KMU Past Paper Practice

Question: A 74-year-old woman with peripheral vascular disease develops sudden cramping left-sided abdominal pain followed several hours later by passage of blood-streaked loose stool. Her abdomen is mildly tender and she has no long history of diarrhea. Which cause of lower gastrointestinal bleeding is most likely?

Options:

Ulcerative colitis

Ischemic colitis

Internal hemorrhoids

Rectal prolapse

Chronic anal fissure

Correct Answer: Ischemic colitis

Explanation: An acute painful episode followed by bloody stool in an older patient with vascular disease favors ischemic colitis from reduced colonic perfusion. UC generally causes recurring inflammatory symptoms; hemorrhoids and prolapse typically cause distal bleeding without this acute colitic pain; fissure causes painful defecation rather than sudden left-sided abdominal pain.

Question: An 80-year-old man with aortic stenosis develops intermittent painless episodes of dark-red rectal bleeding. Colonoscopy between episodes shows several flat, dilated vascular lesions in the right colon. Which diagnosis best accounts for the bleeding?

Options:

Angiodysplasia

Crohn’s colitis

Ischemic colitis

Ulcerative proctitis

Anal fissure

Correct Answer: Angiodysplasia

Explanation: Angiodysplasia consists of fragile dilated mucosal/submucosal vessels and commonly causes intermittent painless bleeding in older adults. Crohn’s and UC show inflammatory mucosal disease; ischemia is usually painful; an anal fissure causes painful bright-red bleeding during defecation.

Question: A 63-year-old man arrives after passing a large quantity of fresh blood per rectum. He is hypotensive and reports black, tarry stools and epigastric discomfort over the preceding day. Which diagnostic principle is most important?

Options:

Fresh blood excludes bleeding above the ligament of Treitz

Lower bowel bleeding is always painless

A brisk upper GI source must also be considered

Colonoscopy is mandatory before resuscitation

Rectal examination alone will establish the source

Correct Answer: A brisk upper GI source must also be considered

Explanation: Very brisk upper GI hemorrhage can present as hematochezia because blood passes rapidly through the intestine. Melena and epigastric symptoms reinforce this possibility. Fresh blood does not reliably localize the source; pain is variable; stabilization precedes definitive endoscopic evaluation; rectal examination cannot establish a proximal source.

Question: A 66-year-old stable woman has had two self-limited episodes of maroon rectal bleeding. After examination and initial blood tests, the bleeding has stopped and bowel preparation can be undertaken. Which diagnostic approach best evaluates the colonic source and allows treatment of an identified lesion?

Options:

Barium swallow

Diagnostic laparoscopy

Serum carcinoembryonic antigen

Colonoscopy after appropriate bowel preparation

Routine abdominal radiography

Correct Answer: Colonoscopy after appropriate bowel preparation

Explanation: In a stable patient, prepared colonoscopy allows visualization, biopsy if appropriate and endoscopic treatment of certain bleeding lesions. Barium swallow evaluates the upper tract; laparoscopy is not a routine diagnostic first choice; CEA cannot localize bleeding; plain radiographs do not identify most mucosal bleeding sources.

Question: A 26-year-old student reports eight months of episodic loose stool and abdominal discomfort. There is no visible blood or weight loss. Examination is normal, but the clinician wants to distinguish functional bowel symptoms from intestinal inflammation before deciding on endoscopy. Which test is most helpful?

Options:

Serum amylase

Serum bilirubin

Fecal occult blood alone

Serum carcinoembryonic antigen

Fecal calprotectin

Correct Answer: Fecal calprotectin

Explanation: Fecal calprotectin reflects neutrophil-associated intestinal inflammation. A raised value supports an inflammatory process, although it does not by itself diagnose IBD. Amylase and bilirubin assess other organs; occult blood does not directly assess mucosal inflammatory activity; CEA is not a diagnostic test for IBD.

Question: A 31-year-old patient with established ulcerative colitis develops an abrupt increase in diarrhea after a recent antibiotic course. There is fever and abdominal tenderness. Before assuming this represents inflammatory relapse and escalating steroids, which test is particularly important?

