Meninges MCQs With Answer

Meninges MCQs With Answer — a focused, Student-friendly post tailored for B. Pharm learners. The meninges (dura mater, arachnoid mater, and pia mater) protect the central nervous system, regulate cerebrospinal fluid (CSF) flow, and influence drug distribution to the brain and spinal cord. Understanding their anatomy, physiology, vascular supply, innervation, and clinical correlations (meningitis, hematomas, lumbar puncture) is essential for pharmacists when considering CNS drug delivery, CSF interpretation, and patient care. This concise set of targeted, clinically relevant questions reinforces core concepts and pharmacological implications. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which layer of the meninges is tightly adherent to the brain surface following its sulci and gyri?

• Dura mater
• Arachnoid mater
• Pia mater
• Periosteum

Correct Answer: Pia mater

Q2. Which meningeal layer contains the dural venous sinuses?

• Pia mater
• Arachnoid mater
• Dura mater
• Subarachnoid membrane

Correct Answer: Dura mater

Q3. The space that normally contains cerebrospinal fluid (CSF) is the:

• Epidural space
• Subdural space
• Subarachnoid space
• Perivascular space

Correct Answer: Subarachnoid space

Q4. Arachnoid villi (granulations) primarily function to:

• Produce CSF
• Absorb CSF into venous sinuses
• Secrete meningothelial cells into CSF
• Form the blood–brain barrier

Correct Answer: Absorb CSF into venous sinuses

Q5. Which artery is most commonly associated with epidural hematoma after skull fracture?

• Middle meningeal artery
• Posterior cerebral artery
• Anterior communicating artery
• Basilar artery

Correct Answer: Middle meningeal artery

Q6. The arachnoid trabeculae connect which two layers of the meninges?

• Dura and pia
• Arachnoid and dura
• Arachnoid and pia
• Pia and periosteum

Correct Answer: Arachnoid and pia

Q7. Which of the following is a key characteristic of the dura mater histologically?

• Single layer of squamous cells
• Dense fibrous connective tissue with collagen and fibroblasts
• Loose trabecular connective tissue
• Highly vascularized pia-like layer

Correct Answer: Dense fibrous connective tissue with collagen and fibroblasts

Q8. Which cranial nerve provides sensory innervation to the anterior cranial dura?

• Glossopharyngeal nerve (IX)
• Vagus nerve (X)
• Trigeminal nerve (V)
• Facial nerve (VII)

Correct Answer: Trigeminal nerve (V)

Q9. In spinal epidural anesthesia, the local anesthetic is injected into the:

• Subarachnoid space
• Epidural space
• Subdural space
• Posterior horn

Correct Answer: Epidural space

Q10. Which statement about the spinal epidural space in the vertebral canal is true?

• It is a potential space in the skull
• It contains fat and the internal vertebral venous plexus
• It is continuous with the subarachnoid space
• It is lined by arachnoid cells

Correct Answer: It contains fat and the internal vertebral venous plexus

Q11. Subdural hematoma typically results from rupture of which vessels?

• Bridging veins between cerebral cortex and dural sinuses
• Middle meningeal artery
• Anterior cerebral artery
• Pia mater capillaries

Correct Answer: Bridging veins between cerebral cortex and dural sinuses

Q12. Which clinical sign suggests meningeal irritation and is elicited by passive extension of the knee at 90° hip flexion?

• Babinski sign
• Kernig sign
• Brudzinski sign
• Hoffmann sign

Correct Answer: Kernig sign

Q13. Which CSF finding is most characteristic of bacterial meningitis?

• High glucose, low protein, lymphocytic pleocytosis
• Low glucose, high protein, neutrophilic pleocytosis
• Normal glucose, normal protein, no cells
• High glucose, high protein, eosinophilic pleocytosis

Correct Answer: Low glucose, high protein, neutrophilic pleocytosis

Q14. Which meningeal fold separates the two cerebral hemispheres?

• Tentorium cerebelli
• Falx cerebri
• Falx cerebelli
• Diaphragma sellae

Correct Answer: Falx cerebri

Q15. The tentorium cerebelli primarily separates which brain structures?

• Right and left cerebral hemispheres
• Cerebellum from occipital lobes of cerebrum
• Cerebrum from brainstem at level of medulla only
• Pons from medulla

Correct Answer: Cerebellum from occipital lobes of cerebrum

Q16. Xanthochromia of CSF indicates:

• Bacterial infection
• Presence of bilirubin from prior subarachnoid hemorrhage
• High glucose concentration
• Increased protein due to viral meningitis

Correct Answer: Presence of bilirubin from prior subarachnoid hemorrhage

Q17. Which pharmacokinetic property most favors drug penetration across the meninges into CSF?

