KMU Past Paper Practice

Question: A 33-year-old office worker has gradually gained 14 kg over four years. He skips breakfast, drinks sweetened beverages throughout the day and sits for most of his working hours. Thyroid examination and TSH are normal. Which explanation best integrates his history with the development of obesity?

Options

Persistently positive energy balance from intake exceeding expenditure

Increased basal energy expenditure during sedentary work

Reduced energy storage caused by high insulin sensitivity

Isolated thyroid hormone deficiency despite normal TSH

Failure of adipose tissue to store circulating triglycerides

Correct Answer: Persistently positive energy balance from intake exceeding expenditure

Explanation: Sustained energy intake above expenditure promotes adipose storage; the history gives no evidence for hypothyroidism.

Question: A 57-year-old man with central obesity develops progressive exertional breathlessness. Echocardiography reveals left ventricular hypertrophy and impaired relaxation, with no significant valve disease. Which obesity-associated process is the most plausible contributor?

Options

Direct bacterial invasion of ventricular muscle

Chronic hemodynamic loading and hypertension

Autoimmune destruction of cardiac valves

Complete cessation of sympathetic activity

Congenital narrowing of the aortic valve

Correct Answer: Chronic hemodynamic loading and hypertension

Explanation: Obesity increases circulating volume and cardiac workload; accompanying hypertension promotes ventricular remodeling.

Question: A 46-year-old woman has obesity and marked fatigue. She reports cold intolerance, constipation and dry skin. Unlike her previous visits, her weight is rising despite reduced food intake. Which investigation most appropriately evaluates an important treatable contributor?

Options

Serum amylase

Serum troponin

Thyroid-stimulating hormone

Serum uric acid

Fecal occult blood

Correct Answer: Thyroid-stimulating hormone

Explanation: The symptom cluster suggests hypothyroidism; TSH is the appropriate initial biochemical test.

Question: A 49-year-old man with obesity has repeated clinic blood pressures of 152/96 mmHg, elevated triglycerides and impaired fasting glucose. He asks why several problems have appeared together. Which process best links these abnormalities?

Options

Reduced sympathetic tone and increased insulin action

Low circulating free fatty acids and improved endothelial function

Isolated loss of pancreatic glucagon secretion

Visceral adiposity with insulin resistance and vascular dysfunction

Increased skeletal muscle glucose uptake without insulin

Correct Answer: Visceral adiposity with insulin resistance and vascular dysfunction

Explanation: Visceral fat contributes to insulin resistance, dyslipidemia and vascular changes that cluster as cardiometabolic disease.

Question: A 41-year-old woman with severe obesity describes social withdrawal after repeated insulting comments about her weight in healthcare settings. She has stopped attending follow-up appointments. Which clinical response best supports treatment engagement?

Options

Tell her weight loss depends entirely on willpower

Delay treatment until she independently overcomes embarrassment

Use a confrontational approach to emphasize consequences

Avoid discussing weight-related concerns altogether

Use non-stigmatizing language and agree on realistic shared goals

Correct Answer: Use non-stigmatizing language and agree on realistic shared goals

Explanation: Respectful, person-centered communication reduces barriers to sustained obesity care.

Question: A 44-year-old woman has a BMI of 34 kg/m² and finds that portion control is difficult because she feels hungry soon after meals. The clinician describes how anti-obesity medicines may address different mechanisms. Which class acts mainly through central appetite and satiety pathways?

Options

GLP-1 receptor agonists

Gastrointestinal lipase inhibitors

Proton-pump inhibitors

Loop diuretics

Bile acid sequestrants

Correct Answer: GLP-1 receptor agonists

Explanation: GLP-1 receptor agonists enhance satiety and reduce energy intake; orlistat acts locally in the intestine.

Question: A 37-year-old man with obesity asks whether taking a diuretic to lose several kilograms in a week is equivalent to losing adipose tissue. Which explanation is most accurate?

Options

Diuretics permanently decrease adipocyte number

Early weight change reflects water loss, not meaningful fat reduction

Diuretics suppress hypothalamic hunger long term

Urinary sodium loss directly reverses insulin resistance

A rapid fall in scale weight always indicates reduced visceral fat

Correct Answer: Early weight change reflects water loss, not meaningful fat reduction

Explanation: Diuresis reduces body water and may cause dehydration; it is not established treatment for excess adiposity.

