KMU Past Paper Practice

Question:
A 51-year-old woman in the menopausal transition has troublesome vasomotor symptoms and an intact uterus. She is started on systemic estrogen, with a progestogen given only during part of each treatment cycle. Which HRT regimen is being used?

Options:

Correct Answer: Sequential combined therapy

Explanation: In sequential HRT, estrogen is given continuously or cyclically while the progestogen is added for only part of each cycle, commonly producing withdrawal bleeding.

Question:
A 58-year-old woman with an intact uterus completed menopause several years ago. She requires systemic hormone therapy and wishes to avoid predictable monthly withdrawal bleeding. Which regimen best matches this preference?

Options:

Correct Answer: Continuous combined estrogen-progestogen therapy

Explanation: Continuous combined HRT supplies both hormones continuously and is designed to avoid regular withdrawal bleeding after the initial adjustment period.

Question:
A postmenopausal woman taking oral systemic estrogen develops recurrent biliary symptoms. Which pharmacological property of oral estrogen contributes to this adverse effect?

Options:

Correct Answer: Prominent first-pass hepatic exposure

Explanation: Oral estrogen reaches the liver in high concentration after absorption and alters hepatic protein and biliary physiology, contributing to gallbladder-related adverse effects.

Question:
A woman with anovulatory infertility receives a drug that reduces estrogenic negative feedback at the hypothalamus, causing an increase in endogenous gonadotropin secretion. Which drug produces this effect?

Options:

Correct Answer: Clomiphene

Explanation: Clomiphene blocks estrogen feedback at the hypothalamus, increasing FSH and LH secretion and thereby promoting follicular development and ovulation.

Question:
A patient with hormone-sensitive breast malignancy receives a drug that binds the estrogen receptor and promotes degradation and down-regulation of that receptor. Which agent has this mechanism?

Options:

Correct Answer: Fulvestrant

Explanation: Fulvestrant is an estrogen-receptor antagonist that promotes receptor down-regulation, reducing estrogen-mediated transcription in responsive tissues.

Question:
A pharmacology student compares agonists and antagonists of female gonadal hormones. Which drug acts principally by antagonizing progesterone receptors?

Options:

Correct Answer: Mifepristone

Explanation: Mifepristone blocks progesterone receptors, whereas norethindrone and medroxyprogesterone act primarily as progestational agonists.

Question:
A woman with acne is prescribed a contraceptive containing a progestin selected partly because it has antiandrogenic and anti-mineralocorticoid activity. Which progestin has these additional properties?

Options:

Correct Answer: Drospirenone

Explanation: Drospirenone is a progestin with additional antiandrogenic and anti-mineralocorticoid activity, distinguishing it from several older progestins.

Question:
A clinician explains why unmodified natural progesterone historically required special formulations for effective oral therapy. Which pharmacokinetic feature is primarily responsible?

Options:

Correct Answer: Rapid hepatic metabolism after oral administration

Explanation: Natural progesterone undergoes extensive hepatic metabolism, giving it limited oral bioavailability unless specially formulated.

Question:
During a pharmacology viva, a student is asked to classify medroxyprogesterone acetate according to its structural relationship. Which classification is most appropriate?

Options:

Correct Answer: Progesterone-related progestin

Explanation: Medroxyprogesterone acetate belongs to the progesterone/17-hydroxyprogesterone-related group of synthetic progestins.

Question:
A student groups norethindrone and levonorgestrel together while revising progestin pharmacology. Which structural class contains both drugs?

Options:

Correct Answer: 19-nortestosterone derivatives

Explanation: Norethindrone and levonorgestrel are synthetic 19-nortestosterone-derived progestins commonly used in hormonal contraception.

Question:
A woman is given an oral contraceptive pack in which every active tablet contains the same amounts of estrogen and progestin. How should this formulation be classified?

Options:

Correct Answer: Monophasic preparation

Explanation: Monophasic combined pills provide the same estrogen-progestin dose in each active tablet, unlike multiphasic preparations in which hormone proportions change.

Question:
A 26-year-old woman seeks contraception and also reports painful, relatively heavy regular menstrual periods. She has no contraindication to estrogen-containing contraception. Which additional benefit is most relevant when discussing combined oral pills?

Options:

Correct Answer: Reduction in menstrual loss and dysmenorrhea

Explanation: Combined oral contraceptives stabilize the endometrium and suppress ovarian cycling, commonly reducing menstrual blood loss and menstrual pain.

Question:
A woman asks whether long-term combined oral contraceptive use has any recognized non-contraceptive effect on future gynecological cancer risk. Which statement best reflects the expected effect?

Options:

Correct Answer: Reduced risk of endometrial and ovarian carcinoma

Explanation: Suppression of repeated ovulation and controlled endometrial exposure contribute to a recognized reduction in ovarian and endometrial cancer risk.

Question:
A 40-year-old woman requests combined oral contraception. Repeated measurements show markedly elevated blood pressure despite treatment. Which feature of the combined pill makes this history particularly important?

Options:

Correct Answer: Its estrogen-associated arterial vascular risk

Explanation: Severe or uncontrolled hypertension increases baseline arterial vascular risk, making estrogen-containing contraception inappropriate because estrogen can further increase thrombotic vascular risk.

Question:
A woman chooses a copper intrauterine device for long-term contraception. Which biological effect accounts most directly for its contraceptive efficacy?

Options:

Correct Answer: Local impairment of sperm function and fertilization

Explanation: Copper produces a local intrauterine environment that impairs sperm viability and function, markedly reducing the probability of fertilization.

Question:
A levonorgestrel-releasing intrauterine system is inserted for long-term contraception. Which local effect contributes most importantly to prevention of pregnancy?

Options:

Correct Answer: Cervical mucus thickening with endometrial suppression

Explanation: Locally released levonorgestrel makes cervical mucus poorly penetrable to sperm and markedly suppresses the endometrium.

Question:
A woman receiving repeated depot medroxyprogesterone injections initially develops irregular bleeding and later becomes amenorrheic. Which tissue change best explains the later bleeding pattern?

Options:

Correct Answer: Progressive endometrial atrophy

Explanation: Sustained progestin exposure suppresses endometrial growth; with prolonged DMPA use the endometrium becomes thin and atrophic, producing amenorrhea in many users.

Question:
A woman considering a levonorgestrel subdermal implant asks about complications that are specific to the method of drug delivery rather than to systemic progestin effects. Which complication best fits this description?

Options:

Correct Answer: Local insertion or removal difficulty

Explanation: Subdermal implants require a minor procedure, so local insertion-site problems or difficulty with removal are delivery-specific complications.

Question:
A primary-care team provides counseling to a couple who wish to delay their next pregnancy. The clinician discusses temporary and permanent methods and allows them to select a method according to their reproductive goals. Which broader concept is best represented by this approach?

Options:

Correct Answer: Family planning

Explanation: Family planning enables individuals and couples to make informed decisions about the number and spacing of children using acceptable reproductive methods.

Question:
A community medicine team is comparing contraceptive prevalence between two surveys. One survey reports current contraceptive use among all women of reproductive age, while the other reports use only among married or in-union women. What information is essential before comparing the reported rates?

Options:

Correct Answer: Population used as the denominator

Explanation: CPR depends on the defined population in the denominator; rates using all reproductive-age women cannot be interpreted identically to rates restricted to married or in-union women.