KMU Past Paper Practice

Question:

A 68-year-old man develops coughing and a wet-sounding voice immediately after swallowing water following a recent stroke. His oxygen saturation falls during feeding. What is the safest immediate clinical decision?

Correct Answer:

Keep oral intake on hold pending swallowing assessment

Explanation:

Coughing, wet voice and desaturation suggest aspiration from impaired swallowing; oral intake should pause until safety is assessed.

Question:

A 57-year-old man with a known esophageal narrowing suddenly cannot swallow even his saliva after eating meat. He is drooling but breathing comfortably. Which management is most appropriate?

Correct Answer:

Urgent therapeutic upper GI endoscopy

Explanation:

Inability to handle secretions indicates complete esophageal obstruction and requires urgent endoscopic assessment and relief.

Question:

A 51-year-old woman describes intermittent chest discomfort and dysphagia to both solids and liquids. Endoscopy shows no structural lesion. Which finding would most strongly support a primary esophageal motility problem?

Correct Answer:

Abnormal coordinated contractions on manometry

Explanation:

After excluding obstruction, manometry can demonstrate disordered esophageal contractions causing dysphagia.

Question:

A 62-year-old man reports painful swallowing, retrosternal discomfort and reduced oral intake. Examination reveals oral candidiasis and he uses an immunosuppressive medicine. Which interpretation best fits his new symptom?

Correct Answer:

Inflammatory or infective esophageal disease

Explanation:

Odynophagia accompanied by oral candidiasis and immunosuppression suggests esophageal inflammation or infection rather than isolated motility dysfunction.

Question:

A 66-year-old patient reports progressive swallowing difficulty. A clinician initially considers a functional swallowing disorder, but finds marked unintentional weight loss and a palpable supraclavicular node. What is the most appropriate interpretation?

Correct Answer:

Alarm features require expedited investigation for malignancy

Explanation:

Progressive dysphagia with weight loss and lymphadenopathy are alarm features that warrant urgent structural evaluation.

Question:

A 74-year-old man arrives after vomiting blood and appears pale. Despite an apparently normal first hemoglobin result, he is tachycardic, cool peripherally and has a narrow pulse pressure. What explains the apparent laboratory–clinical mismatch?

Correct Answer:

An early hemoglobin level can underestimate acute blood loss

Explanation:

In early acute hemorrhage, whole blood is lost before dilution occurs, so the initial hemoglobin may not reflect severity.

Question:

A 60-year-old man with hematemesis has raised urea relative to creatinine while reporting no urinary symptoms. Which mechanism may contribute to this laboratory pattern?

Correct Answer:

Digestion and absorption of blood proteins in the gut

Explanation:

Digested blood proteins increase nitrogen absorption and urea generation; volume depletion may add a prerenal component.

Question:

An older woman taking a nonsteroidal anti-inflammatory drug is admitted with suspected ulcer bleeding. Besides stabilizing her and arranging endoscopy, which modification directly addresses an avoidable contributor to the injury?

Correct Answer:

Withhold the offending NSAID and review safer analgesia

Explanation:

NSAIDs impair prostaglandin-mediated mucosal protection; stopping the culprit drug reduces ongoing injury and rebleeding risk.

Question:

A 47-year-old man with cirrhosis is admitted with suspected portal-hypertensive bleeding. Endoscopy is being arranged. Which additional early measure reduces an important infection-related complication?

Correct Answer:

Antibiotic prophylaxis during the acute bleed

Explanation:

Cirrhotic patients with upper GI bleeding have increased bacterial infection risk; early antibiotic prophylaxis improves outcomes.

Question:

A 59-year-old woman presents with syncope and melena. Her blood pressure is 88/56 mmHg and she remains confused after a brief initial fluid infusion. A relative asks why endoscopy has not begun. What is the best clinical priority?

Correct Answer:

Continue urgent resuscitation and stabilize before endoscopy

Explanation:

In unstable GI bleeding, restoring airway and circulation and arranging urgent definitive care takes priority over immediate endoscopy without stabilization.

