KMU Past Paper Practice

Question:

A 48-year-old woman is prescribed a benzodiazepine for short-term insomnia. After taking a long-acting agent, she experiences troublesome drowsiness the following morning. Which benzodiazepine would better match the aim of providing night-time hypnosis with less prolonged residual effect?

Correct Answer: Temazepam

Explanation: Temazepam is an intermediate-acting benzodiazepine commonly suited to hypnotic use. Longer-acting agents such as diazepam and flurazepam are more likely to produce residual daytime sedation.

Question:

A 74-year-old man receives a benzodiazepine for acute anxiety. Instead of becoming calm, he becomes unusually restless, irritable and verbally aggressive. Which adverse drug effect best explains this response?

Correct Answer: Paradoxical disinhibition

Explanation: Benzodiazepines occasionally produce agitation, irritability or behavioural excitation rather than sedation. This unexpected reaction is termed paradoxical disinhibition.

Question:

A 32-year-old salesman starts a benzodiazepine for severe anxiety. His anxiety improves, but he reports slower reactions and difficulty maintaining concentration while driving to work. Which pharmacological consequence is most relevant to this complaint?

Correct Answer: Impaired psychomotor performance

Explanation: Benzodiazepine-mediated CNS depression can slow reaction time, attention and coordination. These effects are particularly relevant to driving and other activities requiring rapid responses.

Question:

A patient has difficulty falling asleep but must wake early for work and wishes to minimize residual sedation the next morning. Which benzodiazepine is classified among the short-acting agents?

Correct Answer: Triazolam

Explanation: Triazolam is a short-acting benzodiazepine. Diazepam, clonazepam, flurazepam and chlordiazepoxide have longer durations of action.

Question:

A patient repeatedly increases the amount of a barbiturate taken for sleep. With increasing exposure, he progresses from drowsiness to profound unconsciousness and cardiorespiratory depression. Which pharmacological property best explains this progression?

Correct Answer: Progressive dose-dependent CNS depression

Explanation: Barbiturate effects deepen as exposure increases, progressing from sedation and hypnosis to anesthesia, coma and depression of vital centres. This contributes to their narrow safety margin.

Question:

A man who has taken phenobarbital regularly for several months abruptly stops the drug. He becomes restless and tremulous and later develops a generalized seizure. Which process most directly explains this deterioration?

Correct Answer: Physical dependence with withdrawal hyperexcitability

Explanation: Repeated barbiturate exposure can produce physical dependence. Abrupt withdrawal removes chronic CNS inhibition and may cause marked neuronal hyperexcitability and seizures.

Question:

A 29-year-old woman taking buspirone for persistent anxiety reports improvement in daytime anxiety but says the drug does not make her sleepy when taken at bedtime. Which property best explains this observation?

Correct Answer: Little direct sedative-hypnotic action

Explanation: Buspirone is primarily an anxiolytic and produces much less sedation than benzodiazepines. It is therefore not primarily used as a hypnotic for insomnia.

Question:

A 41-year-old patient starts ramelteon for difficulty initiating sleep. Sleep onset improves, but she develops mild daytime fatigue and occasional light-headedness. Which adverse-effect profile best fits this medication?

Correct Answer: Somnolence, fatigue and dizziness

Explanation: Ramelteon may cause somnolence, fatigue and dizziness. It promotes sleep through melatonin receptors rather than producing marked GABA-mediated CNS depression.

Question:

A patient reports repeated unpleasant sensations in the legs accompanied by movements that repeatedly disturb sleep. There is no abnormal nocturnal breathing and no complex behaviour while asleep. Which broad sleep-disorder category best fits this pattern?

Correct Answer: Sleep-related movement disorder

Explanation: Repetitive movements or uncomfortable sensations that interfere with sleep are grouped under sleep-related movement disorders rather than parasomnias or breathing disorders.

Question:

A 35-year-old teacher develops persistent difficulty falling asleep after a period of occupational stress. Medical assessment does not identify an organic disorder. She becomes increasingly preoccupied with sleep failure, and this anxiety is greatest at bedtime. Which diagnosis best fits this presentation?

Correct Answer: Non-organic insomnia

Explanation: Non-organic insomnia is characterized by sleep difficulty in which psychological and behavioural factors are prominent without an adequate primary organic explanation.

