quiz of 10 mcqs from topic of autonomic nervous system for class 2 nd year mbbs

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🧠 Autonomic Nervous System - MCQ Quiz (2nd Year MBBS)

10 Questions | Single Best Answer Format

Q1. The sympathetic division of the autonomic nervous system is called the "thoracolumbar" division because its preganglionic neurons originate from:

A) Cranial nerves III, VII, IX, X and sacral segments S2-S4
B) Thoracic T1 to lumbar L2-L3 segments of the spinal cord
C) All spinal cord segments from C1 to S5
D) Only the lumbar segments L1-L5

✅ Answer: B Explanation: Preganglionic sympathetic neurons are located in the intermediolateral (IML) column of spinal cord segments T1 through L2-L3 (thoracolumbar). The parasympathetic division uses craniosacral outflow (CN III, VII, IX, X and S2-S4). - Ganong's Review of Medical Physiology, 26th Ed.

Q2. All preganglionic autonomic neurons (both sympathetic and parasympathetic) release which neurotransmitter?

A) Norepinephrine
B) Dopamine
C) Acetylcholine
D) Serotonin

✅ Answer: C Explanation: Whether in the sympathetic or parasympathetic division, ALL preganglionic neurons are cholinergic - they release acetylcholine (ACh). Postganglionic neurons may be either adrenergic (norepinephrine) or cholinergic (ACh). - Costanzo Physiology, 7th Ed.

Q3. Sweat glands are an important exception in ANS innervation because they are:

A) Innervated by parasympathetic postganglionic fibers releasing ACh
B) Innervated by sympathetic postganglionic fibers that are cholinergic (release ACh)
C) Innervated by sympathetic adrenergic fibers releasing norepinephrine
D) Not innervated by the autonomic nervous system

✅ Answer: B Explanation: Sweat glands have sympathetic cholinergic innervation - the postganglionic fibers are sympathetic in anatomical origin but release ACh rather than norepinephrine. This is a classic exam exception. - Costanzo Physiology, 7th Ed. (Fig. 2.1 caption)

Q4. The adrenal medulla is essentially a modified sympathetic ganglion. Unlike typical sympathetic postganglionic neurons, the chromaffin cells of the adrenal medulla secrete primarily:

A) Norepinephrine (80%) and epinephrine (20%)
B) Epinephrine (80%) and norepinephrine (20%)
C) Dopamine only
D) Acetylcholine

✅ Answer: B Explanation: The adrenal medulla secretes mainly epinephrine (80%) and a smaller amount of norepinephrine (20%). This is because the enzyme PNMT (phenylethanolamine-N-methyltransferase) is present in the adrenal medulla and converts norepinephrine to epinephrine. PNMT activity requires cortisol from the adrenal cortex. - Costanzo Physiology, 7th Ed.

Q5. A pheochromocytoma that is located ectopically (away from the adrenal gland) secretes predominantly:

A) Epinephrine, because it has more PNMT activity
B) Norepinephrine, because it lacks access to adrenal cortex cortisol needed to activate PNMT
C) Equal amounts of epinephrine and norepinephrine
D) Acetylcholine

✅ Answer: B Explanation: Ectopic pheochromocytomas secrete mainly norepinephrine because they are located too far from the adrenal cortex to receive cortisol, which is required by PNMT to convert norepinephrine to epinephrine. This also applies to extra-adrenal/paraganglioma tumors. - Costanzo Physiology, 7th Ed.

Q6. Which of the following effects is produced by parasympathetic (vagal) stimulation of the heart?

A) Increased heart rate and increased contractility
B) Increased heart rate and decreased contractility
C) Decreased heart rate and slight decrease in contractility
D) No effect on heart rate; only decreases contractility

✅ Answer: C Explanation: Parasympathetic (vagal) stimulation causes a marked decrease in heart rate and a slight decrease in myocardial contractility. The sympathetic nervous system, in contrast, markedly increases both heart rate and contractility. - Guyton & Hall Textbook of Medical Physiology

Q7. The "fight or flight" response is mediated by massive activation of the sympathetic nervous system. Which of the following is NOT a feature of this response?

