: 1 }, { id: 353, question: "Which step represents the formation of a phagolysosome?", options: ["Pseudopod contact", "Lysosome + phagosome fusion", "Antibody binding", "Cell lysis"], correct: 1 }, { id: 354, question: "Which organ has the highest number of macrophages?", options: ["Liver", "Skin", "Pancreas", "Thyroid"], correct: 0 }, { id: 355, question: "Which immune cells are MOST active in tissues?", options: ["Eosinophils", "Macrophages", "Neutrophils", "B cells"], correct: 1 }, { id: 356, question: "Which immune cells are MOST active in blood circulation?", options: ["Macrophages", "Neutrophils", "Basophils", "Plasma cells"], correct: 1 }, { id: 357, question: "Residual bodies are produced after:", options: ["Antibody production", "Digestion of microbes", "Activation of complement", "Fever onset"], correct: 1 }, { id: 358, question: "Which combination is correct?", options: ["Phagosome = lysosome only", "Phagolysosome = phagosome + lysosome", "Lysosome = engulfed microbe", "Pseudopod = membrane pore"], correct: 1 }, { id: 359, question: "Which HIV-related opportunistic infection affects the esophagus?", options: ["PCP", "Kaposi sarcoma", "Candida", "CMV retinitis"], correct: 2 }, { id: 360, question: "A patient with HIV presents with progressive dyspnea and non-productive cough. Chest X-ray shows diffuse bilateral interstitial infiltrates. Which immune defect MOST directly increases risk for this condition?", options: ["Loss of CD8 T-cell cytotoxicity", "Loss of CD4 T-helper cells", "Decreased complement C1", "Increased antibody IgG levels"], correct: 1 }, { id: 361, question: "Which feature helps differentiate Kaposi sarcoma from simple vascular inflammation in HIV patients?", options: ["Red, flat lesions on chest", "Violaceous nodules due to HHV-8", "Lesions that disappear after antihistamine", "White plaques easily scraped off"], correct: 1 }, { id: 362, question: "A patient has painful swallowing and bright-red bleeding in the esophagus. Biopsy reveals pseudohyphae. Which immune pathway failure contributes MOST to this infection?", options: ["MAC formation failure", "Failure of classical complement activation", "T-cell immunodeficiency", "Overactivation of neutrophils"], correct: 2 }, { id: 363, question: "Which oral finding in HIV is MOST predictive of advanced immunosuppression?", options: ["Mild gingivitis", "Dental plaque", "Aggressive periodontitis with rapid bone loss", "Occasional gum bleeding"], correct: 2 }, { id: 364, question: "Integrase inhibitors block which step?", options: ["RNA → DNA conversion", "Viral DNA insertion into host genome", "Viral entry through gp41", "Viral protein cleavage"], correct: 1 }, { id: 365, question: "A patient stops taking HAART for 2 months. Which laboratory pattern is expected FIRST?", options: ["Antibody levels drop immediately", "CD4 count rises sharply", "Viral load spikes upward", "MAC formation decreases"], correct: 2 }, { id: 366, question: "Which HIV drug class prevents conversion of viral RNA into proviral DNA?", options: ["Protease inhibitors", "Fusion inhibitors", "NRTI / NNRTI", "Integrase inhibitors"], correct: 2 }, { id: 367, question: "Which pathway requires antibodies to activate complement?", options: ["Alternative", "Classical", "Lectin", "Both alternative and lectin"], correct: 1 }, { id: 368, question: "Failure of C3 activation MOST severely affects which immune function?", options: ["MAC formation only", "Phagocytosis and opsonization", "IgE binding to mast cells", "Lymphokine secretion"], correct: 1 }, { id: 369, question: "A bacterium is highly resistant to MAC but sensitive to antibiotics. Which description fits best?", options: ["Gram-negative", "Gram-positive", "Acid-fast", "Spirochete"], correct: 1 }, { id: 370, question: "A pathogen forms pores in host cell membranes, leading to lysis. Which complement components form these pores?", options: ["C1 complex", "C3a and C5a", "C5b–C9", "IgM + IgG"], correct: 2 }, { id: 371, question: "The FIRST step of phagocytosis depends on which action?", options: ["Lysosomal enzyme release", "Pseudopod extension", "Residual body exocytosis", "Formation of phagolysosome"], correct: 1 }, { id: 372, question: "A macrophage engulfs a microbe but cannot digest it. Which structure malfunctioned?", options: ["Phagosome", "Lysosome", "Pseudopod", "C3 convertase"], correct: 1 }, { id: 373, question: "In which organ would macrophage dysfunction MOST severely impair pathogen clearance?", options: ["Pancreas", "Liver", "Thyroid", "Cornea"], correct: 1 }, { id: 374, question: "A patient has normal antibody levels but still activates complement against microbes. Which pathway explains this?", options: ["Classical", "Alternative", "Lectin", "None"], correct: 1 }, { id: 375, question: "Which HIV life-cycle step occurs immediately BEFORE integration?", options: ["Fusion", "Reverse transcription", "Assembly", "Budding"], correct: 1 }, { id: 376, question: "HAART commonly includes:", options: ["NRTI + NRTI + NNRTI", "Protease + protease + protease", "NNRTI alone", "NRTI + antifungal + antiviral"], correct: 0 }, { id: 377, question: "A patient receiving HAART shows viral RNA inside the cytoplasm but no viral DNA in nucleus. Which drug class is working?", options: ["Protease inhibitor", "Integrase inhibitor", "NRTI", "NNRTI"], correct: 1 }, { id: 378, question: "In PCP infection, impaired gas exchange occurs primarily because:", options: ["The fungus destroys alveoli", "Interstitial fluid and foamy exudate fill alveoli", "Bronchi collapse", "MAC overactivation causes lysis"], correct: 1 }, { id: 379, question: "Candida esophagitis is classified as which type of infection?", options: ["Opportunistic fungal", "Primary viral", "Autoimmune", "Bacterial toxin-mediated"], correct: 0 }, { id: 380, question: "Which HIV-related condition is BEST explained by depletion of CD4 T-cells?", options: ["Increased neutrophil count", "Inability to activate B-cell antibody production", "Increased RBC production", "Decreased complement C1"], correct: 1 }, { id: 381, question: "A patient with HIV shows the following: High viral load, Low CD4 count, Baseline antibody levels decreasing. Which stage is this MOST consistent with?", options: ["Seroconversion", "HIV-positive latent stage", "AIDS (final stage)", "Window period"], correct: 2 }, { id: 382, question: "A patient has thick gram-positive cell walls. Which complement outcome is expected?", options: ["MAC destroys the bacteria easily", "Bacteria show resistance to MAC", "Complement activation does not occur", "Bacteria inhibit antibody production"], correct: 1 }, { id: 383, question: "Which step occurs LAST during phagocytosis?", options: ["Internalization", "Lysosome fusion", "Pseudopod formation", "Residual body release"], correct: 3 }, { id: 384, question: "A patient with HIV develops violaceous lesions on legs and palate. Which additional finding is MOST expected?", options: ["Viral load low", "Caused by Candida species", "Caused by HHV-8 infection", "Resolves with antihistamines"], correct: 2 } ], "Immunity and infection (part 2)": [ { id: 201, question: "Which complement activation pathway is antibody-independent?", options: ["Classical pathway", "Alternative pathway", "Lectin pathway", "Adaptive pathway"], correct: 1 }, { id: 202, question: "Which protein is the key initiator of the classical pathway?", options: ["C1", "C3", "C5", "C9"], correct: 0 }, { id: 203, question: "Which protein is the key initiator of the alternative pathway?", options: ["C1", "C3", "IgG", "C9"], correct: 1 }, { id: 204, question: "The membrane attack complex (MAC) forms:", options: ["Cytokines", "Cell membrane pores", "Antibody clusters", "Histamine"], correct: 1 }, { id: 205, question: "Gram-positive bacteria are more resistant to MAC because they have:", options: ["Thin cell walls", "Thick peptidoglycan layer", "No cell membrane", "Flagella"], correct: 1 }, { id: 206, question: "The complement system in healthy individuals is:", options: ["Fully active", "Produced only during infection", "Present but inactive", "Absent"], correct: 2 }, { id: 207, question: "Which immune cells are most active in phagocytosis in the bloodstream?", options: ["Macrophages", "Neutrophils", "B cells", "Basophils"], correct: 1 }, { id: 208, question: "Which immune cells perform most phagocytosis in tissues?", options: ["Neutrophils", "Macrophages", "NK cells", "Eosinophils"], correct: 1 }, { id: 209, question: "Organs rich in macrophages include all EXCEPT:", options: ["Liver", "Spleen", "Kidney", "Retina"], correct: 3 }, { id: 210, question: "The first visible step of phagocytosis is:", options: ["Digestion", "Pseudopod formation", "Residual body release", "Phagolysosome formation"], correct: 1 }, { id: 211, question: "The vesicle formed after internalization of the microbe is called:", options: ["Lysosome", "Phagosome", "Ribosome", "Nucleus"], correct: 1 }, { id: 212, question: "Fusion of a phagosome with a lysosome results in:", options: ["Endosome", "Phagolysosome", "MAC", "Secretory vesicle"], correct: 1 }, { id: 213, question: "Residual bodies are released after:", options: ["Pseudopod formation", "Microbe digestion", "Complement activation", "Antibody secretion"], correct: 1 }, { id: 214, question: "Which complement pathway requires antibodies to begin?", options: ["Alternative", "Classical", "Adaptive", "Effector pathway"], correct: 1 }, { id: 215, question: "What is the final shared outcome of both classical and alternative pathways?", options: ["Activation of IgM", "Formation of MAC", "Neutrophil apoptosis", "Antigen presentation"], correct: 1 }, { id: 216, question: "MAC is less effective against which group of bacteria?", options: ["Gram-negative", "Gram-positive", "Intracellular bacteria", "Spirochetes"], correct: 1 }, { id: 217, question: "Lysosomes contribute to phagocytosis by:", options: ["Producing antibodies", "Releasing digestive enzymes", "Forming pseudopods", "Making cytokines"], correct: 1 }, { id: 218, question: "Which step occurs before phagolysosome formation?", options: ["Enzyme release", "Residual body formation", "Internalization", "Microbe digestion"], correct: 2 }, { id: 219, question: "The complement system contributes to all EXCEPT:", options: ["Opsonization", "MAC formation", "Antibody production", "Inflammation"], correct: 2 }, { id: 220, question: "Which of the following indicates the end of phagocytosis?", options: ["Pseudopod formation", "Microbe internalization", "Residual body exocytosis", "Phagosome formation"], correct: 2 }, { id: 221, question: "The key protein for alternative complement activation is:", options: ["C1", "C3", "C5", "C9"], correct: 1 }, { id: 222, question: "The key protein for classical complement activation is:", options: ["C1", "C3", "C8", "IgM"], correct: 0 }, { id: 223, question: "Both classical and alternative pathways lead to formation of:", options: ["IgM", "Antigen-antibody complexes", "MAC", "Neutrophils"], correct: 2 }, { id: 224, question: "MAC destroys cells by:", options: ["Digesting DNA", "Forming pores/channels in the membrane", "Breaking antibodies", "Releasing histamine"], correct: 1 }, { id: 225, question: "Gram-positive bacteria resist MAC more because they have:", options: ["Capsule", "Thin cell wall", "Thick cell wall", "No membrane"], correct: 2 }, { id: 226, question: "In healthy individuals, complement proteins are:", options: ["Fully active all the time", "Present but inactive", "Only produced during fever", "Absent"], correct: 1 }, { id: 227, question: "The two major classes of WBCs mentioned by the professor are:", options: ["B cells and T cells", "NK cells and T cells", "Granulocytes and agranulocytes", "Dendritic cells and macrophages"], correct: 2 }, { id: 228, question: "The most important phagocytic cells in blood are:", options: ["Basophils", "Neutrophils (PMNs)", "Eosinophils", "Macrophages"], correct: 1 }, { id: 229, question: "The most important phagocytic cells in tissues are:", options: ["T cells", "Neutrophils", "Macrophages", "B cells"], correct: 2 }, { id: 230, question: "Organs rich in macrophages include all EXCEPT:", options: ["Liver", "Kidney", "Spleen", "Lymph nodes"], correct: 1 }, { id: 231, question: "The first step of phagocytosis is:", options: ["Digestion", "Formation of pseudopods", "Residual body release", "Fusion of lysosome"], correct: 1 }, { id: 232, question: "Internalization results in formation of:", options: ["Nucleus", "Phagosome", "Lysosome", "Ribosome"], correct: 1 }, { id: 233, question: "Fusion of lysosome + phagosome forms:", options: ["Endosome", "Phagolysosome", "Ribosome", "MAC"], correct: 1 }, { id: 234, question: "Digestion of microbes produces:", options: ["Cytokines", "Residual bodies", "DNA fragments", "Capsules"], correct: 1 }, { id: 235, question: "Which cells are most numerous in severe bacterial infection (as seen in CSF)?", options: ["Lymphocytes", "Eosinophils", "Neutrophils", "Basophils"], correct: 2 }, { id: 236, question: "Which statement about pseudopods is TRUE?", options: ["They digest bacteria", "They are the first action of a phagocyte", "They are lysosomal enzymes", "They produce antibodies"], correct: 1 }, { id: 237, question: "Where are PMNs (neutrophils) primarily located?", options: ["Brain", "Blood", "Lymph nodes", "Spleen"], correct: 1 }, { id: 238, question: "Which statement BEST explains why the alternative pathway can be activated before antibody production?", options: ["It requires IgM only", "It depends solely on C1", "It is antibody-independent and triggered by C3", "It needs antigen-presenting cells first"], correct: 2 }, { id: 239, question: "If a patient lacks C1 protein, which complement function will be MOST impaired?", options: ["Alternative pathway activation", "Classical pathway activation", "MAC formation only", "Neutrophil chemotaxis"], correct: 1 }, { id: 240, question: "A microorganism with a thick outer structure resists MAC. Which organism type best fits this description?", options: ["Gram-negative bacteria", "Gram-positive bacteria", "Enveloped viruses", "Parasites"], correct: 1 }, { id: 241, question: "During phagocytosis, which step would fail FIRST if lysosomal enzymes were absent?", options: ["Internalization", "Pseudopod formation", "Microbial digestion", "Phagosome formation"], correct: 2 }, { id: 242, question: "A defect in pseudopod formation directly prevents:", options: ["Fusion of lysosome with phagosome", "Attachment of antibody to antigen", "Internalization of the microbe", "Release of residual bodies"], correct: 2 }, { id: 243, question: "Which finding would indicate that a cell failed to form a phagolysosome?", options: ["Microbe remains intact inside a vesicle", "Excessive residual bodies", "MAC deposition", "Elevated C1 activation"], correct: 0 }, { id: 244, question: "Which complement protein must be functional for BOTH classical and alternative pathways to produce MAC?", options: ["C1", "C3", "IgG", "C9"], correct: 1 }, { id: 245, question: "If classical pathway activation is delayed, which immunity component is most likely insufficient?", options: ["Cytokines", "IgG or IgM", "C3 convertase", "Tissue macrophages"], correct: 1 }, { id: 246, question: "A pathogen continues multiplying despite normal C1 and C3 levels. Which is the MOST likely defect?", options: ["MAC formation failure", "Excess phagocytosis", "Antibody overproduction", "Pseudopod malfunction"], correct: 0 }, { id: 247, question: "In phagocytosis, which event directly follows antigen internalization?", options: ["Residual body release", "Pseudopod formation", "Phagosome formation", "Enzyme digestion"], correct: 2 }, { id: 248, question: "Liver macrophages (Kupffer cells) are MOST responsible for:", options: ["Blood-borne pathogen filtration", "MAC-mediated killing", "Antibody production", "Complement synthesis"], correct: 0 }, { id: 249, question: "A cell forms a phagosome but cannot digest the microbe. Which structure is defective?", options: ["Lysosome", "Pseudopod", "Cell membrane", "Phagosome"], correct: 0 }, { id: 250, question: "Why are macrophages considered more important than neutrophils for chronic infections?", options: ["They survive longer in tissues", "They produce antibodies", "They activate C1", "They cannot form phagolysosomes"], correct: 0 }, { id: 251, question: "Failure of the complement system to activate MAC will MOST affect which type of bacteria?", options: ["Gram-negative", "Gram-positive", "Gram-variable", "Acid-fast"], correct: 0 }, { id: 252, question: "Which situation MOST decreases classical pathway activity?", options: ["Lack of C3", "Low IgG/IgM", "Excess macrophages", "Increased lysosome activity"], correct: 1 }, { id: 253, question: "A microbe is found inside a vesicle with NO digestive enzyme activity. What stage of phagocytosis is incomplete?", options: ["Internalization", "Pseudopod formation", "Phagolysosome fusion", "Residual body release"], correct: 2 }, { id: 254, question: "Which best describes the relationship between classical and alternative pathways?", options: ["Both require antibodies", "Both ultimately form MAC", "Only alternative forms MAC", "Only classical activates C3"], correct: 1 }, { id: 255, question: "A patient has frequent infections, and labs show normal antibodies but very low C3. Which pathway is MOST impaired?", options: ["Classical pathway only", "Alternative pathway only", "Both pathways", "Neither pathway"], correct: 2 }, { id: 256, question: "Which step directly leads to microbial destruction inside the phagocyte?", options: ["Pseudopod formation", "MAC insertion into membrane", "Action of lysosomal enzymes", "Antibody binding to antigen"], correct: 2 }, { id: 257, question: "What does the presence of many residual bodies in a macrophage indicate?", options: ["MAC failure", "Recent successful phagocytosis", "Antibody deficiency", "Lack of pseudopods"], correct: 1 }, { id: 258, question: "Which cell can recognize antigen WITHOUT the need for MHC or an APC?", options: ["CD4 T cell", "CD8 T cell", "B cell", "NK cell"], correct: 2 }, { id: 259, question: "T cells can recognize antigens only when they are:", options: ["Free and floating in plasma", "Bound to MHC on an antigen-presenting cell", "Attached to antibodies", "Inside lysosomes"], correct: 1 }, { id: 260, question: "According to the lecture, which is the ONLY situation where two humans have identical MHC molecules?", options: ["Fraternal twins", "Two siblings", "Identical twins", "Parent and child"], correct: 2 }, { id: 261, question: "MHC class I is found on:", options: ["Only APCs", "All nucleated cells", "Only B cells", "Red blood cells"], correct: 1 }, { id: 262, question: "MHC class II presents antigens to which cells?", options: ["CD8 T cells", "B cells", "CD4 T cells", "Neutrophils"], correct: 2 }, { id: 263, question: "CD8 T cells (Tc and Ts) receive antigens through:", options: ["MHC I", "MHC II", "No MHC required", "Complement proteins"], correct: 0 }, { id: 264, question: "CD4 T cells (Th and Td delayed hypersensitivity) receive antigens via:", options: ["MHC I", "MHC II", "Free antigen", "B-cell receptors"], correct: 1 }, { id: 265, question: "Which statement about APCs in the lecture is TRUE?", options: ["APCs require a nucleus to present antigen via MHC I", "APCs express both MHC I and MHC II", "APCs can recognize antigen directly", "APCs do not require MHC molecules"], correct: 1 }, { id: 266, question: "In the lecture, the instructor emphasized that B cells recognize:", options: ["Only linear peptides", "Only nonlinear peptides", "Both linear and nonlinear forms directly", "Only antigen–MHC complexes"], correct: 2 }, { id: 267, question: "The lecture states that T cells CANNOT recognize antigen unless:", options: ["Complement proteins are activated", "Antibodies are already produced", "The antigen is attached to MHC", "The antigen is linear"], correct: 2 }, { id: 268, question: "The ONLY two lymphocytes capable of antigen recognition are:", options: ["Neutrophils and macrophages", "B cells and T cells", "Dendritic cells and B cells", "Basophils and T cells"], correct: 1 }, { id: 269, question: "In the T-cell recognition diagram from lecture, the antigen is located:", options: ["Outside the MHC structure", "Inside the MHC structure", "At the surface of B cells", "Inside lysosomes only"], correct: 1 }, { id: 270, question: "Identical twins share the same MHC. This fact is important clinically for:", options: ["Cancer treatment", "Organ transplantation", "Diabetes diagnosis", "Hypertension management"], correct: 1 }, { id: 271, question: "The lecture emphasized that antigen recognition via APC is required for:", options: ["B cells only", "Neutrophils only", "T cells only", "Both B and T cells"], correct: 2 }, { id: 272, question: "Which scenario would make T-cell antigen recognition IMPOSSIBLE?", options: ["Antigen is bound to MHC II on an APC", "Antigen is linear but bound to MHC I", "Antigen is presented on a nucleated cell surface", "Antigen is present but NOT attached to any MHC molecule"], correct: 3 }, { id: 273, question: "A student claims that B cells and T cells both require MHC for activation. Based on the lecture, what is the correct correction?", options: ["Both require MHC I", "Both require MHC II", "B cells do NOT require MHC", "T cells do NOT require MHC"], correct: 2 }, { id: 274, question: "Which antigen presentation combination is INCORRECT?", options: ["MHC I → CD8", "MHC II → CD4", "MHC I → Tc/Ts cells", "MHC II → NK cells"], correct: 3 }, { id: 275, question: "Which statement best explains why MHC matching is extremely rare between unrelated individuals?", options: ["APCs are structurally identical in all humans", "B cells require identical antibodies", "MHC molecules are genetically unique and match only in identical twins", "CD8 and CD4 require different DNA sequences"], correct: 2 }, { id: 276, question: "A patient lacks MHC I molecules. Which immune function would be MOST impaired?", options: ["Activation of CD4 cells", "Recognition by B cells", "Activation of cytotoxic T cells", "Antigen binding to antibodies"], correct: 2 }, { id: 277, question: "Which finding indicates T-cell activation by MHC II rather than MHC I?", options: ["Antigen presented on all nucleated cells", "Antigen presented on APC surface", "Response from cytotoxic T cells", "Response from suppressor T cells"], correct: 1 }, { id: 278, question: "A virus infects only red blood cells. According to the lecture, which is TRUE?", options: ["It will activate CD8 T cells", "It will activate CD4 T cells", "It cannot be presented on MHC I", "It cannot be recognized by B cells"], correct: 2 }, { id: 279, question: "In which situation would antigen recognition by B cells STILL occur normally?", options: ["APC is missing MHC II", "APC cannot process antigen", "Antigen is denatured", "Antigen is free-floating in plasma"], correct: 3 }, { id: 280, question: "Which immune recognition pattern matches the T-cell diagram shown in lecture?", options: ["Antigen floating freely → CD8 activation", "Antigen attached to BCR → T-cell activation", "Antigen bound to MHC on APC → T-cell activation", "Antigen attached to complement → B-cell activation"], correct: 2 }, { id: 281, question: "Which immune cell can recognize antigen directly without MHC or APC?", options: ["CD4 T cell", "CD8 T cell", "B cell", "Macrophage"], correct: 2 }, { id: 282, question: "Which statement about T-cell antigen recognition is TRUE?", options: ["T cells recognize free antigens directly", "T cells require MHC + antigen on an APC", "T cells recognize antigens only inside phagosomes", "T cells recognize only linear peptides"], correct: 1 }, { id: 283, question: "MHC class I presents antigen primarily to:", options: ["B cells", "CD4 T cells", "CD8 T cells", "Macrophages"], correct: 2 }, { id: 284, question: "MHC class II molecules are found mainly on:", options: ["All nucleated cells", "RBCs", "Platelets", "Antigen-presenting cells"], correct: 3 }, { id: 285, question: "The only scenario where two individuals share identical MHC is:", options: ["Siblings", "Parent and child", "Identical twins", "First cousins"], correct: 2 }, { id: 286, question: "Which antigen form can B cells recognize BEST?", options: ["Only MHC-presented peptides", "Only peptide fragments", "Free antigens (linear or nonlinear)", "Only viral antigens"], correct: 2 }, { id: 287, question: "A patient with a defect in C3 would have impairment in which pathway(s)?", options: ["Classical only", "Alternative only", "Both classical and alternative", "Neither pathway"], correct: 2 }, { id: 288, question: "A patient is unable to activate complement without antibodies. Which protein is most likely defective?", options: ["C3", "C1", "C5", "C9"], correct: 1 }, { id: 289, question: "A mutation causes failure of C3 to split spontaneously. Which pathway is impaired?", options: ["Classical only", "Alternative only", "Both classical and alternative", "Only terminal pathway"], correct: 1 }, { id: 290, question: "A child's complement works normally, but he cannot generate MAC. Which components are defective?", options: ["C1–C3", "C5–C9", "C1–C4", "C3 only"], correct: 1 }, { id: 291, question: "A microorganism survives despite MAC activation. Which finding best explains it?", options: ["Lacks MHC molecules", "Thick peptidoglycan layer", "Produces no toxins", "Has no surface antigens"], correct: 1 }, { id: 292, question: "T cells fail to recognize antigen even though antigen is present on APCs. What is defective?", options: ["BCR", "Immunoglobulins", "MHC molecules", "Complement C3"], correct: 2 }, { id: 293, question: "A researcher finds immune cells recognizing antigens without MHC binding. These cells are:", options: ["CD4 T cells", "CD8 T cells", "B cells", "Macrophages"], correct: 2 }, { id: 294, question: "T cells recognize antigen only when:", options: ["Antigen is fragmented inside lysosome", "Antigen is linked to MHC on APC", "Antigen is soluble in blood", "Antigen is a polysaccharide"], correct: 1 }, { id: 295, question: "MHC-I molecules are expected on which of the following?", options: ["Mature RBCs", "Neurons", "Platelets", "Bacteria"], correct: 1 }, { id: 296, question: "A patient's CD8 T cells are normal, but no activation occurs. Which molecule is missing on APC?", options: ["MHC-II", "MHC-I", "Antibody", "Phagosome"], correct: 1 }, { id: 297, question: "A cell lacks nucleus. Which immune presentation is impossible for this cell?", options: ["MHC-I presentation", "MHC-II presentation", "Antibody binding", "Complement activation"], correct: 0 }, { id: 298, question: "A patient's APC shows antigen but does NOT activate CD4 T cells. Which MHC is missing?", options: ["MHC-I", "MHC-II", "BCR", "Complement C1"], correct: 1 }, { id: 299, question: "Which cells display MHC Class II?", options: ["All nucleated cells", "All RBCs", "Only APCs", "Only neutrophils"], correct: 2 }, { id: 300, question: "Which cell type does NOT have MHC class I?", options: ["Neurons", "Hepatocytes", "Erythrocytes (RBCs)", "Kidney cells"], correct: 2 }, { id: 301, question: "HSV-1 MOST commonly affects which area according to the lecture?", options: ["Genital region", "Above the waist", "Below the waist", "Bloodstream"], correct: 1 }, { id: 302, question: "Genital herpes is mainly caused by:", options: ["HSV-1", "HSV-2", "VZV", "EBV"], correct: 1 }, { id: 303, question: "Recurrent HSV lesions are frequently triggered by:", options: ["Antibiotics", "Warm temperature only", "Sunlight and stress", "Parasitic infections"], correct: 2 }, { id: 304, question: "The trigeminal ganglion is the latent site of reactivation for:", options: ["HSV-2", "HSV-1", "CMV", "EBV"], correct: 1 }, { id: 305, question: "Which skin condition is described as painful but NOT itchy?", options: ["Chickenpox", "HSV-1 labial lesions", "Shingles (Herpes zoster)", "Oral candidiasis"], correct: 2 }, { id: 306, question: "Chickenpox lesions are described as:", options: ["Painful, unilateral", "Itchy, non-painful", "Deep, ulcerative", "Firm and purple"], correct: 1 }, { id: 307, question: "Which herpesvirus is specifically associated with Kaposi sarcoma in HIV patients?", options: ["HSV-1", "HSV-2", "HHV-8", "CMV"], correct: 2 }, { id: 308, question: "EBV (Epstein–Barr virus) causes ALL EXCEPT:", options: ["Mono (glandular fever)", "Nasopharyngeal carcinoma", "Burkitt lymphoma", "Kaposi sarcoma"], correct: 3 }, { id: 309, question: "CMV infection in pregnancy can lead to:", options: ["Hyperthyroidism", "Deafness and blindness in the infant", "Cardiomyopathy only", "Chronic skin ulcers"], correct: 1 }, { id: 310, question: "Postnatal CMV infection may lead to:", options: ["Multi-organ failure", "Osteoporosis", "Hyperpigmentation", "Autoimmune diseases"], correct: 0 }, { id: 311, question: "During HSV reactivation, which statement is MOST accurate based on the lecture?", options: ["HSV-2 reactivates mainly in the trigeminal ganglion", "HSV reactivation requires antibody presence", "Reactivation can occur due to sunlight or stress", "HSV latent stage occurs only in the bloodstream"], correct: 2 }, { id: 312, question: "Which presentation is MOST consistent with shingles rather than chickenpox?", options: ["Itchy vesicles all over the body", "Painful lesions on a single dermatome", "Non-itchy, painless vesicles", "Bilateral scattered lesions with fever"], correct: 1 }, { id: 313, question: "Which herpes infection risk increases specifically in pregnancy, according to the lecture?", options: ["Kaposi sarcoma", "EBV-related cancers", "CMV infection causing congenital defects", "HSV-2 causing brain inflammation"], correct: 2 }, { id: 314, question: "Which statement about CMV infection is supported by the lecture?", options: ["It only affects the liver", "It causes blindness and deafness in infants", "It is primarily a skin infection", "It only occurs in HIV patients"], correct: 1 }, { id: 315, question: "A patient presents with painful vesicles, not itchy, and appearing only on the right side of the torso. Which virus is MOST likely?", options: ["HSV-1", "HSV-2", "VZV (shingles)", "CMV"], correct: 2 }, { id: 316, question: "Why are shingles lesions typically unilateral?", options: ["VZV spreads only through blood", "Virus reactivates along a single nerve pathway", "Antibodies prevent bilateral