KMU Past Paper Practice

A 46-year-old man has a blood pressure of 168/96 mmHg immediately after rushing upstairs for his appointment. He is anxious but otherwise well. Which factor is most important before interpreting this reading as sustained hypertension?

Correct Answer: Measurement after adequate rest using correct technique

Exercise and anxiety can transiently raise blood pressure. Reliable interpretation requires appropriate measurement conditions before long-term diagnosis or treatment decisions.

A hypertensive patient is examined using a cuff that is too small for his arm. What is the most likely consequence?

Correct Answer: A falsely high blood-pressure measurement

An undersized cuff requires greater pressure to occlude the artery and may overestimate blood pressure, emphasizing the importance of correct cuff selection.

A 52-year-old woman with newly detected hypertension is overweight and has a strong family history of premature cardiovascular disease. Which additional finding would most strongly increase concern about established vascular risk?

Correct Answer: Coexisting diabetes mellitus

Diabetes substantially adds to global cardiovascular risk and therefore influences the intensity of preventive management in hypertension.

A 57-year-old hypertensive woman has no chest pain or dyspnea but reports intermittent blurred vision. Which assessment is most directly relevant to detecting vascular target-organ involvement?

Correct Answer: Funduscopic assessment

The retinal circulation can show hypertensive vascular injury, particularly when visual symptoms or severe hypertension raise concern about target-organ involvement.

A patient with hypertension has an irregular pulse during routine examination. Which investigation would most directly clarify the associated cardiovascular abnormality?

Correct Answer: Electrocardiogram

An ECG directly evaluates cardiac rhythm and may simultaneously reveal other hypertensive cardiac changes such as ventricular hypertrophy.

A 60-year-old man is being assessed for poorly controlled hypertension. He frequently uses several non-prescription medicines for chronic joint pain. Why is a detailed drug history important?

Correct Answer: Some medicines and substances may interfere with blood-pressure control

Prescription and over-the-counter agents may contribute to difficult blood-pressure control, so medication review is part of focused assessment.

A 44-year-old woman with newly diagnosed hypertension is pregnant. Which commonly used antihypertensive group requires particular caution because of pregnancy-related safety concerns?

Correct Answer: ACE inhibitors and angiotensin receptor blockers

Renin–angiotensin system blockers should not be used inappropriately during pregnancy; pregnancy also changes the referral and management context of hypertension.

A stable hypertensive patient is started on a thiazide-type drug. Which follow-up consideration is most directly related to this drug class?

Correct Answer: Monitoring relevant electrolytes and metabolic effects

Thiazide-type drugs alter renal sodium handling and may produce electrolyte or metabolic changes, making appropriate laboratory monitoring clinically relevant.

A hypertensive man has good blood-pressure control but remains obese and physically inactive. Which statement best reflects preventive care?

Correct Answer: Risk-factor modification should continue despite adequate blood-pressure control

Good hypertension care targets total cardiovascular risk rather than one numerical blood-pressure value alone.

A patient with recently diagnosed hypertension asks why weight reduction may help his condition. Which explanation is most appropriate?

Correct Answer: It can improve blood-pressure control and reduce overall cardiovascular risk

Weight management is part of risk reduction because obesity contributes to hypertension and broader metabolic and cardiovascular risk.

A hypertensive patient has persistent dyspnea on exertion and a displaced, sustained apex beat on cardiovascular examination. Which underlying process best explains this finding?

Correct Answer: Chronic left ventricular pressure overload

Persistent systemic hypertension increases left ventricular afterload, producing hypertrophy and characteristic cardiac examination findings.

A patient with hypertension asks why lipid testing is included during initial assessment when the problem is high blood pressure. What is the best explanation?

Correct Answer: Dyslipidemia contributes to overall cardiovascular risk

Hypertension management is based on total cardiovascular risk; lipid abnormalities identify an additional modifiable vascular risk factor.

A patient with hypertension has a normal blood-pressure reading at one follow-up visit after several months of therapy. He asks whether monitoring can now stop. Which response is most appropriate?

Correct Answer: Long-term monitoring is still required because control should be assessed over time

Hypertension is a chronic condition; repeated measurements, adherence review and risk assessment remain important even when individual readings are satisfactory.

A man receiving antihypertensive treatment reports that medication cost is causing him to miss appointments and reduce doses. Which primary-care principle is most appropriate?

Correct Answer: Address the practical barrier and agree on a sustainable management plan

Financial and social barriers directly influence adherence. Patient-centred management identifies these problems and develops a realistic long-term plan.

A 62-year-old man with hypertension is started on medication and asks why he still needs follow-up laboratory testing. Which principle best explains this?

Correct Answer: Some antihypertensive therapies and comorbid disease require renal or electrolyte monitoring

Monitoring helps detect treatment-related adverse effects and evolving renal involvement while guiding safe long-term therapy.

A hypertensive patient develops sudden marked visual disturbance with very high blood pressure. Which management principle is most appropriate?

Correct Answer: Consider acute target-organ injury and arrange urgent assessment

Acute visual deterioration with severe hypertension may represent significant hypertensive vascular injury and requires urgent rather than routine management.

A patient with hypertension has major differences between the pulse volume in the two upper limbs. Why is this finding clinically important?

Correct Answer: It may indicate an important vascular abnormality requiring further assessment

Marked pulse asymmetry is not a routine feature of simple hypertension and may signal vascular disease that changes the diagnostic approach.

A 55-year-old patient says that his family is willing to change meal preparation and join him in regular walking. What is the most likely benefit of this family involvement?

Correct Answer: It can improve practical support for sustained lifestyle and treatment adherence

Family support can make dietary change, exercise and medication routines easier to sustain, while the patient’s autonomy remains central.

A 36-year-old woman has persistent hypertension and examination findings suggesting a systemic endocrine disorder. Her blood pressure remains difficult to control. Which feature most strongly supports referral?

Correct Answer: Atypical clinical features with difficult-to-control hypertension

An unusual presentation and poor control despite appropriate management should raise suspicion of secondary hypertension and justify further evaluation.

A general practitioner is reviewing a stable patient with hypertension. Which approach best represents good long-term primary-care management?

Correct Answer: Review blood-pressure trend, adherence, adverse effects, cardiovascular risk and preventive measures

Long-term hypertension care is continuous and multidimensional: measure, review treatment, identify barriers, reduce overall risk and reassess when the clinical situation changes.