KMU Past Paper Practice

Question: A 22-year-old football player experiences painful calf contractions during training on a hot day. He is fully alert, has normal coordination and a core temperature of 37.8°C. Symptoms improve after he rests. What is the most likely heat-related illness?

Options:

Heat syncope

Heat cramps

Classic heat stroke

Heat rash

Moderate hypothermia

Correct Answer: Heat cramps

Explanation: Painful muscle contractions with exertion in heat, without altered consciousness or marked hyperthermia, favor heat cramps; rest, cooling and fluid/electrolyte replacement are appropriate.

Question: A 48-year-old woman faints briefly while standing in a long outdoor queue on a hot day. She regains consciousness rapidly when laid supine, with no confusion or persistent neurological deficit. What most plausibly caused the episode?

Options:

Cerebral edema from heat stroke

Primary seizure disorder

Peripheral vasodilatation with transient cerebral hypoperfusion

Acute pulmonary edema

Carbon dioxide retention

Correct Answer: Peripheral vasodilatation with transient cerebral hypoperfusion

Explanation: Heat-related peripheral vasodilatation and venous pooling can temporarily reduce venous return and cerebral perfusion, producing heat syncope.

Question: An obese 76-year-old patient who uses anticholinergic medication remains indoors during a prolonged heatwave. Her family asks why she is unusually vulnerable even without exercising. Which physiological impairment is most relevant?

Options:

Increased shivering response

Enhanced evaporative cooling

Increased brown-fat thermogenesis

Reduced sweating and heat dissipation

Excessive renal bicarbonate loss

Correct Answer: Reduced sweating and heat dissipation

Explanation: Anticholinergic effects can impair sweating, while age and limited environmental cooling reduce heat loss; classic heat stroke may develop without exertion.

Question: A 20-year-old laborer becomes weak and nauseated after several hours in a humid factory. He is alert, sweating heavily, tachycardic and has a temperature of 38.9°C. Which finding would most strongly suggest that his condition has progressed beyond heat exhaustion?

Options:

New disorientation and impaired consciousness

Persistent thirst

Painful leg cramps

Profuse sweating

Postural lightheadedness

Correct Answer: New disorientation and impaired consciousness

Explanation: New central nervous system dysfunction in a markedly hyperthermic patient indicates possible heat stroke and requires emergency cooling and stabilization.

Question: A 67-year-old woman is found after an overnight fall in a cold room. She has a temperature of 34°C and is shivering, awake and able to swallow. She has no trauma or cardiovascular instability. Which approach is most appropriate initially?

Options:

Immediate immersion in very hot water

Rapid administration of cold saline

Vigorous massage of the extremities

Intravenous thrombolysis

Insulation, removal of wet clothing and passive external rewarming

Correct Answer: Insulation, removal of wet clothing and passive external rewarming

Explanation: Stable mild hypothermia generally responds to prevention of further heat loss and passive external rewarming; monitor for deterioration.

Question: A 63-year-old man with hypothermia has a core temperature of 31°C and a very slow heart rate. A colleague proposes repeated atropine solely to normalize the pulse. What is the best interpretation?

Options:

Bradycardia in hypothermia always implies acute myocardial infarction

Bradycardia may be a temperature-related physiological effect requiring rewarming

Atropine is the definitive treatment of hypothermia

The pulse should be ignored because it is always inaccurate

Bradycardia rules out severe hypothermia

Correct Answer: Bradycardia may be a temperature-related physiological effect requiring rewarming

Explanation: Cooling slows the sinoatrial node and cardiac conduction; careful rewarming and monitoring address the cause of hypothermia-associated bradycardia.

Question: An unconscious patient rescued from icy water has very slow, shallow respirations. The rescuers are uncertain whether a pulse is present. What is the most appropriate principle when assessing this patient?

Options:

Declare death when respirations are difficult to detect

Avoid checking circulation because of arrhythmia risk

Assess breathing and circulation carefully for an extended interval before concluding they are absent

Give oral warm fluids before assessment

Place the patient upright to promote circulation

Correct Answer: Assess breathing and circulation carefully for an extended interval before concluding they are absent

Explanation: Profound hypothermia may make pulse and breathing difficult to detect; a careful prolonged assessment helps avoid overlooking minimal vital signs.