A) Increased heart rate and cardiac output
B) Dilation of airways (bronchodilation)
C) Increased gastrointestinal motility and secretions
D) Redistribution of blood flow toward skeletal muscle

✅ Answer: C Explanation: During the fight or flight response, gastrointestinal motility and secretions are DECREASED (not increased), as blood is redirected away from the gut toward skeletal muscles and vital organs. All the other options are true features of sympathetic activation. - Costanzo Physiology, 7th Ed.

Q8. Preganglionic neurons that project directly to the effector organ without synapsing in a peripheral ganglion are found in innervation of which structure?

A) Sweat glands
B) Heart
C) Adrenal medulla
D) Iris of the eye

✅ Answer: C Explanation: The adrenal medulla is the only effector organ that receives direct preganglionic axon terminals without an intervening postganglionic neuron. The chromaffin cells of the adrenal medulla act as the "postganglionic neurons" themselves. - Ganong's Review of Medical Physiology, 26th Ed.

Q9. Which receptors are found at the ganglionic synapse of BOTH the sympathetic and parasympathetic nervous systems?

A) Muscarinic (M2) receptors
B) Nicotinic receptors (N-type / NN)
C) α1-adrenoceptors
D) β2-adrenoceptors

✅ Answer: B Explanation: Nicotinic receptors (specifically the NN or ganglionic subtype) are present at the autonomic ganglia in both sympathetic and parasympathetic divisions. Acetylcholine released from preganglionic neurons acts on these nicotinic receptors on the postganglionic neuron cell body. Muscarinic receptors are on target effector organs, not at the ganglia. - Costanzo Physiology, 7th Ed.

Q10. Which of the following best distinguishes the anatomical organization of the sympathetic versus parasympathetic nervous system?

A) Sympathetic has long preganglionic and short postganglionic fibers; parasympathetic has short preganglionic and long postganglionic fibers
B) Sympathetic has short preganglionic and long postganglionic fibers; parasympathetic has long preganglionic and short postganglionic fibers
C) Both have equally long preganglionic and postganglionic fibers
D) Sympathetic ganglia are located within the wall of the effector organ; parasympathetic ganglia are located in the paravertebral chain

✅ Answer: B Explanation: A key anatomical distinction - sympathetic preganglionic fibers are SHORT (synapse in the paravertebral/paravertebral chain ganglia, close to the spinal cord) and postganglionic fibers are LONG (travel to distant effector organs). Parasympathetic is the opposite: long preganglionic fibers that travel far, and short postganglionic fibers in ganglia located near or within the effector organ wall (terminal ganglia). - Ganong's Review of Medical Physiology, 26th Ed.

📊 Answer Key Summary

Q	Answer	Topic
1	B	Sympathetic outflow origin
2	C	Preganglionic neurotransmitter
3	B	Sweat gland exception
4	B	Adrenal medulla secretion
5	B	Pheochromocytoma - ectopic
6	C	Parasympathetic heart effects
7	C	Fight or flight response
8	C	Direct preganglionic innervation
9	B	Ganglionic receptors
10	B	Pre vs postganglionic fiber length

Sources: Costanzo Physiology 7th Ed. | Ganong's Review of Medical Physiology 26th Ed. | Guyton & Hall Textbook of Medical Physiology

