KMU Past Paper Practice

Question:

A 23-year-old woman has recurrent painful oral ulcers that interfere with eating. Examination shows shallow ulcers on non-keratinized mucosa with no induration, and investigation reveals no systemic disease. Which management is most appropriate to reduce local inflammation?

Options:

Correct Answer:
Topical corticosteroid therapy

Explanation: Topical corticosteroids reduce local inflammation in recurrent aphthous ulcers when no correctable underlying cause is identified.

Question:

A 58-year-old man has a solitary oral ulcer that has persisted for several weeks despite removal of local irritants. It has irregular margins and feels firm at its base. Which investigation is most appropriate?

Options:

Correct Answer:
Biopsy of the lesion

Explanation: A persistent, atypical or indurated oral ulcer requires tissue assessment because a simple recurrent aphthous ulcer should not remain persistently indurated.

Question:

A newborn with an unrepaired cleft palate has difficulty maintaining suction and milk repeatedly escapes through the nose. The infant is otherwise stable. Which immediate management principle is most appropriate?

Options:

Correct Answer:
Provide feeding and nutritional support

Explanation: Early management of cleft palate focuses on safe feeding and adequate nutrition before definitive surgical repair and later functional rehabilitation.

Question:

A school-age child with repaired cleft lip and palate develops abnormal dental alignment and malocclusion. Which component of long-term multidisciplinary care is most relevant to this complication?

Options:

Correct Answer:
Dental and orthodontic assessment

Explanation: Clefts involving the alveolar and maxillary region can disturb tooth eruption and occlusion, making dental and orthodontic follow-up important.

Question:

A 15-year-old boy recovers from an episode of febrile exudative tonsillitis caused by group A streptococci. Two weeks later, he develops migratory joint pains. Which recognized consequence of the original infection best explains the new illness?

Options:

Correct Answer:
Post-infectious immune-mediated disease

Explanation: Acute rheumatic fever is an immune-mediated complication following group A streptococcal pharyngeal infection rather than direct bacterial invasion of tissues.

Question:

A 17-year-old student presents with acute sore throat, fever and tonsillar exudate. The clinical findings do not clearly distinguish a viral from bacterial cause, and the result would alter treatment. Which investigation is most useful?

Options:

Correct Answer:
Throat microbiological testing

Explanation: Microbiological testing is appropriate when confirmation of a bacterial cause will influence whether antibacterial treatment is required.

Question:

A 29-year-old man has a long history of recurrent tonsillar inflammation. Examination between attacks reveals relatively small, firm tonsils rather than hypertrophied tonsils or crypts filled with debris. Which form of chronic tonsillitis best explains this appearance?

Options:

Correct Answer:
Chronic fibroid tonsillitis

Explanation: Repeated inflammation may lead to fibrosis, producing relatively small, firm tonsils characteristic of the fibroid form of chronic tonsillitis.

Question:

A young adult with a peritonsillar collection speaks with a muffled quality despite normal vocal-cord function. Which local change best explains the altered voice?

Options:

Correct Answer:
Oropharyngeal soft-tissue swelling

Explanation: Peritonsillar swelling alters the resonating space of the oropharynx and produces the characteristic muffled quality of speech.

Question:

A 12-year-old boy develops fever and painful bilateral parotid swelling. There is no purulent discharge from Stensen duct and no focal abscess. Which treatment approach is most appropriate?

Options:

Correct Answer:
Hydration, analgesia and supportive care

Explanation: The presentation is consistent with uncomplicated viral parotitis, for which management is mainly supportive rather than antibacterial or surgical.

Question:

A patient presents with a persistent painless lump in the parotid region without fever, meal-related pain or duct discharge. Which broad category of salivary-gland disease should be considered most strongly?

Options:

Correct Answer:
Neoplastic disease

Explanation: A persistent painless salivary-gland mass without inflammatory or obstructive features raises concern for a salivary neoplasm.