Question: A 5-year-old who briefly went underwater is now fully awake, breathing normally, with normal chest examination and normal oxygen saturation. Which management statement is most appropriate?

Options:

Every child requires routine antibiotics

Water must be removed from the lungs by abdominal compression

Chest CT is mandatory before discharge

Clinical observation and reassessment are more useful than routine preventive medication

Induced vomiting reduces delayed lung injury

Correct Answer: Clinical observation and reassessment are more useful than routine preventive medication

Explanation: Following submersion, management is guided by breathing, oxygenation and evolution of symptoms; routine antibiotics and attempts to expel water are not indicated.

Question: A 15-year-old is pulled from a pool after submersion and has no normal breathing. A bystander starts compressions but refuses to provide breaths because the arrest followed drowning. Which response best reflects the underlying physiology?

Options:

Ventilation is especially important because drowning arrest is primarily hypoxic

Defibrillation alone will reverse most drowning arrests

Removing swallowed water is the priority

Rescue breaths are contraindicated after submersion

Oxygenation should wait until a radiograph is obtained

Correct Answer: Ventilation is especially important because drowning arrest is primarily hypoxic

Explanation: Drowning usually progresses from respiratory impairment to hypoxic cardiac arrest; effective ventilation with resuscitation is essential.

Question: A man sustains electrical contact injury at home and is alert with a painful superficial hand burn. He reports a brief loss of consciousness immediately after the event. Which aspect of this history most strongly supports urgent cardiac evaluation?

Options:

Burn pain

Age below 50 years

Brief loss of consciousness

Absence of an exit wound

Normal skin color

Correct Answer: Brief loss of consciousness

Explanation: Loss of consciousness after electrical exposure raises concern for an electrical cardiac event and warrants evaluation, including an ECG.

Question: After a high-voltage electrical accident, a worker has deep forearm pain despite limited skin burns. Which explanation best accounts for the discrepancy between skin appearance and injury severity?

Options:

Electricity affects only superficial epidermis

Current cannot injure muscle unless skin is charred

Deeper structures are protected by high vascular flow

Pain is always caused by anxiety rather than tissue injury

Electrical energy can cause substantial internal tissue heating along the current path

Correct Answer: Electrical energy can cause substantial internal tissue heating along the current path

Explanation: Electrical current can damage muscle, nerves and vessels beneath relatively small skin lesions, so surface appearance may underestimate severity.

Question: A 26-year-old climber experiences headache and poor appetite during the first day at 3,700 metres but has no confusion, ataxia or breathlessness at rest. What is the most appropriate next step?

Options:

Immediately continue to the planned 4,500-metre camp

Stop ascent, rest at the current altitude and reassess symptoms

Start a strenuous acclimatization run

Descend only if pulmonary crackles appear

Ignore symptoms because they are unrelated to altitude

Correct Answer: Stop ascent, rest at the current altitude and reassess symptoms

Explanation: Symptoms suggest uncomplicated acute mountain sickness; further ascent should pause until recovery, with descent if symptoms worsen or fail to improve.

Question: A traveler at 3,600 metres experiences periodic breathing during sleep and mild headache. Which environmental change is primarily responsible for stimulating the altitude-related ventilatory response?

Options:

Higher inspired oxygen partial pressure

Increased ambient barometric pressure

Greater atmospheric carbon dioxide concentration

Lower inspired oxygen partial pressure

Increased pulmonary surfactant production

Correct Answer: Lower inspired oxygen partial pressure

Explanation: As altitude rises, barometric pressure falls and so does inspired oxygen partial pressure, promoting hypoxemia and compensatory hyperventilation.

Question: Two friends ascend rapidly to 3,800 metres. One takes acetazolamide prophylactically and notices tingling in the fingers and more frequent urination. How should these symptoms be interpreted?

