KMU Past Paper Practice

Question:
A 72-year-old man receiving long-term immunosuppressive therapy presents with fever, headache, neck stiffness and confusion. Acute bacterial meningitis is suspected. Which organism deserves particular consideration because of his age and impaired cellular immunity?

Options:

Correct Answer: Listeria monocytogenes

Explanation: Listeria becomes particularly important in older adults and patients with impaired cellular immunity, so it must be considered when selecting initial antimicrobial coverage.

Question:
A 45-year-old patient develops fever, headache and meningeal irritation several days after a penetrating cranial injury. Which route most directly explains how bacteria reached the meninges?

Hematogenous dissemination from the intestine

Retrograde transport through peripheral nerves

Transplacental spread into the circulation

Direct inoculation through the cranial defect

Increased production of cerebrospinal fluid

Correct Answer: Direct inoculation through the cranial defect

Explanation: Penetrating trauma can breach normal protective barriers and provide bacteria with direct access to the intracranial compartment.

Question:
A patient received antibiotics before hospital admission for suspected bacterial meningitis. CSF shows neutrophilic inflammation, raised protein and reduced glucose, but Gram stain and culture are negative. Which investigation may still help identify the causative organism?

CSF nucleic-acid-based testing

Repeat measurement of CSF glucose

Electroencephalography

Plain skull radiography

Peripheral nerve conduction study

Correct Answer: CSF nucleic-acid-based testing

Explanation: Molecular testing may detect microbial genetic material even when prior antibiotics have reduced the yield of conventional CSF culture.

Question:
A 28-year-old man with confirmed acute bacterial meningitis becomes hypotensive, tachycardic and poorly perfused despite initial treatment. Which complication best accounts for these systemic findings?

Hydrocephalus

Cerebral infarction

Sensorineural hearing injury

Cortical seizure activity

Septic shock

Correct Answer: Septic shock

Explanation: Severe systemic bacterial infection may produce circulatory failure with hypotension and poor tissue perfusion, indicating septic shock.

Question:
A 34-year-old woman is diagnosed with tuberculous meningitis after a three-week history of headache, low-grade fever and progressive drowsiness. Which treatment principle best addresses both the infection and damaging meningeal inflammation?

Single antituberculous drug with observation

Broad-spectrum antibiotics with immunoglobulin

Multidrug antituberculous therapy with corticosteroids

Antiviral therapy with anticonvulsants alone

Corticosteroid therapy without antimicrobial treatment

Correct Answer: Multidrug antituberculous therapy with corticosteroids

Explanation: Tuberculous meningitis requires combination antituberculous therapy, while adjunctive corticosteroids help reduce harmful inflammatory injury.

Question:
A patient receiving appropriate treatment for tuberculous meningitis develops progressive headache, vomiting and worsening consciousness. Imaging shows marked hydrocephalus. Which additional management step is most appropriate?

Stop antituberculous treatment

Obtain specialist neurosurgical assessment

Replace treatment with antibacterial monotherapy

Observe until consciousness improves spontaneously

Perform routine repeated lumbar punctures

Correct Answer: Obtain specialist neurosurgical assessment

Explanation: Significant hydrocephalus can cause dangerous intracranial pressure and may require neurosurgical intervention to restore CSF drainage.

Question:
A 23-year-old woman has fever, confusion and seizures. CSF demonstrates a lymphocytic inflammatory response with mildly increased protein. Which additional CSF finding would favor viral encephalitis over tuberculous meningitis?

Marked reduction in glucose concentration

Very high protein with CSF flow obstruction

Predominant neutrophilic pleocytosis

Visible organisms on bacterial Gram stain

Relatively preserved glucose concentration

Correct Answer: Relatively preserved glucose concentration

Explanation: Viral encephalitis commonly produces lymphocytic CSF with relatively preserved glucose, whereas TB meningitis characteristically lowers CSF glucose.

Question:
A young man survives a severe episode of viral encephalitis. Several weeks later, his family reports persistent memory difficulty and marked personality change despite recovery of consciousness. Which complication best explains these findings?

Persistent cognitive and behavioral impairment

Isolated sensorineural hearing loss

Obstructive hydrocephalus

Peripheral flaccid paralysis

Chronic septic shock

Correct Answer: Persistent cognitive and behavioral impairment

Explanation: Encephalitis directly injures brain parenchyma, so survivors may retain deficits in memory, cognition, behavior or personality.

Question:
A localized bacterial infection of the brain initially produces focal cerebritis. Several days later, contrast imaging demonstrates a well-defined ring-enhancing lesion containing pus. Which pathological change best explains this evolution?

Diffuse fibrosis of the meninges

Obstruction of the cerebral ventricles

Peripheral nerve demyelination

Capsule formation around a necrotic center

Generalized cortical atrophy

Correct Answer: Capsule formation around a necrotic center

Explanation: Brain abscess progresses from cerebritis to central necrosis and pus formation, followed by development of a surrounding capsule.

Question:
A patient with a severe untreated dental infection develops headache, fever and a focal neurological deficit. Imaging confirms a brain abscess. Which group of organisms is most consistent with this source?

Mycobacteria and enteroviruses

Meningococci and pneumococci only

Streptococci and anaerobic bacteria

Rabies virus and herpes viruses

Listeria and Toxoplasma only

Correct Answer: Streptococci and anaerobic bacteria

Explanation: Brain abscesses arising from dental or other contiguous infections commonly involve oral streptococci and anaerobic organisms.