Question:

A 40-year-old man has symptoms suggesting submandibular duct obstruction. On examination, a stone is not clearly palpable. Which investigation may demonstrate a calculus when it contains sufficient mineral to be radiopaque?

Options:

Correct Answer:
Plain radiography

Explanation: A sufficiently radiopaque salivary calculus can be visualized on plain radiography, although other imaging may be needed for non-visible stones.

Question:

A patient has mild intermittent salivary duct obstruction without fever, abscess or severe gland damage. Which initial conservative measure is most appropriate?

Options:

Correct Answer:
Hydration, salivary stimulation and massage

Explanation: Minor uncomplicated obstruction may improve by increasing salivary flow and encouraging passage of obstructive material before invasive treatment is considered.

Question:

A woman has had a slowly enlarging painless parotid mass for many years. Histology confirms pleomorphic adenoma. Why is prolonged persistence of this lesion clinically important?

Options:

Correct Answer:
There is a risk of malignant transformation

Explanation: Long-standing pleomorphic adenoma is clinically important because malignant transformation can occur in a lesion that has persisted for a prolonged period.

Question:

A 64-year-old patient has a rapidly enlarging salivary-gland mass that has become fixed to surrounding tissues. Which interpretation is most appropriate?

Options:

Correct Answer:
The findings raise concern for malignant behavior

Explanation: Rapid growth and fixation suggest invasion of surrounding tissues and are concerning clinical features in a salivary-gland mass.

Question:

A salivary-gland carcinoma shows predominantly solid areas, increased cellular atypia and destructive growth rather than prominent cystic spaces. Which interpretation best fits these findings?

Options:

Correct Answer:
Higher-grade mucoepidermoid carcinoma

Explanation: Higher-grade mucoepidermoid carcinomas tend to be more solid, atypical and destructive, whereas lower-grade lesions contain more cystic and mucus-producing areas.

Question:

Gross examination of a parotid tumor shows a well-circumscribed mass with prominent cystic spaces. Microscopy demonstrates oncocytic epithelium supported by lymphoid tissue. Which gross-pathological correlation is most appropriate?

Options:

Correct Answer:
The cystic appearance is compatible with Warthin tumor

Explanation: Warthin tumor is commonly well circumscribed and may be cystic, correlating with its papillary-cystic oncocytic histology and lymphoid stroma.

Question:

A patient has progressive throat discomfort, dysphagia and a lesion suspected to arise from the posterior oropharynx, but the area cannot be fully inspected through the mouth. Which assessment is most appropriate for direct visualization?

Options:

Correct Answer:
Endoscopic examination

Explanation: Endoscopy allows direct assessment of upper aerodigestive sites that are not adequately visualized during routine oral examination.

Question:

A biopsy confirms squamous cell carcinoma of the tonsillar region. The clinician now needs to evaluate deep local extension and cervical lymph-node involvement. Which investigation is most appropriate?

Options:

Correct Answer:
CT or MRI of the relevant region

Explanation: Cross-sectional imaging is used to assess the extent of the primary lesion, deeper tissue involvement and regional cervical nodes.

Question:

A patient with an oropharyngeal mass undergoes complete head-and-neck examination. Why is systematic palpation of the cervical lymph-node regions an essential part of this assessment?

Options:

Correct Answer:
It evaluates possible regional metastatic disease

Explanation: Oropharyngeal cancers can involve cervical lymph nodes, so careful neck examination contributes directly to clinical assessment of regional disease.

Question:

A 57-year-old patient has a localized oropharyngeal squamous cell carcinoma without airway compromise. During counseling, the patient asks about the broad curative treatment approaches that may be used depending on site and disease extent. Which response is most appropriate?

Options:

Correct Answer:
Surgery, radiotherapy or combined oncological treatment

Explanation: Curative management of oropharyngeal carcinoma depends on site and extent and may involve surgery, radiotherapy or combined oncological treatment.