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    q: "The sympathetic division of the ANS is called the 'thoracolumbar' division because its preganglionic neurons originate from:",
    opts: [
      "Cranial nerves III, VII, IX, X and sacral segments S2–S4",
      "Thoracic T1 to lumbar L2–L3 segments of the spinal cord",
      "All spinal cord segments from C1 to S5",
      "Only the lumbar segments L1–L5"
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    diff: "easy",
    exp: "<strong>Thoracolumbar outflow (T1–L2/L3).</strong> Preganglionic sympathetic neurons are located in the intermediolateral (IML) column of the spinal cord at T1 through L2–L3. The parasympathetic division uses <em>craniosacral</em> outflow (CN III, VII, IX, X and S2–S4). <br><small>— Ganong's Review of Medical Physiology, 26th Ed.</small>"
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  {
    q: "All preganglionic autonomic neurons — both sympathetic and parasympathetic — release which neurotransmitter?",
    opts: [
      "Norepinephrine",
      "Dopamine",
      "Acetylcholine",
      "Serotonin"
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    ans: 2,
    diff: "easy",
    exp: "<strong>Acetylcholine (ACh).</strong> Whether in the sympathetic or parasympathetic division, ALL preganglionic neurons are cholinergic. Postganglionic neurons may be adrenergic (NE) or cholinergic (ACh). <br><small>— Costanzo Physiology, 7th Ed.</small>"
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  {
    q: "Sweat glands are innervated by postganglionic fibers that are sympathetic in origin but release:",
    opts: [
      "Norepinephrine — adrenergic innervation",
      "Acetylcholine — sympathetic cholinergic exception",
      "Dopamine — dopaminergic innervation",
      "Substance P — peptidergic innervation"
    ],
    ans: 1,
    diff: "medium",
    exp: "<strong>Sympathetic cholinergic exception.</strong> Sweat glands receive sympathetic postganglionic fibers that are anatomically sympathetic but functionally cholinergic (release ACh, not NE). This is a classic exam exception. <br><small>— Costanzo Physiology, 7th Ed. (Fig. 2.1)</small>"
  },
  {
    q: "The adrenal medulla secretes catecholamines in which ratio?",
    opts: [
      "80% Norepinephrine : 20% Epinephrine",
      "80% Epinephrine : 20% Norepinephrine",
      "50% Epinephrine : 50% Norepinephrine",
      "100% Dopamine"
    ],
    ans: 1,
    diff: "easy",
    exp: "<strong>80% Epinephrine : 20% NE.</strong> The enzyme PNMT in adrenal medullary chromaffin cells converts NE → Epinephrine. PNMT activity depends on cortisol supplied by the nearby adrenal cortex. Sympathetic postganglionic neurons (lacking PNMT) release NE only. <br><small>— Costanzo Physiology, 7th Ed.</small>"
  },
  {
    q: "An ectopic pheochromocytoma (located away from the adrenal gland) predominantly secretes:",
    opts: [
      "Epinephrine, because PNMT is more active outside the adrenal gland",
      "Equal epinephrine and norepinephrine",
      "Norepinephrine, because it lacks cortisol needed to activate PNMT",
      "Acetylcholine"
    ],
    ans: 2,
    diff: "hard",
    exp: "<strong>Mainly Norepinephrine.</strong> Ectopic pheochromocytomas lack access to adrenal cortex cortisol, so PNMT cannot convert NE to epinephrine. Diagnosis is confirmed by elevated urinary VMA, metanephrines, and normetanephrines. Treatment starts with an α1-blocker before surgery. <br><small>— Costanzo Physiology, 7th Ed. (Box 2.1)</small>"
  },
  {
    q: "Parasympathetic (vagal) stimulation of the heart produces:",
    opts: [