spread", "Only one dermatome contains MHC II"], correct: 1 }, { id: 317, question: "Which herpesvirus is MOST commonly associated with genital herpes?", options: ["HHV-1", "HHV-2", "HHV-3", "HHV-4"], correct: 1 }, { id: 318, question: "Which herpesvirus remains latent in the trigeminal ganglion?", options: ["CMV", "HSV-2", "HSV-1", "HHV-6"], correct: 2 }, { id: 319, question: "Which statement correctly compares chickenpox and shingles?", options: ["Chickenpox lesions are painful; shingles lesions are itchy", "Chickenpox lesions are itchy; shingles lesions are painful", "Both are primarily painful", "Both are primarily itchy"], correct: 1 }, { id: 320, question: "Which condition is caused by HHV-8, especially in HIV-positive patients?", options: ["Burkitt lymphoma", "Nasopharyngeal carcinoma", "Kaposi sarcoma", "Oral hairy leukoplakia"], correct: 2 }, { id: 321, question: "Which virus can cause congenital infection leading to deafness or blindness?", options: ["HSV-1", "EBV", "CMV", "HHV-7"], correct: 2 }, { id: 322, question: "Which herpesvirus causes infectious mononucleosis?", options: ["HSV-2", "EBV", "CMV", "VZV"], correct: 1 }, { id: 323, question: "Which HHV virus is MOST associated with multi-organ failure in immunosuppressed patients?", options: ["HHV-1", "HHV-4", "HHV-5", "HHV-8"], correct: 2 }, { id: 324, question: "Which of the following conditions is typically painless but itchy?", options: ["Shingles", "Chickenpox", "Trachoma", "Herpetic whitlow"], correct: 1 }, { id: 325, question: "Which HHV primarily causes oral lesions such as gingivostomatitis?", options: ["HHV-1", "HHV-2", "HHV-3", "HHV-5"], correct: 0 }, { id: 326, question: "Which herpesvirus can cause nasopharyngeal carcinoma?", options: ["HSV-1", "HSV-2", "EBV", "CMV"], correct: 2 }, { id: 327, question: "Which viral infection hides in the trigeminal ganglion during latency?", options: ["EBV", "CMV", "VZV only", "HSV-1"], correct: 3 }, { id: 328, question: "A child with congenital CMV infection is at highest risk for:", options: ["Gingivostomatitis", "Deafness", "Small painful ulcers", "Vesicles on the lips"], correct: 1 }, { id: 329, question: "Which virus is MOST associated with painful unilateral skin lesions?", options: ["HSV-1", "HSV-2", "VZV (shingles)", "HHV-7"], correct: 2 }, { id: 330, question: "Which herpesvirus is primarily associated with fine skin rashes?", options: ["HHV-6", "HHV-7", "HHV-4", "HHV-8"], correct: 1 }, { id: 331, question: "Kaposi sarcoma in HIV patients is caused by:", options: ["HHV-6", "HHV-4", "HHV-8", "HSV-2"], correct: 2 }, { id: 332, question: "A patient has no MHC I molecules on their cells. Which cell type will be MOST affected?", options: ["CD4⁺ T helpers", "Neutrophils", "CD8⁺ T cytotoxic cells", "B cells"], correct: 2 }, { id: 333, question: "A patient with HIV develops gingivostomatitis. Which virus is MOST likely responsible?", options: ["HHV-1", "HHV-3", "HHV-5", "HHV-8"], correct: 0 }, { id: 334, question: "What is the primary difference between HSV-1 and HSV-2 in terms of infection location?", options: ["HSV-1 is always oral", "HSV-2 is always oral", "HSV-2 mainly affects genital area, HSV-1 mainly affects oral area", "They never overlap in location"], correct: 2 }, { id: 335, question: "Which herpesvirus is most strongly associated with multi-organ failure in immunosuppressed adults?", options: ["HHV-1", "HHV-4", "HHV-5", "HHV-7"], correct: 2 }, { id: 336, question: "Which herpesvirus causes reactivation triggered by sunlight and stress?", options: ["CMV", "EBV", "HSV-1", "HHV-7"], correct: 2 }, { id: 337, question: "A child presents with itchy vesicles all over the body, none of which are painful. What is the BEST diagnosis?", options: ["Shingles", "Chickenpox", "HSV-1", "CMV rash"], correct: 1 }, { id: 338, question: "Which herpesvirus most often causes Kaposi sarcoma?", options: ["HSV-1", "HHV-5", "HHV-7", "HHV-8"], correct: 3 }, { id: 339, question: "Which virus is responsible for causing nasopharyngeal carcinoma?", options: ["HHV-3", "HHV-4", "HHV-6", "HHV-8"], correct: 1 }, { id: 340, question: "HSV-2 is MOST strongly associated with:", options: ["Cold sores", "Genital lesions", "Chickenpox", "Oral hairy leukoplakia"], correct: 1 }, { id: 341, question: "A characteristic feature of shingles (VZV reactivation) is:", options: ["Bilateral lesions", "Itchy but painless rash", "Painful unilateral rash", "White patches on tongue"], correct: 2 }, { id: 342, question: "Which virus is MOST associated with Burkitt lymphoma?", options: ["HSV-1", "HSV-2", "VZV", "EBV"], correct: 3 }, { id: 343, question: "CMV infection in adults MOST commonly appears as:", options: ["Multi-organ failure", "Painful vesicles", "Asymptomatic infection", "Severe skin rash"], correct: 2 }, { id: 344, question: "A patient shows a painful unilateral vesicular rash. Which latent location is responsible for reactivation?", options: ["Facial muscles", "Cardiac nerve bundles", "Dorsal root ganglion", "Cerebral cortex"], correct: 2 }, { id: 345, question: "Which virus MOST commonly causes oral hairy leukoplakia in immunocompromised patients?", options: ["HSV-1", "HSV-2", "EBV", "CMV"], correct: 2 }, { id: 346, question: "A newborn is diagnosed with congenital CMV. Which sign is MOST typical?", options: ["Painful lip vesicles", "Blindness or sensorineural hearing loss", "Oral thrush", "Unilateral shingles"], correct: 1 }, { id: 347, question: "The latent site of HSV-1 reactivation is:", options: ["Dorsal root ganglion", "Facial nerve nucleus", "Trigeminal ganglion", "Hippocampus"], correct: 2 }, { id: 348, question: "Shingles skin lesions are typically:", options: ["Bilateral", "Painless", "Unilateral and very painful", "Non-itchy and painless"], correct: 2 }, { id: 349, question: "Chickenpox lesions are:", options: ["Painful and itchy", "Painless and itchy", "Painful and not itchy", "Neither itchy nor painful"], correct: 1 }, { id: 350, question: "Which virus causes mononucleosis?", options: ["HSV-2", "EBV", "CMV", "HHV-6"], correct: 1 }, { id: 351, question: "Hairy leukoplakia is associated with:", options: ["HSV-1", "CMV", "EBV", "HHV-7"], correct: 2 }, { id: 352, question: "HHV-8 is strongly associated with:", options: ["Oral thrush", "Kaposi sarcoma", "Roseola", "Genital herpes"], correct: 1 }, { id: 353, question: "The virus that causes shingles is:", options: ["HHV-1", "HHV-2", "HHV-3", "HHV-4"], correct: 2 }, { id: 354, question: "Stress and sunlight can reactivate which virus?", options: ["CMV", "EBV", "HSV-1 / HSV-2", "HHV-8"], correct: 2 }, { id: 355, question: "A child with high fever followed by a faint rash likely has:", options: ["HSV-1", "HHV-6", "HHV-8", "HSV-2"], correct: 1 }, { id: 356, question: "HHV-7 commonly causes:", options: ["Nasopharyngeal carcinoma", "Mild rashes", "Oral ulcers", "Blindness"], correct: 1 }, { id: 357, question: "Congenital CMV infection may cause all EXCEPT:", options: ["Deafness", "Blindness", "Cognitive impairment", "Strong immunity"], correct: 3 }, { id: 358, question: "CMV infection in adults may cause:", options: ["Severe pneumonia only", "Multi-organ failure", "No symptoms ever", "Only skin rash"], correct: 1 }, { id: 359, question: "Nasopharyngeal carcinoma is associated with:", options: ["HSV-2", "CMV", "EBV", "HHV-7"], correct: 2 }, { id: 360, question: "Which herpesvirus causes Burkitt lymphoma?", options: ["HSV-1", "HSV-2", "EBV", "CMV"], correct: 2 }, { id: 361, question: "Which is TRUE regarding HSV primary vs recurrent infection?", options: ["Primary only occurs in children", "Recurrent infection is due to viral reactivation", "Primary infection occurs in the ganglion", "Recurrent infection is always systemic"], correct: 1 }, { id: 362, question: "Shingles can involve which cranial nerve division and cause blindness?", options: ["CN VII", "CN V – ophthalmic branch", "CN II", "CN IX"], correct: 1 }, { id: 363, question: "Cold sores (herpes labialis) are caused mostly by:", options: ["HSV-2", "EBV", "HSV-1", "CMV"], correct: 2 }, { id: 364, question: "The ONLY herpesvirus specifically highlighted as common in HIV patients was:", options: ["HHV-1", "HHV-3", "HHV-5 (CMV)", "HHV-7"], correct: 2 }, { id: 365, question: "HSV-1 most commonly affects which region?", options: ["Below the waist", "Abdomen", "Above the waist", "Lower limbs"], correct: 2 }, { id: 366, question: "HSV-2 is mainly associated with:", options: ["Oral lesions", "Gingivostomatitis", "Genital herpes", "Ophthalmic infection"], correct: 2 }, { id: 367, question: "A virus hides in sensory ganglia after initial infection. This pattern resembles:", options: ["HSV-1 latency", "Complement deficiency", "T-cell suppression", "Alternative pathway activation"], correct: 0 }, { id: 368, question: "Which statement about MHC I expression is TRUE?", options: ["Only found on B cells", "Found on all nucleated cells", "Found on RBCs", "Not needed for CD8 activation"], correct: 1 }, { id: 369, question: "Which type of antigen presentation will activate CD8⁺ cytotoxic T cells?", options: ["Antigen bound to MHC II", "Antigen directly binding a B cell", "Antigen bound to MHC I", "Antigen without any MHC involvement"], correct: 2 }, { id: 370, question: "T cells fail to respond to an antigen unless it is paired with an MHC molecule. This phenomenon is known as:", options: ["Antigenicity", "MHC restriction", "Tolerance", "Complement activation"], correct: 1 }, { id: 371, question: "Which structure is present ONLY on APCs and not on all nucleated cells?", options: ["MHC I", "MHC II", "CD8 protein", "Integrin receptor"], correct: 1 }, { id: 372, question: "Which type of immune cell is required for T-cell activation?", options: ["Neutrophil", "Eosinophil", "APC", "RBC"], correct: 2 }, { id: 373, question: "Which statement about B cells is TRUE?", options: ["B cells need MHC to detect antigen", "B cells recognize antigen only through APCs", "B cells recognize antigen directly", "B cells only bind linear peptides"], correct: 2 }, { id: 374, question: "Which characteristic uniquely applies to MHC Class I molecules?", options: ["Found only on APCs", "Present only in lymph nodes", "Found on all nucleated cells", "Present only on B cells"], correct: 2 }, { id: 375, question: "A patient's T cell cannot recognize antigen unless an APC is involved. This requirement refers to:", options: ["Antibody-mediated immunity", "Direct antigen recognition", "MHC restriction", "Humoral immunity"], correct: 2 }, { id: 376, question: "Which APC displays antigen specifically using MHC Class II?", options: ["Neutrophil", "Erythrocyte", "Macrophage", "Muscle cell"], correct: 2 }, { id: 377, question: "Which phagocytosis step directly follows pseudopod formation?", options: ["Phagosome formation", "Phagolysosome formation", "Killing of microbe", "Exocytosis of debris"], correct: 0 }, { id: 378, question: "Which statement best explains why macrophages are more common in organs like the liver and spleen?", options: ["These organs have high blood flow and filter pathogens", "They generate antibodies", "They lack neutrophils", "They prevent complement activation"], correct: 0 }, { id: 379, question: "Residual bodies are:", options: ["Undigested waste left after phagocytosis", "Newly synthesized lysosomes", "Viral particles", "Antibody complexes"], correct: 0 }, { id: 380, question: "In the classical pathway, complement activation will NOT occur without:", options: ["C3", "Antibodies", "C9", "Lysosomes"], correct: 1 }, { id: 381, question: "A newborn rapidly develops meningitis after mild exposure to bacteria. Which concept explains this vulnerability?", options: ["Low neutrophil count", "Poorly developed blood-brain barrier", "Lack of complement proteins", "Excessive MHC expression"], correct: 1 }, { id: 382, question: "A patient with a genetic defect preventing fusion of lysosomes with phagosomes will have impaired:", options: ["Antigen presentation", "Phagolysosome formation", "Antibody production", "Complement activation"], correct: 1 }, { id: 383, question: "A lab test shows that a patient's complement system activates normally even without antibodies. Which pathway is functioning?", options: ["Classical", "Alternative", "Lectin", "Terminal pathway only"], correct: 1 }, { id: 384, question: "A patient has recurrent infections with gram-negative bacteria despite normal immunity elsewhere. Which complement component is MOST likely defective?", options: ["C1", "C3", "C5–C9", "Properdin"], correct: 2 }, { id: 385, question: "A blood smear shows abundant neutrophils but very few macrophages. What does this indicate?", options: ["Strong tissue-based immunity", "Acute infection occurring mainly in blood", "Chronic infection in organs", "Autoimmune response"], correct: 1 }, { id: 386, question: "A patient's macrophages engulf bacteria normally, but digestion fails. Which step is impaired?", options: ["Pseudopod formation", "Phagosome formation", "Lysosome–phagosome fusion", "Residual body exocytosis"], correct: 2 }, { id: 387, question: "A defect causes incomplete digestion, and undigested fragments accumulate inside phagocytes. What structure increases?", options: ["Phagosomes", "Lysosomes", "Residual bodies", "MHC-II expression"], correct: 2 }, { id: 388, question: "A newborn has seizures after mild infection. Which mechanism explains vulnerability?", options: ["Overactive macrophages", "High neutrophil count", "Poorly developed blood–brain barrier", "Excess complement activity"], correct: 2 }, { id: 389, question: "An adult with brain infection cannot be treated with certain antibiotics. Why?", options: ["High RBC turnover", "Fully developed BBB prevents drug entry", "Lack of complement activation", "Excess macrophage filtration"], correct: 1 }, { id: 390, question: "A macrophage forms pseudopods normally but cannot internalize the pathogen. Which step is defective?", options: ["Step 1", "Step 2 (internalization)", "Step 4 (fusion)", "Step 7 (expulsion)"], correct: 1 }, { id: 391, question: "A mutation prevents formation of pseudopods. Which process is impaired first?", options: ["Antigen–MHC binding", "Antigen internalization", "Phagolysosome formation", "Cytokine release"], correct: 1 }, { id: 392, question: "A researcher studies a structure containing digestive enzymes and an engulfed bacterium fused together. What is he observing?", options: ["Lysosome", "Phagosome", "Phagolysosome", "Residual body"], correct: 2 }, { id: 393, question: "Complement system remains inactive even during infection. Which explanation fits best?", options: ["Complement proteins are absent in blood", "Complement proteins exist but are inactive", "Antibodies block complement proteins", "Excess MHC expression prevents activation"], correct: 1 }, { id: 394, question: "Which cell can recognize antigen directly without MHC or an APC?", options: ["CD4 T cell", "B cell", "CD8 T cell", "Macrophage"], correct: 1 }, { id: 395, question: "Which of the following is TRUE about T-cell antigen recognition?", options: ["T cells recognize free-floating antigen without MHC", "T cells require antigen bound to MHC on an APC", "T cells only recognize linear peptides", "T cells can recognize antigen directly like B cells"], correct: 1 }, { id: 396, question: "MHC Class I presents antigens to which of the following?", options: ["B cells", "CD4 T cells", "CD8 T cells", "NK cells"], correct: 2 }, { id: 397, question: "Which type of T cell is activated by MHC Class II?", options: ["CD8 T cytotoxic cells", "NK cells", "CD4 T helper cells", "B cells"], correct: 2 }, { id: 398, question: "Which complement pathway is antibody-independent?", options: ["Classical", "Lectin", "Alternative", "Terminal"], correct: 2 }, { id: 399, question: "The key protein for the classical pathway is:", options: ["C3", "C1", "C5", "C9"], correct: 1 }, { id: 400, question: "The key protein for the alternative pathway is:", options: ["C1", "C2", "C3", "C9"], correct: 2 }, { id: 401, question: "The function of the membrane attack complex (MAC) is:", options: ["Neutralizing antibodies", "Destroying microbes by forming membrane pores", "Binding to MHC molecules", "Opsonizing bacteria"], correct: 1 }, { id: 402, question: "Gram-positive bacteria resist MAC mainly because they have:", options: ["A thin cell wall", "A thick peptidoglycan layer", "A lipid envelope", "Flagella"], correct: 1 }, { id: 403, question: "The very first action during phagocytosis is:", options: ["Fusion of phagosome and lysosome", "Expulsion of residual bodies", "Pseudopod formation", "Digestion of microbe"], correct: 2 }, { id: 404, question: "After internalization, the engulfed microbe is enclosed in a:", options: ["Lysosome", "Ribosome", "Phagosome", "Nucleus"], correct: 2 }, { id: 405, question: "A phagolysosome is created when:", options: ["Lysosome fuses with phagosome", "Antibodies coat the microbe", "Cytokines bind to receptors", "Microbe releases toxins"], correct: 0 }, { id: 406, question: "The immune cells MOST active in blood are:", options: ["Macrophages", "Neutrophils", "Basophils", "T cells"], correct: 1 }, { id: 407, question: "How many protections does the brain have, according to the lecture?", options: ["2", "3", "4", "5"], correct: 2 }, { id: 408, question: "Which of the following is NOT one of the brain's four protections listed in lecture?", options: ["Skull bones", "CSF", "Blood-brain barrier", "Lymphatic drainage"], correct: 3 }, { id: 409, question: "The subarachnoid space is located between:", options: ["Dura and skull", "Arachnoid and pia", "Dura and arachnoid", "Pia and brain tissue"], correct: 1 }, { id: 410, question: "The subarachnoid space contains:", options: ["Blood", "Synovial fluid", "CSF", "Lymph"], correct: 2 }, { id: 411, question: "CSF pressure increases when:", options: ["Reabsorption exceeds production", "Production exceeds reabsorption", "Sodium concentration decreases", "Skull bones expand"], correct: 1 }, { id: 412, question: "CSF resembles plasma mainly in:", options: ["Color", "Chemical composition", "Odor", "Cell count"], correct: 1 }, { id: 413, question: "Which brain protection would be MOST directly affected if CSF reabsorption decreases?", options: ["Skull", "Bone marrow", "Ventricular system", "Blood-brain barrier"], correct: 2 }, { id: 414, question: "Which situation indicates decreased CSF pressure?", options: ["Overproduction of CSF", "Reabsorption exceeding production", "Blockage of CSF drainage", "Increased blood flow in meninges"], correct: 1 }, { id: 415, question: "A pathology report states that the subarachnoid space contains abnormal fluid. What fluid should normally be in this space?", options: ["Blood", "Lymph", "CSF", "Interstitial fluid"], correct: 2 }, { id: 416, question: "Which meninges–space pairing is CORRECT?", options: ["Dura – contains CSF", "Subarachnoid – between dura & skull", "Subdural – between arachnoid & pia", "Subarachnoid – contains CSF"], correct: 3 }, { id: 417, question: "Which of the following cells appears in tissues and performs phagocytosis according to the lecture?", options: ["Neutrophils", "Plasma cells", "Macrophages", "Basophils"], correct: 2 }, { id: 418, question: "In the CNS, which structure is located between the arachnoid mater and the pia mater?", options: ["Subdural space", "Subarachnoid space", "Epidural space", "Ventricular space"], correct: 1 }, { id: 419, question: "Which of the following correctly lists the meninges from outermost to innermost?", options: ["Pia → Arachnoid → Dura", "Arachnoid → Dura → Pia", "Dura → Arachnoid → Pia", "Dura → Pia → Arachnoid"], correct: 2 }, { id: 420, question: "What happens when CSF production is greater than CSF reabsorption?", options: ["ICP decreases", "ICP remains unchanged", "CSF disappears", "ICP increases"], correct: 3 }, { id: 421, question: "Which of the following is a protection for the brain but NOT for the spinal cord?", options: ["CSF", "Meninges", "Skull", "Blood-brain barrier"], correct: 2 }, { id: 422, question: "What is the main role of the subarachnoid space?", options: ["Blood filtration", "CSF circulation", "Production of antibodies", "Storage of neurotransmitters"], correct: 1 }, { id: 423, question: "The pia mater is best described as:", options: ["The thick outermost layer", "The middle fibrous layer", "The thin innermost layer directly on brain surface", "The layer containing bone marrow"], correct: 2 }, { id: 424, question: "Which layer of the meninges directly adheres to the surface of the brain?", options: ["Dura mater", "Arachnoid mater", "Pia mater", "Epidural layer"], correct: 2 }, { id: 425, question: "What fills the subarachnoid space?", options: ["Blood", "Lymph", "CSF", "Plasma"], correct: 2 }, { id: 426, question: "Increased intracranial pressure results when:", options: ["CSF absorption > production", "CSF production > absorption", "CSF and plasma mix equally", "Meninges thicken with age"], correct: 1 }, { id: 427, question: "Which of the following is NOT a protection for the spinal cord?", options: ["CSF", "Meninges", "Blood-brain barrier", "Skull bones"], correct: 3 }, { id: 428, question: "To maintain normal intracranial pressure, which must occur?", options: ["CSF production must exceed reabsorption", "CSF reabsorption must exceed production", "Production and reabsorption must be equal", "CSF must be replaced by lymphatic fluid"], correct: 2 }, { id: 429, question: "Which structure does NOT contribute to spinal cord protection?", options: ["Vertebrae", "Meninges", "CSF", "Skull bones"], correct: 3 }, { id: 430, question: "Which substance can easily pass through the blood-brain barrier (BBB)?", options: ["Sodium", "Glucose", "Water", "Lipid-soluble drugs"], correct: 3 }, { id: 431, question: "Why is a poorly developed BBB dangerous in neonates?", options: ["Antibiotics cannot enter the brain", "Too much CSF is produced", "Toxins and drugs can enter the brain easily", "Glucose cannot enter the brain"], correct: 2 }, { id: 432, question: "Why is a fully developed BBB problematic in adults?", options: ["It allows toxins to enter", "It blocks most antibiotics from reaching CNS infections", "It prevents oxygen from entering", "It causes CSF leakage"], correct: 1 }, { id: 433, question: "Which of the following is NOT a protection for the spinal cord?", options: ["Vertebral column", "CSF", "Skull bones", "Meninges"], correct: 2 }, { id: 434, question: "Which statement about the BBB is TRUE?", options: ["It allows proteins to freely diffuse.", "It is fully mature at birth.", "It is composed of tightly joined endothelial cells.", "It permits rapid entry of water-soluble drugs."], correct: 2 }, { id: 435, question: "The BBB most closely resembles which cellular structure?", options: ["Nuclear membrane", "Cytoplasmic (plasma) membrane", "Golgi apparatus", "Ribosomal wall"], correct: 1 }, { id: 436, question: "A drug is water-soluble and large in molecular size. What is MOST likely?", options: ["It crosses the BBB easily.", "It cannot cross the BBB.", "It only crosses in neonates.", "It crosses via saltatory conduction."], correct: 1 }, { id: 437, question: "What is the MAIN risk when BBB is not fully developed in infants?", options: ["Increased CSF pressure", "Increased penetration of harmful substances", "Decreased glucose to the brain", "Brainstem dysfunction"], correct: 1 }, { id: 438, question: "Which statement about MHC I expression is TRUE?", options: ["Only found on B cells", "Found on all nucleated cells", "Found on RBCs", "Not needed for CD8 activation"], correct: 1 }, { id: 439, question: "Which of the following is NOT a protection for the spinal cord?", options: ["Vertebral column", "CSF", "Skull bones", "Meninges"], correct: 2 }, { id: 440, question: "The somatic nervous system controls:", options: ["Heart contraction", "Digestive motility", "Voluntary skeletal movement", "Pupil dilation"], correct: 2 }, { id: 441, question: "What is the functional nervous system division responsible for voluntary movements?", options: ["Sympathetic nervous system", "Parasympathetic nervous system", "Somatic nervous system", "Autonomic nervous system"], correct: 2 }, { id: 442, question: "Which neurological division controls involuntary functions such as heart rate and digestion?", options: ["Somatic nervous system", "Cranial nerve system", "Autonomic nervous system", "Central nervous system"], correct: 2 }, { id: 443, question: "Which of the following is a protection for the brain but NOT for the spinal cord?", options: ["CSF", "Meninges", "Skull", "Blood-brain barrier"], correct: 2 }, { id: 444, question: "Which location correctly matches gray matter?", options: ["Inside of brain", "Outside of spinal cord", "Contains myelinated axons", "Contains neuron cell bodies"], correct: 3 }, { id: 445, question: "Which structure is NOT part of the CNS?", options: ["Brain", "Spinal cord", "Cranial nerves", "Gray matter"], correct: 2 }, { id: 446, question: "Which of the following correctly lists the meninges from outermost to innermost?", options: ["Pia → Arachnoid → Dura", "Arachnoid → Dura → Pia", "Dura → Arachnoid → Pia", "Dura → Pia → Arachnoid"], correct: 2 }, { id: 447, question: "What happens when CSF production is greater than CSF reabsorption?", options: ["ICP decreases", "ICP remains unchanged", "CSF disappears", "ICP increases"], correct: 3 }, { id: 448, question: "Which of the following is a protection for the brain but NOT for the spinal cord?", options: ["CSF", "Meninges", "Skull", "Blood-brain barrier"], correct: 2 }, { id: 449, question: "The pia mater is best described as:", options: ["The thick outermost layer", "The middle fibrous layer", "The thin innermost layer directly on brain surface", "The layer containing bone marrow"], correct: 2 }, { id: 450, question: "Which substance can easily pass through the blood-brain barrier (BBB)?", options: ["Sodium", "Glucose", "Water", "Lipid-soluble drugs"], correct: 3 }, { id: 451, question: "Which arrangement is correct for the spinal cord?", options: ["Gray outside, white inside", "White outside, gray inside", "No gray matter", "Equal amounts of white and gray"], correct: 1 }, { id: 452, question: "Gray matter primarily contains:", options: ["Axons", "Synaptic clefts", "Cell bodies and dendrites", "Myelin sheaths"], correct: 2 }, { id: 453, question: "White matter contains:", options: ["Cell bodies", "Dendrites", "Axons organized into tracts", "Astrocytes"], correct: 2 }, { id: 454, question: "Ascending tracts carry information:", options: ["From brain to spinal cord", "From spinal cord to muscles", "From spinal cord to brain", "Between two sensory receptors"], correct: 2 }, { id: 455, question: "Neurons are non-mitotic. What does this mean?", options: ["They divide only once", "They function only in childhood", "They do not undergo cell division", "They regenerate quickly"], correct: 2 }, { id: 456, question: "The rapid 'jumping' of action potentials between nodes of Ranvier is called:", options: ["Continuous conduction", "Saltatory conduction", "Axonal drift", "Dendritic transmission"], correct: 1 }, { id: 457, question: "Myelin in the CNS is produced by:", options: ["Schwann cells", "Astrocytes", "Oligodendrocytes", "Microglia"], correct: 2 }, { id: 458, question: "Myelin in the PNS is produced by:", options: ["Oligodendrocytes", "Schwann cells", "Astrocytes", "Ependymal cells"], correct: 1 }, { id: 459, question: "Which neuroglial cell is responsible for the blood-brain barrier?", options: ["Microglia", "Schwann cells", "Astrocytes", "Ependymal cells"], correct: 2 }, { id: 460, question: "Which glial cell performs phagocytosis?", options: ["Astrocyte", "Oligodendrocyte", "Schwann cell", "Microglia"], correct: 3 }, { id: 461, question: "Which structure is part of a synapse?", options: ["Myelin sheath", "Presynaptic axon terminal", "Cerebral cortex", "Vertebral arch"], correct: 1 }, { id: 462, question: "The space where neurotransmitters are released is called the:", options: ["Axonal canal", "Synaptic cleft", "Vesicle cavity", "Neural gap"], correct: 1 }, { id: 463, question: "Which neurotransmitter is excitatory?", options: ["GABA", "Glycine", "Serotonin", "Norepinephrine"], correct: 3 }, { id: 464, question: "Which is an inhibitory neurotransmitter?", options: ["Dopamine", "Acetylcholine", "Epinephrine", "GABA"], correct: 3 }, { id: 465, question: "The autonomic nervous system controls:", options: ["Voluntary skeletal muscles", "Involuntary functions", "Balance and hearing", "Memory and emotion"], correct: 1 }, { id: 466, question: "The sympathetic system is also known as:", options: ["Rest and digest", "Feed and breed", "Fight or flight", "Think and respond"], correct: 2 }, { id: 467, question: "Preganglionic sympathetic neurons release:", options: ["Dopamine", "Serotonin", "Acetylcholine", "Norepinephrine"], correct: 2 }, { id: 468, question: "Postganglionic sympathetic neurons release:", options: ["Serotonin", "GABA", "Acetylcholine", "Norepinephrine"], correct: 3 }, { id: 469, question: "Preganglionic parasympathetic neurons release:", options: ["Acetylcholine", "Dopamine", "Epinephrine", "Serotonin"], correct: 0 }, { id: 470, question: "Postganglionic parasympathetic neurons release:", options: ["Norepinephrine", "Acetylcholine", "Dopamine", "Cortisol"], correct: 1 }, { id: 471, question: "Which receptor is associated with postganglionic sympathetic neurons?", options: ["Muscarinic", "Nicotinic", "Cholinergic", "Adrenergic"], correct: 3 }, { id: 472, question: "Damage to ascending tracts would MOST likely affect:", options: ["Voluntary movement", "Sensory input to the brain", "Autonomic regulation", "Motor control of spinal reflexes"], correct: 1 }, { id: 473, question: "Which statement about neurons is correct?", options: ["They divide rapidly in adults.", "They are non-mitotic.", "They store glycogen for emergencies.", "They can survive long periods without oxygen."], correct: 1 }, { id: 474, question: "The MAIN reason CNS injuries are permanent is:", options: ["Schwann cells cannot divide", "Neurons cannot perform phagocytosis", "Neurons lack mitosis", "Too much myelin is present"], correct: 2 }, { id: 475, question: "Saltatory conduction occurs because:", options: ["Myelin slows the conduction", "The signal jumps between nodes of Ranvier", "Gray matter speeds impulses", "CSF enhances neurotransmission"], correct: 1 }, { id: 