Options:

Fecal testing for Clostridioides difficile

Serum alpha-fetoprotein

Hydrogen breath test

Serum lipase

Fecal elastase

Correct Answer: Fecal testing for Clostridioides difficile

Explanation: C. difficile infection can mimic or worsen an IBD flare and may be promoted by recent antibiotics. Infection should be assessed before intensifying immunosuppression. AFP evaluates selected tumors; breath testing investigates some carbohydrate malabsorption; lipase assesses pancreatitis; fecal elastase evaluates pancreatic insufficiency, not this acute infectious concern.

Question: A 36-year-old man with ulcerative colitis has fatigue and itching. Blood tests show a cholestatic pattern, and imaging reveals multifocal narrowing and dilatation of the bile ducts. Which associated condition is most likely?

Options:

Gallstone ileus

Primary sclerosing cholangitis

Acute viral hepatitis

Autoimmune hemolytic anemia

Chronic pancreatitis

Correct Answer: Primary sclerosing cholangitis

Explanation: Primary sclerosing cholangitis is associated with ulcerative colitis and causes inflammatory fibrosis and multifocal biliary strictures with a cholestatic biochemical pattern. Gallstone ileus causes bowel obstruction; viral hepatitis usually has prominent hepatocellular injury; hemolysis causes indirect hyperbilirubinemia; pancreatitis does not cause the characteristic beaded ducts.

Question: A 45-year-old woman with longstanding extensive ulcerative colitis undergoes surveillance colonoscopy. A visible colonic lesion is biopsied and confirms dysplasia. What is the central reason this finding changes management?

Options:

Dysplasia proves an acute intestinal infection

It demonstrates complete mucosal healing

It indicates increased risk of progression to colorectal carcinoma

It confirms the presence of intestinal obstruction

It excludes inflammation-related colorectal cancer

Correct Answer: It indicates increased risk of progression to colorectal carcinoma

Explanation: Dysplasia is premalignant epithelial change, and its grade, visibility and resectability guide endoscopic or surgical management to prevent invasive colorectal cancer. Dysplasia is not an infection, healing marker or mechanical obstruction and does not exclude future malignant progression.

Question: A 33-year-old woman with medication-refractory ulcerative colitis is considering restorative proctocolectomy. She asks how surgery differs from surgery for Crohn’s disease. Which statement is most accurate?

Options:

Colectomy invariably cures all extraintestinal manifestations

Crohn’s disease cannot involve the small bowel after surgery

Both diseases recur identically after removal of the colon

Removing the colon and rectum eliminates the colonic disease of ulcerative colitis

Surgery prevents future small-bowel inflammation in both conditions

Correct Answer: Removing the colon and rectum eliminates the colonic disease of ulcerative colitis

Explanation: Ulcerative colitis is confined to the colon and rectum, so complete proctocolectomy removes its intestinal disease, although pouch complications and extraintestinal manifestations can still occur. Extraintestinal disease may persist; Crohn’s can recur in remaining bowel; recurrence patterns differ and surgery does not prevent Crohn’s elsewhere.

Question: A 28-year-old man with longstanding terminal ileal Crohn’s disease complains of fatigue and tingling in his feet. His hemoglobin is low and mean corpuscular volume is increased. Which mechanism most directly explains his anemia?

Options:

Occult colonic blood loss causing iron depletion

Reduced platelet production

Impaired folate absorption in the stomach

Autoimmune destruction of erythrocytes

Reduced vitamin B12 absorption in the diseased terminal ileum

Correct Answer: Reduced vitamin B12 absorption in the diseased terminal ileum

Explanation: Vitamin B12 is absorbed in the terminal ileum; ileal inflammation or resection can impair absorption and cause macrocytic anemia with neurological symptoms. Iron deficiency is typically microcytic; platelet production does not cause macrocytosis; folate is absorbed chiefly in proximal small intestine; hemolysis is not suggested by the ileal context.