      "Increased heart rate and increased contractility",
      "Increased heart rate and decreased contractility",
      "Decreased heart rate and slight decrease in contractility",
      "No change in heart rate; only decreases contractility"
    ],
    ans: 2,
    diff: "easy",
    exp: "<strong>Decreased HR + slight ↓ contractility.</strong> Vagal (parasympathetic) stimulation markedly slows heart rate (negative chronotropy) and slightly decreases contractility (negative inotropy). Sympathetic stimulation does the opposite — increases both HR and contractility. <br><small>— Guyton & Hall Textbook of Medical Physiology</small>"
  },
  {
    q: "Which of the following is NOT a feature of the 'fight or flight' sympathetic response?",
    opts: [
      "Increased heart rate and cardiac output",
      "Bronchodilation",
      "Increased gastrointestinal motility and secretions",
      "Redistribution of blood flow toward skeletal muscle"
    ],
    ans: 2,
    diff: "medium",
    exp: "<strong>GI motility is DECREASED.</strong> During fight-or-flight, blood is redirected away from the GI tract toward skeletal muscle. GI motility and secretions are inhibited, not stimulated. All other options are true sympathetic effects. <br><small>— Costanzo Physiology, 7th Ed.</small>"
  },
  {
    q: "Which is the ONLY effector organ that receives preganglionic axon terminals directly, without an intervening postganglionic neuron?",
    opts: [
      "Sweat glands",
      "Heart (SA node)",
      "Adrenal medulla",
      "Iris of the eye"
    ],
    ans: 2,
    diff: "medium",
    exp: "<strong>Adrenal medulla.</strong> Preganglionic sympathetic fibers synapse directly on chromaffin cells of the adrenal medulla — there are no postganglionic neurons. The chromaffin cells themselves are the functional equivalent of postganglionic neurons; they secrete catecholamines into the bloodstream. <br><small>— Ganong's Review of Medical Physiology, 26th Ed.</small>"
  },
  {
    q: "Which type of receptors are found at the autonomic ganglia of BOTH sympathetic AND parasympathetic divisions?",
    opts: [
      "Muscarinic M2 receptors",
      "Nicotinic (NN / ganglionic) receptors",
      "α1-adrenoceptors",
      "β2-adrenoceptors"
    ],
    ans: 1,
    diff: "medium",
    exp: "<strong>Nicotinic (NN) receptors.</strong> ACh released from preganglionic neurons acts on nicotinic (ganglionic subtype NN) receptors on postganglionic neuron cell bodies in both divisions. Muscarinic receptors are located on target effector organs (not at ganglia). <br><small>— Costanzo Physiology, 7th Ed.</small>"
  },
  {
    q: "Which best describes the fiber length difference between the sympathetic and parasympathetic divisions?",
    opts: [
      "Sympathetic: long pre-, short post-; Parasympathetic: short pre-, long post-",
      "Sympathetic: short pre-, long post-; Parasympathetic: long pre-, short post-",
      "Both divisions have equally long preganglionic and postganglionic fibers",
      "Sympathetic ganglia are in the organ wall; parasympathetic ganglia are paravertebral"
    ],
    ans: 1,
    diff: "medium",
    exp: "<strong>Sympathetic = short pre- + long post-; Parasympathetic = long pre- + short post-.</strong> Sympathetic ganglia (paravertebral chain / prevertebral) are close to the spinal cord → short preganglionic fibers, long postganglionic fibers to distant organs. Parasympathetic terminal ganglia are in or near the effector organ → long preganglionic fibers, very short postganglionic fibers. <br><small>— Ganong's Review of Medical Physiology, 26th Ed.</small>"
  }
];

