📝 Step 5 — KMU Past Papers & Exam Learning

This section contains KMU-style past paper questions designed to strengthen conceptual understanding. Focus on understanding explanations rather than memorizing answers.

🎯 How to Study KMU Past Papers

• Read the question carefully.
• Think about the answer before looking.
• Read the explanation slowly.
• Understand the reasoning behind the correct answer.
• Revise difficult questions again.

MCQ 1

Question:
A 17-year-old boy dies suddenly during exercise and autopsy suggests hypertrophic cardiomyopathy. What is the most appropriate evaluation for his first-degree relatives?

Options:
Serum troponin only
Chest radiograph only
ECG and echocardiography
Lipid profile only
Blood culture only

Correct Answer:
ECG and echocardiography

Explanation:
Hypertrophic cardiomyopathy may have familial clustering. First-degree relatives require cardiac evaluation, especially with ECG and echocardiography, to detect silent disease.

MCQ 2

Question:
A young patient is diagnosed with hypertrophic cardiomyopathy after exertional syncope. Which inheritance pattern is classically associated with this disorder?

Options:
Autosomal dominant pattern
Autosomal recessive pattern
X-linked recessive pattern
Mitochondrial pattern
Multifactorial pattern only

Correct Answer:
Autosomal dominant pattern

Explanation:
Hypertrophic cardiomyopathy is classically associated with autosomal dominant sarcomeric protein mutations, explaining family history of sudden death.

MCQ 3

Question:
A patient with hypertrophic cardiomyopathy develops atrial fibrillation and suddenly becomes breathless and hypotensive. Which physiological loss best explains the deterioration?

Options:
Right ventricular afterload
Pulmonary valve closure
Aortic elastic recoil
Coronary venous drainage
Atrial contribution to filling

Correct Answer:
Atrial contribution to filling

Explanation:
The stiff hypertrophied ventricle depends on atrial contraction for adequate diastolic filling. Atrial fibrillation can markedly worsen cardiac output.

MCQ 4

Question:
In a patient with suspected obstructive hypertrophic cardiomyopathy, Doppler echocardiography is especially helpful to assess:

Options:
Pleural fluid volume
Outflow tract gradient
Coronary plaque color
Pericardial fat thickness
Pulmonary parenchymal opacity

Correct Answer:
Outflow tract gradient

Explanation:
Doppler echocardiography helps quantify dynamic left ventricular outflow obstruction, which guides severity assessment and management.

MCQ 5

Question:
A patient has left ventricular hypertrophy without long-standing hypertension. Imaging shows disproportionate septal thickening. Which diagnosis is most consistent?

Options:
Dilated cardiomyopathy
Restrictive cardiomyopathy
Acute pericarditis
Hypertrophic cardiomyopathy
Rheumatic mitral stenosis

Correct Answer:
Hypertrophic cardiomyopathy

Explanation:
Disproportionate septal hypertrophy without another clear loading cause supports hypertrophic cardiomyopathy rather than hypertensive heart disease.

MCQ 6

Question:
Disopyramide may be used in selected obstructive hypertrophic cardiomyopathy cases because it mainly provides:

Options:
Negative inotropic effect
Positive chronotropic effect
Strong diuretic effect
Antibacterial effect
Thrombolytic effect

Correct Answer:
Negative inotropic effect

Explanation:
Disopyramide reduces myocardial contractility, which can decrease dynamic obstruction in selected obstructive hypertrophic cardiomyopathy patients.

MCQ 7

Question:
A victim of high-speed chest trauma has a transverse sternal fracture. Which associated injury should be suspected?

Options:
Isolated skin abrasion
Simple muscle fatigue
Chronic lung fibrosis
Thyroid gland rupture
Blunt cardiac injury

Correct Answer:
Blunt cardiac injury

Explanation:
Sternal fracture indicates significant anterior chest force and may be associated with myocardial contusion or other blunt cardiac injuries.

MCQ 8

Question:
A stab wound lies in the precordial region close to the left sternal border. The patient collapses rapidly. Which internal injury is most important to exclude?

Options:
Gallbladder rupture
Renal cortical tear
Pericardial and cardiac injury
Femoral artery injury
Cervical spine fracture

Correct Answer:
Pericardial and cardiac injury

Explanation:
Penetrating wounds in the precordial region may injure the pericardium and heart, causing rapid fatal hemorrhage or tamponade.

MCQ 9

Question:
After rib fracture, a patient develops palpable crackling under the skin of the chest wall. What is the most likely complication?

Options:
Pleural calcification
Subcutaneous emphysema
Myocardial infarction
Pericardial thickening
Pulmonary hypertension

Correct Answer:
Subcutaneous emphysema

Explanation:
Air escaping from injured lung or pleura may track into subcutaneous tissues, producing palpable crepitus over the chest wall.

MCQ 10

Question:
A person crushed in a crowd develops facial congestion, petechial hemorrhages, and cyanosis. The chest shows compression injuries. Which mechanism best explains death?

Options:
Fatty liver failure
Acute renal colic
Cerebellar hemorrhage
Traumatic asphyxia
Septic shock

Correct Answer:
Traumatic asphyxia

Explanation:
Severe chest compression prevents breathing and impedes venous return, causing congestion, petechiae, cyanosis, and possible death.