Question: A 45-year-old man with obesity develops repeated episodes of breathlessness and chest discomfort during moderate exertion. He has diabetes and hypertension and has never undergone a structured risk assessment. Before selecting a weight-loss drug, which is the most appropriate clinical priority?

Options

Ignore cardiovascular conditions if BMI is elevated

Begin a sympathomimetic drug without pulse assessment

Review comorbidities and cardiovascular risk before selecting therapy

Base all treatment decisions solely on waist circumference

Prescribe simultaneous agents from every available drug class

Correct Answer: Review comorbidities and cardiovascular risk before selecting therapy

Explanation: Comorbidity and cardiovascular evaluation inform a safe treatment choice, especially when considering drugs with cardiovascular cautions.

Question: A 52-year-old man with obesity has substantial symptomatic gastroesophageal reflux before choosing a bariatric operation. Which consideration is most important during procedure selection?

Options

All bariatric procedures affect reflux in the same way

Reflux is irrelevant when surgical weight loss is expected

Sleeve gastrectomy consistently cures pre-existing reflux

Pre-existing reflux may influence the choice between sleeve and bypass procedures

Bariatric surgery does not require gastrointestinal symptom assessment

Correct Answer: Pre-existing reflux may influence the choice between sleeve and bypass procedures

Explanation: Sleeve gastrectomy can aggravate reflux; reflux symptoms influence individualized procedure choice.

Question: A 38-year-old woman with obesity requests bariatric surgery, expecting to resume unrestricted eating immediately afterward and stop all follow-up after one month. Which element of counselling should be emphasized?

Options

The operation removes the need for dietary modification

Long-term vitamin monitoring is required only if symptoms occur

Psychological follow-up has no role after successful surgery

All weight loss occurs independently of lifestyle behaviors

Durable benefit requires dietary adaptation and lifelong follow-up

Correct Answer: Durable benefit requires dietary adaptation and lifelong follow-up

Explanation: Bariatric surgery is part of long-term treatment, requiring nutritional, behavioral and clinical monitoring.

Question: A 50-year-old patient has sustained vomiting after a bariatric procedure and is unable to maintain oral fluid intake. He feels dizzy on standing and passes very little urine. Which immediate concern should guide assessment?

Options

Dehydration with possible electrolyte and renal complications

Expected postoperative weight reduction without complications

An isolated increase in muscle mass

A normal consequence requiring no investigations

A purely psychological aversion to drinking water

Correct Answer: Dehydration with possible electrolyte and renal complications

Explanation: Persistent vomiting with oliguria and postural symptoms suggests volume depletion and requires timely clinical review.

Question: A 43-year-old woman had bariatric surgery 18 months ago and now reports progressive tiredness and reduced exercise tolerance. Her CBC shows microcytic anemia. Which nutritional explanation is most likely?

Options

Increased vitamin K absorption

Reduced iron intake or absorption following surgery

Excessive endogenous erythropoietin release

Increased production of hemoglobin after surgery

Excess dietary folate as the only cause

Correct Answer: Reduced iron intake or absorption following surgery

Explanation: Iron deficiency may develop after bariatric procedures due to reduced intake or absorption and commonly causes microcytic anemia.

Question: A 19-year-old student is markedly underweight but persistently believes that her abdomen is excessively large. She avoids meals, wears loose clothes and becomes distressed when relatives mention weight restoration. What key psychopathological feature is illustrated?

Options

Fixed auditory hallucinations unrelated to eating

Excessive concern about a genuine abdominal tumor

Disturbed perception of body shape and weight

Uncontrolled eating without compensatory behavior

Fear of contamination as the principal symptom

Correct Answer: Disturbed perception of body shape and weight

Explanation: Distorted body image and intense fear of weight gain are central features of anorexia nervosa.

Question: A 17-year-old with restrictive eating has lost considerable weight. Her family says the problem began during intense academic stress and was reinforced by comments about her appearance. Which statement best describes the origin of anorexia nervosa?