476, question: "Which pair is correctly matched?", options: ["CNS myelin – Schwann cell", "PNS myelin – oligodendrocyte", "CNS myelin – oligodendrocyte", "PNS myelin – astrocyte"], correct: 2 }, { id: 477, question: "Astrocytes function mainly to:", options: ["Produce myelin in CNS", "Form the blood-brain barrier", "Perform phagocytosis", "Generate CSF"], correct: 1 }, { id: 478, question: "Which cell type performs phagocytosis in the CNS?", options: ["Astrocyte", "Schwann cell", "Ependymal cell", "Microglia"], correct: 3 }, { id: 479, question: "The synaptic cleft is located between:", options: ["Two axons", "Two dendrites", "Presynaptic terminal and postsynaptic receptor", "Axon and myelin sheath"], correct: 2 }, { id: 480, question: "Which neurotransmitter is MOST associated with excitatory actions?", options: ["GABA", "Glycine", "Norepinephrine", "Serotonin"], correct: 2 }, { id: 481, question: "Which neurotransmitter is inhibitory?", options: ["Dopamine", "Acetylcholine", "GABA", "Epinephrine"], correct: 2 }, { id: 482, question: "The autonomic nervous system regulates:", options: ["Skeletal muscle", "Voluntary actions", "Involuntary functions", "Somatic reflexes only"], correct: 2 }, { id: 483, question: "The sympathetic division originates from which region?", options: ["Craniosacral", "Thoracolumbar", "Cervical only", "Lumbar only"], correct: 1 }, { id: 484, question: "'Fight or flight' is associated with:", options: ["Parasympathetic system", "Sympathetic system", "Somatic system", "Enteric system"], correct: 1 }, { id: 485, question: "Preganglionic sympathetic neurons use which neurotransmitter?", options: ["Norepinephrine", "Serotonin", "Acetylcholine", "Dopamine"], correct: 2 }, { id: 486, question: "Postganglionic sympathetic neurons use which neurotransmitter?", options: ["Serotonin", "Acetylcholine", "Norepinephrine", "Glutamate"], correct: 2 }, { id: 487, question: "Preganglionic parasympathetic neurons use:", options: ["Acetylcholine", "Epinephrine", "GABA", "Dopamine"], correct: 0 }, { id: 488, question: "Postganglionic parasympathetic neurons use:", options: ["Norepinephrine", "Acetylcholine", "Epinephrine", "Glutamate"], correct: 1 }, { id: 489, question: "Which receptor type is found at sympathetic postganglionic synapses?", options: ["Nicotinic", "Muscarinic", "Adrenergic", "Cholinergic only"], correct: 2 }, { id: 490, question: "Which receptor type is found at parasympathetic postganglionic synapses?", options: ["Nicotinic", "Adrenergic", "GABAergic", "Muscarinic"], correct: 3 }, { id: 491, question: "Which statement correctly describes neurotransmitter patterns in the autonomic nervous system?", options: ["Both sympathetic and parasympathetic systems use norepinephrine in preganglionic synapses.", "Sympathetic preganglionic fibers use acetylcholine, while postganglionic fibers use norepinephrine.", "Parasympathetic postganglionic fibers release norepinephrine.", "Sympathetic postganglionic receptors are muscarinic."], correct: 1 }, { id: 492, question: "Which of the following is TRUE regarding parasympathetic control of the digestive system?", options: ["It inhibits motility and secretion.", "It is the only organ system where parasympathetic activity dominates.", "It is stimulated primarily by norepinephrine.", "It acts independently of sympathetic influence."], correct: 1 }, { id: 493, question: "Which receptor is activated on the sympathetic postganglionic target organ?", options: ["Muscarinic", "Nicotinic", "Adrenergic", "Serotonergic"], correct: 2 }, { id: 494, question: "Which scenario indicates an increase in parasympathetic activity?", options: ["Pupil dilation and increased heart rate", "Bronchodilation and decreased GI motility", "Slowed heart rate and increased peristalsis", "Increased sweating and vasoconstriction"], correct: 2 }, { id: 495, question: "The neurotransmitter released at all ANS preganglionic synapses is:", options: ["Norepinephrine", "Acetylcholine", "Dopamine", "Serotonin"], correct: 1 }, { id: 496, question: "Which receptor is located on the parasympathetic postganglionic target organ?", options: ["α1 adrenergic", "β1 adrenergic", "Nicotinic", "Muscarinic"], correct: 3 }, { id: 497, question: "Which structure releases acetylcholine onto nicotinic receptors?", options: ["Sympathetic postganglionic nerve", "Parasympathetic postganglionic nerve", "All preganglionic ANS fibers", "Somatic motor neurons only"], correct: 2 }, { id: 498, question: "Which ANS division decreases heart rate?", options: ["Sympathetic", "Parasympathetic", "Somatic", "Enteric"], correct: 1 }, { id: 499, question: "The primary neurotransmitter released by sympathetic postganglionic neurons is:", options: ["Acetylcholine", "GABA", "Norepinephrine", "Serotonin"], correct: 2 }, { id: 500, question: "In parasympathetic pathways, which part uses muscarinic receptors?", options: ["Preganglionic to preganglionic", "Preganglionic to postganglionic", "Postganglionic to effector organ", "Somatic neuromuscular junction"], correct: 2 }, { id: 501, question: "Which seizure type lasts less than 5 seconds and typically leaves no residual effects?", options: ["Tonic-clonic", "Myoclonic", "Absence seizure", "Status epilepticus"], correct: 2 }, { id: 502, question: "A seizure that lasts longer than 5 minutes or involves repeated seizures within 5 minutes is called:", options: ["Myoclonic seizure", "Simple partial seizure", "Epilepsy", "Status epilepticus"], correct: 3 }, { id: 503, question: "Which statement best differentiates seizure vs. epilepsy?", options: ["Seizure always implies epilepsy.", "Epilepsy refers to chronic recurrent seizures.", "Epilepsy only occurs after head trauma.", "Seizure is a chronic disease."], correct: 1 }, { id: 504, question: "Which type of tumor is the most common malignant primary brain tumor?", options: ["Meningioma", "Astrocytoma", "Glioma", "Neuroblastoma"], correct: 2 }, { id: 505, question: "What imaging finding is highly suggestive of a brain tumor?", options: ["Increased number of gyri", "Flattened gyri in affected regions", "Excessive CSF in ventricles only", "Symmetric brain swelling"], correct: 1 }, { id: 506, question: "What is the FIRST common sign of a brain tumor?", options: ["Visual disturbances", "Paralysis", "Seizures", "Coma"], correct: 2 }, { id: 507, question: "Which tumor characteristic is TRUE for primary brain tumors?", options: ["They commonly metastasize outside the CNS.", "They often originate from glial cells.", "They have well-defined margins.", "They are usually non–life threatening."], correct: 1 }, { id: 508, question: "Which is NOT a typical symptom of increased intracranial pressure (ICP)?", options: ["Headache", "Vomiting", "Lethargy", "Bradycardia"], correct: 3 }, { id: 509, question: "Which finding best indicates a complex partial seizure rather than a simple partial seizure?", options: ["Preserved consciousness", "Entire brain is affected", "Loss of awareness or altered behavior", "Seizure duration < 5 seconds"], correct: 2 }, { id: 510, question: "Which symptom most strongly suggests tonic-clonic seizure?", options: ["Brief staring spells", "Sudden muscle jerks only", "Auras with preserved consciousness", "Muscle stiffening followed by rhythmic jerking"], correct: 3 }, { id: 511, question: "What differentiates myoclonic seizure from tonic-clonic seizure?", options: ["Myoclonic seizures involve prolonged unconsciousness", "Myoclonic seizures involve isolated muscle jerks", "Myoclonic seizures affect the entire brain", "Myoclonic seizures last over 5 minutes"], correct: 1 }, { id: 512, question: "Which feature suggests a malignant brain tumor?", options: ["Well-defined smooth borders", "Slow-growing mass", "Ability to invade nearby tissue without metastasis", "Benign pathology but severe symptoms"], correct: 2 }, { id: 513, question: "Which sign indicates elevated intracranial pressure (ICP)?", options: ["Hyperactivity", "Sudden weight loss", "Early morning headaches", "Bradycardia only"], correct: 2 }, { id: 514, question: "Which treatment is most appropriate for a deeply located, inaccessible malignant glioma?", options: ["Surgical removal", "Radiation or chemotherapy", "Manual decompression therapy", "No treatment is required"], correct: 1 }, { id: 515, question: "Which best describes secondary brain tumors?", options: ["They originate in CNS tissue.", "They never metastasize.", "They commonly arise from lung or breast cancers.", "They are usually benign."], correct: 2 }, { id: 516, question: "A patient with repeated seizures for months is best classified as:", options: ["Status epilepticus", "Epilepsy", "Absence seizure", "Myoclonic disorder"], correct: 1 }, { id: 517, question: "A 25-year-old patient is brought to the ER after a car accident. He is sweating heavily, his pupils are dilated, his heart rate is 132 bpm, and bowel sounds are absent. What autonomic state is most likely activated?", options: ["Parasympathetic", "Sympathetic", "Somatic", "Enteric"], correct: 1 }, { id: 518, question: "A 25-year-old patient is brought to the ER after a car accident. He is sweating heavily, his pupils are dilated, his heart rate is 132 bpm, and bowel sounds are absent. Which neurotransmitter is acting on the target organs?", options: ["Acetylcholine (muscarinic)", "Acetylcholine (nicotinic)", "Norepinephrine", "Serotonin"], correct: 2 }, { id: 519, question: "A 6-year-old child develops a high fever of 40.5°C and begins having full-body convulsions that last approximately 7 minutes. The child has two additional convulsions within the next 10 minutes. What is the diagnosis?", options: ["Myoclonic seizure", "Complex partial seizure", "Status epilepticus", "Simple absence seizure"], correct: 2 }, { id: 520, question: "A 6-year-old child develops a high fever of 40.5°C and begins having full-body convulsions that last approximately 7 minutes. The child has two additional convulsions within the next 10 minutes. What is the greatest danger associated with this condition?", options: ["Permanent blindness", "Irreversible brain damage", "Digestive system shutdown", "Loss of peripheral sensation"], correct: 1 }, { id: 521, question: "A 48-year-old patient presents with progressive headaches, morning vomiting, behavioral changes, and a new-onset seizure. MRI shows flattened gyri and a mass with poorly defined margins in the frontal lobe. What is the most likely diagnosis?", options: ["Benign meningioma", "Malignant glioma", "Ischemic stroke", "Multiple sclerosis"], correct: 1 }, { id: 522, question: "A 48-year-old patient presents with progressive headaches, morning vomiting, behavioral changes, and a new-onset seizure. MRI shows flattened gyri and a mass with poorly defined margins in the frontal lobe. What is the FIRST symptom that often brings patients with brain tumors to the hospital?", options: ["Memory loss", "Seizures", "Hearing loss", "Facial paralysis"], correct: 1 }, { id: 523, question: "A 30-year-old woman reports abdominal cramps, increased bowel sounds, diarrhea, and bradycardia following a vagal nerve stimulation therapy. Which system is overly activated?", options: ["Sympathetic", "Parasympathetic", "Somatic", "Enteric only"], correct: 1 }, { id: 524, question: "A 30-year-old woman reports abdominal cramps, increased bowel sounds, diarrhea, and bradycardia following a vagal nerve stimulation therapy. Which receptor subtype is responsible for the postganglionic response?", options: ["Adrenergic", "Nicotinic", "Muscarinic", "Serotonergic"], correct: 2 }, { id: 525, question: "A 19-year-old student reports sudden brief episodes of staring lasting 2–3 seconds. He does not fall, does not jerk, and immediately returns to normal without confusion. What type of seizure is most likely?", options: ["Absence seizure", "Myoclonic seizure", "Tonic seizure", "Complex partial seizure"], correct: 0 }, { id: 526, question: "A 19-year-old student reports sudden brief episodes of staring lasting 2–3 seconds. He does not fall, does not jerk, and immediately returns to normal without confusion. What EEG pattern is typically seen?", options: ["Sharp waves only", "3-Hz spike and wave pattern", "Delta waves", "Flattened pattern"], correct: 1 }, { id: 527, question: "Which best explains why benign brain tumors can still be life-threatening?", options: ["They metastasize widely", "They produce toxins", "They increase intracranial pressure in a fixed space", "They transform into infections"], correct: 2 }, { id: 528, question: "A patient has a seizure affecting only the right arm with full awareness maintained. This is most consistent with:", options: ["Absence seizure", "Simple partial seizure", "Myoclonic seizure", "Complex partial seizure"], correct: 1 }, { id: 529, question: "Flattening of gyri on MRI is most commonly due to:", options: ["Hyperglycemia", "Vitamin deficiency", "Space-occupying mass", "Cerebral atrophy"], correct: 2 }, { id: 530, question: "Which symptom is LEAST likely in increased intracranial pressure (ICP)?", options: ["Morning headache", "Projectile vomiting", "Irritability", "Increased appetite"], correct: 3 }, { id: 531, question: "Which best describes secondary brain tumors?", options: ["Originate in astrocytes", "Rarely metastasize", "Originate from cancers outside CNS", "Usually present in childhood"], correct: 2 }, { id: 532, question: "Sudden muscle jerks without loss of consciousness best describes:", options: ["Tonic seizure", "Myoclonic seizure", "Absence seizure", "Status epilepticus"], correct: 1 }, { id: 533, question: "Which of the following is the MOST dangerous complication of status epilepticus?", options: ["Hair loss", "Diabetes", "Irreversible neuronal damage", "Constipation"], correct: 2 }, { id: 534, question: "A patient reports 10–20 brief 'blank stare' episodes daily lasting 3 seconds. This suggests:", options: ["Myoclonic seizure", "Complex partial seizure", "Absence seizure", "Tonic-clonic seizure"], correct: 2 }, { id: 535, question: "Which statement about gliomas is TRUE?", options: ["They arise from glial cells", "They metastasize frequently", "They are usually benign", "They occur only in children"], correct: 0 }, { id: 536, question: "A 10-second seizure with stiffening followed by jerking is a:", options: ["Absence seizure", "Myoclonic seizure", "Tonic-clonic seizure", "Psychomotor seizure"], correct: 2 }, { id: 537, question: "Which brain region change suggests tumor-related pressure?", options: ["Deepened sulci", "Flattened cortex", "Increased gray matter thickness", "Enlarged hippocampus"], correct: 1 }, { id: 538, question: "A patient with brain tumor shows personality changes. Which lobe is most likely affected?", options: ["Occipital", "Temporal", "Frontal", "Parietal"], correct: 2 }, { id: 539, question: "Which seizure type most commonly presents with an aura?", options: ["Simple partial", "Absence", "Myoclonic", "Atonic"], correct: 0 }, { id: 540, question: "Which is the FIRST-line imaging sign of a brain tumor?", options: ["Enhancing white matter", "Loss of gyri definition", "Excessive CSF reabsorption", "Enlarged spinal canal"], correct: 1 }, { id: 541, question: "A patient has a seizure affecting only the right arm with full awareness maintained. This is most consistent with:", options: ["Absence seizure", "Simple partial seizure", "Myoclonic seizure", "Complex partial seizure"], correct: 1 }, { id: 542, question: "Which finding best indicates a complex partial seizure rather than a simple partial seizure?", options: ["Preserved consciousness", "Entire brain is affected", "Loss of awareness or altered behavior", "Seizure duration < 5 seconds"], correct: 2 }, { id: 543, question: "Which symptom most strongly suggests tonic-clonic seizure?", options: ["Brief staring spells", "Sudden muscle jerks only", "Auras with preserved consciousness", "Muscle stiffening followed by rhythmic jerking"], correct: 3 }, { id: 544, question: "What differentiates myoclonic seizure from tonic-clonic seizure?", options: ["Myoclonic seizures involve prolonged unconsciousness", "Myoclonic seizures involve isolated muscle jerks", "Myoclonic seizures affect the entire brain", "Myoclonic seizures last over 5 minutes"], correct: 1 }, { id: 545, question: "Which feature suggests a malignant brain tumor?", options: ["Well-defined smooth borders", "Slow-growing mass", "Ability to invade nearby tissue without metastasis", "Benign pathology but severe symptoms"], correct: 2 }, { id: 546, question: "Which sign indicates elevated intracranial pressure (ICP)?", options: ["Hyperactivity", "Sudden weight loss", "Early morning headaches", "Bradycardia only"], correct: 2 }, { id: 547, question: "Which treatment is most appropriate for a deeply located, inaccessible malignant glioma?", options: ["Surgical removal", "Radiation or chemotherapy", "Manual decompression therapy", "No treatment is required"], correct: 1 }, { id: 548, question: "Which best describes secondary brain tumors?", options: ["They originate in CNS tissue.", "They never metastasize.", "They commonly arise from lung or breast cancers.", "They are usually benign."], correct: 2 }, { id: 549, question: "A patient with repeated seizures for months is best classified as:", options: ["Status epilepticus", "Epilepsy", "Absence seizure", "Myoclonic disorder"], correct: 1 }, { id: 550, question: "Which best explains why benign brain tumors can still be life-threatening?", options: ["They metastasize widely", "They produce toxins", "They increase intracranial pressure in a fixed space", "They transform into infections"], correct: 2 }, { id: 551, question: "Flattening of gyri on MRI is most commonly due to:", options: ["Hyperglycemia", "Vitamin deficiency", "Space-occupying mass", "Cerebral atrophy"], correct: 2 }, { id: 552, question: "Which symptom is LEAST likely in increased intracranial pressure (ICP)?", options: ["Morning headache", "Projectile vomiting", "Irritability", "Increased appetite"], correct: 3 }, { id: 553, question: "The neurotransmitter released at all ANS preganglionic synapses is:", options: ["Norepinephrine", "Acetylcholine", "Dopamine", "Serotonin"], correct: 1 }, { id: 554, question: "Which receptor is located on the parasympathetic postganglionic target organ?", options: ["α1 adrenergic", "β1 adrenergic", "Nicotinic", "Muscarinic"], correct: 3 }, { id: 555, question: "Which structure releases acetylcholine onto nicotinic receptors?", options: ["Sympathetic postganglionic nerve", "Parasympathetic postganglionic nerve", "All preganglionic ANS fibers", "Somatic motor neurons only"], correct: 2 }, { id: 556, question: "Which ANS division decreases heart rate?", options: ["Sympathetic", "Parasympathetic", "Somatic", "Enteric"], correct: 1 }, { id: 557, question: "The primary neurotransmitter released by sympathetic postganglionic neurons is:", options: ["Acetylcholine", "GABA", "Norepinephrine", "Serotonin"], correct: 2 }, { id: 558, question: "A patient reports 10–20 brief 'blank stare' episodes daily lasting 3 seconds. This suggests:", options: ["Myoclonic seizure", "Complex partial seizure", "Absence seizure", "Tonic-clonic seizure"], correct: 2 }, { id: 559, question: "Sudden muscle jerks without loss of consciousness best describes:", options: ["Tonic seizure", "Myoclonic seizure", "Absence seizure", "Status epilepticus"], correct: 1 }, { id: 560, question: "Which of the following is the MOST dangerous complication of status epilepticus?", options: ["Hair loss", "Diabetes", "Irreversible neuronal damage", "Constipation"], correct: 2 }, { id: 561, question: "Which statement about gliomas is TRUE?", options: ["They arise from glial cells", "They metastasize frequently", "They are usually benign", "They occur only in children"], correct: 0 }, { id: 562, question: "A 10-second seizure with stiffening followed by jerking is a:", options: ["Absence seizure", "Myoclonic seizure", "Tonic-clonic seizure", "Psychomotor seizure"], correct: 2 }, { id: 563, question: "Which brain region change suggests tumor-related pressure?", options: ["Deepened sulci", "Flattened cortex", "Increased gray matter thickness", "Enlarged hippocampus"], correct: 1 }, { id: 564, question: "A patient with brain tumor shows personality changes. Which lobe is most likely affected?", options: ["Occipital", "Temporal", "Frontal", "Parietal"], correct: 2 }, { id: 565, question: "Which seizure type most commonly presents with an aura?", options: ["Simple partial", "Absence", "Myoclonic", "Atonic"], correct: 0 }, { id: 566, question: "Which is the FIRST-line imaging sign of a brain tumor?", options: ["Enhancing white matter", "Loss of gyri definition", "Excessive CSF reabsorption", "Enlarged spinal canal"], correct: 1 }, { id: 567, question: "Which receptor is activated on the sympathetic postganglionic target organ?", options: ["Muscarinic", "Nicotinic", "Adrenergic", "Serotonergic"], correct: 2 }, { id: 568, question: "Which scenario indicates an increase in parasympathetic activity?", options: ["Pupil dilation and increased heart rate", "Bronchodilation and decreased GI motility", "Slowed heart rate and increased peristalsis", "Increased sweating and vasoconstriction"], correct: 2 }, { id: 569, question: "Which seizure type lasts less than 5 seconds and typically leaves no residual effects?", options: ["Tonic-clonic", "Myoclonic", "Absence seizure", "Status epilepticus"], correct: 2 }, { id: 570, question: "A seizure that lasts longer than 5 minutes or involves repeated seizures within 5 minutes is called:", options: ["Myoclonic seizure", "Simple partial seizure", "Epilepsy", "Status epilepticus"], correct: 3 }, { id: 571, question: "Which statement best differentiates seizure vs. epilepsy?", options: ["Seizure always implies epilepsy.", "Epilepsy refers to chronic recurrent seizures.", "Epilepsy only occurs after head trauma.", "Seizure is a chronic disease."], correct: 1 }, { id: 572, question: "Which type of tumor is the most common malignant primary brain tumor?", options: ["Meningioma", "Astrocytoma", "Glioma", "Neuroblastoma"], correct: 2 }, { id: 573, question: "What imaging finding is highly suggestive of a brain tumor?", options: ["Increased number of gyri", "Flattened gyri in affected regions", "Excessive CSF in ventricles only", "Symmetric brain swelling"], correct: 1 }, { id: 574, question: "What is the FIRST common sign of a brain tumor?", options: ["Visual disturbances", "Paralysis", "Seizures", "Coma"], correct: 2 }, { id: 575, question: "Which tumor characteristic is TRUE for primary brain tumors?", options: ["They commonly metastasize outside the CNS.", "They often originate from glial cells.", "They have well-defined margins.", "They are usually non–life threatening."], correct: 1 }, { id: 576, question: "Which is NOT a typical symptom of increased intracranial pressure (ICP)?", options: ["Headache", "Vomiting", "Lethargy", "Bradycardia"], correct: 3 }, { id: 577, question: "Which finding best indicates a complex partial seizure rather than a simple partial seizure?", options: ["Preserved consciousness", "Entire brain is affected", "Loss of awareness or altered behavior", "Seizure duration < 5 seconds"], correct: 2 }, { id: 578, question: "Which symptom most strongly suggests tonic-clonic seizure?", options: ["Brief staring spells", "Sudden muscle jerks only", "Auras with preserved consciousness", "Muscle stiffening followed by rhythmic jerking"], correct: 3 }, { id: 579, question: "What differentiates myoclonic seizure from tonic-clonic seizure?", options: ["Myoclonic seizures involve prolonged unconsciousness", "Myoclonic seizures involve isolated muscle jerks", "Myoclonic seizures affect the entire brain", "Myoclonic seizures last over 5 minutes"], correct: 1 }, { id: 580, question: "Which feature suggests a malignant brain tumor?", options: ["Well-defined smooth borders", "Slow-growing mass", "Ability to invade nearby tissue without metastasis", "Benign pathology but severe symptoms"], correct: 2 }, { id: 581, question: "Which sign indicates elevated intracranial pressure (ICP)?", options: ["Hyperactivity", "Sudden weight loss", "Early morning headaches", "Bradycardia only"], correct: 2 }, { id: 582, question: "Which treatment is most appropriate for a deeply located, inaccessible malignant glioma?", options: ["Surgical removal", "Radiation or chemotherapy", "Manual decompression therapy", "No treatment is required"], correct: 1 }, { id: 583, question: "Which best describes secondary brain tumors?", options: ["They originate in CNS tissue.", "They never metastasize.", "They commonly arise from lung or breast cancers.", "They are usually benign."], correct: 2 }, { id: 584, question: "A patient with repeated seizures for months is best classified as:", options: ["Status epilepticus", "Epilepsy", "Absence seizure", "Myoclonic disorder"], correct: 1 }, { id: 585, question: "A 25-year-old patient is brought to the ER after a car accident. He is sweating heavily, his pupils are dilated, his heart rate is 132 bpm, and bowel sounds are absent. What autonomic state is most likely activated?", options: ["Parasympathetic", "Sympathetic", "Somatic", "Enteric"], correct: 1 }, { id: 586, question: "A 25-year-old patient is brought to the ER after a car accident. He is sweating heavily, his pupils are dilated, his heart rate is 132 bpm, and bowel sounds are absent. Which neurotransmitter is acting on the target organs?", options: ["Acetylcholine (muscarinic)", "Acetylcholine (nicotinic)", "Norepinephrine", "Serotonin"], correct: 2 }, { id: 587, question: "A 6-year-old child develops a high fever of 40.5°C and begins having full-body convulsions that last approximately 7 minutes. The child has two additional convulsions within the next 10 minutes. What is the diagnosis?", options: ["Myoclonic seizure", "Complex partial seizure", "Status epilepticus", "Simple absence seizure"], correct: 2 }, { id: 588, question: "A 6-year-old child develops a high fever of 40.5°C and begins having full-body convulsions that last approximately 7 minutes. The child has two additional convulsions within the next 10 minutes. What is the greatest danger associated with this condition?", options: ["Permanent blindness", "Irreversible brain damage", "Digestive system shutdown", "Loss of peripheral sensation"], correct: 1 }, { id: 589, question: "A 48-year-old patient presents with progressive headaches, morning vomiting, behavioral changes, and a new-onset seizure. MRI shows flattened gyri and a mass with poorly defined margins in the frontal lobe. What is the most likely diagnosis?", options: ["Benign meningioma", "Malignant glioma", "Ischemic stroke", "Multiple sclerosis"], correct: 1 }, { id: 590, question: "A 48-year-old patient presents with progressive headaches, morning vomiting, behavioral changes, and a new-onset seizure. MRI shows flattened gyri and a mass with poorly defined margins in the frontal lobe. What is the FIRST symptom that often brings patients with brain tumors to the hospital?", options: ["Memory loss", "Seizures", "Hearing loss", "Facial paralysis"], correct: 1 }, { id: 591, question: "A 30-year-old woman reports abdominal cramps, increased bowel sounds, diarrhea, and bradycardia following a vagal nerve stimulation therapy. Which system is overly activated?", options: ["Sympathetic", "Parasympathetic", "Somatic", "Enteric only"], correct: 1 }, { id: 592, question: "A 30-year-old woman reports abdominal cramps, increased bowel sounds, diarrhea, and bradycardia following a vagal nerve stimulation therapy. Which receptor subtype is responsible for the postganglionic response?", options: ["Adrenergic", "Nicotinic", "Muscarinic", "Serotonergic"], correct: 2 }, { id: 593, question: "A 19-year-old student reports sudden brief episodes of staring lasting 2–3 seconds. He does not fall, does not jerk, and immediately returns to normal without confusion. What type of seizure is most likely?", options: ["Absence seizure", "Myoclonic seizure", "Tonic seizure", "Complex partial seizure"], correct: 0 }, { id: 594, question: "A 19-year-old student reports sudden brief episodes of staring lasting 2–3 seconds. He does not fall, does not jerk, and immediately returns to normal without confusion. What EEG pattern is typically seen?", options: ["Sharp waves only", "3-Hz spike and wave pattern", "Delta waves", "Flattened pattern"], correct: 1 }, { id: 595, question: "Which best explains why benign brain tumors can still be life-threatening?", options: ["They metastasize widely", "They produce toxins", "They increase intracranial pressure in a fixed space", "They transform into infections"], correct: 2 }, { id: 596, question: "A patient has a seizure affecting only the right arm with full awareness maintained. This is most consistent with:", options: ["Absence seizure", "Simple partial seizure", "Myoclonic seizure", "Complex partial seizure"], correct: 1 }, { id: 597, question: "Flattening of gyri on MRI is most commonly due to:", options: ["Hyperglycemia", "Vitamin deficiency", "Space-occupying mass", "Cerebral atrophy"], correct: 2 }, { id: 598, question: "Which symptom is LEAST likely in increased intracranial pressure (ICP)?", options: ["Morning headache", "Projectile vomiting", "Irritability", "Increased appetite"], correct: 3 }, { id: 599, question: "Which best describes secondary brain tumors?", options: ["Originate in astrocytes", "Rarely metastasize", "Originate from cancers outside CNS", "Usually present in childhood"], correct: 2 }, { id: 600, question: "Which receptor is activated on the sympathetic postganglionic target organ?", options: ["Muscarinic", "Nicotinic", "Adrenergic", "Serotonergic"], correct: 2 } ], "Nervous System Disorders": [ { id: 701, question: "Which substance crosses the BBB most easily?", options: ["Sodium", "Glucose", "Water", "Lipid-soluble substances"], correct: 3 }, { id: 702, question: "Why is a poorly developed BBB dangerous in neonates?", options: ["They produce too much CSF", "Toxins and drugs can enter the brain easily", "Myelin blocks nutrient flow", "Gray matter is less developed"], correct: 1 }, { id: 703, question: "Why is a fully developed BBB a problem in adults?", options: ["It increases CSF production", "It prevents synapse formation", "Most antibiotics cannot enter the CNS", "It causes neuronal swelling"], correct: 2 }, { id: 704, question: "Which of