KMU Past Paper Practice

Question:

A 28-year-old previously healthy man develops a rapidly progressive febrile illness with a new regurgitant murmur. Blood cultures grow an organism capable of infecting even a previously normal valve. Which organism is most consistent with this pattern?

Correct Answer: Staphylococcus aureus

Explanation: Staphylococcus aureus is an important cause of acute infective endocarditis and can infect previously normal valves.

Question:

A patient with chronic valvular disease develops several weeks of low-grade fever, malaise and weight loss. Which organism classically produces this relatively indolent form of infective endocarditis in a susceptible valve?

Correct Answer: Viridans streptococci

Explanation: Viridans streptococci classically cause a more indolent infection, particularly when a structurally abnormal valve provides a susceptible surface.

Question:

A patient with a prosthetic cardiac valve develops infective endocarditis. Which organism group is particularly relevant when prosthetic material is involved?

Correct Answer: Coagulase-negative staphylococci

Explanation: Coagulase-negative staphylococci are particularly important in infection involving prosthetic cardiac material.

Question:

Histological examination of an infected cardiac valve shows an irregular friable mass attached to the valve surface. Which combination best describes the basic composition of this lesion?

Correct Answer: Platelets, fibrin and microorganisms

Explanation: An infective vegetation consists mainly of platelet-fibrin material containing microorganisms and inflammatory components.

Question:

A patient with left-sided infective endocarditis develops sudden abdominal pain and splenic tenderness. Which feature of the valvular lesion most directly allows this complication to occur?

Correct Answer: Fragmentation of friable vegetation

Explanation: Friable vegetations can break off and embolize through the systemic circulation, producing infarction or infection in organs such as the spleen.

Question:

A patient with suspected infective endocarditis has linear reddish-brown streaks beneath several fingernails. How should this examination finding be interpreted?

Correct Answer: It supports infective endocarditis but is not specific

Explanation: Splinter hemorrhages can occur in infective endocarditis but are supportive rather than diagnostic because they may occur in other conditions.

Question:

Fundoscopy in a patient with infective endocarditis reveals retinal hemorrhages with pale centers. Which examination finding is being described?

Correct Answer: Roth spots

Explanation: Roth spots are retinal hemorrhagic lesions with pale centers and may occur as a peripheral manifestation of infective endocarditis.

Question:

A patient with infective endocarditis requires several weeks of antimicrobial therapy. Which characteristic of the infection best explains the need for prolonged bactericidal treatment?

Correct Answer: Microorganisms are embedded within vegetations

Explanation: Organisms within platelet-fibrin vegetations are relatively protected, so sustained bactericidal therapy is required to eradicate infection.

Question:

Blood cultures in a patient with infective endocarditis identify a specific organism and susceptibility pattern. What is the most appropriate therapeutic principle once these results are available?

Correct Answer: Tailor antimicrobial therapy to the identified organism

Explanation: Once microbiology is available, therapy should be refined according to the causative organism and its antimicrobial susceptibility.

Question:

A child being treated for infective endocarditis is reviewed daily. Which combination best reflects appropriate monitoring during treatment?

Correct Answer: Clinical response together with cardiac and systemic complications

Explanation: Treatment monitoring should assess resolution of infection while actively looking for valvular dysfunction, heart failure, embolic disease and other complications.

Question:

A child with acute rheumatic fever develops a murmur, mild cardiomegaly and a pericardial rub. Which concept best explains this combination?

Correct Answer: Rheumatic carditis may involve multiple layers of the heart

Explanation: Rheumatic carditis may involve endocardial, myocardial and pericardial structures, although valvular involvement is most important clinically.

Question:

A child with suspected rheumatic fever is found to have small, firm, painless nodules over extensor surfaces. Which interpretation is most appropriate?

Correct Answer: They are a major rheumatic manifestation associated with significant cardiac disease

Explanation: Subcutaneous nodules are a major manifestation of acute rheumatic fever and are particularly associated with important cardiac involvement.

Question:

During examination of a child with possible acute rheumatic fever, the clinician wants to assess the neurological component of the disease. Which observation is most relevant?

Correct Answer: Presence of involuntary choreiform movements

Explanation: Neurological examination should look for choreiform movements because Sydenham chorea is an important rheumatic manifestation.

Question:

A child with rheumatic fever has inflammatory involvement of several large joints. Which feature would fit the expected articular pattern most closely?

Correct Answer: Inflammatory involvement of large joints

Explanation: Rheumatic arthritis characteristically involves large joints, helping distinguish it from several chronic inflammatory arthropathies.

Question:

A child with acute rheumatic fever develops marked involuntary movements that interfere with feeding and daily activity. Which management principle is most appropriate?

Correct Answer: Supportive care with pharmacological treatment when clinically significant

Explanation: Sydenham chorea is managed supportively, with pharmacological treatment considered when the movements are clinically significant.

Question:

Two children previously had acute rheumatic fever. One had carditis with residual valve disease, while the other had no cardiac involvement. Which principle should guide the duration of secondary prophylaxis?

Correct Answer: Duration is influenced by previous carditis and residual valve disease

Explanation: Secondary-prophylaxis duration is individualized, with previous carditis and persistent valvular disease being important determinants.

Question:

A child has fever, pallor and a cardiac murmur. The clinician is considering both infective endocarditis and rheumatic carditis. Which feature most strongly favors infective endocarditis over rheumatic fever?

Correct Answer: Persistent bloodstream infection with a causative organism

Explanation: Infective endocarditis is an active microbial infection and therefore microbiological evidence of bacteremia strongly favors it over immune-mediated rheumatic carditis.

Question:

During counselling after recovery from rheumatic fever, the parents ask what they should do if their child develops another significant sore throat. Which advice is most appropriate?

Correct Answer: Seek appropriate clinical assessment for possible streptococcal infection

Explanation: Future throat infections should be assessed appropriately because recurrent streptococcal infection may trigger another rheumatic episode.

Question:

A child treated for infective endocarditis is clinically well at follow-up. Which parental instruction is most important regarding the completed antimicrobial course?

Correct Answer: Complete the prescribed treatment and attend follow-up

Explanation: Adequate completion of antimicrobial therapy and follow-up are essential because endocarditis requires sustained treatment and monitoring for cardiac or systemic complications.

Question:

A child with suspected rheumatic fever has joint, skin and neurological manifestations. Why should the clinician still perform a careful cardiovascular examination even if the child’s main complaint is joint pain?

Correct Answer: Cardiac involvement determines important acute and long-term consequences

Explanation: Rheumatic fever is multisystem disease, but carditis carries major prognostic importance because it can lead to heart failure and chronic rheumatic valve disease.