KMU Past Paper Practice

A 24-year-old woman presents with reduced left radial pulse, exertional pain in her left arm and a significant difference in blood pressure between her arms. An inflammatory vascular disorder affecting the aorta and its major branches is suspected. According to vessel-size classification, which group does this disorder belong to?

Correct Answer: Large-vessel vasculitis

Explanation: Inflammation of the aorta and its major branches is characteristic of large-vessel vasculitis. Unequal pulses and arm blood pressures suggest involvement of major arterial branches, as seen in Takayasu arteritis.

A 70-year-old woman with a new temporal headache undergoes temporal artery ultrasonography. The radiologist identifies a circumferential hypoechoic thickening around the arterial lumen that persists despite compression. Which pathological change is responsible for this finding?

Correct Answer: Inflammatory edema of the arterial wall

Explanation: The ultrasound halo sign in giant cell arteritis represents inflammatory thickening and edema of the arterial wall. It is an important supportive imaging finding in suspected cranial GCA.

A 76-year-old man receiving treatment for giant cell arteritis is reviewed after several months. His cranial symptoms have improved, but he reports new persistent chest and upper back discomfort. Examination reveals a new vascular bruit. Which vascular complication should be considered?

Correct Answer: Aortic aneurysm

Explanation: Giant cell arteritis may involve the aorta and weaken its wall, causing aneurysm formation. Large-vessel complications can occur even after cranial symptoms improve and require further vascular assessment.

A 66-year-old woman has bilateral shoulder pain and prolonged morning stiffness. Her ESR is elevated. Examination shows restricted active movement because of pain, but passive movement is relatively preserved and muscle power is normal when pain is overcome. Which finding most strongly favors polymyalgia rheumatica over inflammatory myopathy?

Correct Answer: Absence of objective proximal muscle weakness

Explanation: Polymyalgia rheumatica produces pain and stiffness around the shoulder and hip girdles, whereas inflammatory myopathy primarily causes true proximal muscle weakness. Patients with PMR may appear weak because movement is painful.

A 60-year-old woman has been receiving systemic glucocorticoids for giant cell arteritis for several months. Her symptoms are controlled, but she develops elevated blood glucose and progressive reduction in bone density. Which principle is most important during continued therapy?

Correct Answer: Monitor and prevent glucocorticoid-related complications

Explanation: Prolonged glucocorticoid therapy may cause hyperglycemia, osteoporosis, hypertension and infection risk. Monitoring treatment toxicity and using appropriate preventive measures are essential during management of systemic vasculitis.

A 44-year-old man has fever, hypertension, abdominal pain and peripheral neuropathy. Angiography reveals irregular narrowing and dilatation of several medium-sized visceral arteries. Which additional finding would be least consistent with classical polyarteritis nodosa and suggest another vasculitic disorder?

Correct Answer: Diffuse alveolar hemorrhage

Explanation: Classical polyarteritis nodosa affects medium-sized arteries and typically spares the pulmonary microcirculation. Diffuse alveolar hemorrhage suggests pulmonary capillaritis, particularly an ANCA-associated small-vessel vasculitis.

A 46-year-old man with suspected polyarteritis nodosa develops progressively worsening abdominal pain, abdominal distension and signs of peritoneal irritation. Laboratory investigations show increasing serum lactate. Which complication most urgently explains his deterioration?

Correct Answer: Mesenteric ischemia with possible bowel infarction

Explanation: Necrotizing inflammation of mesenteric arteries in PAN may reduce intestinal blood supply, causing ischemia and infarction. Severe abdominal pain with peritoneal signs indicates a potentially life-threatening complication requiring urgent evaluation.

A 52-year-old patient with suspected granulomatosis with polyangiitis has chronic nasal crusting and recurrent sinus inflammation. Examination reveals progressive depression of the nasal bridge. Which underlying process is most likely responsible for this deformity?

Correct Answer: Destructive granulomatous inflammation of nasal structures

Explanation: GPA produces necrotizing granulomatous inflammation of the upper respiratory tract. Destruction of nasal septal cartilage can produce a saddle-nose deformity, an important clue to destructive ENT involvement.

A 48-year-old woman with established granulomatosis with polyangiitis is undergoing treatment. Her symptoms have improved, but repeat PR3-ANCA testing remains positive. Kidney function, urine findings and clinical examination show no evidence of active disease. Which decision is most appropriate?

Correct Answer: Assess disease activity using clinical and organ-specific findings

Explanation: ANCA titers may remain positive during clinical remission. Treatment decisions require assessment of symptoms, organ function and relevant investigations rather than antibody levels alone.

A 55-year-old man has recurrent sinus inflammation, pulmonary nodules and microscopic hematuria. Serological testing supports ANCA-associated vasculitis. Which additional investigation would most directly help determine whether active renal glomerular injury is present?

Correct Answer: Urine microscopy for dysmorphic red cells and casts

Explanation: Dysmorphic red blood cells and red-cell casts indicate glomerular bleeding. In suspected GPA, these findings raise concern for active glomerulonephritis and require assessment of renal function and disease severity.

