KMU Past Paper Practice

Question:

A 56-year-old man is brought to the emergency department with progressive loss of consciousness. He has no evidence of head trauma or focal neurological deficit. Examination reveals symmetrical pupillary responses and generalized reduction in motor responses. Laboratory investigations subsequently demonstrate significant renal impairment and metabolic derangement. Which interpretation best explains the pattern of neurological dysfunction?

Correct Answer: Diffuse cerebral dysfunction due to metabolic disturbance

Explanation: Metabolic encephalopathy commonly produces generalized cerebral dysfunction without prominent lateralizing signs. Renal failure can cause accumulation of neurotoxic metabolites and impaired consciousness.

Question:

A 70-year-old woman is brought to the emergency department in a deeply unconscious state. She has noisy breathing, pooling of oral secretions and a weak cough response. Her oxygen saturation is 91% despite supplemental oxygen. Which management priority is most appropriate before proceeding to detailed neurological investigations?

Correct Answer: Secure the airway and ensure adequate ventilation

Explanation: Loss of airway protection in coma creates immediate risks of obstruction and aspiration. Airway and breathing stabilization take priority over definitive neurological investigations.

Question:

A 44-year-old man is admitted with reduced consciousness after an acute illness. He has no lateralizing neurological signs, but examination shows abnormal respiratory effort and poor peripheral perfusion. The treating doctor begins simultaneous assessment of airway, breathing, circulation and neurological responsiveness. What is the principal advantage of this approach?

Correct Answer: It identifies and treats immediate physiological threats before definitive diagnosis

Explanation: The ABCDE approach prioritizes reversible threats such as hypoxia and shock. Stabilization must proceed alongside investigation because physiological deterioration can rapidly worsen brain injury.

Question:

A 63-year-old patient with severe respiratory failure is intubated and receiving mechanical ventilation. During neurological assessment, he opens his eyes spontaneously and obeys motor commands, but his verbal response cannot be tested because of the endotracheal tube. Which documentation method most accurately represents his neurological examination?

Correct Answer: Record E4, V not testable, M6 with the reason documented

Explanation: GCS components should be recorded individually. Intubation prevents reliable verbal assessment, so this component should be documented as not testable rather than assigned an artificial score.

Question:

A 36-year-old man presents after an episode of collapse at work. He remembers feeling unusual but cannot recall the event itself. A colleague reports that the patient’s eyes deviated to one side, followed by repetitive movements of one arm before loss of responsiveness. What is the most useful next step for characterizing the episode?

Correct Answer: Obtain a detailed eyewitness description of the event sequence

Explanation: Eyewitness information helps establish seizure onset, progression and associated motor signs when awareness or memory is impaired. This can guide classification and investigation.

Question:

A 42-year-old woman has a witnessed convulsive episode lasting approximately two minutes. During recovery, she develops temporary weakness of her left arm. Her blood pressure and glucose are normal, and the weakness resolves completely over the next hour. Which clinical interpretation best explains this transient finding?

Correct Answer: Temporary postictal focal neurological dysfunction

Explanation: Todd paresis is transient focal weakness after a seizure. Because acute stroke can present similarly, a new focal deficit still requires urgent clinical assessment rather than automatic attribution to a seizure.

Question:

A 20-year-old patient experiences recurrent episodes beginning with tingling in the right leg, followed by repetitive jerking of the same limb. Neurological examination is normal between episodes. The clinician suspects an underlying focal cortical abnormality and requests structural neuroimaging. Which result would most strongly support this clinical localization?

Correct Answer: An abnormality involving the left perirolandic cortex

Explanation: Focal sensory and motor symptoms affecting the right leg suggest involvement of the contralateral sensorimotor cortex. The perirolandic region includes the primary motor and sensory areas.

Question:

A 39-year-old man is brought to the emergency department after a generalized convulsion. The seizure has stopped, but he remains drowsy and has vomited repeatedly. His breathing is spontaneous, and he requires observation while regaining consciousness. Which immediate supportive intervention is most appropriate to reduce a preventable complication?

Correct Answer: Position the patient laterally and monitor airway patency

Explanation: Reduced consciousness and vomiting increase aspiration risk. Lateral positioning when safe, airway monitoring and withholding oral intake until recovery help protect the airway.

Question:

A 3-year-old girl develops a generalized seizure during a febrile illness. After the seizure stops, she remains unusually lethargic and irritable. Examination reveals neck stiffness and persistent high fever. Which clinical decision is most appropriate?

Correct Answer: Arrange urgent assessment for a possible CNS infection

Explanation: Persistent altered consciousness with neck stiffness and fever raises suspicion of meningitis or encephalitis. These findings require urgent evaluation rather than reassurance about a simple febrile seizure.

Question:

A previously healthy 2-year-old boy is reviewed after a brief generalized seizure during fever. He has returned to his usual behavior, examination is normal, and there are no findings suggesting CNS infection or a metabolic disorder. His parents ask whether he requires routine EEG and brain MRI. Which approach is most appropriate?