the following is NOT a protection of the brain?", options: ["Skull", "Meninges", "CSF", "Diaphragm"], correct: 3 }, { id: 705, question: "The innermost layer of the meninges is:", options: ["Dura mater", "Pia mater", "Arachnoid mater", "Epidural space"], correct: 1 }, { id: 706, question: "The subarachnoid space contains:", options: ["Blood vessels only", "Lymph", "CSF", "Bone marrow"], correct: 2 }, { id: 707, question: "Equal production and absorption of CSF is necessary to maintain:", options: ["Blood pressure", "Intracranial pressure", "Neuron growth", "Synaptic release"], correct: 1 }, { id: 708, question: "If CSF production > absorption, the result is:", options: ["Low ICP", "Hydrocephalus / increased ICP", "BBB breakdown", "Synaptic failure"], correct: 1 }, { id: 709, question: "Which is TRUE about gray matter in the spinal cord?", options: ["Located outside", "Contains axons", "Contains cell bodies and dendrites", "Contains myelin"], correct: 2 }, { id: 710, question: "Which direction do ascending tracts conduct signals?", options: ["From brain downward", "Toward the brain", "Only to muscles", "Only to glands"], correct: 1 }, { id: 711, question: "Neurons are non-mitotic, meaning:", options: ["They cannot produce receptors", "They cannot undergo normal cell division", "They divide every 24 hours", "They only divide in infants"], correct: 1 }, { id: 712, question: "Which cell forms myelin in the PNS?", options: ["Astrocyte", "Oligodendrocyte", "Schwann cell", "Microglia"], correct: 2 }, { id: 713, question: "Which CNS cell is important for the BBB?", options: ["Schwann cell", "Astrocyte", "Microglia", "Ependymal cell"], correct: 1 }, { id: 714, question: "Which cell performs phagocytosis within the CNS?", options: ["Oligodendrocyte", "Schwann cell", "Microglia", "Astrocyte"], correct: 2 }, { id: 715, question: "Why does myelin increase conduction speed?", options: ["Neurons become longer", "It increases ATP", "Signals jump between nodes of Ranvier", "It thickens the axon"], correct: 2 }, { id: 716, question: "Which part of the synapse receives the neurotransmitter?", options: ["Presynaptic axon", "Nodes of Ranvier", "Postsynaptic receptor", "Myelin sheath"], correct: 2 }, { id: 717, question: "What occupies the synaptic cleft?", options: ["Cell bodies", "Neurotransmitters during signaling", "DNA fragments", "Microtubules"], correct: 1 }, { id: 718, question: "Which neurotransmitter is excitatory?", options: ["GABA", "Glycine", "Acetylcholine", "Serotonin"], correct: 2 }, { id: 719, question: "Which neurotransmitter is inhibitory?", options: ["Dopamine", "Norepinephrine", "GABA", "Acetylcholine"], correct: 2 }, { id: 720, question: "Sympathetic preganglionic neurons release:", options: ["Dopamine", "Acetylcholine", "Serotonin", "Epinephrine"], correct: 1 }, { id: 721, question: "Sympathetic postganglionic neurons release:", options: ["Norepinephrine", "Acetylcholine", "Serotonin", "GABA"], correct: 0 }, { id: 722, question: "Parasympathetic preganglionic neurons release:", options: ["Norepinephrine", "Acetylcholine", "Dopamine", "Serotonin"], correct: 1 }, { id: 723, question: "Parasympathetic postganglionic neurons release:", options: ["GABA", "Acetylcholine", "Epinephrine", "Dopamine"], correct: 1 }, { id: 724, question: "Which receptor is used by sympathetic POSTganglionic neurons?", options: ["Nicotinic", "Muscarinic", "Adrenergic", "Cholinergic"], correct: 2 }, { id: 725, question: "Which receptor is used by parasympathetic postganglionic neurons?", options: ["Adrenergic", "Muscarinic", "Dopaminergic", "Beta-2"], correct: 1 }, { id: 726, question: "\"Fight or flight\" corresponds to:", options: ["Parasympathetic", "Sympathetic", "Somatic", "Enteric"], correct: 1 }, { id: 727, question: "Which autonomic branch decreases heart rate and increases digestion?", options: ["Sympathetic", "Parasympathetic", "Somatic", "Central"], correct: 1 }, { id: 728, question: "Which is located OUTSIDE the CNS?", options: ["Preganglionic neurons", "Postganglionic neurons", "Microglia", "Astrocytes"], correct: 1 }, { id: 729, question: "Which statement is TRUE about cranial nerves?", options: ["All are motor nerves", "All are sensory nerves", "They originate from the brain", "They control only digestion"], correct: 2 }, { id: 730, question: "The BBB structure resembles cell membrane mainly because it is:", options: ["Protein-based", "Carbohydrate-based", "Lipid-based", "Nucleic-acid based"], correct: 2 }, { id: 731, question: "Which substance crosses the BBB most easily?", options: ["Glucose", "Sodium ions", "Lipid-soluble anesthetics", "Large water-soluble proteins"], correct: 2 }, { id: 732, question: "What is the major reason antibiotics often fail to treat CNS infections in adults?", options: ["Increased metabolism in neurons", "BBB becomes fully developed and impermeable", "CSF lacks immune cells", "Cranial nerves block drug entry"], correct: 1 }, { id: 733, question: "The greatest danger of a poorly developed BBB in neonates is:", options: ["Poor glucose uptake", "Excessive synapse formation", "Easy entry of toxins into the brain", "Increased CSF absorption"], correct: 2 }, { id: 734, question: "Which structure is found in the gray matter of the spinal cord?", options: ["Myelinated axons", "Cell bodies & dendrites", "Schwann cells", "Nodes of Ranvier"], correct: 1 }, { id: 735, question: "Which statement about spinal cord tracts is TRUE?", options: ["Ascending tracts carry signals from brain to body", "Descending tracts carry sensory signals", "Ascending tracts carry sensory signals toward the brain", "Both tracts are located in gray matter"], correct: 2 }, { id: 736, question: "Which cell forms myelin in the CNS?", options: ["Schwann cell", "Astrocyte", "Microglia", "Oligodendrocyte"], correct: 3 }, { id: 737, question: "Neurons are non-mitotic. This explains why:", options: ["They store glycogen", "Neural disorders are reversible", "Damage to neurons is permanent", "They produce antibodies"], correct: 2 }, { id: 738, question: "Which neurotransmitter is inhibitory according to lecture?", options: ["Dopamine", "Acetylcholine", "GABA", "Norepinephrine"], correct: 2 }, { id: 739, question: "Which receptor is used by sympathetic preganglionic neurons?", options: ["Muscarinic", "Nicotinic", "Adrenergic", "Serotonergic"], correct: 1 }, { id: 740, question: "Sympathetic postganglionic fibers release:", options: ["Acetylcholine", "Epinephrine", "Norepinephrine", "Serotonin"], correct: 2 }, { id: 741, question: "Parasympathetic postganglionic receptors are:", options: ["Muscarinic", "Adrenergic", "Nicotinic", "Dopaminergic"], correct: 0 }, { id: 742, question: "Which structure is the site of neurotransmitter release?", options: ["Presynaptic soma", "Synaptic cleft", "Postsynaptic nucleus", "Myelin sheath"], correct: 1 }, { id: 743, question: "Which cell type participates in phagocytosis in CNS?", options: ["Astrocyte", "Oligodendrocyte", "Microglia", "Schwann cell"], correct: 2 }, { id: 744, question: "Which is TRUE about synaptic transmission?", options: ["Postsynaptic cell releases neurotransmitter", "Synaptic cleft is filled with myelin", "Receptors are located on postsynaptic membrane", "Presynaptic membrane contains no vesicles"], correct: 2 }, { id: 745, question: "Nodes of Ranvier are essential because they:", options: ["Produce neurotransmitters", "Allow saltatory conduction", "Prevent axonal regeneration", "Form the BBB"], correct: 1 }, { id: 746, question: "Which nerve type is mixed (sensory + motor)?", options: ["Olfactory", "Optic", "Trigeminal", "Trochlear"], correct: 2 }, { id: 747, question: "The sympathetic system is also known as:", options: ["Rest and digest", "Feed and breed", "Fight or flight", "Slow and stable"], correct: 2 }, { id: 748, question: "Parasympathetic preganglionic fibers originate from:", options: ["Brain & spinal cord", "Muscles", "Blood vessels", "Skin"], correct: 0 }, { id: 749, question: "White matter appears white because:", options: ["Neuron cell bodies", "High lipid content in myelin", "Dense capillaries", "High water content"], correct: 1 }, { id: 750, question: "Which is inhibited when BBB becomes fully impermeable?", options: ["Viral entry", "Passage of water", "Movement of lipid-soluble drugs", "Entry of many antibiotics"], correct: 3 }, { id: 751, question: "Which of the following describes a CVA (stroke)?", options: ["Excess CSF production", "Loss of blood flow to the brain", "Excess neurotransmitter release", "Increased synaptic conduction"], correct: 1 }, { id: 752, question: "Irreversible neuronal damage occurs after approximately:", options: ["1 minute of ischemia", "3 minutes of ischemia", "5 minutes of ischemia", "10 minutes of ischemia"], correct: 2 }, { id: 753, question: "Which is NOT a cause of stroke?", options: ["Vessel occlusion", "Vessel rupture", "Increased CSF absorption", "Hemorrhage"], correct: 2 }, { id: 754, question: "A stroke caused by a blood clot blocking a vessel is called:", options: ["Hemorrhagic", "Ischemic", "Subarachnoid", "Compensated"], correct: 1 }, { id: 755, question: "Which disease increases the risk of stroke?", options: ["Asthma", "Diabetes", "Appendicitis", "Gastritis"], correct: 1 }, { id: 756, question: "Which autoimmune disorder is a risk factor for CVA?", options: ["Psoriasis", "Systemic lupus erythematosus", "Crohn disease", "Hashimoto thyroiditis"], correct: 1 }, { id: 757, question: "A patient with a blocked cerebral vessel may still have reduced damage due to:", options: ["Tachycardia", "Collateral circulation", "Hyperglycemia", "Photophobia"], correct: 1 }, { id: 758, question: "Collateral circulation refers to:", options: ["Blood moving from brain to body", "Other organs redirecting blood to brain", "Increased CSF flow", "Increased heart rate"], correct: 1 }, { id: 759, question: "Damage in the left hemisphere typically causes deficits on:", options: ["Left side", "Right side", "Both sides", "Neither"], correct: 1 }, { id: 760, question: "Flaccid paralysis occurs when:", options: ["Inhibitory neurotransmitters are blocked", "Excitatory neurotransmitters decrease", "CSF increases", "Meninges inflame"], correct: 1 }, { id: 761, question: "Spastic paralysis occurs when:", options: ["Excitatory neurotransmitters are blocked", "Inhibitory neurotransmitters decrease", "CSF flow decreases", "Brainstem is damaged"], correct: 1 }, { id: 762, question: "Which is NOT a specific treatment for CVA?", options: ["Clot-busting drugs", "Surgical removal of clot", "Glucocorticoids", "Antibiotics"], correct: 2 }, { id: 763, question: "Which is TRUE about meningitis transmission?", options: ["It spreads through the nervous system", "It spreads by respiratory droplets", "It spreads by fecal-oral route", "It spreads by direct skin contact"], correct: 1 }, { id: 764, question: "Meningitis in children and young adults is most commonly caused by:", options: ["E. coli", "Streptococcus pneumoniae", "Haemophilus influenzae", "Neisseria meningitidis"], correct: 2 }, { id: 765, question: "Neonatal meningitis is most commonly caused by:", options: ["E. coli", "S. pneumoniae", "Meningococcus", "EBV"], correct: 0 }, { id: 766, question: "Haemophilus influenzae most commonly causes meningitis in:", options: ["Older adults", "Young children", "Neonates", "Infants < 2 weeks"], correct: 1 }, { id: 767, question: "Pneumococcal meningitis is most common in:", options: ["Newborns", "Young adults", "Older adults", "Teenagers"], correct: 2 }, { id: 768, question: "A hallmark symptom of meningitis is:", options: ["Chronic cough", "Severe headache", "Diarrhea", "Hair loss"], correct: 1 }, { id: 769, question: "Nuchal rigidity refers to:", options: ["Leg weakness", "Stiff neck", "Arm paralysis", "Facial spasms"], correct: 1 }, { id: 770, question: "Kernig's sign involves pain during:", options: ["Neck flexion", "Hip extension with knee flexed", "Knee extension when hip is flexed", "Back flexion"], correct: 2 }, { id: 771, question: "Brudzinski's sign occurs when:", options: ["Passive neck flexion causes hip/knee flexion", "Hip flexion causes neck pain", "Arm movement triggers leg movement", "Deep breathing causes cough"], correct: 0 }, { id: 772, question: "Photophobia means:", options: ["Fear of sound", "Fear of light", "Fear of touch", "Fear of water"], correct: 1 }, { id: 773, question: "In bacterial meningitis, CSF typically shows:", options: ["0–1 WBC", "Many neutrophils", "Only RBCs", "No microorganisms"], correct: 1 }, { id: 774, question: "Leukocytosis means:", options: ["High WBC", "Low RBC", "Low WBC", "High platelets"], correct: 0 }, { id: 775, question: "Treatment of meningitis includes:", options: ["Antivirals only", "Aggressive antimicrobials", "Antihistamines", "Diuretics"], correct: 1 }, { id: 776, question: "Which virus causes rabies?", options: ["EBV", "HSV-2", "Lyssavirus", "Adenovirus"], correct: 2 }, { id: 777, question: "Rabies is transmitted primarily via:", options: ["Air", "Bite of infected animal", "Contaminated water", "Inhalation"], correct: 1 }, { id: 778, question: "The virus travels to the CNS via:", options: ["CSF flow", "Bloodstream", "Retrograde neural movement", "Hematogenous spread"], correct: 2 }, { id: 779, question: "A classic symptom of rabies is:", options: ["Hydrophobia", "Photophobia", "Jaundice", "Hair loss"], correct: 0 }, { id: 780, question: "The main cause of death in rabies is:", options: ["Liver failure", "Respiratory failure", "Hypotension", "Dehydration"], correct: 1 }, { id: 781, question: "Reye syndrome is associated with:", options: ["Acetaminophen", "Ibuprofen", "Aspirin use in children", "Steroid use"], correct: 2 }, { id: 782, question: "Reye syndrome affects primarily the:", options: ["Lungs", "Liver and brain", "Heart", "Kidneys"], correct: 1 }, { id: 783, question: "The outcome of Reye syndrome is dangerous because:", options: ["It is easily cured", "It causes skin rashes", "There is no immediate cure", "It only affects adults"], correct: 2 }, { id: 784, question: "Which is NOT a symptom of meningitis?", options: ["Stiff neck", "Severe headache", "Kernig's sign", "Hyperthyroidism"], correct: 3 }, { id: 785, question: "A stroke patient cannot move the right arm. The lesion is likely in:", options: ["Right hemisphere", "Left hemisphere", "Brainstem only", "Cerebellum"], correct: 1 }, { id: 786, question: "Which stroke treatment removes clots?", options: ["Antivirals", "Heparin", "Antifungals", "Antihistamines"], correct: 1 }, { id: 787, question: "A patient shows photophobia, fever, and nuchal rigidity. Most likely diagnosis:", options: ["Stroke", "Rabies", "Meningitis", "Reye syndrome"], correct: 2 }, { id: 788, question: "What age group is most affected by pneumococcal meningitis?", options: ["Teenagers", "Children", "Older adults", "Neonates"], correct: 2 }, { id: 789, question: "Which infection causes retrograde nerve travel?", options: ["Reye syndrome", "Rabies", "Meningitis", "TIA"], correct: 1 }, { id: 790, question: "Hydrophobia in rabies is due to:", options: ["CNS swelling", "Painful swallowing", "Lung damage", "Thirst"], correct: 1 }, { id: 791, question: "Which sign appears when passive neck flexion triggers knee/hip flexion?", options: ["Kernig", "Babinski", "Brudzinski", "Hoffman"], correct: 2 }, { id: 792, question: "Which infection often shows neutrophils in CSF?", options: ["Viral meningitis", "Bacterial meningitis", "Rabies", "Reye syndrome"], correct: 1 }, { id: 793, question: "Which lifestyle factor increases stroke risk?", options: ["Aerobic exercise", "Sedentary lifestyle", "High water intake", "Vegetarian diet"], correct: 1 }, { id: 794, question: "TIA stands for:", options: ["Temporary immune allergy", "Transient ischemic attack", "Toxic inflammatory anemia", "Total ischemic arrest"], correct: 1 }, { id: 795, question: "Stroke involving rupture is called:", options: ["Embolic", "Hemorrhagic", "Silent", "Transient"], correct: 1 }, { id: 796, question: "Which symptom is unique to meningitis compared to stroke?", options: ["Hemiplegia", "Kernig's sign", "Facial drop", "Spastic paralysis"], correct: 1 }, { id: 797, question: "Which best describes Reye syndrome?", options: ["Viral infection of meninges", "Autoimmune liver attack", "Aspirin-related brain/liver damage", "Bacterial CNS infection"], correct: 2 }, { id: 798, question: "What is the earliest sign of many brain tumors and severe meningitis?", options: ["Seizure", "Hair loss", "Diarrhea", "Polyuria"], correct: 0 }, { id: 799, question: "Retrograde neural movement means:", options: ["CNS → PNS", "Brain → muscles", "PNS → CNS", "Muscle → spine"], correct: 2 }, { id: 800, question: "Which meningitis symptom indicates severe bacterial infection?", options: ["Flat affect", "Multiple neutrophils in CSF", "High RBC count", "Low CSF pressure"], correct: 1 }, { id: 801, question: "Which of the following best describes Cerebral Palsy (CP)?", options: ["A progressive degenerative disorder", "A group of motor impairment disorders caused by early brain damage", "A genetic blood disorder", "A reversible neurological condition"], correct: 1 }, { id: 802, question: "Cerebral palsy can occur at which time?", options: ["Only after birth", "Only before birth", "Before, during, or shortly after birth", "Only during adulthood"], correct: 2 }, { id: 803, question: "Which is the most common type of Cerebral Palsy?", options: ["Ataxic", "Dyskinetic", "Spastic", "Flaccid"], correct: 2 }, { id: 804, question: "Spastic CP occurs due to a lack of which neurotransmitter effect?", options: ["Excitatory", "Inhibitory", "Sensory", "Adrenergic"], correct: 1 }, { id: 805, question: "Ataxic Cerebral Palsy is primarily due to damage in which structure?", options: ["Frontal lobe", "Cerebellum", "Pons", "Basal ganglia"], correct: 1 }, { id: 806, question: "Which of the following symptoms is LEAST associated with CP?", options: ["Cognitive impairment", "Speech difficulties", "Visual problems", "Regeneration of neurons"], correct: 3 }, { id: 807, question: "Which statement about CP treatment is correct?", options: ["CP can be cured with medication", "Only surgery is effective", "No cure exists; therapy is supportive", "Antibiotics are the main treatment"], correct: 2 }, { id: 808, question: "Why are many nervous system disorders degenerative?", options: ["Neurons divide too rapidly", "Neurons are non-mitotic", "Blood supply is excessive", "Too many neurotransmitters"], correct: 1 }, { id: 809, question: "Parkinson's disease primarily involves the deficiency of:", options: ["Acetylcholine", "Dopamine", "Serotonin", "GABA"], correct: 1 }, { id: 810, question: "Which is a classic early sign of Parkinson's disease?", options: ["Severe dementia", "Loss of balance", "Mask-like facial expression", "Apnea"], correct: 2 }, { id: 811, question: "\"Pill-rolling tremor\" occurs:", options: ["Only during sleep", "During voluntary movement", "At rest", "Only during eating"], correct: 2 }, { id: 812, question: "Which of the following is a LATE sign of Parkinson's disease?", options: ["Early fatigue", "Mild tremor", "Propulsive gait", "Slight facial stiffness"], correct: 2 }, { id: 813, question: "Propulsive gait refers to:", options: ["Walking backward", "Walking with head up", "Leaning forward and shuffling", "Jumping movements"], correct: 2 }, { id: 814, question: "Difficulty swallowing in Parkinson's patients is due to:", options: ["Overproduction of dopamine", "Cerebral tumor", "Muscle rigidity affecting throat muscles", "Excess saliva production"], correct: 2 }, { id: 815, question: "Which of the following is true regarding Parkinson's?", options: ["Always fatal", "Never leads to dementia", "Can lead to autonomic dysfunction", "Caused by bacteria"], correct: 2 }, { id: 816, question: "Secondary parkinsonism can be caused by:", options: ["Viral meningitis", "Encephalitis", "Dental caries", "Hypertension"], correct: 1 }, { id: 817, question: "Which drug is a dopamine precursor used in Parkinson's treatment?", options: ["Acetaminophen", "Levodopa", "Ibuprofen", "Penicillin"], correct: 1 }, { id: 818, question: "Which medication type helps reduce excessive neuronal stimulation in Parkinson's?", options: ["Antibiotics", "Anticoagulants", "Anticholinergics", "Antivirals"], correct: 2 }, { id: 819, question: "A mask-like facial expression in Parkinson's is due to:", options: ["Weak eye muscles", "Reduced voluntary movement", "Excessive dopamine", "Facial nerve paralysis"], correct: 1 }, { id: 820, question: "Which of the following statements is TRUE about CP and Parkinson's?", options: ["Both are fully reversible", "Both are caused by bacterial infection", "CP is non-progressive; Parkinson's is progressive", "CP only affects adults"], correct: 2 }, { id: 821, question: "What type of CP involves involuntary movements?", options: ["Spastic", "Dyskinetic", "Ataxic", "Flaccid"], correct: 1 }, { id: 822, question: "What is a common complication in Parkinson's?", options: ["Excessive blinking", "Rapid speech", "Orthostatic hypotension", "High body temperature"], correct: 2 }, { id: 823, question: "Which symptom indicates difficulty initiating movement in Parkinson's?", options: ["Bradykinesia", "Tachykinesia", "Hyperreflexia", "Hypermobility"], correct: 0 }, { id: 824, question: "Neurons are non-mitotic, meaning:", options: ["They divide rapidly", "They regenerate quickly", "They do not undergo cell division", "They multiply after injury"], correct: 2 }, { id: 825, question: "CP is MOST associated with damage from:", options: ["Adulthood infections", "Childhood sports injuries", "Perinatal hypoxia", "Vitamin overdose"], correct: 2 }, { id: 826, question: "Parkinson's disease tremors are typically:", options: ["Absent during rest", "Worse during sleep", "Worse at rest", "Related to blood pressure"], correct: 2 }, { id: 827, question: "The stooped posture in Parkinson's is due to:", options: ["Weak cranial nerves", "Loss of consciousness", "Increased muscle rigidity", "Bone deformities"], correct: 2 }, { id: 828, question: "The best description of dyskinetic CP is:", options: ["Loss of balance", "Involuntary writhing or repetitive movements", "Complete paralysis", "Normal movement but poor vision"], correct: 1 }, { id: 829, question: "Why does Parkinson's impair communication?", options: ["Brainstem is destroyed", "Mask-like face reduces expression", "Tongue is paralyzed", "Vision loss causes speech delay"], correct: 1 }, { id: 830, question: "Which is common to BOTH CP and Parkinson's?", options: ["Progressive degeneration", "Motor dysfunction", "Caused by dopamine excess", "Caused by viral infection"], correct: 1 }, { id: 831, question: "Which of the following is NOT a risk factor for secondary parkinsonism?", options: ["Encephalitis", "Repeated brain trauma", "Long-term antianxiety medications", "Genetic mutation in childhood"], correct: 3 }, { id: 832, question: "Which condition is characterized by resting tremor, rigidity, and bradykinesia?", options: ["Cerebral palsy", "Meningitis", "Parkinson's disease", "Epilepsy"], correct: 2 }, { id: 833, question: "Which type of CP results from cerebellar dysfunction?", options: ["Spastic", "Ataxic", "Dyskinetic", "Mixed"], correct: 1 }, { id: 834, question: "Which symptom is most strongly associated with spastic CP?", options: ["Weak reflexes", "Hypotonia", "Hypertonia", "Loss of sensation"], correct: 2 }, { id: 835, question: "What is the primary neurotransmitter deficit in Parkinson's disease?", options: ["Acetylcholine", "Dopamine", "Glutamate", "Norepinephrine"], correct: 1 }, { id: 836, question: "\"Pill-rolling tremor\" involves repetitive movement of the:", options: ["Neck", "Fingers and thumb", "Foot", "Eyelids"], correct: 1 }, { id: 837, question: "Which best describes the gait of a person with advanced Parkinson's disease?", options: ["Wide, unsteady gait", "Propulsive, shuffling gait", "Waddling gait", "High-stepping gait"], correct: 1 }, { id: 838, question: "A child presents with involuntary writhing movements and difficulty controlling muscles. Which type of CP is most likely?", options: ["Spastic", "Mixed", "Dyskinetic", "Ataxic"], correct: 2 }, { id: 839, question: "Which of the following is TRUE regarding cerebral palsy?", options: ["It worsens rapidly over time", "It is a non-progressive brain injury", "It is caused by dopamine deficiency", "It only affects adults"], correct: 1 }, { id: 840, question: "Which autonomic symptom is common in Parkinson's disease?", options: ["Excessive sweating", "Orthostatic hypotension", "Hyperventilation", "Tachycardia"], correct: 1 }, { id: 841, question: "Which is LEAST likely to occur in cerebral palsy?", options: ["Motor impairment", "Cognitive impairment", "Seizures", "Rapid neuronal regeneration"], correct: 3 }, { id: 842, question: "Which medication helps replace low dopamine levels in Parkinson's disease?", options: ["Penicillin", "Levodopa", "Aspirin", "Diazepam"], correct: 1 }, { id: 843, question: "Which part of the brain degenerates in Parkinson's disease?", options: ["Hippocampus", "Cerebellum", "Basal ganglia (substantia nigra)", "Occipital lobe"], correct: 2 }, { id: 844, question: "Which of the following best describes bradykinesia?", options: ["Rapid movement", "Slow initiation of movement", "Tremors during sleep", "Muscle paralysis"], correct: 1 }, { id: 845, question: "Dysphagia in Parkinson's is caused by:", options: ["Sensory loss", "Respiratory infection", "Rigidity of throat and facial muscles", "Reduced appetite"], correct: 2 }, { id: 846, question: "Which complication is common in both CP and Parkinson's?", options: ["Drooling", "High fever", "Hypertension", "Hearing loss"], correct: 0 }, { id: 847, question: "What is the primary goal of therapy in cerebral palsy?", options: ["Cure the disease", "Improve motor function and independence", "Reduce dopamine levels", "Reverse brain damage"], correct: 1 }, { id: 848, question: "Which of the following gait abnormalities is typical of ataxic CP?", options: ["Shuffling gait", "Wide-based unsteady gait", "Dragging feet", "Involuntary fast steps"], correct: 1 }, { id: 849, question: "Facial mask in Parkinson's indicates:", options: ["Facial nerve paralysis", "Reduced facial expressiveness", "Severe pain", "Acute infection"], correct: 1 }, { id: 850, question: "Which of the following is NOT typically seen in Parkinson's disease?", options: ["Resting tremor", "Muscle rigidity", "Sudden recovery of motor function", "Bradykinesia"], correct: 2 }, { id: 851, question: "Which neurotransmitter imbalance contributes to tremor in Parkinson's?", options: ["Excess dopamine", "Imbalance between dopamine and acetylcholine", "Increased serotonin", "Excess GABA"], correct: 1 }, { id: 852, question: "CP most commonly results from which perinatal condition?", options: ["Excessive glucose", "Perinatal hypoxia", "Low vitamin D", "Hypoglycemia"], correct: 1 }, { id: 853, question: "Mixed CP involves:", options: ["Only cerebellar signs", "Both spastic and dyskinetic features", "Only involuntary movements", "Only sensory loss"], correct: 1 }, { id: 854, question: "Which of the following symptoms is more typical of Parkinson's than CP?", options: ["Postural instability", "Intellectual disability", "Congenital onset", "Spasticity"], correct: 0 }, { id: 855, question: "Which therapy is commonly used for CP but NOT curative?", options: ["Physical therapy", "Dopamine replacement", "Chemotherapy", "Antivirals"], correct: 0 }, { id: 856, question: "A patient with Parkinson's presents with severe rigidity, slow movement, and freezing episodes. This indicates:", options: ["Mild disease", "Early stage only", "Progressive neurodegeneration", "Reversible symptoms"], correct: 2 }, { id: 857, question: "A baby shows difficulty maintaining balance and coordination. Which CP type?", options: ["Spastic", "Ataxic", "Dyskinetic", "Mixed"], correct: 1 }, { id: 858, question: "Which sign supports the diagnosis of Parkinson's?", options: ["Positive Kernig sign", "Positive Brudzinski sign", "Resting tremor", "Photophobia"], correct: 2 }, { id: 859, question: "Why is cerebral palsy described as \"non-progressive\"?", options: ["Brain damage resolves on its own", "Symptoms disappear by adulthood", "The original brain injury does not worsen", "Neurons regenerate fully"], correct: 2 }, { id: 860, question: "Which symptom occurs LATE in Parkinson's disease?", options: ["Eating difficulty", "Mask-like face", "Resting tremor", "Dementia"], correct: 3 }, { id: 861, question: "Which neurotransmitter is primarily deficient in Alzheimer's disease?", options: ["Dopamine", "Serotonin", "Acetylcholine", "GABA"], correct: 2 }, { id: 862, question: "Which motor neuron lesion causes spastic paralysis?", options: ["Lower motor neuron", "Upper motor neuron", "Sensory neuron", "Parasympathetic neuron"], correct: 1 }, { id: 863, question: "The most common cause of death in ALS is:", options: ["Cardiac arrest", "Renal failure", "Respiratory failure", "Seizure"], correct: 2 }, { id: 864, question: "Which statement about dementia is TRUE?", options: ["Long-term memory is the first affected", "Short-term memory is typically affected first", "Dementia is a single disease", "Dementia never affects behavior"], correct: 1 }, { id: 865, question: "Riluzole is used in ALS because it:", options: ["Cures the disease", "Reverses paralysis", "Slows disease progression", "Increases dopamine secretion"], correct: 2 }, { id: 866, question: "Alzheimer's disease typically progresses over:", options: ["Hours", "Days", "Weeks", "10–20 years"], correct: 3 }, { id: 867, question: "ALS affects which neurons?", options: ["Only sensory neurons", "Only upper motor neurons", "Upper and lower motor neurons", "Only peripheral nerves"], correct: 2 }, { id: 868, question: "Dementia primarily involves dysfunction of the:", options: ["Cerebellum", "Brainstem", "Cerebral cortex", "Spinal cord"], correct: 2 }, { id: 869, question: "Spastic paralysis is due to loss of:", options: ["Sensory receptors", "Excitatory neurotransmitters", "Inhibitory neurotransmitters", "Myelin"], correct: 2 }, { id: 870, question: "Which of the following is NOT true about Alzheimer's disease?", options: ["It involves short-term memory loss", "It is progressive", "It is fully reversible", "It involves ACh deficiency"], correct: 2 }, { id: 871, question: "Which feature distinguishes ALS from Alzheimer's disease?", options: ["Memory impairment is severe", "Cognitive function is preserved in ALS", "Patients develop hallucinations", "ALS is caused by ACh deficiency"], correct: 1 }, { id: 872, question: "Lower motor neuron damage results in:", options: ["Hyperreflexia", "Spasticity", "Flaccid paralysis", "Increased muscle tone"], correct: 2 }, { id: 873, question: "A hallmark microscopic finding in Alzheimer's disease includes:", options: ["Demyelination plaques", "Neurofibrillary tangles", "Viral inclusions", "Neutrophil clusters"], correct: 1 }, { id: 874, question: "Early Alzheimer patients typically show difficulty with:", options: ["Recognizing childhood memories", "Short-term recall and new learning", "Motor coordination", "Swallowing"], correct: 1 }, { id: 875, question: "Which of the following increases ACh levels in Alzheimer's patients?", options: ["Cholinesterase inhibitors", "Dopamine agonists", "GABA blockers", "Nerve growth factors"], correct: 0 }, { id: 876, question: "In ALS, flaccid paralysis is more common because:", options: ["UMN lesions dominate", "Cortical neurons are unaffected", "LMN degeneration is more prominent", "Sensory pathways degenerate first"], correct: 2 }, { id: 877, question: "Which clinical sign suggests spastic paralysis?", options: ["Muscle atrophy", "Loss of reflexes", "Hyperreflexia", "Fasciculations"], correct: 2 }, { id: 878, question: "Dementia due to vascular disease is most associated with:", options: ["Sudden, stepwise decline", "Rapid memory recovery", "Improved cognition after sleep", "Increased ACh levels"], correct: 0 }, { id: 879, question: "A major characteristic distinguishing dementia from delirium is:", options: ["Dementia is chronic and progressive", "Dementia is caused by infection", "Delirium affects long-term memory only", "Delirium develops over decades"], correct: 0 }, { id: 880, question: "Which brain region degenerates primarily in Alzheimer's disease?", options: ["Cerebellum", "Cerebral cortex", "Brainstem", "Spinal cord"], correct: 1 }, { id: 881, question: "A 72-year-old woman cannot remember what she ate for breakfast but recalls her childhood clearly. Most likely diagnosis?", options: ["ALS", "Alzheimer's disease", "Parkinson's disease", "Stroke"], correct: 1 }, { id: 882, question: "A patient presents with muscle wasting, flaccid limbs, difficulty walking, and intact cognition. Most likely?", options: ["Alzheimer's disease", "ALS (LMN predominant)", "Parkinson's disease", "Dementia"], correct: 1 }, { id: 883, question: "A 65-year-old man shows gradual behavioral changes, irritability, poor judgment, and memory loss over 12 years. Most likely?", options: ["Stroke", "Alzheimer's disease", "ALS", "Rabies"], correct: 1 }, { id: 884, question: "A patient with ALS reports increasing shortness of breath. What complication is developing?", options: ["Kidney failure", "Respiratory muscle paralysis", "Dementia", "Viral infection"], correct: 1 }, { id: 885, question: "A patient exhibits hyperreflexia and muscle stiffness. Which motor neuron is damaged?", options: ["Lower motor neuron", "Upper motor neuron", "Sensory fibers", "Parasympathetic nerves"], correct: 1 }, { id: 886, question: "A man bitten by a dog develops progressive limb weakness but normal memory. Later he develops respiratory failure. Which disease fits?", options: ["Alzheimer's", "Rabies", "Dementia", "ALS"], correct: 3 }, { id: 887, question: "A caregiver reports their patient cannot recognize family members anymore. This is typical of:", options: ["ALS", "Late-stage Alzheimer's", "Parkinson's", "Lower motor neuron lesion"], correct: 1 }, { id: 888, question: "A patient shows muscle rigidity, hyperreflexia, spasticity but normal cognition. Which condition?", options: ["Dementia", "Alzheimer's", "ALS (UMN involvement)", "Stroke"], correct: 2 }, { id: 889, question: "A patient's medication slows the progression of ALS. Which drug is it?", options: ["Levodopa", "Riluzole", "Acetaminophen", "Morphine"], correct: 1 }, { id: 890, question: "A patient with dementia has sudden worsening after several small strokes. Diagnosis?", options: ["Alzheimer's disease", "Vascular dementia", "ALS", "Parkinson's disease"], correct: 1 }, { id: 891, question: "Which of the following is preserved in ALS?", options: ["Voluntary motor control", "Cognitive function", "Swallowing ability", "Respiratory strength"], correct: 1 }, { id: 892, question: "Which finding is most consistent with lower motor neuron damage in ALS?", options: ["Hyperreflexia", "Spasticity", "Fasciculations", "Increased tone"], correct: 2 }, { id: 893, question: "A hallmark of early Alzheimer's disease is:", options: ["Loss of distant memories", "Movement abnormalities", "Short-term memory impairment", "Rapid onset symptoms"], correct: 2 }, { id: 894, question: "Dementia due to infection (e.g., HIV, syphilis) is classified as:", options: ["Primary dementia", "Secondary dementia", "Vascular dementia", "Alzheimer's dementia"], correct: 1 }, { id: 895, question: "Which type of paralysis occurs with upper motor neuron involvement in ALS?", options: ["Flaccid paralysis", "Spastic paralysis", "No paralysis", "Mixed sensory loss"], correct: 1 }, { id: 896, question: "Which neurotransmitter is reduced because of rapid breakdown in Alzheimer's?", options: ["Dopamine", "Norepinephrine", "Acetylcholine", "Serotonin"], correct: 2 }, { id: 897, question: "A patient with Alzheimer's is prescribed a cholinesterase inhibitor to:", options: ["Increase dopamine", "Slow breakdown of acetylcholine", "Increase serotonin", "Improve motor control"], correct: 1 }, { id: 898, question: "The pathological protein associated with Alzheimer's plaques is:", options: ["Alpha-synuclein", "Beta-amyloid", "Tau-protein", "Prion protein"], correct: 1 }, { id: 899, question: "ALS is classified as which type of disease?", options: ["Autoimmune", "Infectious", "Neurodegenerative", "Metabolic"], correct: 2 }, { id: 900, question: "Which condition MOST commonly leads to respiratory muscle weakness?", options: ["Alzheimer's", "Dementia", "ALS", "Stroke"], correct: 2 }, { id: 901, question: "Which motor neuron sign would you expect to find early in ALS?", options: ["Loss of pain sensation", "Bilateral facial paralysis", "Mixed UMN + LMN signs", "Rapid cognitive decline"], correct: 2 }, { id: 902, question: "Why does vascular dementia often progress in a \"stepwise\" pattern?", options: ["Due to progressive infection", "Due to multiple small strokes", "Due to neurotransmitter depletion", "Due to vitamin deficiency"], correct: 1 }, { id: 903, question: "Which factor increases the likelihood of Alzheimer's disease?", options: ["Excessive exercise", "Increasing age", "High dopamine", "Viral infections"], correct: 1 }, { id: 904, question: "In ALS patients, fasciculations occur because of:", options: ["UMN degeneration", "Demyelination", "LMN irritation", "Excess ACh production"], correct: 2 }, { id: 905, question: "Which of the following is NOT characteristic of dementia?", options: ["Impaired judgment", "Slow, progressive decline", "Acute onset in hours", "Memory impairment"], correct: 2 }, { id: 906, question: "A 70-year-old woman remembers events from 30 years ago but cannot recall her doctor's instructions from the morning. Most likely?", options: ["ALS", "Alzheimer's", "Rabies", "Stroke"], correct: 1 }, { id: 907, question: "A patient displays hyperreflexia, muscle stiffness, and no sensory loss. Which is MOST likely?", options: ["LMN lesion", "Dementia", "UMN involvement", "Alzheimer's disease"], correct: 2 }, { id: 908, question: "A man with ALS now struggles to breathe deeply. This indicates:", options: ["Cognitive decline", "Brainstem stroke", "Respiratory muscle involvement", "Dopamine deficiency"], correct: 2 }, { id: 909, question: "A 66-year-old shows forgetfulness, irritability, wandering, and failure to recognize family. This stage of Alzheimer's is MOST likely:", options: ["Mild", "Moderate", "Severe", "Post-traumatic"], correct: 2 }, { id: 910, question: "A patient with progressive leg weakness and muscle twitching has normal MRI and normal sensation. Which condition fits best?", options: ["ALS", "Alzheimer's", "Meningitis", "MS"], correct: 0 }, { id: 911, question: "ALS involves degeneration of:", options: ["Sensory neurons only", "Upper and lower motor neurons", "Autonomic neurons only", "Cognitive processing centers"], correct: 1 }, { id: 912, question: "Which of the following is most typical of dementia?", options: ["Sudden paralysis", "Progressive memory loss", "Loss of motor neurons", "Excess dopamine"], correct: 1 }, { id: 913, question: "Alzheimer's disease is primarily associated with deficiency of:", options: ["Dopamine", "Acetylcholine", "Serotonin", "Glutamate"], correct: 1 }, { id: 914, question: "Early Alzheimer's most commonly affects:", options: ["Balance", "Long-term memory", "Short-term memory", "Pain sensation"], correct: 2 }, { id: 915, question: "Which finding is specific to LMN damage in ALS?", options: ["Hypertonia", "Clonus", "Fasciculations", "Spasticity"], correct: 2 }, { id: 916, question: "The major cause of death in ALS is:", options: ["Liver failure", "Respiratory failure", "Severe infection", "Dementia progression"], correct: 1 }, { id: 917, question: "Which pathology is associated with Alzheimer's?", options: ["Demyelination of axons", "Beta-amyloid plaque buildup", "Cerebellar degeneration", "Viral inflammation"], correct: 1 }, { id: 918, question: "Dementia caused by multiple mini-strokes is known as:", options: ["Alzheimer's dementia", "Vascular dementia", "Infectious dementia", "Metabolic dementia"], correct: 1 }, { id: 919, question: "Which symptom is NOT typical of Alzheimer's?", options: ["Wandering", "Short memory loss", "Increased reflexes", "Personality changes"], correct: 2 }, { id: 920, question: "ALS patients typically retain which function the longest?", options: ["Motor control", "Vision", "Cognition", "Facial muscle strength"], correct: 2 }, { id: 921, question: "Which brain region is most affected early in Alzheimer's disease?", options: ["Brainstem", "Hippocampus", "Cerebellum", "Occipital lobe"], correct: 1 }, { id: 922, question: "Which is TRUE about ALS?", options: ["It is curable with high-dose steroids", "It involves sensory loss", "It preserves intellectual function", "It causes early confusion"], correct: 2 }, { id: 923, question: "Spastic paralysis in ALS is due to:", options: ["LMN degeneration", "UMN degeneration", "Loss of acetylcholine", "Reduced serotonin levels"], correct: 1 }, { id: 924, question: "A hallmark of severe Alzheimer's is:", options: ["Hyperreflexia", "Loss of ability to recognize family", "Excessive dopamine release", "Full recovery with therapy"], correct: 1 }, { id: 925, question: "Which is the mechanism of cholinesterase inhibitors?", options: ["Destroy acetylcholine receptors", "Prevent breakdown of acetylcholine", "Increase dopamine", "Reduce serotonin reuptake"], correct: 1 }, { id: 926, question: "A patient with ALS shows increased muscle tone and hyperreflexia in legs. Which motor neuron is affected?", options: ["LMN only", "Sensory neuron", "UMN", "No neurons involved"], correct: 2 }, { id: 927, question: "An elderly man cannot remember where he placed items, forgets conversations, but recalls childhood clearly. Most likely diagnosis?", options: ["Dementia from infection", "Early Alzheimer's disease", "ALS", "Brain tumor"], correct: 1 }, { id: 928, question: "A patient shows difficulty swallowing, drooling, and respiratory muscle weakness. Which stage of ALS is this?", options: ["Very early", "Mild", "Advanced", "Non-progressive"], correct: 2 }, { id: 929, question: "A 72-year-old woman shows sudden stepwise decline in memory after multiple TIAs. Diagnosis?", options: ["Alzheimer's", "ALS", "Vascular dementia", "Parkinson's disease"], correct: 2 }, { id: 930, question: "A patient presents with spastic paralysis in one arm but flaccid paralysis in the other. What does this indicate?", options: ["Damage to both UMN and LMN pathways", "Only sensory nerve injury", "Reversible inflammation", "Pure Alzheimer's disease"], correct: 0 }, { id: 931, question: "Which clinical feature is LEAST likely to appear in ALS?", options: ["Fasciculations", "Muscle atrophy", "Loss of sensation", "Respiratory weakness"], correct: 2 }, { id: 932, question: "Which type of memory is most impaired first in Alzheimer's?", options: ["Childhood memories", "Long-term stored memories", "Recent short-term memory", "Procedural memory"], correct: 2 }, { id: 933, question: "Dementia generally involves impairment in all EXCEPT:", options: ["Learning", "Judgment", "Sensory pathways", "Memory"], correct: 2 }, { id: 934, question: "Which neurotransmitter is most linked to Alzheimer's cognitive decline?", options: ["GABA", "Acetylcholine", "Dopamine", "Serotonin"], correct: 1 }, { id: 935, question: "A patient develops both hyperreflexia and muscle twitching. Which disorder fits best?", options: ["Alzheimer's", "ALS", "Meningitis", "Rabies"], correct: 1 }, { id: 936, question: "A characteristic feature of advanced Alzheimer's includes:", options: ["Increased motor strength", "Complete sensory loss", "Inability to recognize family", "Preserved recent memory"], correct: 2 }, { id: 937, question: "Which structural protein contributes to Alzheimer's neurofibrillary tangles?", options: ["Tau protein", "Keratin", "Elastin", "Actin"], correct: 0 }, { id: 938, question: "ALS most commonly spares which function?", options: ["Limb strength", "Breathing", "Cognition", "Swallowing"], correct: 2 }, { id: 939, question: "In vascular dementia, symptoms progress in which pattern?", options: ["Continuous gradual decline", "Stepwise deterioration", "Rapid full recovery", "Only behavioral problems"], correct: 1 }, { id: 940, question: "Lower motor neuron damage results in:", options: ["Spasticity", "Hyperreflexia", "Flaccid paralysis", "Clonus"], correct: 2 }, { id: 941, question: "In ALS, degeneration of upper motor neurons specifically causes:", options: ["Fasciculations", "Hypotonia", "Spastic paralysis", "Loss of reflexes"], correct: 2 }, { id: 942, question: "Which brain structure is responsible for forming new memories and is hit early in Alzheimer's?", options: ["Thalamus", "Hippocampus", "Medulla", "Cerebellum"], correct: 1 }, { id: 943, question: "Which is TRUE regarding dementia?", options: ["It always involves motor neuron degeneration", "It is usually reversible", "It impairs executive function", "It is caused only by aging"], correct: 2 }, { id: 944, question: "What is the purpose of anti-cholinesterase medications in Alzheimer's?", options: ["Increase dopamine breakdown", "Keep acetylcholine available longer", "Lower glutamate levels", "Reduce beta-amyloid deposits"], correct: 1 }, { id: 945, question: "A patient shows increasing difficulty swallowing and speaking due to motor neuron loss. This indicates:", options: ["Alzheimer's", "ALS progression", "Dementia onset", "Meningitis recovery"], correct: 1 }, { id: 946, question: "A 76-year-old man repeats questions, forgets appointments, but tells detailed childhood stories. Most likely diagnosis?", options: ["ALS", "Early Alzheimer's", "Wernicke's stroke", "Rabies"], correct: 1 }, { id: 947, question: "A patient presents with progressive muscle weakness, intact sensation, and preserved memory. Which disorder?", options: ["ALS", "Dementia", "Alzheimer's", "Stroke"], correct: 0 }, { id: 948, question: "A patient with dementia suddenly declines after a minor stroke. This represents:", options: ["Alzheimer's", "Vascular dementia", "ALS", "MS"], correct: 1 }, { id: 949, question: "A 70-year-old woman cannot dress herself, wanders outside, and fails to recognize her daughter. This indicates:", options: ["Early dementia", "Advanced Alzheimer's", "Stroke recovery", "Normal aging"], correct: 1 }, { id: 950, question: "A 65-year-old shows arm stiffness, brisk reflexes, but also visible muscle twitches. Which mechanism explains BOTH findings?", options: ["UMN + LMN degeneration", "Pure sensory loss", "Increased dopamine", "Immune-mediated demyelination"], correct: 0 } ], "Stress and Associated problems": [ { id: 501, question: "Which stage of the General Adaptation Syndrome involves catecholamine release?", options: ["Exhaustion stage", "Resistance stage", "Alarm stage", "Recovery stage"], correct: 2 }, { id: 502, question: "Which organ is MOST responsible for initiating the stress response?", options: ["Thalamus", "Hypothalamus", "Cerebellum", "Pituitary gland"], correct: 1 }, { id: 503, question: "Which hormone increases during the resistance stage?", options: ["Oxytocin", "Insulin", "Cortisol", "Melatonin"], correct: 2 }, { id: 504, question: "Which of the following is NOT a significant physiological effect of the stress response?", options: ["Increased blood glucose", "Bronchodilation", "Increased inflammatory response", "Increased heart rate"], correct: 2 }, { id: 505, question: "Prolonged vasoconstriction during stress can lead to:", options: ["Kidney failure", "Hyperthyroidism", "Increased urine output", "Muscle hypertrophy"], correct: 0 }, { id: 506, question: "Which best describes a precipitating factor?", options: ["A factor that worsens a condition", "A factor that initially triggers stress", "A genetic mutation", "A treatment for stress"], correct: 1 }, { id: 507, question: "Which is an example of an exacerbating factor?", options: ["Chronic eczema", "Latent herpes infection", "Emotional stress", "Vaccination"], correct: 2 }, { id: 508, question: "What is the final possible outcome of the exhaustion stage?", options: ["Elevated cortisol", "Full recovery", "Death", "Increased glucose"], correct: 2 }, { id: 509, question: "Which part of the nervous system is activated during the alarm stage?", options: ["Parasympathetic nervous system", "Somatic nervous system", "Sympathetic nervous system", "Enteric nervous system"], correct: 2 }, { id: 510, question: "Which statement about stress effects is TRUE?", options: ["It decreases blood pressure", "It decreases glucose levels", "It decreases immune responses", "It decreases ventilation"], correct: 2 }, { id: 511, question: "PTSD typically appears within:", options: ["24 hours", "1 week", "1 month", "3 months"], correct: 3 }, { id: 512, question: "Which stress effect increases the risk of infection?", options: ["Increased glucose", "Increased ventilation", "Suppressed inflammatory response", "Bronchodilation"], correct: 2 }, { id: 513, question: "Elevated cortisol during stress causes:", options: ["Faster wound healing", "Immunosuppression", "Hypotension", "Hypoglycemia"], correct: 1 }, { id: 514, question: "Necrotizing periodontal disease can be triggered by:", options: ["Dehydration", "Stress-related immune suppression", "Increased saliva", "Vasodilation"], correct: 1 }, { id: 515, question: "Which organ pair is MOST involved in stress response?", options: ["Kidney & pancreas", "Hypothalamus & adrenal glands", "Heart & liver", "Lungs & cerebellum"], correct: 1 }, { id: 516, question: "Which organs are activated during the alarm stage of the General Adaptation Syndrome (GAS)?", options: ["Cerebellum, pancreas, kidneys", "Hypothalamus, sympathetic nervous system, adrenal glands", "Occipital lobe, bronchi, liver", "Parasympathetic system, thyroid gland, spleen"], correct: 1 }, { id: 517, question: "Which hormones are released during acute stress in the alarm stage?", options: ["Oxytocin and ADH", "Epinephrine and norepinephrine", "Dopamine and serotonin", "Cortisol only"], correct: 1 }, { id: 518, question: "The resistance stage of GAS is characterized by:", options: ["Exhaustion of all resources", "Immediate catecholamine release", "Elevated hormone levels such as cortisol", "Activation of parasympathetic system"], correct: 2 }, { id: 519, question: "The exhaustion stage may lead to all EXCEPT:", options: ["Recovery", "Resolution", "Death", "Increased immune activity"], correct: 3 }, { id: 520, question: "Which of the following is a significant physiological effect of stress mentioned in the lecture?", options: ["Bronchoconstriction", "Decreased ventilation", "Elevated glucose levels", "Decreased heart rate"], correct: 2 }, { id: 521, question: "Stress decreases inflammatory responses primarily due to increased:", options: ["ADH", "Cortisol", "Insulin", "Histamine"], correct: 1 }, { id: 522, question: "Prolonged vasoconstriction during stress may result in:", options: ["Kidney failure", "Hypertension relief", "Increased urine production", "Improved GI motility"], correct: 0 }, { id: 523, question: "Which is a specific problem of chronic stress mentioned by the professor?", options: ["Chronic back pain", "Necrotizing periodontal disease", "Frequent urination", "Weight gain"], correct: 1 }, { id: 524, question: "A precipitating factor is defined as:", options: ["A factor that worsens a disease", "A factor that initially triggers stress", "A genetic disorder", "A treatment intervention"], correct: 1 }, { id: 525, question: "An exacerbating factor is BEST defined as:", options: ["A factor that starts a disease", "A factor that worsens an existing disease", "A bacterial infection only", "A genetic factor"], correct: 1 }, { id: 526, question: "Autoimmune diseases that worsen under emotional stress include all EXCEPT:", options: ["Multiple sclerosis (MS)", "Systemic lupus erythematosus (SLE)", "Rheumatoid arthritis (RA)", "Diabetes insipidus"], correct: 3 }, { id: 527, question: "Which of the following is a potential effect of prolonged severe stress?", options: ["Renal failure", "Improved immunity", "Enhanced wound healing", "Vasodilation"], correct: 0 }, { id: 528, question: "Why does stress delay wound healing?", options: ["Decreased cortisol", "Increased catecholamine destruction", "Increased cortisol suppresses immune response", "Decreased glucose supply"], correct: 2 }, { id: 529, question: "PTSD (Post-traumatic stress disorder) typically appears within:", options: ["1 week", "1 month", "3 months", "6 months"], correct: 2 }, { id: 530, question: "PTSD is commonly associated with:", options: ["Brain tumors", "Soldiers exposed to warfare", "Vitamin deficiency", "Food allergies"], correct: 1 }, { id: 531, question: "A 46-year-old man experiences a sudden stressful event. Within minutes, his heart rate increases, blood pressure rises, bronchi dilate, and glucose level spikes. Which stage of GAS is he experiencing?", options: ["Resistance stage", "Exhaustion stage", "Alarm stage", "Post-recovery stage"], correct: 2 }, { id: 532, question: "A patient reports severe emotional stress due to family issues. Her chronic eczema suddenly worsens. This worsening is due to a(n):", options: ["Precipitating factor", "Exacerbating factor", "Compensatory factor", "Homeostatic factor"], correct: 1 }, { id: 533, question: "A patient with long-term stress develops increased cortisol and chronic vasoconstriction. She now presents with reduced kidney function. Which mechanism explains her renal failure?", options: ["Decreased immune response", "Poor blood supply to the kidneys", "Increased neural activity", "Elevated body temperature"], correct: 1 }, { id: 534, question: "A soldier develops recurring nightmares, anxiety, and difficulty concentrating 2 months after returning from combat. What condition does this most likely represent?", options: ["Acute stress", "PTSD", "Panic disorder", "Bipolar disorder"], correct: 1 }, { id: 535, question: "A patient is under long-term stress and notes that her wounds take longer to heal after surgery. Which physiological change explains this?", options: ["Increased histamine", "Increased parasympathetic activity", "Increased cortisol suppressing inflammation", "Decreased catecholamine release"], correct: 2 }, { id: 536, question: "The first stage of the stress response (GAS) that activates the hypothalamus, sympathetic nervous system, and adrenal glands is:", options: ["Resistance stage", "Exhaustion stage", "Alarm stage", "Recovery stage"], correct: 2 }, { id: 537, question: "During the alarm stage, the adrenal glands release which hormones?", options: ["Insulin and cortisol", "Epinephrine and norepinephrine", "ADH and oxytocin", "Thyroxine and calcitonin"], correct: 1 }, { id: 538, question: "The resistance stage of GAS is characterized by:", options: ["Immediate catecholamine release", "Elevated hormone levels that keep the body functioning at high performance", "Body collapse", "No hormonal involvement"], correct: 1 }, { id: 539, question: "The exhaustion stage can result in:", options: ["Complete recovery only", "Resolution or death", "Increased immune function", "Hyperinflammation"], correct: 1 }, { id: 540, question: "Which is a MAJOR physiological effect of stress?", options: ["Low glucose", "Low heart rate", "Bronchodilation to increase oxygen", "Immune system overactivation"], correct: 2 }, { id: 541, question: "Stress increases blood glucose levels primarily because:", options: ["Cortisol raises glucose for energy", "The kidneys release insulin", "The liver shuts down", "Catecholamines reduce glucose"], correct: 0 }, { id: 542, question: "Chronic vasoconstriction due to stress may lead to:", options: ["Enhanced kidney filtration", "Renal failure", "Increased urine output", "Decreased blood pressure"], correct: 1 }, { id: 543, question: "Necrotizing periodontal disease is associated with:", options: ["Low stress levels", "Chronic high stress", "Vitamin deficiency", "Allergic reactions"], correct: 1 }, { id: 544, question: "A precipitating factor is BEST described as:", options: ["Something that worsens a condition", "Something that initially triggers the stress or disease", "A treatment", "A genetic mutation"], correct: 1 }, { id: 545, question: "An exacerbating factor refers to:", options: ["A trigger of the disease", "Something that makes an existing condition worse", "A bacterial infection", "A type of treatment"], correct: 1 }, { id: 546, question: "Emotional distress worsening eczema or lupus is an example of:", options: ["Precipitating factor", "Exacerbating factor", "Compensatory mechanism", "Homeostasis"], correct: 1 }, { id: 547, question: "Which autoimmune disorders were specifically listed as worsened by stress?", options: ["Eczema, UC, MS, SLE, RA", "Diabetes type 1 only", "Thyroid disorders only", "Asthma only"], correct: 0 }, { id: 548, question: "Severe or prolonged stress can lead to delayed wound healing because:", options: ["Cortisol suppresses inflammation", "Cortisol increases blood flow", "Low epinephrine enhances healing", "Bronchodilation slows healing"], correct: 0 }, { id: 549, question: "A soldier develops nightmares and anxiety 3 months after a traumatic event. This is:", options: ["Acute stress", "PTSD", "Panic disorder", "Seasonal depression"], correct: 1 }, { id: 550, question: "PTSD most commonly occurs in:", options: ["Children with eczema", "Soldiers after traumatic events", "Infants exposed to infection", "People with allergies"], correct: 1 }, { id: 551, question: "A patient suddenly encounters a threatening situation. Within seconds, her HR rises, BP rises, bronchi dilate, glucose increases. Which stage is this?", options: ["Exhaustion", "Alarm", "Resistance", "Recovery"], correct: 1 }, { id: 552, question: "A patient with known chronic eczema experiences severe emotional stress and the eczema worsens. This is due to:", options: ["Precipitating factor", "Exacerbating factor", "Homeostasis", "GAS resistance stage"], correct: 1 }, { id: 553, question: "A person under long-term stress shows decreased immune response and delayed wound healing. Which hormone is responsible?", options: ["Dopamine", "Cortisol", "Insulin", "Aldosterone"], correct: 1 }, { id: 554, question: "A patient under prolonged vasoconstriction due to stress now has poor kidney function. The cause is:", options: ["High glucose levels", "Reduced renal blood flow", "High immune activity", "Increased ADH"], correct: 1 }, { id: 555, question: "A man experiences severe stress and later develops increased risk of infections and slow recovery from surgery. Which GAS stage is he likely entering?", options: ["Alarm", "Resistance", "Exhaustion", "Adaptation"], correct: 2 }, { id: 556, question: "A 22-year-old student is writing multiple exams this week. Her body keeps blood pressure, temperature, and blood glucose within a normal range despite mild stress. This balance is called:", options: ["Compensation", "Homeostasis", "Exhaustion", "Adaptation syndrome"], correct: 1 }, { id: 557, question: "A 45-year-old man has been under severe work stress for months. Recently, chronic eczema and a recurrent cold sore (HSV) flare up. This shows which effect of prolonged stress?", options: ["Improved tissue repair", "Increased wear and tear of tissues", "Decreased susceptibility to infection", "Enhanced immune system"], correct: 1 }, { id: 558, question: "A sudden car accident almost happens in front of a woman. Her heart rate and blood pressure increase immediately, breathing becomes faster, and she feels very alert. Which stage of General Adaptation Syndrome (GAS) is this?", options: ["Alarm stage", "Resistance stage", "Exhaustion stage", "Recovery stage"], correct: 0 }, { id: 559, question: "In the alarm stage, which of the following is NOT a key structure involved?", options: ["Hypothalamus", "Sympathetic nervous system", "Adrenal medulla", "Pancreatic beta cells"], correct: 3 }, { id: 560, question: "A nurse is working on night shifts for several weeks. Her body keeps functioning \"okay\" with high hormone levels, but she feels constantly wired. This stage of GAS is:", options: ["Alarm", "Resistance", "Exhaustion", "Recovery"], correct: 1 }, { id: 561, question: "A caregiver has been under intense stress for years caring for a sick family member. Suddenly she develops severe illness, weight loss, and cannot cope anymore. Which stage is this?", options: ["Alarm", "Resistance", "Exhaustion", "Recovery"], correct: 2 }, { id: 562, question: "A patient under acute stress shows: Increased blood pressure, Increased heart rate. Which category of stress effect is this?", options: ["Bronchodilation", "CNS stimulation", "Cardiovascular activation", "Anti-inflammatory effect"], correct: 