KMU Past Paper Practice

Question:

A 38-year-old woman has experienced three clearly separated episodes of depressed mood, anhedonia, poor concentration and disturbed sleep. Between episodes she returns to her previous level of functioning. There is no history of elevated mood or increased activity. Which classification best describes this pattern?

Options:

Correct Answer: Recurrent depressive disorder

Explanation: Separate depressive episodes with recovery between them and no mania or hypomania fit recurrent depressive disorder rather than a chronic or bipolar pattern.

Question:

A patient reports little improvement after several weeks of antidepressant treatment. On further discussion, he admits skipping many doses because the medicine causes nausea. What is the most appropriate next step before labeling the depression treatment-resistant?

Options:

Correct Answer: Reassess adherence and treatment tolerability

Explanation: Apparent treatment failure cannot be interpreted reliably when the prescribed medicine is not being taken adequately; adherence and adverse effects should be reviewed first.

Question:

During assessment of a severely depressed patient, the junior doctor avoids asking directly about suicide because he fears that mentioning it may increase suicidal thinking. Which approach is most appropriate?

Options:

Correct Answer: Ask directly about thoughts, intent, planning and access to means

Explanation: Direct assessment is an essential safety measure. Asking clearly about suicide does not create suicidal intent and allows risk to be identified accurately.

Question:

A psychiatrist plans to use an antidepressant that inhibits reuptake of both serotonin and noradrenaline rather than selectively affecting serotonin alone. Which drug belongs to this class?

Options:

Correct Answer: Venlafaxine

Explanation: Venlafaxine is a serotonin-noradrenaline reuptake inhibitor, whereas sertraline is an SSRI and the other options belong to different drug groups.

Question:

A woman recently started on an SSRI for depression reports nausea and loose stools but has no fever, clonus or confusion. Which pharmacological effect most directly explains these gastrointestinal symptoms?

Options:

Correct Answer: Increased serotonergic activity in the gut

Explanation: Serotonin has important gastrointestinal actions, so increased serotonergic transmission with SSRIs can produce nausea, abdominal discomfort and diarrhoea.

Question:

A patient who has been clinically stable on a relatively short-acting SSRI stops the medicine abruptly because she feels well. Soon afterward she develops new unpleasant symptoms without recurrence of her original depressive syndrome. What is the most likely explanation?

Options:

Correct Answer: Antidepressant discontinuation symptoms

Explanation: Abrupt withdrawal of some shorter-acting SSRIs can produce discontinuation symptoms; gradual treatment adjustment reduces this risk.

Question:

A patient takes a medicine whose concentration is normally controlled by hepatic cytochrome P450 metabolism. After introduction of an SSRI, the concentration of the other medicine rises despite an unchanged dose. Which mechanism best explains this interaction?

Options:

Correct Answer: Reduced hepatic metabolism from enzyme inhibition

Explanation: Some SSRIs inhibit hepatic cytochrome P450 enzymes, reducing metabolism and potentially increasing concentrations of interacting medicines.

Question:

A patient receiving amitriptyline develops marked daytime drowsiness and progressive weight gain. Which receptor action most directly contributes to this combination?

Options:

Correct Answer: Histamine H1 receptor blockade

Explanation: H1 blockade by TCAs contributes to both sedation and weight gain, separate from their therapeutic monoamine-reuptake inhibition.

Question:

A patient taking a sedating tricyclic antidepressant begins using another central nervous system depressant and develops excessive drowsiness. Which interaction best explains the change?

Options:

Correct Answer: Additive central nervous system depression

Explanation: TCAs can cause sedation, and combining them with other CNS depressants can intensify this effect through additive pharmacodynamic actions.

Question:

During revision of tricyclic antidepressant classification, a student is asked to identify a secondary-amine TCA rather than a tertiary-amine TCA. Which drug is the best answer?

Options:

Correct Answer: Nortriptyline

Explanation: Nortriptyline is a secondary-amine TCA; amitriptyline, imipramine and clomipramine are tertiary-amine TCAs.