Question: A 25-year-old woman with Crohn’s disease develops tender red nodules over the anterior shins during a period of increased bowel symptoms. They have no purulent discharge and improve as the bowel inflammation is treated. Which extraintestinal manifestation is most likely?

Options:

Erythema nodosum

Pyoderma gangrenosum

Venous stasis ulceration

Cellulitis

Superficial thrombophlebitis

Correct Answer: Erythema nodosum

Explanation: Erythema nodosum produces tender erythematous subcutaneous nodules, usually over the shins, and commonly parallels IBD activity. Pyoderma gangrenosum causes painful ulceration; stasis ulcers and thrombophlebitis have vascular patterns; cellulitis is usually a localized spreading infection.

Question: A 32-year-old man with inflammatory bowel disease develops a rapidly enlarging, very painful leg ulcer with a violaceous undermined edge. The lesion began after minor trauma. Which associated skin complication is most likely?

Options:

Erythema nodosum

Pyoderma gangrenosum

Psoriasis

Herpes zoster

Contact dermatitis

Correct Answer: Pyoderma gangrenosum

Explanation: Pyoderma gangrenosum is a neutrophilic inflammatory disorder associated with IBD and causes painful ulcers with undermined violaceous edges; trauma may worsen it. Erythema nodosum causes intact tender nodules; psoriasis causes plaques; zoster causes dermatomal vesicles; contact dermatitis usually causes pruritic eczematous changes.

Question: A 30-year-old woman with active Crohn’s colitis has new painful red eye, photophobia and blurred vision. Her visual acuity has fallen. What is the most appropriate interpretation and action?

Options:

Uncomplicated dry eye; start lubricants only

Typical conjunctivitis; review in one month

Possible uveitis requiring urgent ophthalmic assessment

Expected adverse effect of mesalazine; stop all medications

Referred discomfort from abdominal pain; reassure

Correct Answer: Possible uveitis requiring urgent ophthalmic assessment

Explanation: Painful photophobic red eye with reduced vision suggests uveitis, an important extraintestinal inflammatory manifestation that needs prompt ophthalmic evaluation to protect vision. Dry eye and typical conjunctivitis do not explain this full warning pattern; medication attribution is unsupported; reassurance risks preventable visual harm.

Question: A 49-year-old man with longstanding Crohn’s disease develops watery diarrhea after resection of an inflamed terminal ileal segment. There is no fever, blood or increase in inflammatory markers. Which mechanism may explain the diarrhea?

Options:

Excess secretion of pancreatic enzymes

Reduced gastric acid production

Increased rectal compliance

Unabsorbed bile acids reaching the colon

Failure of colonic mucus production

Correct Answer: Unabsorbed bile acids reaching the colon

Explanation: Terminal ileal disease or resection reduces bile-acid reabsorption. Excess bile acids reaching the colon stimulate fluid secretion and cause watery diarrhea. Pancreatic enzymes and acid secretion are not the main mechanism; rectal compliance and mucus changes do not explain the ileal surgery association.

Question: A 38-year-old man with established ulcerative colitis reports worsening diarrhea, but stool blood is absent and symptom severity is difficult to interpret. Which combination best helps distinguish active inflammation from symptoms alone?

Options:

CEA and serum amylase

Plain radiography and serum bilirubin

Blood group and serum calcium

Urine dipstick and serum sodium

Fecal calprotectin and inflammatory markers, with endoscopy when indicated

Correct Answer: Fecal calprotectin and inflammatory markers, with endoscopy when indicated

Explanation: Objective inflammatory markers such as fecal calprotectin and CRP support assessment of disease activity; endoscopy can directly assess mucosal inflammation when required. The other test pairs do not assess intestinal mucosal inflammation reliably and cannot establish activity or guide escalation in this setting.

Question: A 69-year-old woman develops progressive abdominal distension, cramping, constipation and intermittent small-volume rectal bleeding over several months. Imaging reveals an annular constricting tumor in the sigmoid colon. Which mechanism best explains her obstructive symptoms?

