KMU Past Paper Practice

Question

A 66-year-old woman presents after a low-trauma hip fracture. Dual-energy X-ray absorptiometry shows a T-score of −2.8 at the femoral neck. Which interpretation is most appropriate?

Options

• Normal bone mineral density
• Osteopenia without osteoporosis
• Established osteoporosis
• Osteomalacia due to vitamin D deficiency
• Paget disease involving the femur

Correct Answer: Established osteoporosis

Explanation: A T-score of −2.5 or lower defines osteoporosis; the associated fragility fracture confirms clinically significant skeletal fragility.

Question

A 52-year-old man with chronic liver disease has diffuse bone discomfort. Serum calcium is low-normal, phosphate is reduced, alkaline phosphatase is raised, and 25-hydroxyvitamin D is low. Which investigation best distinguishes this disorder from uncomplicated osteoporosis?

Options

• Serum alkaline phosphatase
• Plain radiograph of the skull
• Serum uric acid
• Creatine kinase level
• Erythrocyte sedimentation rate

Correct Answer: Serum alkaline phosphatase

Explanation: Raised alkaline phosphatase supports defective mineralization in osteomalacia, whereas routine biochemical tests are generally normal in uncomplicated osteoporosis.

Question

A 74-year-old man with Paget disease develops new worsening pain localized to one femur and a rapidly enlarging bony swelling. Which complication should be suspected?

Options

• Secondary hyperparathyroidism
• Rheumatoid arthritis
• Septic arthritis
• Calcium pyrophosphate deposition
• Osteosarcoma

Correct Answer: Osteosarcoma

Explanation: New focal pain and enlargement in Paget disease raise concern for sarcomatous transformation, especially osteosarcoma.

Question

A 9-month-old infant is exclusively breastfed, receives little sunlight, and has delayed sitting with widened wrists. Which preventive measure would most directly reduce the risk of this condition in similar infants?

Options

• Routine calcium restriction
• Vitamin D supplementation
• Prolonged indoor confinement
• Early bisphosphonate therapy
• Annual skeletal radiography

Correct Answer: Vitamin D supplementation

Explanation: Infants with limited sunlight and low dietary vitamin D benefit from supplementation to prevent nutritional rickets.

Question

A 38-year-old woman develops carpopedal spasm after thyroid surgery. Her serum calcium is markedly reduced. Which preparation is most appropriate for rapid correction?

Options

• Oral calcium carbonate
• Intramuscular calcitonin
• Oral alendronate
• Intravenous calcium gluconate
• Subcutaneous denosumab

Correct Answer: Intravenous calcium gluconate

Explanation: Symptomatic acute hypocalcemia requires intravenous calcium; calcium gluconate is commonly preferred because it is less irritating than calcium chloride.

Question

A patient with stage 5 chronic kidney disease has hypocalcemia and reduced calcitriol production. Which vitamin D preparation is most appropriate?

Options

• Cholecalciferol
• Ergocalciferol
• Calcitriol
• Calcium carbonate
• Raloxifene

Correct Answer: Calcitriol

Explanation: Calcitriol bypasses impaired renal 1-alpha hydroxylation and is useful when the kidney cannot adequately activate vitamin D.

Question

A 62-year-old woman is prescribed oral calcium carbonate for osteoporosis prevention. She has been taking it on an empty stomach and reports poor tolerance. Which advice is most appropriate?

Options

• Take it with meals
• Take it only at bedtime
• Combine it with an NSAID
• Avoid dietary vitamin D
• Crush it into acidic fruit juice only

Correct Answer: Take it with meals

Explanation: Calcium carbonate requires gastric acid for optimal absorption and is therefore best taken with food.

Question

A 59-year-old man with chronic musculoskeletal pain has a history of ischemic heart disease. A selective COX-2 inhibitor is being considered. Which concern is most relevant?

Options

• Severe bone marrow suppression
• Marked hypocalcemia
• Permanent hearing loss
• Acute vitamin D toxicity
• Increased thrombotic cardiovascular risk

Correct Answer: Increased thrombotic cardiovascular risk

Explanation: Selective COX-2 inhibition can reduce prostacyclin without equivalent platelet inhibition, increasing thrombotic cardiovascular risk.

Question

A 46-year-old woman with rheumatoid arthritis receives an NSAID for pain relief. Which statement best describes its role in her disease?

Options

• It reverses established joint deformity
• It suppresses pain and inflammation
• It prevents all future erosions
• It restores damaged cartilage
• It induces permanent remission

Correct Answer: It suppresses pain and inflammation

Explanation: NSAIDs provide symptomatic relief by reducing prostaglandin-mediated pain and inflammation but do not modify the underlying disease course.

Question

A 7-year-old child has bilateral aching pain in the calves at night after active days. Examination is normal, there is no limp, and the child is well the next morning. Which diagnosis is most likely?