2 }, { id: 563, question: "A woman with stage fright has rapid breathing and feels she can take in more air before a speech. Which effect of stress is this?", options: ["Bronchodilation & increased ventilation", "Reduced metabolism", "Immune suppression", "Decreased blood glucose"], correct: 0 }, { id: 564, question: "A man under stress for an exam has increased blood glucose levels even though he didn't eat recently. This is due to:", options: ["Increased insulin secretion", "Decreased cortisol", "Increased gluconeogenesis and glycogen breakdown", "Increased antibody production"], correct: 2 }, { id: 565, question: "During acute stress, which combination is correct?", options: ["CNS stimulation & increased inflammatory response", "CNS stimulation & decreased inflammatory response", "CNS inhibition & increased inflammatory response", "CNS inhibition & decreased inflammatory response"], correct: 1 }, { id: 566, question: "A student under stress before exams develops: Tension headaches, Aphthous ulcers in the mouth, Necrotizing periodontal disease. These are:", options: ["Systemic effects of infection", "Specific problems caused by stress", "Genetic disorders", "Autoimmune diseases"], correct: 1 }, { id: 567, question: "A 55-year-old hypertensive man under chronic stress develops decreased kidney function due to reduced blood supply. Which stress-related mechanism explains this?", options: ["Persistent vasodilation", "Prolonged vasoconstriction", "Decreased catecholamines", "Increased inflammatory response"], correct: 1 }, { id: 568, question: "A patient in ICU under severe physical and emotional stress develops a bleeding gastric ulcer. The main contributing factors are:", options: ["High WBC count and fever", "Prolonged vasoconstriction and decreased mucosal regeneration", "Hyperventilation and respiratory alkalosis", "Allergy-mediated histamine release"], correct: 1 }, { id: 569, question: "A woman after a major disaster develops frequent respiratory infections. Lab shows high cortisol. Why does stress increase her infection risk?", options: ["Cortisol increases WBC activity", "Cortisol suppresses immune response", "Catecholamines directly kill WBCs", "Stress antibodies block T cells"], correct: 1 }, { id: 570, question: "A postoperative patient is under high stress and anxiety. His surgical wound is healing slowly. Most likely cause?", options: ["Increased blood flow and RBCs", "Decreased protein synthesis and cell proliferation", "Increased mitosis in fibroblasts", "Excessive inflammation"], correct: 1 }, { id: 571, question: "A woman has chronic asthma. She is stable most of the time, but during exam week her asthma attacks become frequent. In this scenario, stress is best described as:", options: ["Only a precipitating factor", "Only an exacerbating factor", "Both a precipitating and exacerbating factor", "Neither"], correct: 2 }, { id: 572, question: "Which is the BEST example of a precipitating factor for a stress-related problem?", options: ["Chronic asthma already diagnosed", "Latent herpes infection (cold sores) becoming active during exams", "Long-standing rheumatoid arthritis", "Normal immune function"], correct: 1 }, { id: 573, question: "A patient with multiple sclerosis (MS) reports that symptoms always worsen during periods of family conflict. Here, stress acts mainly as:", options: ["Precipitating factor", "Exacerbating factor", "Protective factor", "Infectious agent"], correct: 1 }, { id: 574, question: "A soldier returns from war. Months later, he has nightmares, flashbacks, anxiety, and avoids reminders of the event. He also drinks heavily. This condition is:", options: ["Acute stress response", "General adaptation syndrome", "Post-traumatic stress disorder (PTSD)", "Simple anxiety disorder"], correct: 2 }, { id: 575, question: "According to the lecture, PTSD usually appears:", options: ["Immediately after the event", "Within a few hours", "Within about 3 months of the event", "After 10 years only"], correct: 2 }, { id: 576, question: "A stressed student wants to cope in a healthy way. Which is a recommended strategy from the lecture?", options: ["Heavy drinking", "Regular moderate exercise", "Ignoring sleep and studying all night", "Taking anxiolytic drugs without prescription"], correct: 1 }, { id: 577, question: "A busy nurse under stress decides to sleep only 3 hours a night and lives on coffee and chips. This behavior will:", options: ["Improve coping with stress", "Worsen stress and health", "Have no effect", "Guarantee no PTSD"], correct: 1 }, { id: 578, question: "Which statement about anti-anxiety medications as a coping method is MOST accurate according to the lecture?", options: ["They are the first and best solution for any stress", "They should be avoided completely", "They can be used, but not regularly and not as the only coping strategy", "They cure the cause of stress"], correct: 2 }, { id: 579, question: "A patient with ulcerative colitis experiences a flare of bloody diarrhea right after a major work deadline. This illustrates stress as:", options: ["Viral infection", "Exacerbating factor in chronic inflammatory disease", "Only a precipitating factor", "Direct bacterial cause"], correct: 1 }, { id: 580, question: "A critically ill man under long-term severe stress develops renal failure. The main mechanism is:", options: ["Chronic hyperglycemia only", "Prolonged vasodilation of renal arteries", "Prolonged vasoconstriction → decreased renal blood flow", "Excess immune activation"], correct: 2 }, { id: 581, question: "A woman had surgery and is also experiencing severe emotional stress. Her incision becomes infected and healing is delayed. Which two stress effects contribute MOST?", options: ["Increased inflammation & increased immunity", "Decreased immune response & decreased inflammatory response", "Increased WBC activity & increased antibody production", "Increased sleep & rest"], correct: 1 }, { id: 582, question: "Which patient is at the highest risk for developing a stress-related ulcer?", options: ["Healthy teenager with mild exam stress", "ICU patient on ventilator with severe burns and trauma", "Middle-aged runner after a 5 km race", "Elderly patient walking daily and eating well"], correct: 1 }, { id: 583, question: "A stressed dental hygiene student has: Tension headache, Mouth ulcers, Necrotizing gingivitis. These are best classified as:", options: ["General systemic effects", "Specific stress-related problems", "GAS stages", "Immune deficiency disorders"], correct: 1 }, { id: 584, question: "A small amount of stress before a presentation helps a student stay alert and focused. It does not damage health. This is best described as:", options: ["Distress only", "Eustress (positive stress)", "Exhaustion stage", "PTSD"], correct: 1 }, { id: 585, question: "A 60-year-old man has: Long-term work stress, Hypertension, Uses alcohol to cope. Now he develops: Mild renal failure, Recurrent infections, Delayed healing after minor injuries, Poor sleep and irritability. Which combination BEST explains his condition based on Lecture 5?", options: ["Acute alarm reaction with increased immunity", "Chronic stress → prolonged vasoconstriction, high cortisol, CNS stimulation", "Short-term stress → only beneficial effects", "Infection causing stress"], correct: 1 }, { id: 586, question: "Roughly what percentage of doctor's office visits are directly or indirectly related to stress?", options: ["5–10%", "20–30%", "40–50%", "75–90%"], correct: 3 }, { id: 587, question: "Homeostasis is best defined as:", options: ["The body's response only to severe injury", "The body's compensation to minor changes to keep the internal environment stable", "The body's tendency to always increase blood pressure", "The body's immune response to infection"], correct: 1 }, { id: 588, question: "Long-term severe stress can cause all of the following EXCEPT:", options: ["Increased wear and tear on tissues", "Exhaustion of energy resources", "Improvement of chronic infections", "Exacerbation of chronic conditions such as eczema"], correct: 2 }, { id: 589, question: "The stress syndrome \"GAS – General Adaptation Syndrome\" has how many stages?", options: ["2", "3", "4", "5"], correct: 1 }, { id: 590, question: "In the alarm stage of GAS, which structures are primarily involved?", options: ["Cerebellum and pancreas", "Hypothalamus, sympathetic nervous system, adrenal glands", "Spinal cord and pituitary only", "Liver and kidneys"], correct: 1 }, { id: 591, question: "Which hormone group is mainly secreted from the adrenal gland during the ALARM stage?", options: ["Thyroid hormones", "Catecholamines (epinephrine, norepinephrine)", "Insulin only", "Sex hormones"], correct: 1 }, { id: 592, question: "The resistance stage of GAS is characterized by:", options: ["No hormonal change", "Decreased hormonal levels", "Elevated hormonal levels to operate at peak performance", "Complete shutdown of the endocrine system"], correct: 2 }, { id: 593, question: "Which is NOT a possible outcome of the final stage of GAS?", options: ["Resolution and recovery", "Death due to prolonged stress", "Immediate tissue regeneration", "Exhaustion of resources"], correct: 2 }, { id: 594, question: "Which of the following is NOT one of the 5 significant effects of the stress response listed by the professor?", options: ["Increased blood pressure and heart rate", "Bronchodilation and increased ventilation", "Increased blood glucose level", "Increased inflammatory response"], correct: 3 }, { id: 595, question: "Decreased inflammatory response during stress can lead to:", options: ["Faster wound healing", "Slower healing and more infections after trauma/surgery", "No change in immunity", "Immediate recovery from chronic disease"], correct: 1 }, { id: 596, question: "Which of the following can be a specific problem during the stress response?", options: ["Improved oral health", "Necrotizing periodontal disease", "Increased salivary flow", "Hyper-regeneration of tissues"], correct: 1 }, { id: 597, question: "Prolonged vasoconstriction due to stress can lead to:", options: ["Increased blood flow to all organs", "Decreased blood flow and impaired organ function", "Only changes in skin color but no organ effect", "Increased urine production only"], correct: 1 }, { id: 598, question: "Which statement about precipitating factor is correct?", options: ["It worsens an already existing disease only", "It is a factor that initially triggers stress or disease", "It is always an emotional factor", "It is the same as exacerbating factor"], correct: 1 }, { id: 599, question: "Which is an example of an exacerbating factor for stress-related disease?", options: ["Latent viral infection", "Genetic mutation", "Physical or emotional distress", "Congenital malformation"], correct: 2 }, { id: 600, question: "Which chronic conditions did the professor mention as being worsened by stress? (Choose the BEST combination.)", options: ["Diabetes only", "Asthma and common cold only", "Multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, eczema, ulcerative colitis", "Migraine only"], correct: 2 }, { id: 601, question: "Which is a possible effect of prolonged or severe stress mentioned in the lecture?", options: ["Renal failure", "Improved kidney function", "Increased bone density", "Hyper-immunity"], correct: 0 }, { id: 602, question: "Which of the following best describes PTSD (Post-Traumatic Stress Disorder) as explained?", options: ["It develops only in children", "It is a common consequence of major disasters or personal threats", "It appears immediately within 24 hours of trauma", "It is rarely seen in soldiers"], correct: 1 }, { id: 603, question: "PTSD is associated with:", options: ["Very low risk of substance dependence", "High risk of developing dependence on alcohol or drugs", "Only physical symptoms without psychological ones", "Only temporary mild stress"], correct: 1 }, { id: 604, question: "Which of the following was mentioned as a healthy way to cope with stress?", options: ["Completely ignoring problems", "Adequate rest and healthy diet", "Taking any medication randomly", "Isolating yourself from everyone"], correct: 1 }, { id: 605, question: "Which of the following is TRUE regarding anti-anxiety medications, as the professor said?", options: ["They should always be taken regularly without concern", "They are the first and only way to cope", "They can help but should not be taken regularly if possible", "They completely cure stress"], correct: 2 }, { id: 606, question: "A 23-year-old student hears suddenly that she has to take a surprise exam. Her heart rate and blood pressure increase, she starts to sweat, and her pupils dilate. Which stage of GAS is she most likely in?", options: ["No stage – this is not stress", "Alarm stage", "Resistance stage", "Final (exhaustion) stage"], correct: 1 }, { id: 607, question: "A nurse has been working in an ICU under high stress for months. Her hormones (cortisol, catecholamines) have been elevated for a long time and she still functions at high performance, but feels tired. Which stage of GAS is this?", options: ["Alarm", "Resistance", "Final exhaustion", "Recovery"], correct: 1 }, { id: 608, question: "An elderly man has been under extreme stress for years. He now has severe weight loss, fatigue, frequent infections, and his organs begin to fail. Which GAS stage best fits this description?", options: ["Alarm", "Resistance", "Final stage (exhaustion)", "Recovery"], correct: 2 }, { id: 609, question: "A patient under prolonged stress shows signs of decreased kidney function due to reduced blood flow to the kidneys. Which mechanism is most directly responsible?", options: ["Bronchodilation", "Prolonged vasoconstriction", "Increased inflammatory response", "Increased saliva production"], correct: 1 }, { id: 610, question: "After major surgery, a woman has been under extreme emotional stress. Her wound is healing very slowly and she develops an infection. Which stress effect best explains this?", options: ["Increased immune response", "Decreased inflammatory and immune response", "Decreased blood glucose", "Bronchoconstriction"], correct: 1 }, { id: 611, question: "A man has had a latent hepatitis infection for years without symptoms. After a very stressful event, his hepatitis becomes active and symptomatic. The latent infection in this story is best described as:", options: ["Exacerbating factor", "Precipitating factor", "Coping mechanism", "Recovery factor"], correct: 1 }, { id: 612, question: "A woman with known rheumatoid arthritis experiences a major emotional shock, after which her joint pain suddenly gets much worse. The emotional shock is:", options: ["Precipitating factor", "Exacerbating factor", "Protective factor", "Immune deficiency"], correct: 1 }, { id: 613, question: "A soldier returns from war. Three months after coming home, he has nightmares, flashbacks, anxiety, and starts drinking heavily. What condition best fits this description?", options: ["Acute stress response", "PTSD", "Generalized anxiety only", "Dementia"], correct: 1 }, { id: 614, question: "A student under constant stress decides to: Sleep 7–8 hours regularly, Eat balanced meals, Do 30 minutes of moderate exercise daily, Attend counselling once a week. These behaviors are best described as:", options: ["Precipitating factors", "Exacerbating factors", "Healthy coping strategies", "Symptoms of PTSD"], correct: 2 }, { id: 615, question: "A chronic eczema patient is stable for months. Then she starts a very stressful new job, and her eczema suddenly flares up. Which statement is MOST accurate?", options: ["Stress is the precipitating factor and eczema is the exacerbating factor", "Eczema is the precipitating factor and stress is the exacerbating factor", "Both are precipitating factors", "Neither is related"], correct: 1 } ], "Blood and circulatory system disorders": [ { id: 601, question: "Which component makes up 55% of total blood volume?", options: ["Hematocrit", "RBCs", "Plasma", "Platelets"], correct: 2 }, { id: 602, question: "The hematocrit is composed primarily of:", options: ["WBCs", "Plasma proteins", "RBCs", "Platelets"], correct: 2 }, { id: 603, question: "Which blood vessel type is the ONLY site of gas and nutrient exchange?", options: ["Arteries", "Veins", "Arterioles", "Capillaries"], correct: 3 }, { id: 604, question: "The buffy coat contains:", options: ["Only RBCs", "WBCs and platelets", "Albumin and globulins", "Fibrinogen"], correct: 1 }, { id: 605, question: "Which hormone stimulates RBC production?", options: ["Aldosterone", "Insulin", "Erythropoietin", "ADH"], correct: 2 }, { id: 606, question: "Plasma differs from serum because plasma contains:", options: ["Electrolytes", "Antibodies", "Clotting factors", "RBCs"], correct: 2 }, { id: 607, question: "Which plasma protein maintains osmotic pressure?", options: ["Globulin", "Albumin", "Fibrinogen", "Myoglobin"], correct: 1 }, { id: 608, question: "CO₂ binds to which part of hemoglobin?", options: ["Heme", "Iron", "Globin", "Bilirubin"], correct: 2 }, { id: 609, question: "Before reaching the liver, bilirubin is:", options: ["Conjugated", "Water-soluble", "Bound to glucuronic acid", "Unconjugated"], correct: 3 }, { id: 610, question: "Hemochromatosis involves excessive accumulation of:", options: ["Albumin", "Fibrinogen", "Hemosiderin", "Lymphocytes"], correct: 2 }, { id: 611, question: "Why do RBCs lose their nucleus during maturation?", options: ["To increase division rate", "To enlarge the mitochondria", "To allow more hemoglobin storage", "To increase membrane rigidity"], correct: 2 }, { id: 612, question: "Which part of the cardiovascular system comes immediately before capillaries?", options: ["Veins", "Arterioles", "Venules", "Atria"], correct: 1 }, { id: 613, question: "Which individual is expected to have the highest hematocrit?", options: ["Adult female", "Adult male", "Child", "Elderly patient"], correct: 1 }, { id: 614, question: "Which plasma protein is essential for clot formation?", options: ["Albumin", "Globulins", "Fibrinogen", "Prothrombin only"], correct: 2 }, { id: 615, question: "Why does serum appear more yellow than plasma?", options: ["Contains more bilirubin", "Contains no clotting factors", "Contains more RBC fragments", "Has lower water content"], correct: 1 }, { id: 616, question: "A patient's blood sample shows: Normal plasma, Very thin buffy coat, Very high hematocrit. Which condition is MOST likely?", options: ["Leukemia", "Severe dehydration", "Polycythemia (↑RBC count)", "Viral infection"], correct: 2 }, { id: 617, question: "A patient has a genetic mutation causing massive iron accumulation in the liver. What is the MOST likely cause?", options: ["Low EPO production", "Hemochromatosis", "Iron-deficiency anemia", "Increased albumin synthesis"], correct: 1 }, { id: 618, question: "A newborn develops jaundice due to an inability to conjugate bilirubin. Which step is impaired?", options: ["Bilirubin transport", "Glucuronic acid binding", "Hemoglobin breakdown", "RBC production"], correct: 1 }, { id: 619, question: "A patient's blood sample forms a clot. The remaining fluid is:", options: ["Plasma", "Serum", "Hematocrit", "Buffy coat"], correct: 1 }, { id: 620, question: "A male patient has a hematocrit of 53%. Which statement is TRUE?", options: ["This is normal for males", "This is dangerously low", "Plasma volume is too high", "Platelet count is elevated"], correct: 0 }, { id: 621, question: "A scientist examines a biconcave cell without a nucleus. What is its primary function?", options: ["Fight infection", "Initiate clotting", "Carry oxygen and carbon dioxide", "Produce antibodies"], correct: 2 }, { id: 622, question: "A patient has low albumin. What symptom is most likely?", options: ["Hypertension", "Edema", "Polycythemia", "Excessive clotting"], correct: 1 }, { id: 623, question: "Which condition increases the amount of carbaminohemoglobin?", options: ["Excess oxygenation", "Increased tissue CO₂", "High albumin", "High bilirubin"], correct: 1 }, { id: 624, question: "Which statement about RBCs is TRUE?", options: ["They divide frequently", "They contain mitochondria", "They rely on anaerobic metabolism", "They have a short lifespan because they are nucleated"], correct: 2 }, { id: 625, question: "Which of the following is a function shared by WBCs and plasma?", options: ["Clot formation", "Maintaining osmotic pressure", "Immune protection", "Oxygen transport"], correct: 2 }, { id: 626, question: "What percentage of blood is composed of plasma?", options: ["10%", "45%", "55%", "90%"], correct: 2 }, { id: 627, question: "The cellular portion (hematocrit) makes up what percentage of blood?", options: ["10%", "45%", "55%", "99%"], correct: 1 }, { id: 628, question: "Which component forms the buffy coat?", options: ["Only RBCs", "WBCs and platelets", "Plasma proteins", "Albumin and globulin"], correct: 1 }, { id: 629, question: "The plasma protein essential for clotting is:", options: ["Albumin", "Globulins", "Fibrinogen", "Hemoglobin"], correct: 2 }, { id: 630, question: "Which hormone stimulates RBC production?", options: ["ACTH", "Erythropoietin", "Aldosterone", "ADH"], correct: 1 }, { id: 631, question: "RBCs lose their nucleus to:", options: ["Prevent infection", "Increase hemoglobin storage space", "Divide faster", "Increase ATP production"], correct: 1 }, { id: 632, question: "Which is the MOST abundant blood cell?", options: ["Neutrophils", "Platelets", "RBCs", "Lymphocytes"], correct: 2 }, { id: 633, question: "Which structure is the ONLY site of nutrient & gas exchange?", options: ["Arteries", "Arterioles", "Capillaries", "Veins"], correct: 2 }, { id: 634, question: "Plasma differs from serum because plasma contains:", options: ["More bilirubin", "Clotting factors", "More RBCs", "Globin"], correct: 1 }, { id: 635, question: "Which protein maintains osmotic pressure of blood?", options: ["Globulins", "Fibrinogen", "Albumin", "Myosin"], correct: 2 }, { id: 636, question: "Hemoglobin binds oxygen via the ______ portion and CO₂ via the ______ portion.", options: ["Globin / heme", "Heme / globin", "Iron / bilirubin", "Bilirubin / heme"], correct: 1 }, { id: 637, question: "Before reaching the liver, bilirubin is in which form?", options: ["Conjugated", "Water-soluble", "Bound to glucuronic acid", "Unconjugated"], correct: 3 }, { id: 638, question: "Conjugation of bilirubin occurs where?", options: ["Bone marrow", "Spleen", "Liver", "Kidneys"], correct: 2 }, { id: 639, question: "Excess iron stored in tissues forms:", options: ["Albumin", "Fibrin", "Hemosiderin", "Myoglobin"], correct: 2 }, { id: 640, question: "A genetic disease with massive iron storage in the liver is:", options: ["Hemophilia", "Hemochromatosis", "Leukocytosis", "Polycythemia"], correct: 1 }, { id: 641, question: "A man has a hematocrit of 52%. Based on the lecture, this finding is:", options: ["Normal for males", "Dangerously low", "Due to low testosterone", "Evidence of infection"], correct: 0 }, { id: 642, question: "A patient's blood sample clots, and fluid remains. What is the fluid?", options: ["Plasma", "Serum", "Bilirubin", "Hematocrit"], correct: 1 }, { id: 643, question: "A newborn has high unconjugated bilirubin. The impaired step is:", options: ["Breakdown of hemoglobin", "Binding to albumin", "Conjugation with glucuronic acid in liver", "RBC production"], correct: 2 }, { id: 644, question: "A patient with bone marrow suppression has decreased ALL formed elements. Which component drops?", options: ["Plasma", "Serum", "RBC, WBC, and platelets", "Only RBCs"], correct: 2 }, { id: 645, question: "A patient shows extremely thin buffy coat. What is most likely?", options: ["Leukemia", "Low WBC count", "High hematocrit", "High albumin"], correct: 1 }, { id: 646, question: "Which best explains why plasma is less yellow than serum?", options: ["Serum has more bilirubin", "Serum lacks clotting factors", "Plasma contains fewer proteins", "Plasma has fewer electrolytes"], correct: 0 }, { id: 647, question: "Which component increases during dehydration?", options: ["Plasma volume", "Hematocrit", "Serum bilirubin", "Platelet size"], correct: 1 }, { id: 648, question: "Carbaminohemoglobin increases when:", options: ["CO₂ level rises in tissues", "O₂ saturation increases", "Albumin rises", "Bilirubin rises"], correct: 0 }, { id: 649, question: "Which best describes hematopoiesis?", options: ["Breakdown of hemoglobin", "Production of all blood cells from a stem cell", "Formation of antibodies", "Process of clotting"], correct: 1 }, { id: 650, question: "Which is TRUE regarding RBC lifespan and structure?", options: ["They divide rapidly", "They rely on aerobic ATP production", "They lack a nucleus after maturation", "They store clotting factors"], correct: 2 }, { id: 651, question: "Which component makes up 55% of total blood volume?", options: ["RBCs", "WBCs", "Plasma", "Serum"], correct: 2 }, { id: 652, question: "The buffy coat contains:", options: ["Only RBCs", "WBCs and platelets", "Plasma proteins", "Hemoglobin"], correct: 1 }, { id: 653, question: "Plasma contains clotting factors, but serum does not because:", options: ["Serum is dehydrated", "Clotting factors precipitate at the bottom", "Serum contains more water", "Serum contains more protein"], correct: 1 }, { id: 654, question: "The protein responsible for maintaining osmotic pressure in blood is:", options: ["Globulin", "Albumin", "Hemoglobin", "Bilirubin"], correct: 1 }, { id: 655, question: "Which plasma protein is essential for blood clotting?", options: ["Actin", "Fibrinogen", "Albumin", "Globulin"], correct: 1 }, { id: 656, question: "RBCs lose their nucleus after maturation to:", options: ["Divide faster", "Prevent mutation", "Increase space for hemoglobin", "Produce more ATP"], correct: 2 }, { id: 657, question: "Which hormone stimulates the bone marrow to produce RBCs?", options: ["Insulin", "Erythropoietin", "ACTH", "Cortisol"], correct: 1 }, { id: 658, question: "Hemoglobin binds oxygen to the ___ portion and carbon dioxide to the ___ portion.", options: ["Heme / globin", "Globin / heme", "Iron / albumin", "Bilirubin / heme"], correct: 0 }, { id: 659, question: "A combination of oxygen + hemoglobin is called:", options: ["Carbaminohemoglobin", "Deoxyhemoglobin", "Oxyhemoglobin", "Ferritin"], correct: 2 }, { id: 660, question: "Excess iron stored in tissues forms:", options: ["Albumin", "Hemosiderin", "Fibrin", "Bilirubin"], correct: 1 }, { id: 661, question: "A person has extremely high serum ferritin due to a genetic issue. What is the condition?", options: ["Hemophilia", "Hemochromatosis", "Leukocytosis", "Hypochromic anemia"], correct: 1 }, { id: 662, question: "Before the liver processes bilirubin, it is in the form of:", options: ["Conjugated bilirubin", "Bound bilirubin", "Unconjugated bilirubin", "Bile-salt bilirubin"], correct: 2 }, { id: 663, question: "Conjugation of bilirubin occurs when it binds to:", options: ["Hemoglobin", "Glucuronic acid", "Ferritin", "Globulin"], correct: 1 }, { id: 664, question: "The ONLY site of nutrient, oxygen, and waste exchange is:", options: ["Arteries", "Arterioles", "Capillaries", "Venules"], correct: 2 }, { id: 665, question: "Which blood vessel order is correct (from heart → return)?", options: ["Artery → venule → capillary → vein", "Vein → capillary → artery → venule", "Artery → arteriole → capillary → venule → vein", "Capillary → artery → vein"], correct: 2 }, { id: 666, question: "Hematocrit is approximately 5–10% higher in males due to:", options: ["High estrogen", "Higher platelet count", "Testosterone stimulating marrow", "Larger plasma volume"], correct: 2 }, { id: 667, question: "Which part of blood carries both oxygen and CO₂?", options: ["Platelets", "Hemoglobin in RBCs", "Plasma proteins", "WBCs"], correct: 1 }, { id: 668, question: "Which part of blood contributes MOST to immune defense?", options: ["Platelets", "WBCs (leukocytes)", "RBCs", "Serum"], correct: 1 }, { id: 669, question: "Which part of blood is MOST responsible for preventing blood loss?", options: ["WBCs", "Platelets", "RBCs", "Plasma water"], correct: 1 }, { id: 670, question: "Which statement best describes hematopoiesis?", options: ["Production of all blood cells from bone marrow", "Breakdown of hemoglobin in spleen", "Conversion of bilirubin", "Production of serum proteins"], correct: 0 }, { id: 671, question: "In an average adult, the total blood volume is approximately:", options: ["1 liter", "3 liters", "5 liters", "10 liters"], correct: 2 }, { id: 672, question: "Which statement about the composition of blood is MOST accurate?", options: ["Plasma is about 90% of blood volume", "Formed elements (cells) make up about 45% of blood volume", "Red blood cells represent less than 10% of hematocrit", "Plasma does not contain any proteins"], correct: 1 }, { id: 673, question: "Hematocrit refers to:", options: ["The percentage of plasma in blood", "The percentage of blood volume occupied by red blood cells", "The number of white blood cells per mm³", "The concentration of clotting factors"], correct: 1 }, { id: 674, question: "Compared with females, hematocrit in males is:", options: ["5–10% higher", "5–10% lower", "Exactly the same", "Not related to hormones"], correct: 0 }, { id: 675, question: "Which statement best describes the difference between plasma and serum?", options: ["Plasma has no proteins; serum is rich in proteins", "Plasma contains clotting factors; serum does not", "Serum contains clotting factors; plasma does not", "They are identical"], correct: 1 }, { id: 676, question: "Which plasma protein is primarily responsible for maintaining osmotic pressure of the blood?", options: ["Globulins", "Fibrinogen", "Albumin", "Hemoglobin"], correct: 2 }, { id: 677, question: "Gas and nutrient exchange between blood and tissues occurs mainly at the level of:", options: ["Arteries", "Arterioles", "Capillaries", "Veins"], correct: 2 }, { id: 678, question: "Which of the following correctly lists the major blood vessels in order from the heart to the tissues and back?", options: ["Vein → venule → capillary → arteriole → artery", "Artery → arteriole → capillary → venule → vein", "Capillary → artery → venule → arteriole → vein", "Arteriole → artery → capillary → vein → venule"], correct: 1 }, { id: 679, question: "Which blood cell type is the most abundant in blood?", options: ["Leukocytes", "Thrombocytes (platelets)", "Erythrocytes", "All are equal"], correct: 2 }, { id: 680, question: "Leukocytes (white blood cells) are developed from stem cells in the bone marrow through a process called:", options: ["Erythropoiesis", "Leukopoiesis", "Thrombopoiesis", "Fibrinolysis"], correct: 1 }, { id: 681, question: "The unique ability of some leukocytes to leave the bloodstream and enter tissues is called:", options: ["Phagocytosis", "Diapedesis", "Fibrinolysis", "Hemostasis"], correct: 1 }, { id: 682, question: "According to the lecture, which TWO leukocytes are specifically mentioned as being able to perform diapedesis (exit the bloodstream and go to tissues)?", options: ["Neutrophils and eosinophils", "Basophils and monocytes", "Lymphocytes and monocytes", "Eosinophils and lymphocytes"], correct: 1 }, { id: 683, question: "Which of the following is a granulocyte?", options: ["Lymphocyte", "Monocyte", "Neutrophil", "Macrophage"], correct: 2 }, { id: 684, question: "Which leukocyte is most important in allergic reactions and parasitic infections?", options: ["Neutrophils", "Eosinophils", "Basophils", "Lymphocytes"], correct: 1 }, { id: 685, question: "Which leukocytes release histamine and heparin and are involved in inflammation?", options: ["Neutrophils", "Eosinophils", "Basophils", "Lymphocytes"], correct: 2 }, { id: 686, question: "Which cells are mainly responsible for cell-mediated and humoral immunity?", options: ["Neutrophils", "Eosinophils", "Lymphocytes", "Basophils"], correct: 2 }, { id: 687, question: "Monocytes that exit the bloodstream and enter tissues differentiate into:", options: ["Neutrophils", "Platelets", "Macrophages", "Basophils"], correct: 2 }, { id: 688, question: "Thrombocytes (platelets) are:", options: ["Nucleated cells involved in oxygen transport", "Non-nucleated cell fragments essential for hemostasis", "Immune cells that produce antibodies", "Large nucleated cells that live for months"], correct: 1 }, { id: 689, question: "Hemostasis refers to:", options: ["Maintenance of stable internal environment", "Regulation of blood glucose", "Stopping bleeding and forming a blood clot", "Destruction of pathogens"], correct: 2 }, { id: 690, question: "Which is the correct sequence of steps in blood clot formation?", options: ["Platelet plug → vasoconstriction → coagulation", "Coagulation → platelet plug → vasodilation", "Vasoconstriction → platelet accumulation (platelet plug) → coagulation (fibrin clot)", "Fibrinolysis → vasoconstriction → platelet plug"], correct: 2 }, { id: 691, question: "The process of breaking down a blood clot is called:", options: ["Hemopoiesis", "Diapedesis", "Fibrinolysis", "Leukopoiesis"], correct: 2 }, { id: 692, question: "Which of the following can act as a clotting inhibitor to prevent unnecessary clot formation?", options: ["Vitamin K", "Hemoglobin", "Heparin and antithrombin III", "Calcium ions"], correct: 2 }, { id: 693, question: "Which factors were specifically highlighted in the clotting cascade as important for the exam?", options: ["Factors I, II, and V only", "Factor VIII, calcium ions, and vitamin K", "Factor IX and XII only", "Only vitamin C"], correct: 1 }, { id: 694, question: "Antigens that determine blood type (A, B) are located:", options: ["In plasma only", "Inside the nucleus of the RBC", "On the surface of red blood cells", "On platelets only"], correct: 2 }, { id: 695, question: "Which blood type is called the universal donor?", options: ["AB+", "AB−", "O+", "O−"], correct: 3 }, { id: 696, question: "Which blood type is the universal recipient?", options: ["AB+", "AB−", "O+", "O−"], correct: 0 }, { id: 697, question: "A person with blood type A will have:", options: ["Antigen A on RBC and antibody B in plasma", "Antigen B on RBC and antibody A in plasma", "Antigens A and B and no antibodies", "No antigens and both A and B antibodies"], correct: 0 }, { id: 698, question: "A person with A negative (A−) blood:", options: ["Can donate to A and AB, and receive from any type", "Can donate to A and AB (regardless of Rh), but receive only from A− and O−", "Can donate only to A−, and receive from A and AB", "Can only donate to O−"], correct: 1 }, { id: 699, question: "All anemias result in:", options: ["Increased oxygen transport", "Significant reduction in oxygen transport", "Increased hemoglobin synthesis", "Increased ATP production"], correct: 1 }, { id: 700, question: "Decreased oxygen transport in anemia leads to:", options: ["Increased energy production", "Less energy (ATP) production in cells", "No change in cellular metabolism", "Only increased inflammation"], correct: 1 }, { id: 701, question: "Which of the following is a compensatory mechanism in anemia?", options: ["Bradycardia and vasodilation", "Tachycardia and vasoconstriction", "Decreased respiratory rate", "Decreased heart rate"], correct: 1 }, { id: 702, question: "General signs of anemia include all of the following EXCEPT:", options: ["Pallor", "Fatigue", "Dyspnea (shortness of breath)", "Increased regeneration of epithelial cells"], correct: 3 }, { id: 703, question: "Iron deficiency anemia (IDA) is mainly due to:", options: ["Defective white blood cells", "Impaired hemoglobin synthesis because of insufficient iron", "Excessive vitamin B12", "Excessive folic acid intake"], correct: 1 }, { id: 704, question: "In iron deficiency anemia, red blood cells are typically:", options: ["Large and hyperchromic", "Microcytic and hypochromic", "Normal size with normal color", "Macrocytic and hyperchromic"], correct: 1 }, { id: 705, question: "Which of the following is NOT a typical etiology of iron deficiency anemia mentioned in the lecture?", options: ["Insufficient iron intake or absorption", "Chronic blood loss", "Acute liver disease", "Genetic mutation of hemoglobin (like sickle cell disease)"], correct: 3 }, { id: 706, question: "Which symptoms did the professor highlight as especially important for IDA (iron deficiency anemia)?", options: ["Muscle cramps and seizures", "Stomatitis, glossitis, and menstrual irregularities", "Hearing loss and tinnitus", "Night blindness and dry skin"], correct: 1 }, { id: 707, question: "The best treatment strategy for iron deficiency anemia includes:", options: ["High-fat diet", "Iron-rich foods and iron supplements", "Only vitamin C supplementation", "Bed rest only"], correct: 1 }, { id: 708, question: "Pernicious anemia (PA) is primarily associated with deficiency of:", options: ["Iron only", "Vitamin C and vitamin D", "Vitamin B12 and folic acid (B9)", "Calcium and phosphorus"], correct: 2 }, { id: 709, question: "Red blood cells in pernicious anemia are typically:", options: ["Small and hypochromic", "Large (macrocytic / megaloblastic) and pale", "Normal size with increased hemoglobin", "Fragmented and sickle-shaped"], correct: 1 }, { id: 710, question: "In pernicious anemia, red blood cells are typically:", options: ["Microcytic and hypochromic", "Macrocytic (megaloblastic) with low hemoglobin", "Normal size with high hemoglobin", "Fragmented and sickle-shaped"], correct: 1 }, { id: 711, question: "Which deficiencies are most closely associated with pernicious anemia?", options: ["Iron only", "Vitamin B12 and folic acid (B9)", "Vitamin C and vitamin D", "Calcium and phosphorus"], correct: 1 }, { id: 712, question: "Which of the following is NOT listed as a cause (etiology) of pernicious anemia in the lecture?", options: ["Genetic factors", "Malabsorption of vitamin B12", "Gastrectomy (removal of part of the stomach)", "Acute trauma to long bones"], correct: 3 }, { id: 713, question: "Why does gastrectomy increase the risk of pernicious anemia?", options: ["The liver cannot store iron anymore", "The stomach can no longer produce intrinsic factor needed for B12 absorption", "The kidneys stop making erythropoietin", "The intestine stops absorbing glucose"], correct: 1 }, { id: 714, question: "Which symptoms did the professor specifically highlight for pernicious anemia?", options: ["Leg cramps, dry skin, blurred vision", "Glossitis, paresthesia, and digestive discomfort", "Severe bruising and nosebleeds", "Night blindness and hair loss"], correct: 1 }, { id: 715, question: "Which of the following is an appropriate treatment for pernicious anemia?", options: ["Only iron tablets", "High-dose vitamin C", "Oral supplements and vitamin B12 injections", "No treatment is needed"], correct: 2 }, { id: 716, question: "Aplastic anemia is primarily characterized by:", options: ["Excessive destruction of red blood cells in the spleen", "Impairment or failure of bone marrow", "Overproduction of red blood cells", "Defective hemoglobin structure"], correct: 1 }, { id: 717, question: "Which of the following is NOT listed as an etiology (cause) of aplastic anemia?", options: ["Myelotoxic agents (radiation, chemicals, drugs)", "Viral infections such as hepatitis C", "Genetic abnormalities", "Dehydration due to vomiting"], correct: 3 }, { id: 718, question: "In aplastic anemia, the professor emphasized two key laboratory findings:", options: ["Leukocytosis and thrombocytosis", "Leukopenia and thrombocytopenia", "High hemoglobin and high RBC count", "Increased neutrophils and eosinophils"], correct: 1 }, { id: 719, question: "What does the term \"leukopenia\" mean?", options: ["Low red blood cell count", "Low platelet count", "Low white blood cell count", "Low hemoglobin only"], correct: 2 }, { id: 720, question: "Which of the following treatment strategies was mentioned for aplastic anemia?", options: ["Only iron-rich diet", "Removal of bone marrow–suppressing agents, blood transfusion, and possibly bone marrow transplant", "Simple rest and hydration", "Vitamin C and D supplementation"], correct: 1 }, { id: 721, question: "Hemolytic anemia is best defined as:", options: ["Failure of bone marrow to produce any blood cells", "Excessive destruction of red blood cells", "Lack of iron intake", "Overproduction of platelets"], correct: 1 }, { id: 722, question: "Which of the following was NOT listed as an etiology of hemolytic anemia?", options: ["Genetic disorders", "Immune reactions", "Changes in blood chemistry", "Vitamin C deficiency only"], correct: 3 }, { id: 723, question: "Which two specific hemolytic anemias were mentioned as major types?", options: ["Iron deficiency anemia and thalassemia", "Sickle cell anemia and thalassemia", "Aplastic anemia and pernicious anemia", "Hemophilia and sickle cell anemia"], correct: 1 }, { id: 724, question: "Sickle cell anemia is caused by:", options: ["Lack of iron intake", "Lack of vitamin B12", "Formation of abnormal hemoglobin due to a genetic mutation", "Excess erythropoietin secretion"], correct: 2 }, { id: 725, question: "What does \"diploid\" mean, as explained in the lecture?", options: ["Having only one copy of each gene", "Having two sets of chromosomes, thus two copies (alleles) of each gene", "Having three copies of each gene", "Having no chromosomes"], correct: 1 }, { id: 726, question: "In the simplified notation used in the textbook and lecture, the genotype AA represents:", options: ["A person with sickle cell disease", "A carrier (trait)", "A healthy person with normal hemoglobin", "A person with thalassemia"], correct: 2 }, { id: 727, question: "The genotype AS (or HBA HBS) represents:", options: ["A diseased person with severe sickle cell anemia", "A carrier (sickle cell trait)", "A person with aplastic anemia", "A person with iron deficiency anemia"], correct: 1 }, { id: 728, question: "The genotype SS (or HBS HBS) represents:", options: ["Completely healthy", "Carrier with no risk for children", "Diseased person with sickle cell anemia", "Person with only thalassemia minor"], correct: 2 }, { id: 729, question: "Which amino acid substitution in the beta chain of hemoglobin is responsible for sickle cell anemia?", options: ["Valine → glutamic acid", "Glutamic acid → valine", "Lysine → alanine", "Glycine → serine"], correct: 1 }, { id: 730, question: "What is the MAIN consequence of the abnormal sickle hemoglobin on red blood cells?", options: ["RBCs become smaller and paler", "RBCs become spherical and very flexible", "RBCs become sickle-shaped, get stuck in capillaries, and have shorter lifespan", "RBCs become transparent and invisible in smear"], correct: 2 }, { id: 731, question: "Which of the following best describes the risk in a couple where BOTH parents are carriers (AS x AS) for sickle cell?", options: ["0% chance of sickle cell disease in children", "25% healthy (AA), 50% carriers (AS), 25% disease (SS)", "50% healthy, 50% disease", "100% carriers only"], correct: 1 }, { id: 732, question: "Which statement about carriers (AS / trait) is TRUE?", options: ["They always have severe symptoms of sickle cell disease", "They never pass the gene to their children", "They may have mild or no symptoms, but can transmit the defective allele", "They cannot marry another carrier"], correct: 2 }, { id: 733, question: "A person with genotype AA for the sickle cell gene (using the simplified notation from the lecture) is:", options: ["Diseased (sickle cell anemia)", "Carrier (trait)", "Healthy", "Unable to produce hemoglobin"], correct: 2 }, { id: 734, question: "A person with genotype AS is best described as:", options: ["Having full sickle cell anemia", "A carrier (sickle cell trait)", "Completely healthy with no abnormal allele", "Having thalassemia"], correct: 1 }, { id: 735, question: "A person with genotype SS will:", options: ["Be a normal healthy individual", "Be a carrier only", "Have sickle cell anemia", "Be unable to have children"], correct: 2 }, { id: 736, question: "Which of the following best describes homozygous for the sickle cell gene?", options: ["AA only", "AS only", "AA and SS", "Only SS"], correct: 2 }, { id: 737, question: "Which of the following best describes heterozygous for the sickle cell gene?", options: ["AA", "AS", "SS", "No alleles present"], correct: 1 }, { id: 738, question: "What is the probability of a child with sickle cell anemia (SS) if a carrier man (AS) marries a healthy woman (AA)?", options: ["0%", "25%", "50%", "75%"], correct: 0 }, { id: 739, question: "In the example from the lecture, what is the probability of a child with sickle cell anemia if both parents are carriers (AS × AS)?", options: ["0%", "25%", "50%", "75%"], correct: 1 }, { id: 740, question: "Which of the following is a major complication of sickle cell anemia, as described in the lecture?", options: ["RBCs become smaller and very flexible", "RBCs become sickle-shaped, get stuck in vessels, causing thrombosis and necrosis", "Platelets disappear completely", "Plasma volume is zero"], correct: 1 }, { id: 741, question: "Which symptom is particularly associated with sickle cell anemia in the lecture?", options: ["Hyperbilirubinemia and jaundice", "Only headache", "Only hypertension", "Only night blindness"], correct: 0 }, { id: 742, question: "Hemophilia A is mainly caused by a deficiency of:", options: ["Clotting factor II", "Clotting factor V", "Clotting factor VIII", "Clotting factor X"], correct: 2 }, { id: 743, question: "Hemophilia A is transmitted via:", options: ["Y chromosome", "X chromosome (X-linked)", "Autosomal dominant gene", "Mitochondrial DNA"], correct: 1 }, { id: 744, question: "Why is hemophilia A more common and more severe in males?", options: ["Males have more platelets", "Males have no X chromosome", "Males have only one X chromosome, so one abnormal allele causes disease", "Males cannot produce factor VIII at all"], correct: 2 }, { id: 745, question: "Which genotypes are possible in females for hemophilia A, using the notation in lecture?", options: ["XᴴY and XʰY", "XᴴXᴴ, XᴴXʰ, and XʰXʰ", "Only XʰXʰ", "Only XᴴXᴴ"], correct: 1 }, { id: 746, question: "What are the two possible genotypes for males regarding hemophilia A?", options: ["XᴴXᴴ and XʰXʰ", "XᴴY and XʰY", "XᴴY and YY", "XᴴXʰ and XY"], correct: 1 }, { id: 747, question: "In the lecture example, a diseased man (XʰY) marries a trait woman (XᴴXʰ). What is the probability that their daughters (girls) have hemophilia A?", options: ["0%", "25% of all daughters (50% of daughters)", "50% of all children", "100% of daughters"], correct: 1 }, { id: 748, question: "Which of the following is a typical clinical feature of hemophilia A?", options: ["Severe hemorrhage after minor trauma", "Dehydration without bleeding", "Only low blood pressure", "Only headache without bleeding"], correct: 0 }, { id: 749, question: "Which of the following treatments was mentioned for hemophilia A?", options: ["High-dose iron only", "Vitamin B12 injection", "DDAVP and replacement of factor VIII", "Bone marrow transplant only"], correct: 2 }, { id: 750, question: "Leukemia is best defined as:", options: ["Overproduction of platelets", "Overproduction of erythrocytes", "Uncontrolled multiplication of leukocytes (white blood cells)", "Complete absence of plasma"], correct: 2 }, { id: 751, question: "Which statement correctly matches acute leukemia?", options: ["Involves mature cells and usually older adults", "Involves immature white blood cells and is more common in children", "Involves only red blood cells", "Only affects platelets"], correct: 1 }, { id: 752, question: "ALL stands for:", options: ["Acute Lymphocytic Leukemia", "Acute Liver Lesion", "Adult Lymph Node Loss", "Acute Low Leukocyte"], correct: 0 }, { id: 753, question: "AML stands for:", options: ["Acute Myelogenous Leukemia", "Acute Muscle Lesion", "Adult Myxoma Leukemia", "Autoimmune Myeloid Loss"], correct: 0 }, { id: 754, question: "Which of the following is TRUE about chronic leukemia according to the lecture?", options: ["It produces immature cells and usually affects children", "It produces mature cells and usually affects older people", "It only affects platelets", "It is always caused by vitamin deficiency"], correct: 1 }, { id: 755, question: "Common symptoms of leukemia mentioned in the lecture include:", options: ["Severe hemorrhage, bone pain, weight loss, splenomegaly and hepatomegaly", "Only fever and cough", "Only nausea and vomiting", "Only hair loss"], correct: 0 }, { id: 756, question: "Which treatment options were listed for leukemia?", options: ["Antibiotics only", "Chemotherapy, interferons, and bone marrow transplant in severe cases", "Vitamin C tablets only", "Iron-rich diet only"], correct: 1 }, { id: 757, question: "Which of the following is NOT one of the five key functions of blood mentioned?", options: ["Transport of oxygen and nutrients", "Removal of waste products", "Maintaining homeostasis", "Producing bile in the liver"], correct: 3 }, { id: 758, question: "Approximately what percentage of whole blood volume is cells (hematocrit)?", options: ["10%", "25%", "45%", "90%"], correct: 2 }, { id: 759, question: "Plasma minus clotting factors is called:", options: ["Serum", "Bile", "Lymph", "Interstitial fluid"], correct: 0 }, { id: 760, question: "Which three components did the professor highlight as especially important for blood clotting?", options: ["Albumin, hemoglobin, sodium", "Calcium, vitamin K, and clotting factor VIII", "Iron, vitamin C, and albumin", "Glucose, insulin, and fibrinogen"], correct: 1 }, { id: 761, question: "Correct sequence of events in hemostasis (clot formation) is:", options: ["Coagulation → vasoconstriction → platelet plug", "Platelet plug → vasoconstriction → coagulation", "Vasoconstriction → platelet accumulation (platelet plug) → coagulation", "Coagulation → platelet accumulation → vasodilation"], correct: 2 }, { id: 762, question: "The breakdown of a blood clot (fibrin) is called:", options: ["Hematopoiesis", "Fibrinolysis", "Diapedesis", "Hemostasis"], correct: 1 } ] }; export default function ImprovedTestBankApp() { const [screen, setScreen] = useState('home'); const [selectedSubject, setSelectedSubject] = useState(null); const [selectedSubtopic, setSelectedSubtopic] = useState(null); const [currentQuestionIndex, setCurrentQuestionIndex] = useState(0); const [selectedAnswer, setSelectedAnswer] = useState(null); const [answers, setAnswers] = useState([]); const [timeLeft, setTimeLeft] = useState(0); const [testStarted, setTestStarted] = useState(false); const [totalTestTime, setTotalTestTime] = useState(0); const [testHistory, setTestHistory] = useState([]); const [selectedQuestions, setSelectedQuestions] = useState([]); const [questionLimit, setQuestionLimit] = useState({}); const [shuffledOptions, setShuffledOptions] = useState([]); const [isAnswerSubmitted, setIsAnswerSubmitted] = useState(false); const [studyMode, setStudyMode] = useState(false); const [flaggedQuestions, setFlaggedQuestions] = useState([]); const [showReview, setShowReview] = useState(false); const [reviewAnswers, setReviewAnswers] = useState([]); const [isPaused, setIsPaused] = useState(false); const [parentSubject, setParentSubject] = useState(null); // Load data from localStorage on mount useEffect(() => { try { const savedHistory = localStorage.getItem('testHistory'); if (savedHistory) { setTestHistory(JSON.parse(savedHistory)); } const savedFlags = localStorage.getItem('flaggedQuestions'); if (savedFlags) { setFlaggedQuestions(JSON.parse(savedFlags)); } } catch (error) { console.error('Error loading saved data:', error); } }, []); // Save test history to localStorage useEffect(() => { try { localStorage.setItem('testHistory', JSON.stringify(testHistory)); } catch (error) { console.error('Error saving test history:', error); } }, [testHistory]); // Save flagged questions to localStorage useEffect(() => { try { localStorage.setItem('flaggedQuestions', JSON.stringify(flaggedQuestions)); } catch (error) { console.error('Error saving flagged questions:', error); } }, [flaggedQuestions]); // Timer logic - FIXED to only run during active test and when not paused useEffect(() => { if (testStarted && !studyMode && !isPaused && timeLeft > 0 && screen === 'test') { const timer = setInterval(() => { setTimeLeft(prev => prev - 1); }, 1000); return () => clearInterval(timer); } else if (!studyMode && timeLeft === 0 && testStarted && screen === 'test') { finishTest(); } }, [testStarted, timeLeft, screen, studyMode, isPaused]); // Memoized statistics calculation const detailedStats = useMemo(() => { if (testHistory.length === 0) return null; const totalTests = testHistory.length; const averageScore = Math.round( testHistory.reduce((sum, t) => sum + t.score, 0) / totalTests ); const totalQuestions = testHistory.reduce((sum, t) => sum + t.total, 0); const totalCorrect = testHistory.reduce((sum, t) => sum + t.correct, 0); const bestScore = Math.max(...testHistory.map(t => t.score)); const worstScore = Math.min(...testHistory.map(t => t.score)); // Calculate recent trend (last 5 tests vs previous 5 tests) let trend = 'stable'; if (totalTests >= 10) { const recent5 = testHistory.slice(0, 5).reduce((sum, t) => sum + t.score, 0) / 5; const previous5 = testHistory.slice(5, 10).reduce((sum, t) => sum + t.score, 0) / 5; if (recent5 > previous5 + 5) trend = 'improving'; else if (recent5 < previous5 - 5) trend = 'declining'; } return { totalTests, averageScore, totalQuestions, totalCorrect, bestScore, worstScore, accuracy: Math.round((totalCorrect / totalQuestions) * 100), trend }; }, [testHistory]); // Memoized subject statistics const subjectStats = useMemo(() => { const stats = {}; testHistory.forEach(test => { const key = test.subtopic || test.subject; if (!stats[key]) { stats[key] = { total: 0, scores: [], questions: 0, correct: 0 }; } stats[key].total++; stats[key].scores.push(test.score); stats[key].questions += test.total; stats[key].correct += test.correct; }); return stats; }, [testHistory]); const selectSubject = (subject) => { if (subjectsWithSubtopics[subject]) { setSelectedSubject(subject); setQuestionLimit({}); setScreen('subtopics'); } else { setSelectedSubject(subject); setScreen('questionInput'); } }; const handleQuestionLimitChange = (key, value) => { setQuestionLimit(prev => ({ ...prev, [key]: value })); }; const shuffleArray = (array) => { const shuffled = [...array]; for (let i = shuffled.length - 1; i > 0; i--) { const j = Math.floor(Math.random() * (i + 1)); [shuffled[i], shuffled[j]] = [shuffled[j], shuffled[i]]; } return shuffled; }; const shuffleOptions = (question) => { const optionsWithIndex = question.options.map((option, index) => ({ text: option, originalIndex: index })); const shuffled = [...optionsWithIndex]; for (let i = shuffled.length - 1; i > 0; i--) { const j = Math.floor(Math.random() * (i + 1)); [shuffled[i], shuffled[j]] = [shuffled[j], shuffled[i]]; } return shuffled; }; const startTest = (subject, subtopic = null) => { try { // Store parent for back navigation if (subtopic) { setParentSubject(subject); } else { setParentSubject(null); } setSelectedSubject(subject); setSelectedSubtopic(subtopic); setCurrentQuestionIndex(0); setSelectedAnswer(null); setAnswers([]); setReviewAnswers([]); setIsAnswerSubmitted(false); setIsPaused(false); const questionKey = subtopic || subject; const allQuestions = questionBank[questionKey] || []; if (allQuestions.length === 0) { alert('No questions available for this topic yet.'); return; } const limit = questionLimit[questionKey]; let questionsToUse = allQuestions; if (limit && !isNaN(limit) && limit > 0 && limit < allQuestions.length) { questionsToUse = shuffleArray(allQuestions).slice(0, parseInt(limit)); } setSelectedQuestions(questionsToUse); // Shuffle options for all questions const allShuffledOptions = questionsToUse.map(q => shuffleOptions(q)); setShuffledOptions(allShuffledOptions); const totalTime = studyMode ? 0 : questionsToUse.length * 90; setTimeLeft(totalTime); setTotalTestTime(totalTime); setTestStarted(true); setScreen('test'); } catch (error) { console.error('Error starting test:', error); alert('An error occurred while starting the test. Please try again.'); } }; const startFlaggedTest = (subject, subtopic = null) => { try { // Store parent for back navigation if (subtopic) { setParentSubject(subject); } else { setParentSubject(null); } setSelectedSubject(subject); setSelectedSubtopic(subtopic); setCurrentQuestionIndex(0); setSelectedAnswer(null); setAnswers([]); setReviewAnswers([]); setIsAnswerSubmitted(false); setIsPaused(false); const questionKey = subtopic || subject; const flaggedQs = getFlaggedQuestionsForTopic(questionKey); if (flaggedQs.length === 0) { alert('No flagged questions for this topic yet. Flag questions during practice to review them later!'); return; } setSelectedQuestions(flaggedQs); // Shuffle options for all questions const allShuffledOptions = flaggedQs.map(q => shuffleOptions(q)); setShuffledOptions(allShuffledOptions); const totalTime = studyMode ? 0 : flaggedQs.length * 90; setTimeLeft(totalTime); setTotalTestTime(totalTime); setTestStarted(true); setScreen('test'); } catch (error) { console.error('Error starting flagged test:', error); alert('An error occurred while starting the test. Please try again.'); } }; const selectAnswer = (index) => { if (!isAnswerSubmitted) { setSelectedAnswer(index); } }; const submitAnswer = () => { if (selectedAnswer === null) return; setIsAnswerSubmitted(true); }; const toggleFlag = () => { const currentQuestion = selectedQuestions[currentQuestionIndex]; const questionId = currentQuestion.id; if (flaggedQuestions.includes(questionId)) { setFlaggedQuestions(flaggedQuestions.filter(id => id !== questionId)); } else { setFlaggedQuestions([...flaggedQuestions, questionId]); } }; const nextQuestion = () => { const currentQuestion = selectedQuestions[currentQuestionIndex]; const currentShuffledOptions = shuffledOptions[currentQuestionIndex]; // Map the selected shuffled option back to original index const originalCorrectIndex = selectedAnswer !== null ? currentShuffledOptions[selectedAnswer]?.originalIndex : null; const newAnswers = [...answers, originalCorrectIndex]; setAnswers(newAnswers); // Store for review const reviewData = { question: currentQuestion, selectedAnswer: originalCorrectIndex, correctAnswer: currentQuestion.correct, isCorrect: originalCorrectIndex === currentQuestion.correct }; setReviewAnswers([...reviewAnswers, reviewData]); if (currentQuestionIndex < selectedQuestions.length - 1) { setCurrentQuestionIndex(currentQuestionIndex + 1); setSelectedAnswer(null); setIsAnswerSubmitted(false); } else { finishTest(newAnswers); } }; const finishTest = (finalAnswers = answers) => { setTestStarted(false); let correct = 0; finalAnswers.forEach((answer, idx) => { if (answer === selectedQuestions[idx].correct) correct++; }); const score = selectedQuestions.length > 0 ? Math.round((correct / selectedQuestions.length) * 100) : 0; const timeTaken = studyMode ? 0 : totalTestTime - timeLeft; const result = { subject: selectedSubject, subtopic: selectedSubtopic, score, correct, total: selectedQuestions.length, timeTaken, date: new Date().toLocaleString(), studyMode }; setTestHistory([result, ...testHistory]); setShowReview(false); setScreen('results'); }; const exportResults = () => { try { const csv = testHistory.map(t => `${t.date},${t.subject},"${t.subtopic || ''}",${t.score}%,${t.correct}/${t.total},${formatTime(t.timeTaken)},${t.studyMode ? 'Study' : 'Timed'}` ).join('\n'); const csvContent = `Date,Subject,Topic,Score,Correct/Total,Time,Mode\n${csv}`; const blob = new Blob([csvContent], { type: 'text/csv' }); const url = URL.createObjectURL(blob); const a = document.createElement('a'); a.href = url; a.download = `test-history-${new Date().toISOString().split('T')[0]}.csv`; a.click(); URL.revokeObjectURL(url); } catch (error) { console.error('Error exporting results:', error); alert('Failed to export results. Please try again.'); } }; const clearHistory = () => { if (window.confirm('Are you sure you want to clear all test history? This cannot be undone.')) { setTestHistory([]); localStorage.removeItem('testHistory'); } }; const formatTime = (seconds) => { const mins = Math.floor(seconds / 60); const secs = seconds % 60; return `${mins}:${secs.toString().padStart(2, '0')}`; }; const getFlaggedQuestionsForTopic = (topicKey) => { const allQuestions = questionBank[topicKey] || []; return allQuestions.filter(q => flaggedQuestions.includes(q.id)); }; // Home Screen if (screen === 'home') { return (

