KMU Past Paper Practice

Question:

A 46-year-old man is brought to the emergency department after a convulsive episode during sleep. His wife woke only after the movements had already started, so no one saw how the event began. No focal neurological deficit is found afterward. How should the onset of this seizure be classified from the available information?

Options:

Correct Answer:
Unknown onset

Explanation: When the beginning of an event is not witnessed and available information cannot establish focal or generalized onset, the seizure should initially be classified as unknown onset.

Question:

A 22-year-old man with well-controlled epilepsy remains adherent to treatment but spends two consecutive nights awake preparing for an examination. The following morning he develops a generalized convulsion. Which factor most likely lowered his seizure threshold?

Options:

Correct Answer:
Severe sleep deprivation

Explanation: Sleep deprivation increases neuronal excitability and can precipitate seizures in susceptible patients even when anti-seizure medication is being taken correctly.

Question:

During a generalized tonic-clonic seizure, a patient first becomes rigid and later develops repetitive rhythmic jerking of the limbs. Which physiological change best explains the later motor pattern?

Options:

Correct Answer:
Alternating excitation and inhibitory recovery producing repeated contraction and relaxation

Explanation: The clonic phase reflects repeated cycles of neuronal excitation and partial inhibitory recovery, producing rhythmic contraction and relaxation after the sustained tonic phase.

Question:

An 8-year-old child is being evaluated for several brief episodes of interrupted activity during the school day. During examination, the clinician wants to increase the likelihood of reproducing a typical episode. Which bedside maneuver is most appropriate?

Options:

Correct Answer:
Voluntary hyperventilation for several minutes

Explanation: Hyperventilation can provoke typical absence seizures in susceptible children and is a useful bedside clue when brief staring episodes are suspected.

Question:

A 34-year-old woman receiving carbamazepine for focal epilepsy develops fever, sore throat and marked neutropenia on a complete blood count. Which adverse effect should be suspected?

Options:

Correct Answer:
Agranulocytosis

Explanation: Carbamazepine can rarely produce serious bone-marrow suppression. Fever and sore throat with severe neutropenia should raise concern for agranulocytosis.

Question:

A 39-year-old man receiving phenytoin for epilepsy develops horizontal nystagmus, diplopia and an unsteady gait. Which interpretation best explains these findings?

Options:

Correct Answer:
Dose-related phenytoin neurotoxicity

Explanation: Nystagmus, diplopia and ataxia are characteristic concentration-related neurological adverse effects of phenytoin and should prompt assessment for toxicity.

Question:

A 25-year-old man treated with valproate for generalized epilepsy develops severe upper abdominal pain and repeated vomiting. Serum pancreatic enzymes are markedly elevated. Which complication best accounts for his presentation?

Options:

Correct Answer:
Acute pancreatitis

Explanation: Pancreatitis is an uncommon but serious adverse effect of valproate. Severe abdominal pain with vomiting and raised pancreatic enzymes is the key clinical pattern.

Question:

A student compares the actions of commonly used broad-spectrum anti-seizure drugs. Which mechanism best accounts for the activity of lamotrigine?

Options:

Correct Answer:
Reduction of sodium-channel firing with decreased excitatory transmitter release

Explanation: Lamotrigine reduces voltage-gated sodium-channel activity and decreases release of excitatory neurotransmitters such as glutamate, thereby limiting seizure propagation.

Question:

A patient is prescribed an anti-seizure drug that suppresses voltage-gated sodium channels, enhances inhibitory GABA activity and reduces excitatory glutamatergic transmission. Which drug best matches this combined mechanism?

Options:

Correct Answer:
Topiramate

Explanation: Topiramate is a broad-spectrum drug with multiple actions, including sodium-channel inhibition, enhanced GABA activity and reduced glutamatergic transmission.

Question:

A patient with focal seizures requires adjunctive treatment and is prescribed a newer drug that binds the α2δ subunit of voltage-gated calcium channels. Which medicine has this mechanism?

Options:

Correct Answer:
Pregabalin

Explanation: Pregabalin and gabapentin bind the α2δ subunit of voltage-gated calcium channels and may be used as adjunctive therapy in focal seizures.