A 9-year-old child develops a palpable purpuric rash, ankle pain and mild abdominal discomfort after a respiratory infection. Examination shows purpura predominantly over the buttocks and lower limbs. The platelet count is normal. Which underlying immunological process best explains the vascular inflammation?

Correct Answer: Deposition of IgA-containing immune complexes

Explanation: IgA vasculitis is characterized by IgA-dominant immune-complex deposition in small vessels. This triggers inflammation and vascular leakage, producing palpable purpura and potentially gastrointestinal, joint and renal manifestations.

An 8-year-old boy presents with non-blanching palpable purpura over both legs. His platelet count is normal, and he has mild joint discomfort. Which feature best explains why the purpuric lesions are palpable rather than simply flat discolorations?

Correct Answer: Inflammation with damage and leakage of small blood vessels

Explanation: Small-vessel inflammation allows erythrocytes and fluid to escape into surrounding tissues. The associated inflammatory infiltration produces raised, palpable purpuric lesions, unlike simple non-inflammatory bleeding into the skin.

A 7-year-old girl is diagnosed with IgA vasculitis. She has mild ankle pain and a purpuric rash but is otherwise stable. Urinalysis, renal function and blood pressure are normal. Which management approach is most appropriate?

Correct Answer: Supportive care with appropriate renal monitoring

Explanation: Mild uncomplicated IgA vasculitis is generally managed with hydration, appropriate analgesia and observation. Blood pressure and urinalysis should be monitored because renal involvement may develop after the initial presentation.

A 30-year-old man has recurrent painful oral ulcers, previous genital ulceration, episodic painful eye inflammation and erythematous skin lesions. Routine autoimmune antibody investigations are negative. Which principle is most appropriate for establishing the diagnosis?

Correct Answer: Diagnosis is primarily based on characteristic clinical features

Explanation: Behçet syndrome is a clinical diagnosis based on characteristic recurrent mucocutaneous, ocular and systemic manifestations after considering alternative causes. No single antibody test confirms or excludes the disorder.

A 27-year-old woman with Behçet syndrome experiences frequent painful oral ulcers and mild recurrent skin lesions. She has no current eye, neurological or major vascular involvement. Which treatment is commonly used to help control recurrent mucocutaneous manifestations?

Correct Answer: Colchicine as part of anti-inflammatory management

Explanation: Colchicine is an anti-inflammatory option for recurrent mucocutaneous and joint manifestations of Behçet syndrome. More intensive immunosuppression is selected according to severity, especially when sight-threatening or other major organ disease is present.

A 2-year-old boy is evaluated for fever lasting seven days. He has bilateral nonpurulent conjunctival injection, erythematous oral mucosa and swollen hands. The physician suspects Kawasaki disease. Which additional finding would further support this diagnosis?

Correct Answer: Enlargement of a cervical lymph node

Explanation: Cervical lymphadenopathy is one of the principal clinical features of Kawasaki disease, along with prolonged fever, conjunctival injection, oral changes, extremity changes and polymorphous rash.

A 3-year-old girl has persistent fever, conjunctival redness and erythematous lips but does not meet the full clinical criteria for Kawasaki disease. Her inflammatory markers are elevated, and the treating team remains concerned about coronary artery involvement. Which diagnostic principle is most appropriate?

Correct Answer: Evaluate for incomplete Kawasaki disease using clinical and cardiac assessment

Explanation: Incomplete Kawasaki disease occurs when prolonged fever is accompanied by fewer than the classical clinical features. Supportive laboratory findings and echocardiography help assess suspected cases and prevent delayed recognition of coronary involvement.

A 4-year-old child recovering from Kawasaki disease develops peeling of the skin around the fingertips during the second week of illness. His fever has resolved and he is clinically stable. How should this new finding be interpreted?

Correct Answer: It is a recognized subacute manifestation of Kawasaki disease

Explanation: Periungual desquamation commonly appears during the subacute phase of Kawasaki disease as acute inflammation resolves. Its appearance does not replace the need for scheduled coronary follow-up.

A 5-year-old boy is discharged after treatment for Kawasaki disease. Follow-up echocardiography identifies persistent coronary artery dilatation. His parents ask whether further assessment is needed because he is now asymptomatic. Which recommendation is most appropriate?

Correct Answer: Continue cardiology surveillance according to coronary findings

Explanation: Persistent coronary abnormalities after Kawasaki disease require cardiology follow-up because aneurysm progression, thrombosis and myocardial ischemia are potential complications. Surveillance intensity depends on the severity of coronary involvement.

A 58-year-old patient has fever, weight loss, purpuric skin lesions and progressive renal dysfunction. The physician suspects systemic vasculitis and needs to assess disease severity before selecting treatment. Which finding would most strongly support classification as organ-threatening disease requiring urgent specialist management?

Correct Answer: Rapid deterioration in renal function with active urinary sediment

Explanation: Rapid kidney dysfunction with hematuria or urinary casts suggests active renal vasculitic injury, which can cause irreversible loss of kidney function. Disease severity and organ involvement determine the urgency and intensity of treatment.