KMU Past Paper Practice

Question:

A 20-year-old university student reports intermittent cough and chest tightness during cold weather and exercise. Examination and spirometry are normal when she attends clinic. Which additional assessment would be most useful for demonstrating variability of her airway obstruction?

Options:

Correct Answer: Serial peak expiratory flow measurements

Explanation: Asthma may have normal spirometry between attacks. Demonstrating variation in expiratory airflow over time supports variable airway obstruction.

Question:

A patient with asthma continues to experience symptoms despite being prescribed appropriate inhaled treatment. Before increasing therapy, which factor should be assessed because failure in this area can make effective treatment appear ineffective?

Options:

Correct Answer: Inhaler technique and treatment adherence

Explanation: Poor technique or adherence can prevent inhaled therapy from reaching its therapeutic target and should be addressed before assuming pharmacological failure.

Question:

A 69-year-old smoker has progressive breathlessness. Pulmonary function testing demonstrates obstruction and markedly reduced gas-transfer capacity. Which structural abnormality most plausibly accounts for the reduced gas transfer?

Options:

Correct Answer: Destruction of alveolar gas-exchanging surface

Explanation: Emphysematous destruction reduces the effective alveolar-capillary surface available for gas transfer, explaining a reduced diffusing capacity in obstructive disease.

Question:

A patient with COPD has stable respiratory symptoms but has experienced repeated acute worsening episodes during the previous year. Which preventive component of long-term care should be reviewed in addition to inhaled treatment?

Options:

Correct Answer: Vaccination and exacerbation-prevention measures

Explanation: Preventing respiratory infections and reviewing adherence and inhaler use are important components of reducing future COPD exacerbations.

Question:

Two patients have reduced diffusing capacity. One has emphysema and the other has pulmonary fibrosis. Which explanation best accounts for this finding in both patients?

Options:

Correct Answer: Both impair transfer across the alveolar-capillary gas-exchange unit

Explanation: Emphysema reduces available surface area, whereas fibrosis thickens the diffusion barrier; both therefore reduce gas-transfer efficiency by different mechanisms.

Question:

A 46-year-old woman with a systemic connective-tissue disorder develops progressive exertional breathlessness and a dry cough. Examination reveals fine inspiratory crackles. Which respiratory complication should be considered?

Options:

Correct Answer: Associated interstitial lung disease

Explanation: Connective-tissue disease is an important identifiable association of ILD, especially when progressive dyspnea, dry cough and fine inspiratory crackles coexist.

Question:

A patient develops progressive dry cough and breathlessness several months after starting a medication known to cause pulmonary toxicity. Imaging demonstrates bilateral interstitial abnormalities. Which history item has the greatest diagnostic relevance?

Options:

Correct Answer: Temporal relationship between drug exposure and symptoms

Explanation: Drug exposure is a recognized potentially identifiable cause of ILD, and the timing of symptoms in relation to treatment helps establish causation.

Question:

A patient with suspected fibrotic lung disease has progressive breathlessness and fine inspiratory crackles. Why does fibrosis typically increase the work of breathing?

Options:

Correct Answer: It makes the lungs stiffer and harder to expand

Explanation: Fibrosis reduces lung compliance, so greater inspiratory effort is required to generate the same change in lung volume.

Question:

A patient with severe parenchymal lung disease develops marked arterial hypoxemia. Ventilation is preserved and carbon dioxide is not elevated. Which physiological mechanism is most consistent with this pattern?

Options:

Correct Answer: Ventilation-perfusion mismatch or impaired diffusion

Explanation: Type I respiratory failure commonly results from failure of oxygen transfer caused by V/Q mismatch, diffusion impairment or shunt while ventilation may remain relatively preserved.

Question:

An ABG from a patient with longstanding chronic ventilatory impairment shows elevated PaCO₂ with a near-normal pH and increased bicarbonate. Which interpretation best explains this pattern?

Options:

Correct Answer: Chronic respiratory acidosis with renal compensation

Explanation: Persistent CO₂ retention stimulates renal bicarbonate retention over time, partially restoring pH toward normal despite ongoing hypercapnia.