Correct Answer: Avoid routine neurological testing without additional clinical indications

Explanation: An otherwise well child with a typical simple febrile seizure generally does not need routine EEG or neuroimaging. Further testing depends on concerning findings or an atypical presentation.

Question:

An 11-year-old girl with newly diagnosed epilepsy has achieved good seizure control. Her parents want her to stop attending school because they fear that another seizure might occur in the classroom. Which counselling recommendation best balances safety and normal development?

Correct Answer: Support school attendance with an individualized seizure safety plan

Explanation: Children with epilepsy should participate in education with appropriate safety precautions. A seizure action plan enables caregivers and teachers to respond effectively without unnecessary restriction.

Question:

A 7-year-old boy has a history of prolonged convulsive seizures. His pediatrician develops a home emergency plan and prescribes an age-appropriate rescue medication for use when a convulsion exceeds the specified duration. His mother asks why this medicine is different from the child’s daily treatment. Which explanation is most appropriate?

Correct Answer: It is intended to terminate a prolonged seizure rapidly

Explanation: Rescue benzodiazepines are used according to an individualized emergency plan to stop prolonged seizures. They do not replace regular antiseizure therapy or the need for emergency escalation when indicated.

Question:

A 5-year-old child with epilepsy is prescribed an oral suspension. The clinician writes a dose in milligrams and confirms that the medicine is available in two different concentrations. The parent reports having a bottle from a previous prescription. Which action is most important to prevent a dosing error?

Correct Answer: Verify the concentration and calculate the required volume

Explanation: Different liquid formulations may contain different milligram amounts per milliliter. Checking concentration and using an appropriate measuring device prevents pediatric dosing errors.

Question:

A 40-year-old man with generalized epilepsy is being considered for antiseizure treatment. His medical records show chronic liver disease, and baseline laboratory investigations reveal impaired hepatic function. The clinician is reviewing medicines that may cause additional hepatic toxicity. Which factor should most strongly influence the selection of treatment?

Correct Answer: Consider drug-related hepatotoxicity and hepatic handling

Explanation: Liver disease can alter drug metabolism and increase adverse-effect risk. Medication selection should account for hepatic function, particularly with potentially hepatotoxic agents such as valproate.

Question:

A 68-year-old woman with epilepsy is receiving levetiracetam and has recently developed worsening chronic kidney disease. She reports increased drowsiness, although her seizure frequency has decreased. Which prescribing consideration is most appropriate during her medication review?

Correct Answer: Review renal function and adjust the dose when indicated

Explanation: Levetiracetam is substantially eliminated by the kidneys. Reduced renal clearance can increase exposure, making renal function assessment and appropriate dose adjustment important.

Question:

A 17-year-old student receiving treatment for epilepsy attends follow-up because of declining academic performance. His seizure diary shows fewer episodes, but he reports daytime sleepiness and difficulty concentrating after a recent medication adjustment. Which management decision best reflects appropriate long-term epilepsy care?

Correct Answer: Assess seizure control together with adverse effects and daily functioning

Explanation: The goal of epilepsy treatment is seizure control with acceptable tolerability and quality of life. Sedation, cognition and school performance are important outcomes during follow-up.

Question:

A 29-year-old man with epilepsy reports that he enjoys swimming alone in a lake and occasionally takes long baths while no one is at home. He has experienced two seizures during the previous year. Which counselling recommendation is most appropriate to reduce injury risk while preserving independence?

Correct Answer: Choose supervised swimming and safer bathing arrangements

Explanation: Seizures in water can cause drowning. Supervision, use of showers where appropriate and individualized precautions reduce risk without unnecessarily restricting activity.

Question:

A 23-year-old man is undergoing assessment for recurrent episodes of transient loss of consciousness. His history includes palpitations immediately before some events and rapid recovery afterward. Neurological examination is normal. Which initial investigation is most appropriate to assess an important non-epileptic cause?

Correct Answer: Twelve-lead electrocardiography

Explanation: Palpitations preceding transient loss of consciousness raise concern for arrhythmic syncope. ECG is an important initial investigation to identify potentially dangerous cardiac abnormalities.

Question:

A 41-year-old woman receiving treatment for epilepsy attends her annual review. She reports that her seizures are more likely after several nights of reduced sleep. Her medication regimen is unchanged, and she has no new neurological symptoms. Which recommendation is most appropriate as part of her individualized seizure-control plan?

Correct Answer: Maintain regular sleep and document episodes in a seizure diary

Explanation: Sleep deprivation can lower seizure threshold. Regular sleep and seizure documentation support identification of triggers and evaluation of treatment response.

Question:

A 27-year-old woman with epilepsy attends a consultation before planning pregnancy. Her seizures are controlled with regular medication, and she asks whether she should stop taking the medicine immediately to avoid exposing the fetus. Which approach best reflects safe, patient-centred management?

Correct Answer: Arrange preconception medication review and individualized risk counselling

Explanation: Preconception review balances maternal seizure control with fetal medication risks. Abrupt antiseizure drug withdrawal may provoke dangerous seizures, so changes require specialist supervision.