let current = 0, score = 0, answered = false;
let timerInterval = null, timeLeft = 90;
let startTime = 0, totalTime = 0;
let results = [];

function startQuiz() {
  document.getElementById('start-screen').style.display = 'none';
  document.getElementById('quiz-screen').style.display  = 'block';
  current = 0; score = 0; results = []; totalTime = 0;
  loadQuestion();
}

function loadQuestion() {
  answered = false;
  timeLeft  = 90;
  startTime = Date.now();

  const q = QUESTIONS[current];
  document.getElementById('q-number').textContent = `Question ${current+1} of ${QUESTIONS.length}`;
  document.getElementById('q-text').textContent   = q.q;
  document.getElementById('progress-bar').style.width = `${((current+1)/QUESTIONS.length)*100}%`;
  document.getElementById('score-live').textContent   = `Score: ${score}`;
  document.getElementById('btn-next').classList.remove('show');
  document.getElementById('explanation').classList.remove('show');
  document.getElementById('explanation').innerHTML = '';

  // Difficulty badge
  const diff = document.getElementById('q-diff');
  diff.textContent = q.diff.charAt(0).toUpperCase() + q.diff.slice(1);
  diff.className = 'difficulty ' + q.diff;

  // Options
  const container = document.getElementById('options');
  container.innerHTML = '';
  const labels = ['A', 'B', 'C', 'D'];
  q.opts.forEach((opt, i) => {
    const btn = document.createElement('button');
    btn.className = 'option-btn';
    btn.innerHTML = `
      <span class="opt-label">${labels[i]}</span>
      <span class="opt-text">${opt}</span>
      <span class="opt-icon" id="icon-${i}"></span>`;
    btn.onclick = () => selectAnswer(i);
    container.appendChild(btn);
  });

  // Timer
  clearInterval(timerInterval);
  updateTimerDisplay();
  timerInterval = setInterval(() => {
    timeLeft--;
    updateTimerDisplay();
    if (timeLeft <= 0) { clearInterval(timerInterval); autoSubmit(); }
  }, 1000);
}

function updateTimerDisplay() {
  const mins = Math.floor(timeLeft / 60);
  const secs = timeLeft % 60;
  const el   = document.getElementById('timer');
  el.textContent = `${mins}:${secs.toString().padStart(2,'0')}`;
  if (timeLeft <= 15) el.classList.add('danger'); else el.classList.remove('danger');
}

function autoSubmit() {
  if (answered) return;
  answered = true;
  const q   = QUESTIONS[current];
  const btns = document.querySelectorAll('.option-btn');
  btns.forEach(b => b.disabled = true);
  btns[q.ans].classList.add('missed');
  btns[q.ans].querySelector('.opt-icon').textContent = '✓';
  showExplanation(false, q.ans);
  results.push({ correct: false, qIndex: current, chosen: -1 });
  document.getElementById('btn-next').classList.add('show');
}

function selectAnswer(idx) {
  if (answered) return;
  answered = true;
  clearInterval(timerInterval);
  const elapsed = Math.round((Date.now() - startTime) / 1000);
  totalTime += elapsed;

  const q    = QUESTIONS[current];
  const btns = document.querySelectorAll('.option-btn');
  btns.forEach(b => b.disabled = true);

  const isCorrect = idx === q.ans;
  if (isCorrect) {
    score++;
    btns[idx].classList.add('correct');
    btns[idx].querySelector('.opt-icon').textContent = '✓';
    results.push({ correct: true,  qIndex: current, chosen: idx });
  } else {
    btns[idx].classList.add('wrong');
    btns[idx].querySelector('.opt-icon').textContent = '✗';
    btns[q.ans].classList.add('missed');
    btns[q.ans].querySelector('.opt-icon').textContent = '✓';
    results.push({ correct: false, qIndex: current, chosen: idx });
  }
  showExplanation(isCorrect, q.ans);
  document.getElementById('score-live').textContent = `Score: ${score}`;
  document.getElementById('btn-next').classList.add('show');
}

function showExplanation(correct, correctIdx) {
  const q   = QUESTIONS[current];
  const exp = document.getElementById('explanation');
  const labels = ['A','B','C','D'];
  exp.innerHTML = `
    <strong>${correct ? '✅ Correct!' : '❌ Incorrect'}</strong>
    ${correct ? '' : `&nbsp;|&nbsp; Correct answer: <strong>${labels[correctIdx]}) ${q.opts[correctIdx]}</strong><br><br>`}
    ${correct ? '<br>' : ''}
    ${q.exp}`;
  exp.classList.add('show');
}

function nextQuestion() {
  current++;
  if (current < QUESTIONS.length) loadQuestion();
  else showResult();
}

function showResult() {
  document.getElementById('quiz-screen').style.display  = 'none';
  document.getElementById('result-screen').style.display = 'block';

  const pct   = Math.round((score / QUESTIONS.length) * 100);
  const deg   = Math.round((score / QUESTIONS.length) * 360);
  const wrong = QUESTIONS.length - score;
  const avgT  = results.length ? Math.round(totalTime / results.length) : 0;