Question:

A pharmacology teacher contrasts the actions of benzodiazepines and phenobarbitone at the GABA-A receptor. Which effect is characteristic of phenobarbitone?

Options:

Correct Answer:
Prolonged duration of chloride-channel opening

Explanation: Barbiturates such as phenobarbitone prolong GABA-A chloride-channel opening, whereas benzodiazepines characteristically increase the frequency of channel opening.

Question:

A 12-year-old girl has brief interruptions of awareness without post-event confusion. She is mistakenly prescribed a drug primarily suited to focal seizures, and the episodes become more frequent. Which medicine is the least appropriate choice for this seizure pattern?

Options:

Correct Answer:
Carbamazepine

Explanation: Carbamazepine is mainly suited to focal seizures and may aggravate some generalized seizure syndromes, including typical absence seizures.

Question:

A 28-year-old patient receiving valproate notices easy bruising and scattered petechiae. The platelet count is reduced while hemoglobin and leukocyte counts remain satisfactory. Which adverse effect best explains this finding?

Options:

Correct Answer:
Drug-induced thrombocytopenia

Explanation: Valproate can reduce the platelet count. Bruising or petechiae with isolated thrombocytopenia is therefore an important treatment-related clue.

Question:

A woman with epilepsy attends a preconception consultation while her anti-seizure treatment is being reviewed. Which additional measure is appropriate as part of pregnancy planning?

Options:

Correct Answer:
Appropriate folate supplementation before conception

Explanation: Preconception care in women receiving anti-seizure therapy includes review of drug exposure and appropriate folate supplementation while maintaining effective seizure control.

Question:

A man develops continuous generalized convulsive activity outside the hospital. Intravenous access cannot be obtained immediately. Which treatment is particularly useful because it can be administered rapidly without an IV line?

Options:

Correct Answer:
Midazolam by an appropriate non-IV route

Explanation: Midazolam is a rapidly acting benzodiazepine and is particularly valuable when urgent seizure termination is required before intravenous access is available.

Question:

A 58-year-old patient arrives with ongoing convulsive status epilepticus. Airway and breathing are being supported while anti-seizure treatment is prepared. Which bedside investigation should be obtained promptly because it may identify an immediately reversible precipitant?

Options:

Correct Answer:
Capillary blood glucose measurement

Explanation: Hypoglycemia can precipitate seizures and must be identified rapidly because correcting it treats an immediately reversible cause while seizure management continues.

Question:

A patient with ongoing convulsive status epilepticus is selected for intravenous phenytoin therapy after initial emergency treatment. Which complication is particularly important during intravenous administration?

Options:

Correct Answer:
Hypotension and cardiac arrhythmia

Explanation: Intravenous phenytoin can cause clinically important cardiovascular toxicity, particularly hypotension and rhythm disturbance, so appropriate monitoring is required.

Question:

A 42-year-old man who consumes alcohol heavily stops drinking abruptly. Two days later he develops a generalized tonic-clonic seizure with no previous diagnosis of epilepsy. Which factor is the most likely precipitant?

Options:

Correct Answer:
Alcohol withdrawal

Explanation: Abrupt alcohol withdrawal can markedly increase neuronal excitability and precipitate generalized convulsions even in a person without established epilepsy.

Question:

A 67-year-old man with epilepsy takes several medicines for other chronic illnesses. The clinician wants a broad-spectrum anti-seizure drug with relatively few pharmacokinetic interactions. Which option best fits this requirement?

Options:

Correct Answer:
Levetiracetam

Explanation: Levetiracetam has broad anti-seizure activity and relatively few pharmacokinetic interactions, making it useful when polypharmacy is an important concern.

Question:

A 55-year-old man collapses suddenly while walking. His wife reports brief loss of consciousness without a prolonged post-event confusional state. He mentions preceding palpitations. Which investigation is particularly important because a cardiac cause of transient loss of consciousness must be considered?

Options:

Correct Answer:
Electrocardiography

Explanation: Palpitations, brief loss of consciousness and rapid recovery raise concern for cardiac syncope. ECG helps identify rhythm or conduction abnormalities that can mimic epileptic events.