Options:

Progressive narrowing of the bowel lumen by a circumferential lesion

Acute inflammation of the pancreatic duct

Excessive secretion from normal intestinal mucosa

Failure of gastric emptying

Portal venous congestion without bowel narrowing

Correct Answer: Progressive narrowing of the bowel lumen by a circumferential lesion

Explanation: A circumferential left-sided colorectal tumor progressively narrows the relatively smaller lumen, causing altered bowel habits and eventual large-bowel obstruction. The other mechanisms do not account for a demonstrated annular sigmoid lesion producing distal mechanical obstruction.

Question: A 43-year-old woman has colorectal cancer, and her mother developed endometrial cancer at age 45. An uncle had colon cancer at 42. The team considers a hereditary cancer syndrome. Which feature particularly supports that concern?

Options:

Isolated hemorrhoidal bleeding

Early-onset cancers in relatives involving colon and endometrium

A single benign hyperplastic polyp in an elderly relative

Occasional constipation without family disease

A family history limited to gallstones

Correct Answer: Early-onset cancers in relatives involving colon and endometrium

Explanation: Early colorectal and endometrial cancers clustering in a family suggest Lynch syndrome, an inherited mismatch-repair-associated cancer predisposition that affects counseling and surveillance. Hemorrhoids, isolated benign polyps, constipation and gallstones do not establish a characteristic hereditary colorectal/endometrial cancer pattern.

Question: A 61-year-old man undergoes apparently curative resection for colon cancer and later has serial carcinoembryonic antigen (CEA) measurements as part of follow-up. Which interpretation is most appropriate if the CEA level begins rising repeatedly?

Options:

It confirms Crohn’s disease

It proves benign postoperative inflammation

It raises concern for recurrence and prompts further evaluation

It establishes the exact anatomical site of recurrence

It removes the need for imaging or clinical assessment

Correct Answer: It raises concern for recurrence and prompts further evaluation

Explanation: A sustained or rising CEA trend after treatment can raise suspicion for colorectal cancer recurrence and warrants clinical and imaging evaluation, but it is not diagnostic by itself. CEA does not diagnose Crohn’s, cannot prove benign inflammation, does not localize disease, and cannot substitute for imaging.

Question: A 73-year-old man arrives with progressive distension, obstipation and vomiting. CT shows a large-bowel obstruction at a previously unsuspected descending-colon mass and marked proximal dilatation. There is increasing abdominal tenderness. What is the best management principle?

Options:

Begin routine outpatient bowel preparation

Delay intervention until routine surveillance colonoscopy

Treat with oral mesalazine

Urgent resuscitation and surgical assessment for obstructing cancer

Discharge with laxatives and return precautions

Correct Answer: Urgent resuscitation and surgical assessment for obstructing cancer

Explanation: An obstructing colorectal tumor with distension, obstipation and worsening tenderness is a surgical emergency. Stabilization and urgent surgical assessment are needed because ischemia and perforation may develop. Outpatient preparation, surveillance, mesalazine and laxatives do not relieve dangerous mechanical obstruction and may delay definitive care.

Question: A 57-year-old woman receives oxaliplatin-containing adjuvant chemotherapy after surgery for node-positive colon cancer. She describes tingling in her fingers, especially when touching cold objects. Which explanation is most appropriate?

Options:

Colorectal cancer has necessarily metastasized to the brain

This is diagnostic of iron deficiency

The symptoms indicate acute intestinal obstruction

An immediate allergic reaction is the only explanation

Oxaliplatin can produce cold-triggered peripheral sensory neuropathy

Correct Answer: Oxaliplatin can produce cold-triggered peripheral sensory neuropathy

Explanation: Oxaliplatin may cause acute cold-triggered paresthesia and cumulative sensory neuropathy. Recognizing it supports treatment monitoring and possible dose adjustment. Neuropathic tingling is not proof of brain metastasis, iron deficiency, obstruction or necessarily an allergic reaction.