MCQ 11

Question:
At autopsy, a rib fracture is surrounded by tissue hemorrhage and inflammatory reaction. What does this finding indicate?

Options:
Postmortem fracture only
Old healed childhood injury
Antemortem chest trauma
Congenital rib deformity
Artifact of dissection

Correct Answer:
Antemortem chest trauma

Explanation:
Hemorrhage and vital tissue reaction around a fracture indicate injury during life, not a purely postmortem artifact.

MCQ 12

Question:
A middle-aged man suddenly collapses after a severe headache. Autopsy reveals blood in the subarachnoid space. Which natural cause of sudden death is most likely?

Options:
Ruptured intracranial aneurysm
Chronic peptic ulcer
Renal tubular necrosis
Acute cholecystitis
Pulmonary emphysema

Correct Answer:
Ruptured intracranial aneurysm

Explanation:
Sudden severe headache followed by collapse and subarachnoid hemorrhage suggests rupture of an intracranial aneurysm.

MCQ 13

Question:
A sudden unexplained death shows no gross structural heart disease and toxicology is negative. Which mechanism may still explain death?

Options:
Slow intestinal obstruction
Simple skin contusion
Chronic tonsillitis
Old healed rib fracture
Fatal cardiac arrhythmia

Correct Answer:
Fatal cardiac arrhythmia

Explanation:
Some sudden deaths occur due to lethal electrical disturbances without major gross anatomical findings at autopsy.

MCQ 14

Question:
In a sudden unexpected death, why should autopsy be performed before embalming or extensive handling of the body?

Options:
To improve cosmetic appearance
To preserve medicolegal evidence
To reduce funeral expenses
To confirm family consent
To shorten police paperwork

Correct Answer:
To preserve medicolegal evidence

Explanation:
Embalming and handling may alter injuries, contaminate samples, or interfere with toxicological and forensic interpretation.

MCQ 15

Question:
During autopsy of a suspected sudden cardiac death, which step is most important for identifying ischemic heart disease?

Options:
Measuring stomach volume
Examining coronary arteries
Inspecting the appendix
Opening urinary bladder
Sampling thyroid cartilage

Correct Answer:
Examining coronary arteries

Explanation:
Coronary artery narrowing, thrombosis, or atherosclerosis is a major cause of sudden cardiac death and must be carefully assessed.

MCQ 16

Question:
A patient with hypertrophic cardiomyopathy has recurrent symptoms despite initial drug therapy. Which management principle is most appropriate before escalating treatment?

Options:
Induce tachycardia during exertion
Optimize rate control and filling
Avoid cardiac follow-up
Use routine thrombolysis
Restrict all oral fluids

Correct Answer:
Optimize rate control and filling

Explanation:
Symptom control in hypertrophic cardiomyopathy focuses on slowing heart rate, improving diastolic filling, and avoiding factors that worsen obstruction.

MCQ 17

Question:
A fractured rib has pierced the underlying lung. The patient develops cough with blood-stained sputum soon after trauma. Which injury best explains this finding?

Options:
Pericardial adhesion
Aortic atherosclerosis
Pulmonary laceration
Tracheal papilloma
Esophageal rupture

Correct Answer:
Pulmonary laceration

Explanation:
Sharp rib fragments may tear lung tissue, producing bleeding into airways and hemoptysis after chest trauma.

MCQ 18

Question:
A small penetrating cardiac wound causes rapid accumulation of blood in the pericardial sac. Why can even limited bleeding become fatal?

Options:
Pericardium expands freely
Pleura closes the wound
Blood enters the stomach
Lungs absorb the fluid
Ventricular filling is impaired

Correct Answer:
Ventricular filling is impaired

Explanation:
The fibrous pericardium limits expansion, so accumulating blood compresses the heart and prevents adequate ventricular filling.

MCQ 19

Question:
A young man with undiagnosed hypertrophic cardiomyopathy dies during intense physical activity. Which immediate terminal event is most likely?

Options:
Ventricular tachyarrhythmia
Acute appendiceal rupture
Progressive renal failure
Bacterial meningitis
Portal hypertension

Correct Answer:
Ventricular tachyarrhythmia

Explanation:
Exercise can trigger malignant ventricular arrhythmias in hypertrophic cardiomyopathy, leading to sudden cardiac death.

MCQ 20

Question:
A man dies suddenly in police custody after complaining of chest discomfort. No obvious external injury is present. What is the main medicolegal importance of autopsy?

Options:
To certify hospital attendance
To document clothing brand
To estimate educational status
To determine cause and manner of death
To decide funeral expenses

Correct Answer:
To determine cause and manner of death

Explanation:
Sudden death in custody has major medicolegal importance. Autopsy helps determine whether death was natural, traumatic, toxicological, or related to negligence.

📌 Important Exam Strategy

KMU examinations often test integrated understanding rather than isolated facts. Focus on linking anatomy, embryology, histology, and clinical concepts when reviewing questions.

✅ Revision Tip

If you can explain the reason behind the correct answer without looking at notes, your concept is strong.