Question:

A medical student follows a fixed bedtime and keeps the room dark and quiet but continues drinking several cups of coffee during evening study sessions. He complains mainly of delayed sleep onset. Which single change is most appropriate?

Correct Answer: Avoid caffeine later in the day

Explanation: Caffeine is a stimulant and late-day intake can delay sleep onset. Avoiding evening stimulants is a core sleep-hygiene measure.

Question:

A 40-year-old man begins drinking alcohol at bedtime because it makes him drowsy. He falls asleep quickly but wakes repeatedly later in the night and feels unrefreshed in the morning. Which explanation is most appropriate?

Correct Answer: Alcohol may cause initial drowsiness but later fragment sleep

Explanation: Alcohol may initially shorten sleep latency, but it can disrupt sleep later in the night. It should therefore not be recommended as a sleep aid.

Question:

A university student with difficulty sleeping at night takes a two-hour nap every evening after returning from classes. She then remains awake for a long time after going to bed. Which sleep-hygiene modification is most appropriate?

Correct Answer: Limit naps that interfere with night-time sleep

Explanation: Long or late naps reduce the normal drive for sleep at night and can worsen sleep-onset difficulty. Limiting interfering naps supports more consolidated night-time sleep.

Question:

A businessman travels rapidly across several time zones and develops sleepiness during the day and difficulty sleeping at the local night-time. Which approach most directly helps realign his internal biological clock with the new environment?

Correct Answer: Timed light exposure with structured sleep and melatonin-based timing

Explanation: Rapid time-zone travel produces circadian misalignment. Appropriately timed light, regular sleep scheduling and selected melatonin-based approaches help shift the biological clock.

Question:

A 12-year-old child occasionally sits up, walks around the room and performs simple activities during the early part of the night. He is difficult to engage during the event and has no memory of it the next day. Which mechanism best explains these episodes?

Correct Answer: Incomplete arousal from deep non-REM sleep

Explanation: Sleepwalking results from an incomplete transition from deep non-REM sleep toward wakefulness. Motor activity occurs while awareness and later memory remain impaired.

Question:

A 23-year-old student reports sleeping for unusually long periods but still experiences excessive sleepiness and repeatedly falls asleep during daytime activities. There is no history of sleepwalking or abnormal breathing during sleep. Which broad category best describes this problem?

Correct Answer: Hypersomnolence disorder

Explanation: Hypersomnolence disorders are characterized by excessive sleepiness or an excessive need for sleep rather than difficulty initiating sleep or abnormal nocturnal behaviour.

Question:

A woman with persistent insomnia repeatedly thinks, “If I do not sleep eight hours tonight, I will be unable to function tomorrow.” These thoughts increase her anxiety at bedtime. Which component of psychological treatment most directly addresses this problem?

Correct Answer: Cognitive restructuring of sleep-related beliefs

Explanation: Cognitive techniques within CBT-I target unrealistic or catastrophic beliefs about sleep. Reducing these thoughts decreases the mental arousal that can perpetuate insomnia.

Question:

A patient taking a benzodiazepine for anxiety starts an additional sedating medicine for allergy symptoms. He subsequently develops much greater drowsiness and poor coordination. Which principle best explains this change?

Correct Answer: Additive CNS depression

Explanation: Combining benzodiazepines with other sedating medicines can produce additive CNS depression, increasing drowsiness, psychomotor impairment and related safety risks.

Question:

A patient with difficulty initiating sleep and painful muscle spasm is prescribed ramelteon for the sleep complaint. The clinician explains that a separate treatment may be needed for the muscle problem. Which pharmacological feature best explains this limitation of ramelteon?

Correct Answer: Its melatonin-receptor action lacks benzodiazepine-like muscle relaxation

Explanation: Ramelteon promotes sleep through MT1 and MT2 melatonin receptors rather than GABA-A receptors. It therefore lacks the clinically important muscle-relaxant action of benzodiazepines.

Question:

A patient with a seizure disorder is maintained on phenobarbital. During a pharmacology discussion, students are asked to classify this drug according to its duration of barbiturate action. Which classification is correct?

Correct Answer: Long-acting barbiturate

Explanation: Phenobarbital is a long-acting barbiturate and remains clinically important for selected seizure disorders. Thiopental is the classic very short-acting barbiturate.