Question:

A 26-year-old woman has recurrent major depressive episodes. She also describes distinct periods of unusually high energy, reduced need for sleep and increased productivity, but these periods have not caused marked functional impairment, psychosis or hospitalization. Which diagnosis best fits this pattern?

Options:

Correct Answer: Bipolar II disorder

Explanation: Bipolar II disorder combines major depressive episodes with hypomania, whereas a full manic episode would indicate bipolar I disorder.

Question:

Two patients have elevated mood, increased energy and reduced need for sleep. One remains able to function and has no psychosis, whereas the other develops severe impairment and requires urgent psychiatric care. Which feature most strongly separates hypomania from mania?

Options:

Correct Answer: Absence of marked functional impairment

Explanation: Hypomania resembles mania symptomatically but lacks the marked functional impairment, severe disruption or psychotic features characteristic of full mania.

Question:

A patient with bipolar disorder presents with an acute manic episode. The treating team wants an anticonvulsant mood stabilizer with a particularly established role in acute mania. Which drug best fits this aim?

Options:

Correct Answer: Valproate

Explanation: Valproate is an important mood-stabilizing anticonvulsant with particular usefulness in acute mania.

Question:

A psychiatrist is reviewing anticonvulsant drugs that may also be used as mood stabilizers in selected patients with bipolar disorder. Which drug is an alternative mood-stabilizing agent?

Options:

Correct Answer: Carbamazepine

Explanation: Carbamazepine is an anticonvulsant with mood-stabilizing properties and may be used as an alternative agent in selected bipolar patients.

Question:

A patient taking maintenance lithium reports a mild fine tremor. He is otherwise well, with no ataxia, confusion, severe gastrointestinal symptoms or reduced consciousness. How should this finding be interpreted?

Options:

Correct Answer: A recognized adverse effect of lithium

Explanation: A fine tremor can occur during therapeutic lithium use; a new coarse tremor with ataxia or confusion is much more concerning for toxicity.

Question:

A woman with bipolar disorder who is stable on lithium informs her psychiatrist that she is planning pregnancy. Which property of lithium makes specialist treatment review particularly important?

Options:

Correct Answer: Potential fetal risk during pregnancy

Explanation: Lithium has pregnancy-related fetal risk, so treatment during pregnancy requires individualized specialist assessment of maternal benefit and fetal risk.

Question:

A patient with bipolar disorder is clinically stable on long-term lithium. Which monitoring combination most directly addresses the major pharmacological concerns associated with this treatment?

Options:

Correct Answer: Lithium concentration, renal function and thyroid function

Explanation: Lithium has a narrow therapeutic index, is renally eliminated and may impair thyroid function, making these three areas central to safe monitoring.

Question:

A patient with bipolar disorder has recovered from an acute episode and asks why maintenance mood-stabilizing treatment is still required when he currently feels normal. Which explanation best describes the therapeutic objective?

Options:

Correct Answer: To reduce recurrence while maintaining stability between mood poles

Explanation: Mood stabilization aims to control pathological mood shifts and prevent recurrence without pushing the patient toward either mania or depression.

Question:

A patient with major depressive disorder has a history of impulsive self-harm, so the psychiatrist considers the relative toxicity of antidepressants if taken in overdose. Which drug class is generally preferred over tricyclic antidepressants for this reason?

Options:

Correct Answer: Selective serotonin reuptake inhibitors

Explanation: SSRIs are generally safer in overdose than TCAs, whose sodium-channel effects can produce dangerous cardiac conduction disturbances.

Question:

A 45-year-old man develops depression after a major personal loss. He also has a family history of depressive illness and a longstanding tendency toward negative thinking. Which model best explains the development of his disorder?

Options:

Correct Answer: Interaction of biological, psychological and social factors

Explanation: Depression is best understood through a biopsychosocial model in which genetic vulnerability, psychological factors and life circumstances interact.