Question:

A newborn begins vomiting on day 1 of life. The vomitus is green, but the abdomen is not visibly distended. Which interpretation is safest?

Correct Answer:

Bilious vomiting requires urgent exclusion of surgical obstruction

Explanation:

Bilious vomiting can indicate obstruction distal to the ampulla; lack of distension does not reliably exclude a surgical emergency.

Question:

A 5-week-old infant has several days of vomiting and fewer wet nappies. Examination reveals a sunken fontanelle, prolonged capillary refill and lethargy. Which assessment best determines the immediate treatment priority?

Correct Answer:

Clinical perfusion and dehydration severity

Explanation:

Signs of poor perfusion and severe dehydration indicate urgent fluid resuscitation before detailed etiological treatment.

Question:

A 7-week-old infant with repeated vomiting has low serum chloride and high bicarbonate. After initial stabilization, which additional measurement is most useful for monitoring safe correction of the disturbance?

Correct Answer:

Repeat serum electrolytes and acid–base status

Explanation:

Serial electrolytes and bicarbonate establish whether vomiting-related alkalosis and salt deficits are being corrected.

Question:

A thriving 4-month-old infant frequently brings up small amounts of milk. Parents ask whether to position the child prone during sleep to prevent regurgitation. Which advice best balances feeding management with safety?

Correct Answer:

Use age-appropriate feeding adjustments while maintaining supine sleep

Explanation:

Simple regurgitation can be managed with feeding advice; infants should still sleep supine on a flat, firm surface to reduce sleep-related death risk.

Question:

A neonate with ongoing vomiting becomes progressively distended and lethargic. The surgical team requests gastric decompression while arranging urgent assessment. What is the main purpose of the nasogastric tube in this context?

Correct Answer:

To reduce gastric accumulation and aspiration risk

Explanation:

Nasogastric decompression reduces accumulated gastric contents while resuscitation and definitive evaluation proceed; it does not correct obstruction.

Question:

A pregnant woman at 10 weeks reports persistent vomiting and abdominal discomfort. She has significant dysuria, fever and costovertebral angle tenderness. What should guide the next decision?

Correct Answer:

Investigate for urinary infection in addition to treating vomiting

Explanation:

Fever, dysuria and flank tenderness suggest urinary tract infection, an alternative or additional cause needing prompt assessment.

Question:

A patient admitted with hyperemesis gravidarum has persistent inability to eat and substantial weight loss. Vomiting is improving after fluid and antiemetic treatment, but oral nutrition remains poor. What additional care principle is most appropriate?

Correct Answer:

Assess nutrition and arrange graded intake or further support

Explanation:

Successful treatment includes restoration of adequate nutrition, not merely reduction in vomiting frequency.

Question:

A 25-year-old at 9 weeks’ gestation has severe vomiting. An ultrasound shows a multiple pregnancy. Which interpretation most appropriately connects this finding with the presenting problem?

Correct Answer:

Higher pregnancy-related hCG levels may contribute to severe nausea and vomiting

Explanation:

Multiple gestation is associated with higher hCG exposure, which can contribute to pregnancy-related nausea and hyperemesis.

Question:

A pregnant patient recovering from severe vomiting asks why her pulse, urine output and blood chemistry are being checked even though nausea is improving. Which explanation best connects monitoring to safe care?

Correct Answer:

Clinical improvement can precede full correction of fluid and electrolyte deficits

Explanation:

Improved nausea does not establish correction of dehydration, renal hypoperfusion or electrolyte abnormalities; these need reassessment.

Question:

A 29-year-old woman treated for hyperemesis can drink small amounts but still becomes dizzy on standing and has passed very little urine. She requests discharge because vomiting is less frequent. Which disposition is most appropriate?

Correct Answer:

Continue supervised hydration and reassess clinical stability

Explanation:

Orthostatic symptoms and oliguria suggest unresolved volume depletion; safe discharge requires stable hydration and ability to maintain intake.