• High molecular weight and hydrophilicity
• Low plasma protein binding and high lipid solubility
• Strong ionization at physiological pH
• Extensive binding to erythrocytes

Correct Answer: Low plasma protein binding and high lipid solubility

Q18. A lumbar puncture to sample CSF is usually performed between which vertebral levels to avoid spinal cord injury?

• T1–T2
• L3–L4 or L4–L5
• T10–T11
• S1–S2

Correct Answer: L3–L4 or L4–L5

Q19. Inflammation of the meninges primarily involving the leptomeninges refers to:

• Dural pachymeningitis
• Leptomeningitis (arachnoid and pia)
• Periosteal infection
• Myelitis

Correct Answer: Leptomeningitis (arachnoid and pia)

Q20. Which of the following is a contraindication to lumbar puncture?

• Suspected meningitis in all cases
• Signs of raised intracranial pressure or mass lesion with focal deficits
• Fever without focal signs
• Thrombocytosis

Correct Answer: Signs of raised intracranial pressure or mass lesion with focal deficits

Q21. Which structure forms a barrier preventing free passage of substances from CSF into brain interstitium?

• Arachnoid granulation
• Endothelial tight junctions of brain capillaries (blood–brain barrier)
• Dural collagen fibers
• Choroid plexus ependymal tight junctions only

Correct Answer: Endothelial tight junctions of brain capillaries (blood–brain barrier)

Q22. The choroid plexus is primarily responsible for:

• Absorption of CSF into venous sinuses
• Production of CSF
• Anchoring the spinal cord
• Sensory innervation of the dura

Correct Answer: Production of CSF

Q23. Cerebrospinal fluid normally flows from the lateral ventricles to the third ventricle through the:

• Foramen of Magendie
• Interventricular foramina (foramina of Monro)
• Cerebral aqueduct (aqueduct of Sylvius)
• Foramina of Luschka

Correct Answer: Interventricular foramina (foramina of Monro)

Q24. Which meningeal layer is impermeable to CSF and forms a barrier under the skull?

• Arachnoid mater
• Pia mater
• Dura mater
• Choroid plexus

Correct Answer: Arachnoid mater

Q25. Which cerebral herniation involves displacement of the uncus through the tentorial notch?

• Cerebellar tonsillar herniation
• Central herniation
• Uncal (transtentorial) herniation
• Subfalcine herniation

Correct Answer: Uncal (transtentorial) herniation

Q26. Meningeal lymphatic vessels discovered near dural sinuses primarily contribute to:

• CSF production
• Immune cell trafficking and clearance of solutes from CNS
• Generation of CSF pressure
• Myelination of axons

Correct Answer: Immune cell trafficking and clearance of solutes from CNS

Q27. Which organism is the most common cause of acute bacterial meningitis in neonates?

• Neisseria meningitidis
• Group B Streptococcus (Streptococcus agalactiae)
• Streptococcus pneumoniae
• Listeria monocytogenes in all neonates

Correct Answer: Group B Streptococcus (Streptococcus agalactiae)

Q28. Which imaging modality is most sensitive for detecting subarachnoid hemorrhage within 24 hours?

• Non-contrast CT scan of head
• Plain skull X-ray
• Ultrasound
• Chest radiograph

Correct Answer: Non-contrast CT scan of head

Q29. Which pharmacologic agent is commonly administered empirically before imaging in suspected bacterial meningitis?

• Antiviral acyclovir only
• Broad-spectrum IV antibiotics plus dexamethasone if indicated
• Oral acetaminophen only
• Intravenous antifungal agents routinely

Correct Answer: Broad-spectrum IV antibiotics plus dexamethasone if indicated

Q30. The diaphragma sellae is a dural fold that surrounds which structure?

• Pineal gland
• Pituitary gland (sella turcica)
• Optic chiasm
• Cerebellar vermis

Correct Answer: Pituitary gland (sella turcica)

Q31. In lumbar puncture, the “pop” felt when the needle penetrates the ligamentum flavum and dura is entering which space next?

• Posterior epidural space
• Subarachnoid space
• Subdural space
• Spinal cord substance

Correct Answer: Subarachnoid space

Q32. Which molecule in CSF is most useful to assess blood–brain barrier dysfunction when elevated?

• Glucose only
• Albumin (CSF/serum albumin ratio)
• Chloride
• Vitamin D

Correct Answer: Albumin (CSF/serum albumin ratio)

Q33. Herniation of cerebellar tonsils through the foramen magnum most often leads to compression of which structure?

• Frontal lobes
• Medulla oblongata
• Optic chiasm
• Corpus callosum

Correct Answer: Medulla oblongata

Q34. Which sign is elicited by passive neck flexion causing hip and knee flexion in meningitis?

• Kernig sign
• Romberg sign
• Brudzinski sign
• Clonus

Correct Answer: Brudzinski sign

Q35. Which dural venous sinus runs in the attached margin of the falx cerebri?