Dental Hygiene Test Bank

{detailedStats && (
Your Progress {detailedStats.trend === 'improving' && }
{detailedStats.averageScore}%
Avg Score
{detailedStats.totalTests}
Tests
{detailedStats.accuracy}%
Accuracy
)}

Select a lecture to view subjects

{Object.keys(subjectsByLecture).map((lecture, index) => { const subjectCount = subjectsByLecture[lecture].length; return ( ); })}
); } // Question Input Screen if (screen === 'questionInput') { const totalQuestions = questionBank[selectedSubject]?.length || 0; const currentLimit = questionLimit[selectedSubject] || ''; const flaggedCount = getFlaggedQuestionsForTopic(selectedSubject).length; return (

{selectedSubject}

Total available questions: {totalQuestions} {flaggedCount > 0 && ( • {flaggedCount} flagged )}

handleQuestionLimitChange(selectedSubject, e.target.value)} placeholder={`Enter 1-${totalQuestions}`} className="w-full px-4 py-3 border-2 border-gray-300 rounded-xl focus:border-blue-500 focus:outline-none text-lg" aria-label="Number of questions" />

Leave empty to practice all {totalQuestions} questions

{flaggedCount > 0 && ( )}
); } // Subtopics Screen if (screen === 'subtopics') { const subtopics = subjectsWithSubtopics[selectedSubject]; const isLecture = selectedSubject.startsWith('Lecture'); return (

{selectedSubject}

{isLecture ? 'Select a subject to start your test' : 'Select a topic to start your test'}

{subtopics.map((subtopic, index) => { const hasQuestions = questionBank[subtopic]?.length > 0; const questionCount = questionBank[subtopic]?.length || 0; const currentLimit = questionLimit[subtopic] || ''; const flaggedCount = getFlaggedQuestionsForTopic(subtopic).length; // Check if this subtopic has its own subtopics (like Pathophysiology) const hasSubSubtopics = subjectsWithSubtopics[subtopic]; return (
{subtopic}
{hasSubSubtopics ? ( ) : hasQuestions ? ( <> {questionCount} Q {flaggedCount > 0 && ( {flaggedCount} )} ) : ( Coming soon )}
{hasQuestions && !hasSubSubtopics && (
handleQuestionLimitChange(subtopic, e.target.value)} placeholder={`Max ${questionCount}`} className="flex-1 px-3 py-2 border border-gray-300 rounded-lg focus:border-blue-500 focus:outline-none text-sm" onClick={(e) => e.stopPropagation()} aria-label={`Number of questions for ${subtopic}`} />
{flaggedCount > 0 && ( )}
)}
); })}
); } // Test Screen if (screen === 'test') { const currentQuestion = selectedQuestions[currentQuestionIndex]; const currentShuffledOptions = shuffledOptions[currentQuestionIndex]; if (!currentQuestion) { return (

No questions available for this subject yet.

); } const correctAnswerIndex = currentShuffledOptions.findIndex( opt => opt.originalIndex === currentQuestion.correct ); const isCorrect = selectedAnswer === correctAnswerIndex; const isFlagged = flaggedQuestions.includes(currentQuestion.id); return (
{/* Spacer to maintain layout */} {!studyMode && (
{formatTime(timeLeft)}
)} {studyMode &&
Study Mode
}
{currentQuestionIndex + 1}/{selectedQuestions.length}
{selectedSubject}{selectedSubtopic ? ` • ${selectedSubtopic}` : ''}
{!studyMode && ( )}
{/* Blur overlay when paused */} {isPaused && (

Test Paused

Timer is stopped

)}

{currentQuestion.question}

{currentShuffledOptions.map((option, index) => { const isThisCorrect = index === correctAnswerIndex; const isSelected = selectedAnswer === index; let buttonClass = 'bg-gray-100 text-gray-700 hover:bg-gray-200'; if (isAnswerSubmitted) { if (isThisCorrect) { buttonClass = 'bg-green-500 text-white'; } else if (isSelected && !isCorrect) { buttonClass = 'bg-red-500 text-white'; } else { buttonClass = 'bg-gray-100 text-gray-400'; } } else if (isSelected) { buttonClass = 'bg-blue-600 text-white shadow-lg scale-105'; } return ( ); })}
{isAnswerSubmitted && !isCorrect && (

Incorrect Answer

Correct answer: {currentQuestion.options[currentQuestion.correct]}

)} {isAnswerSubmitted && isCorrect && (

Correct!

)}
); } // Review Screen if (screen === 'review') { return (

Answer Review

{reviewAnswers.map((review, index) => (

Question {index + 1}: {review.question.question}

{review.isCorrect ? ( ) : ( )}
{review.question.options.map((option, optIndex) => { const isCorrect = optIndex === review.correctAnswer; const wasSelected = optIndex === review.selectedAnswer; return (
{String.fromCharCode(65 + optIndex)}. {option} {isCorrect && ✓ Correct} {wasSelected && !isCorrect && Your answer}
); })}
))}
); } // Results Screen if (screen === 'results') { const lastResult = testHistory[0]; return (

{lastResult.studyMode ? 'Study Session Complete!' : 'Test Complete!'}

{lastResult.subject}

{lastResult.subtopic &&

{lastResult.subtopic}

}
{lastResult.score}%

Your Score

{lastResult.correct}
Correct
{lastResult.total - lastResult.correct}
Incorrect
{!lastResult.studyMode && (
Time: {formatTime(lastResult.timeTaken)}
)}
{reviewAnswers.length > 0 && ( )} {selectedSubtopic && ( )}
); } // Progress Screen if (screen === 'progress') { return (

Progress Analytics

{detailedStats && (

Overall Statistics

{detailedStats.averageScore}%
Average Score
{detailedStats.totalTests}
Tests Taken
{detailedStats.bestScore}%
Best Score
{detailedStats.accuracy}%
Accuracy
{detailedStats.trend !== 'stable' && (
Your scores are {detailedStats.trend}!
)}
)} {Object.keys(subjectStats).length === 0 ? (

No test data yet. Take a test to see your progress!

) : (

Subject Breakdown

{Object.entries(subjectStats).map(([subject, stats]) => { const avgScore = Math.round(stats.scores.reduce((a, b) => a + b, 0) / stats.scores.length); const accuracy = Math.round((stats.correct / stats.questions) * 100); return (

{subject}

Average Score {avgScore}%
Tests
{stats.total}
Questions
{stats.questions}
Accuracy
{accuracy}%
); })}
)}
); } // History Screen if (screen === 'history') { return (

Test History

{testHistory.length > 0 && (
)} {testHistory.length === 0 ? (

No test history yet. Start taking tests!

) : (
{testHistory.map((test, index) => (

{test.subject}

{test.studyMode && ( Study )}
{test.subtopic &&

{test.subtopic}

}

{test.date}

= 70 ? 'text-green-600' : 'text-red-600'}`}> {test.score}%
{test.correct}/{test.total} correct {!test.studyMode && {formatTime(test.timeTaken)}}
))}
)}
); } }