Options

• Septic arthritis
• Osteosarcoma
• Nutritional rickets
• Growing pains
• Juvenile inflammatory arthritis

Correct Answer: Growing pains

Explanation: Growing pains are bilateral, episodic nocturnal limb pains with a normal examination and no daytime functional limitation.

Question

A newborn has multiple fractures, blue sclerae, and a family history of similar disease. Which underlying defect is most likely?

Options

• Type I collagen abnormality
• FGFR3 activation
• Osteoclast carbonic anhydrase deficiency
• Vitamin D receptor resistance
• RANK-ligand overexpression

Correct Answer: Type I collagen abnormality

Explanation: Osteogenesis imperfecta results from defective type I collagen, causing brittle bones and extraskeletal connective-tissue features.

Question

A child with osteopetrosis develops visual impairment and facial weakness despite dense bones on radiographs. Which mechanism best explains these neurological findings?

Options

• Inflammation of peripheral nerves
• Vitamin D toxicity
• Compression of cranial nerves in narrowed foramina
• Spinal cord demyelination
• Autoimmune destruction of ganglia

Correct Answer: Compression of cranial nerves in narrowed foramina

Explanation: Excess bone formation narrows skull foramina and can compress cranial nerves, causing visual, auditory, or facial deficits.

Question

A child with achondroplasia has disproportionate short limbs but a relatively preserved trunk. Which part of a long bone is primarily responsible for longitudinal growth?

Options

• Articular cartilage surface
• Periosteal fibrous layer
• Medullary cavity
• Synovial membrane
• Epiphyseal growth plate

Correct Answer: Epiphyseal growth plate

Explanation: Longitudinal growth occurs at the epiphyseal plate through endochondral ossification, the process impaired in achondroplasia.

Question

A 69-year-old woman with osteoporosis is advised to begin regular weight-bearing exercise. Which physiological effect is expected?

Options

• Suppression of intestinal calcium uptake
• Mechanical stimulation of bone formation
• Complete inhibition of osteoclasts
• Loss of cortical thickness
• Reduced muscle strength

Correct Answer: Mechanical stimulation of bone formation

Explanation: Weight-bearing activity generates mechanical strain that supports osteoblastic activity, preserves bone mass, and improves fall-preventing muscle strength.

Question

An office employee develops lateral elbow and wrist pain after prolonged keyboard work. Which ergonomic change is most appropriate?

Options

• Raise the keyboard above shoulder level
• Place the mouse beyond arm’s reach
• Maintain continuous static posture
• Keep wrists neutral and forearms supported
• Remove all scheduled breaks

Correct Answer: Keep wrists neutral and forearms supported

Explanation: Neutral wrist posture and forearm support reduce tendon loading and repetitive strain during computer work.

Question

A factory worker with an upper-limb disability is denied employment despite being capable of performing the job with a minor workstation adjustment. Which public-health issue is illustrated?

Options

• Social discrimination and restricted participation
• Failure of disease notification
• Nutritional deficiency screening
• Inadequate vector control
• Occupational infection transmission

Correct Answer: Social discrimination and restricted participation

Explanation: Persons with disability may face stigma, employment exclusion, and environmental barriers that limit social and economic participation.

Question

A patient with permanent hand impairment is provided with a modified utensil that allows independent feeding. Which rehabilitation measure is being used?

Options

• Primary disease prevention
• Mass chemoprophylaxis
• Assistive-device rehabilitation
• Genetic screening
• Environmental sanitation

Correct Answer: Assistive-device rehabilitation

Explanation: Adaptive equipment compensates for functional loss and increases independence in activities of daily living.

Question

Following blunt trauma to the orbit, a patient develops diplopia and numbness over the cheek. Imaging shows a fracture of the orbital floor. Which adjacent space is most likely involved?

Options

• Frontal sinus
• Middle cranial fossa
• Nasal septum
• Mastoid antrum
• Maxillary sinus

Correct Answer: Maxillary sinus

Explanation: The thin orbital floor forms the roof of the maxillary sinus; blowout fractures may trap orbital tissue and injure the infraorbital nerve.

Question

A patient has acute angle-closure glaucoma caused by obstruction of aqueous humor drainage. Which structure normally receives aqueous humor from the anterior chamber?

Options

• Central retinal vein
• Scleral venous sinus
• Vitreous chamber
• Choroidal plexus
• Nasolacrimal duct

Correct Answer: Scleral venous sinus

Explanation: Aqueous humor drains through the trabecular meshwork into the scleral venous sinus, also called the canal of Schlemm.

Question

A child with otitis media develops infection after an upper respiratory illness. Which anatomical pathway most directly allows spread from the nasopharynx to the middle ear?

Options

• External acoustic meatus
• Internal acoustic meatus
• Cochlear duct
• Pharyngotympanic tube
• Vestibular aqueduct

Correct Answer: Pharyngotympanic tube

Explanation: The pharyngotympanic tube connects the nasopharynx to the middle ear and provides a route for ascending infection, especially in children.