Neurology: brainstem death: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: brainstem death

Sample item

While testing for brainstem death in a ventilated patient with irreversible brain injury, which finding is incompatible with the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. A brisk pupillary light reflex

Brainstem death requires an irreversible cause, exclusion of reversible factors such as sedation and hypothermia, absent brainstem reflexes (pupillary, corneal, oculocephalic, vestibulo-ocular, gag and cough) and a positive apnoea test. Spinal reflexes may persist. In India, the declaration is made by a board of doctors under the Transplantation of Human Organs and Tissues Act, with repeated testing.

Option by option

  • A. Apnoea with a rising PaCO2 above 60 mmHg

    Failure to breathe despite a high PaCO2 confirms loss of medullary respiratory drive.

  • B. Absent gag and cough reflexes

    Absent gag and cough reflexes are expected.

  • C. Absent corneal reflex

    Absent corneal reflex is expected.

  • D. A brisk pupillary light reflex (correct)

    Correct. A present pupillary reflex means the midbrain is functioning.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, A brisk pupillary light reflex. Brainstem death requires an irreversible cause, exclusion of reversible factors such as sedation and hypothermia, absent brainstem reflexes (pupillary, corneal, oculocephalic, vestibulo-ocular, gag and cough) and a positive apnoea test.

Why is "Apnoea with a rising PaCO2 above 60 mmHg" not the answer?

Failure to breathe despite a high PaCO2 confirms loss of medullary respiratory drive.

Why is "Absent gag and cough reflexes" not the answer?

Absent gag and cough reflexes are expected.

Why is "Absent corneal reflex" not the answer?

Absent corneal reflex is expected.

What concept does this question test?

It tests Neurology: brainstem death in General Medicine. Spinal reflexes may persist. In India, the declaration is made by a board of doctors under the Transplantation of Human Organs and Tissues Act, with repeated testing.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: brainstem death?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.