Options:

Expected carbonic anhydrase inhibitor effects

Evidence of high-altitude cerebral edema

Evidence of pulmonary hypertension

Features of severe decompression sickness

Proof that acclimatization has failed

Correct Answer: Expected carbonic anhydrase inhibitor effects

Explanation: Acetazolamide promotes bicarbonate diuresis and can cause paresthesia and increased urination; it facilitates ventilation but does not eliminate the need for appropriate ascent practices.

Question: A trekker develops shortness of breath during walking at high altitude, followed by worsening cough and breathlessness even at rest. What feature most strongly favors high-altitude pulmonary edema over uncomplicated acute mountain sickness?

Options:

Headache after ascending

Reduced appetite

Hypoxemia accompanied by pulmonary crackles

Mild nausea

Disturbed sleep

Correct Answer: Hypoxemia accompanied by pulmonary crackles

Explanation: Crackles and respiratory compromise indicate fluid accumulation in the lungs, making high-altitude pulmonary edema more likely than uncomplicated mountain sickness.

Question: A diver performs several deep dives in one day and plans another immediately after a short surface interval. What is the principal reason to lengthen the interval?

Options:

To increase retained nitrogen before the next dive

To build tolerance to elevated pressure

To prevent ocean-water aspiration

To eliminate the need for controlled ascent

To permit additional elimination of dissolved tissue nitrogen

Correct Answer: To permit additional elimination of dissolved tissue nitrogen

Explanation: Surface intervals allow dissolved nitrogen to wash out, reducing the residual inert-gas load before another dive and lowering decompression risk.

Question: A recreational diver experiences intensely itchy, mottled skin shortly after an unusually rapid ascent. He has no limb weakness or breathing difficulty. What does this presentation suggest?

Options:

Primary bacterial skin infection

Possible cutaneous decompression sickness requiring diving-medicine assessment

Classic heat rash unrelated to diving

Severe electrical burn

Primary allergic asthma

Correct Answer: Possible cutaneous decompression sickness requiring diving-medicine assessment

Explanation: Cutaneous decompression sickness may present with pruritus and mottling after ascent; neurological and cardiopulmonary manifestations should also be assessed.

Question: A 32-year-old diver becomes markedly breathless and develops chest discomfort soon after surfacing from a deep dive. Decompression illness is suspected. Which initial intervention is most appropriate while specialist care is arranged?

Options:

Encourage another dive to the original depth

Give routine oral antibiotics

Ask the patient to exercise to accelerate nitrogen clearance

Provide high-concentration oxygen and arrange urgent specialist evaluation

Withhold oxygen to avoid masking the diagnosis

Correct Answer: Provide high-concentration oxygen and arrange urgent specialist evaluation

Explanation: High-concentration oxygen supports tissue oxygenation and nitrogen washout. Serious symptoms after diving require urgent evaluation for decompression illness.

Question: A diver is treated for decompression sickness and asks whether symptom disappearance immediately proves that all risk has resolved. Which advice best reflects safe patient care?

Options:

Improvement is reassuring, but medical reassessment and clearance are needed before diving again

Symptoms always recur after treatment

He may return to depth immediately if joint pain settles

A normal skin examination excludes neurological injury

There is no value in monitoring after recompression

Correct Answer: Improvement is reassuring, but medical reassessment and clearance are needed before diving again

Explanation: Neurological or other complications may require reassessment and follow-up even when symptoms improve; return to diving should follow appropriate medical clearance.

Question: A patient develops very high temperature and confusion during extreme environmental heat exposure. Another patient has fever during infection. Which clinical distinction is most useful when selecting immediate treatment?

Options:

Both conditions result from identical increases in hypothalamic set point

Environmental hyperthermia is primarily treated by antipyretics

Hyperthermia requires rapid physical cooling because heat gain exceeds effective heat loss

Infectious fever cannot produce a temperature above 39°C

Sweating alone determines which illness is present

Correct Answer: Hyperthermia requires rapid physical cooling because heat gain exceeds effective heat loss

Explanation: Unlike regulated fever, environmental hyperthermia is not driven by a raised hypothalamic set point; rapid physical cooling rather than antipyretics is crucial in heat stroke.