Question:

A patient with acute severe respiratory illness arrives cyanosed, distressed and profoundly hypoxemic. There is no known risk of chronic carbon-dioxide retention. Which oxygen approach is most appropriate while definitive treatment is being arranged?

Options:

Correct Answer: Provide appropriate high-concentration oxygen with monitoring

Explanation: Severe acute hypoxemia is immediately dangerous and should be corrected promptly while the cause is investigated and definitive management proceeds.

Question:

A breathless patient has a normal oxygen saturation and no evidence of hypoxemia. Which statement best describes the role of supplemental oxygen in this situation?

Options:

Correct Answer: Oxygen is primarily indicated for hypoxemia rather than breathlessness alone

Explanation: Oxygen corrects deficient arterial oxygenation; breathlessness without hypoxemia requires assessment and treatment of its underlying cause.

Question:

A patient with progressive ILD becomes increasingly hypoxemic during exertion despite stable resting symptoms. Which management measure most directly addresses this physiological consequence when clinically indicated?

Options:

Correct Answer: Appropriate supplemental oxygen

Explanation: In ILD, impaired diffusion may produce clinically important hypoxemia; oxygen provides supportive correction while disease-specific management continues.

Question:

A child with cystic fibrosis performs regular airway-clearance therapy even when clinically stable. What is the main therapeutic rationale for this intervention?

Options:

Correct Answer: To mobilize retained secretions and reduce airway obstruction

Explanation: Thick secretions are central to CF respiratory disease; airway-clearance measures help remove mucus and interrupt the cycle of obstruction and infection.

Question:

A child with cystic fibrosis has chronic respiratory symptoms and poor weight gain. The respiratory condition is stable, but nutritional status remains unsatisfactory. Which additional problem should be considered as part of the multisystem disease?

Options:

Correct Answer: Pancreatic insufficiency affecting nutrition

Explanation: Cystic fibrosis is multisystem disease; pancreatic involvement may impair digestion and contribute to poor growth, requiring nutritional management.

Question:

A child with cystic fibrosis is receiving comprehensive care. The treating team considers a therapy designed to act more directly on the abnormal protein responsible for the disease. Which therapeutic principle does this represent?

Options:

Correct Answer: CFTR-directed treatment selected for an appropriate defect

Explanation: Selected CF therapies target abnormal CFTR function itself, complementing airway clearance, infection control and nutritional support.

Question:

A patient with chronic respiratory disease becomes confused and increasingly fatigued. Oxygen saturation is reduced, but the respiratory rate is now falling rather than rising. Which interpretation should concern the clinical team most?

Options:

Correct Answer: The patient may be developing respiratory exhaustion and decompensation

Explanation: Falling respiratory effort with confusion and persistent hypoxemia can signal fatigue and impending ventilatory failure rather than clinical improvement.

Question:

A patient with chronic breathlessness has spirometry suggesting obstruction. The clinician also wants information about oxygenation and possible ventilatory failure because the patient is now drowsy and cyanosed. Which investigation best provides this additional information?

Options:

Correct Answer: Arterial blood gas analysis

Explanation: Spirometry defines ventilatory pattern, whereas ABG directly assesses oxygenation, carbon-dioxide retention and acid-base consequences of respiratory failure.

Question:

A patient with respiratory symptoms has a low FEV₁, low FVC and a reduced FEV₁/FVC ratio. Which interpretation should be made first?

Options:

Correct Answer: The reduced ratio indicates an obstructive component

Explanation: A reduced FEV₁/FVC ratio signals airflow obstruction; a low FVC alone should not be assumed to represent pure restriction.

Question:

A final-year student compares three respiratory patients: one has episodic symptoms between normal examinations, one has persistent symptoms after years of harmful inhalational exposure, and one has progressive dry cough with restrictive physiology. Which principle best distinguishes these conditions?

Options:

Correct Answer: The symptom pattern, exposure history and physiological defect should be interpreted together

Explanation: KMU-style respiratory reasoning integrates clinical pattern, relevant exposure and objective physiology rather than diagnosing from one isolated clue.