• Transverse sinus
• Superior sagittal sinus
• Inferior petrosal sinus
• Cavernous sinus

Correct Answer: Superior sagittal sinus

Q36. Which of the following best describes CSF composition compared to plasma?

• Higher protein, higher glucose than plasma
• Lower protein, lower glucose than plasma
• Lower protein, similar glucose (but slightly lower) than plasma
• Identical to plasma in all components

Correct Answer: Lower protein, similar glucose (but slightly lower) than plasma

Q37. Which condition involves congenital failure of neural tube closure with meningeal and spinal cord tissue protrusion?

• Meningocele or meningomyelocele
• Anencephaly only
• Arnold–Chiari I malformation only
• Hydrocephalus unrelated to meninges

Correct Answer: Meningocele or meningomyelocele

Q38. Which meningeal artery runs in grooves on the inner aspect of the skull and is susceptible to tear in temporal bone fractures?

• Anterior cerebral artery
• Middle meningeal artery
• Internal carotid artery
• Posterior inferior cerebellar artery

Correct Answer: Middle meningeal artery

Q39. Which feature differentiates subdural from epidural hematoma on CT imaging classically?

• Subdural is lens-shaped, epidural is crescent-shaped
• Subdural crosses suture lines; epidural does not
• Epidural often crosses suture lines; subdural is limited by sutures
• Subdural never crosses midline; epidural always does

Correct Answer: Subdural crosses suture lines; epidural does not

Q40. Which antimicrobial property improves meningeal penetration during meningitis due to increased permeability?

• High molecular weight and hydrophilicity
• Low lipid solubility and high protein binding
• Low protein binding and increased lipophilicity
• Strong cationic charge at physiologic pH

Correct Answer: Low protein binding and increased lipophilicity

Q41. Which dural fold helps form the lateral wall of the cavernous sinus?

• Tentorium cerebelli
• Falx cerebri
• Diaphragma sellae
• None; the cavernous sinus wall is formed by dura mater reflections

Correct Answer: None; the cavernous sinus wall is formed by dura mater reflections

Q42. CSF opening pressure measured during lumbar puncture reflects:

• Intracranial pressure
• Systemic arterial pressure only
• Central venous pressure only
• Intra-abdominal pressure only

Correct Answer: Intracranial pressure

Q43. Which statement about the subdural space is correct?

• It is a true space filled with CSF in healthy individuals
• It is a potential space between dura and arachnoid that can fill with blood
• It contains arachnoid granulations normally
• It is continuous with the epidural space

Correct Answer: It is a potential space between dura and arachnoid that can fill with blood

Q44. Which meningeal layer is primarily involved in formation of the blood–CSF barrier at the choroid plexus?

• Dura mater epithelial cells
• Ependymal cells with tight junctions of choroid plexus
• Pia mater connective tissue only
• Arachnoid granulation cells

Correct Answer: Ependymal cells with tight junctions of choroid plexus

Q45. Which of the following best explains post-lumbar puncture headache?

• Infection introduced into CSF
• Cerebral vasodilation and downward sagging due to CSF leakage
• Allergic reaction to local anesthetic
• Immediate increase in intracranial pressure

Correct Answer: Cerebral vasodilation and downward sagging due to CSF leakage

Q46. Which cell type lines the pia mater and participates in blood–brain barrier interactions?

• Oligodendrocytes
• Astrocytic end-feet closely associated with pia
• Erythrocytes
• Chondrocytes

Correct Answer: Astrocytic end-feet closely associated with pia

Q47. The most common route for pathogens to reach the meninges in bacterial meningitis is:

• Direct extension from sinusitis or otitis media or hematogenous spread
• Direct inoculation only through head trauma
• Retrograde neural spread exclusively
• Transdermal absorption

Correct Answer: Direct extension from sinusitis or otitis media or hematogenous spread

Q48. Which diagnostic test on CSF helps to rapidly distinguish bacterial from viral meningitis at bedside?

• Gram stain and cell differential
• Routine culture that takes several days
• Serology for HIV only
• Complete blood count only

Correct Answer: Gram stain and cell differential

Q49. Which dural sinus receives blood from the cavernous sinus and drains into the internal jugular vein?

• Superior sagittal sinus
• Sigmoid sinus (via transverse sinus)
• Basilar plexus
• Emissary veins only

Correct Answer: Sigmoid sinus (via transverse sinus)

Q50. Which pharmacologic consideration is important when treating CNS infections regarding the meninges?

• Choose antibiotics with poor CSF penetration regardless of pathogen
• Prefer drugs with known CSF penetration and bactericidal activity at achievable CSF concentrations
• Always avoid adjunctive corticosteroids
• Rely solely on topical treatments

Correct Answer: Prefer drugs with known CSF penetration and bactericidal activity at achievable CSF concentrations

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com