  // Emoji & title
  let emoji, title, sub, gradeClass, gradeText;
  if (pct >= 90) {
    emoji='🏆'; title='Outstanding!'; sub='Excellent command of the ANS. Keep it up!';
    gradeClass='grade-A'; gradeText='Grade A – Distinction';
  } else if (pct >= 70) {
    emoji='🌟'; title='Well Done!'; sub='Good understanding. Review the explanations to perfect your knowledge.';
    gradeClass='grade-B'; gradeText='Grade B – Pass';
  } else if (pct >= 50) {
    emoji='📚'; title='Good Effort!'; sub='A few gaps remain. Re-read the ANS chapter and try again.';
    gradeClass='grade-C'; gradeText='Grade C – Borderline';
  } else {
    emoji='💪'; title='Keep Practicing!'; sub='Review the Costanzo/Ganong ANS chapter thoroughly.';
    gradeClass='grade-D'; gradeText='Grade D – Needs Improvement';
  }

  document.getElementById('res-emoji').textContent = emoji;
  document.getElementById('res-title').textContent = title;
  document.getElementById('res-sub').textContent   = sub;
  document.getElementById('res-score').textContent = score;
  document.getElementById('res-correct').textContent = score;
  document.getElementById('res-wrong').textContent   = wrong;
  document.getElementById('res-time').textContent    = avgT + 's';

  const circle = document.getElementById('score-circle');
  circle.style.setProperty('--deg', deg + 'deg');

  const badge = document.getElementById('grade-badge');
  badge.textContent = gradeText;
  badge.className   = 'grade-badge ' + gradeClass;

  // Review list
  const reviewList = document.getElementById('review-list');
  reviewList.innerHTML = '<div style="font-weight:700;margin-bottom:10px;font-size:.95rem;">📋 Question Review</div>';
  results.forEach((r, i) => {
    const q   = QUESTIONS[r.qIndex];
    const labels = ['A','B','C','D'];
    const div = document.createElement('div');
    div.className = 'review-item ' + (r.correct ? 'correct-r' : 'wrong-r');
    const chosenText = r.chosen >= 0
      ? `Your answer: <span class="${r.correct ? 'r-correct-txt' : 'r-wrong-txt'}">${labels[r.chosen]}) ${q.opts[r.chosen]}</span>`
      : `<span class="r-wrong-txt">⏰ Time's up — not answered</span>`;
    div.innerHTML = `
      <div class="r-q">${i+1}. ${q.q}</div>
      <div class="r-ans">
        ${chosenText}
        ${!r.correct ? `<br>Correct: <span class="r-correct-txt">${labels[q.ans]}) ${q.opts[q.ans]}</span>` : ''}
      </div>`;
    reviewList.appendChild(div);
  });
}

function retakeQuiz() {
  document.getElementById('result-screen').style.display = 'none';
  document.getElementById('start-screen').style.display  = 'block';
}
</script>
</body>
</html>

Running Command

cd /home/daytona/workspace/ans-quiz && wc -l index.html && echo "File size: $(du…

Your interactive ANS quiz is ready! Download and open it in any browser:

index

HTML File · HTML

What's included in the quiz:

Feature	Details
📋 Questions	10 MCQs — one at a time
⏱ Timer	90 seconds per question (turns red at 15s)
✅ Instant feedback	Green = correct, Red = wrong, shows missed answer
📖 Explanations	Detailed explanation with textbook source after each answer
🏷 Difficulty	Each question tagged Easy / Medium / Hard
📊 Score tracker	Live score in the top bar
🏆 Results screen	Score circle, correct/wrong count, avg time, grade badge
📋 Question review	Full summary of all answers at the end
🔄 Retake button	Restart the quiz anytime

Topics covered: Thoracolumbar outflow, preganglionic neurotransmitters, sweat gland exception, adrenal medulla secretion ratio, pheochromocytoma, vagal effects on heart, fight-or-flight, direct preganglionic innervation, ganglionic receptors, pre/postganglionic fiber lengths.

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