Options

It results only from an endocrine lesion

It is explained solely by deliberate food refusal

It develops exclusively after infectious illness

It reflects interacting biological, psychological and social vulnerabilities

It is always caused by parental behavior

Correct Answer: It reflects interacting biological, psychological and social vulnerabilities

Explanation: Eating disorders are multifactorial; triggers such as stress act on existing vulnerabilities rather than representing a single cause.

Question: A 20-year-old with severe dietary restriction reports feeling cold even in warm weather. Examination shows dry skin, fine body hair and reduced resting pulse. Which mechanism best accounts for the low body temperature and pulse?

Options

Uncontrolled thyroid hormone excess

Increased basal metabolic rate from starvation

Persistent high sympathetic drive

Rapid fat gain with increased insulation

Adaptive reduction in metabolic activity during starvation

Correct Answer: Adaptive reduction in metabolic activity during starvation

Explanation: Prolonged undernutrition produces metabolic adaptation, bradycardia and cold intolerance.

Question: A 21-year-old woman with an eating disorder presents with progressive weakness, lightheadedness and poor oral intake. Her pulse is 42/min and blood pressure is 82/52 mmHg. Which feature makes immediate medical evaluation most necessary?

Options

Cardiovascular instability in the context of malnutrition

Concern about appearance without physical symptoms

A history of occasional exercise

Preference for eating alone

Distress when discussing body image

Correct Answer: Cardiovascular instability in the context of malnutrition

Explanation: Profound bradycardia and hypotension indicate medical instability and potentially serious starvation complications.

Question: A 23-year-old has recurrent episodes of eating very large quantities of food rapidly while alone. She feels unable to stop and then fasts for prolonged periods to compensate. Her body weight is not markedly reduced. Which clinical feature most strongly supports bulimia nervosa rather than binge-eating disorder?

Options

A preference for sweet foods during episodes

Recurrent compensatory behaviors after binge eating

Occasional eating in response to stress

Normal BMI during the first assessment

A history of anxiety before examinations

Correct Answer: Recurrent compensatory behaviors after binge eating

Explanation: Bulimia nervosa includes recurrent binge eating plus inappropriate compensatory behavior, whereas binge-eating disorder does not.

Question: A 22-year-old with a history of recurrent vomiting after meals reports persistent throat discomfort and increased sensitivity of her teeth. Examination shows erosive changes of the palatal surfaces. Which mechanism best explains the dental findings?

Options

Increased salivary calcium mineralization

Bacterial destruction of tooth roots alone

Repeated exposure of enamel to gastric acid

Deficiency of vitamin K as the primary lesion

Increased enamel formation from acid contact

Correct Answer: Repeated exposure of enamel to gastric acid

Explanation: Repeated exposure to gastric acid erodes enamel, particularly on palatal tooth surfaces.

Question: A 24-year-old with bulimia nervosa takes stimulant laxatives after eating large meals. She believes this prevents absorption of most meal calories. Which response is most accurate?

Options

Laxatives prevent absorption of nearly all calories in the stomach

Laxatives remove absorbed carbohydrates from blood

Laxatives selectively block intestinal fat digestion

Most calorie absorption occurs before laxatives act; they mainly cause fluid and electrolyte loss

Laxative use is an established treatment for obesity

Correct Answer: Most calorie absorption occurs before laxatives act; they mainly cause fluid and electrolyte loss

Explanation: Laxative misuse primarily causes water and electrolyte losses and does not undo most energy absorption.

Question: A 19-year-old with recurrent binge eating followed by vomiting is embarrassed and fears being judged. She has begun missing university and avoids seeking medical help. During the first assessment, which approach is most appropriate?

Options

Insist that she disclose symptoms in front of family members

Warn her that the behavior demonstrates weak self-control

Discuss weight alone and omit compensatory practices

Postpone assessment until visible physical complications appear

Ask sensitively about bingeing, purging and associated medical risks

Correct Answer: Ask sensitively about bingeing, purging and associated medical risks

Explanation: A nonjudgmental, confidential assessment clarifies behaviors, safety and treatment needs and helps build engagement.