Question:
A severely immunocompromised patient develops fever, confusion and focal neurological deficits. Imaging demonstrates several necrotic intracerebral lesions compatible with CNS toxoplasmosis. Which process most likely led to the cerebral disease?

Reactivation of latent infection after loss of cellular immunity

Direct bacterial spread from the middle ear

Retrograde migration through a peripheral nerve

Obstruction of normal CSF absorption

Primary infection confined to the meninges

Correct Answer: Reactivation of latent infection after loss of cellular immunity

Explanation: Cerebral toxoplasmosis commonly results from reactivation of latent Toxoplasma infection when cell-mediated immunity becomes severely impaired.

Question:
A man bitten by a suspected rabid dog several weeks earlier develops progressive flaccid weakness. He has no prominent agitation or pharyngeal spasms. Which clinical form of rabies best fits this presentation?

Tuberculous meningitis

Furious rabies

Acute pyogenic meningitis

Brain abscess

Paralytic rabies

Correct Answer: Paralytic rabies

Explanation: Paralytic rabies presents with progressive flaccid weakness and may lack the hyperexcitability and hydrophobic spasms typical of furious rabies.

Question:
A patient with encephalitic rabies becomes extremely distressed when a fan blows air across his face because the air movement triggers painful inspiratory spasms. Which term describes this manifestation?

Hydrophobia

Aerophobia

Photophobia

Dysarthria

Aphasia

Correct Answer: Aerophobia

Explanation: Aerophobia describes painful spasms triggered by air movement and is a characteristic manifestation of furious rabies.

Question:
A veterinarian examines a dog suspected of rabies. During the examination, saliva from the animal splashes directly into his conjunctiva. There is no bite or skin wound. How should this exposure be classified?

Category I exposure

Category II exposure

Non-exposure contact

Category III exposure

Indirect environmental exposure

Correct Answer: Category III exposure

Explanation: Saliva contacting a mucous membrane represents significant exposure even without a bite and is classified as Category III.

Question:
A previously unvaccinated man sustains a deep bite from a suspected rabid dog. Vaccine is started and rabies immunoglobulin is indicated. Which method of immunoglobulin administration best achieves its preventive purpose?

Give the entire amount at a distant muscle site

Administer the entire amount intravenously

Infiltrate it carefully into and around the wound

Administer it orally together with vaccine

Inject it directly into the cerebrospinal fluid

Correct Answer: Infiltrate it carefully into and around the wound

Explanation: Local infiltration places ready-made neutralizing antibodies at the site where rabies virus was introduced before it enters peripheral nerves.

Question:
A previously unvaccinated man presents three days after a significant bite from a dog suspected of rabies. He has no neurological symptoms and received no treatment at the time of exposure. Which principle should guide management now?

Wait for encephalitic symptoms before intervening

Perform brain imaging before preventive measures

Avoid prophylaxis because the exposure was not treated immediately

Use symptomatic treatment while monitoring for hydrophobia

Begin indicated post-exposure prophylaxis promptly

Correct Answer: Begin indicated post-exposure prophylaxis promptly

Explanation: The goal of PEP is to prevent neural invasion before clinical rabies develops; a delayed presentation without symptoms does not justify waiting for disease.

Question:
A 4-year-old incompletely immunized child presents with fever, headache, vomiting, neck stiffness and altered consciousness. Which bacterial pathogen becomes particularly relevant because of the incomplete immunization history?

Haemophilus influenzae

Listeria monocytogenes

Escherichia coli

Group B Streptococcus

Toxoplasma gondii

Correct Answer: Haemophilus influenzae

Explanation: Haemophilus influenzae remains an important cause of childhood bacterial meningitis when effective immunization is incomplete or absent.

Question:
A 9-month-old infant presents with fever, irritability, vomiting and a bulging fontanelle. He is hemodynamically stable and has no focal neurological deficit. Which investigation is most important for establishing the diagnosis of bacterial meningitis?

Serum glucose measurement alone

Plain radiograph of the skull

Electroencephalography

Lumbar puncture with CSF analysis

Peripheral nerve conduction testing

Correct Answer: Lumbar puncture with CSF analysis

Explanation: In a stable child without contraindications, CSF examination provides the key inflammatory, biochemical and microbiological evidence for meningitis.

Question:
A patient with suspected pneumococcal meningitis receives appropriate intravenous antibacterial treatment together with an adjunctive corticosteroid. What is the main purpose of adding the corticosteroid?

Directly sterilize the cerebrospinal fluid

Reduce damaging meningeal inflammatory responses

Prevent replication of neurotropic viruses

Provide immediate passive antibacterial immunity

Prevent development of antibiotic resistance

Correct Answer: Reduce damaging meningeal inflammatory responses

Explanation: Adjunctive corticosteroids aim to limit host inflammatory injury within the CNS; they do not replace bactericidal antimicrobial therapy.

Question:
A patient presents with fever, headache, seizures and a focal neurological deficit. Contrast CT shows a ring-enhancing intracerebral lesion, but the appearance is not sufficient to confidently distinguish an abscess from another focal lesion. Which additional imaging technique may provide useful diagnostic clarification?

Plain skull radiography

Electroencephalography

MRI with diffusion-sensitive imaging

Carotid Doppler ultrasonography

MRI of the lumbar spine

Correct Answer: MRI with diffusion-sensitive imaging

Explanation: Diffusion-sensitive MRI can provide additional evidence supporting a brain abscess when a ring-enhancing lesion remains diagnostically uncertain.