KMU Past Paper Practice

Question:

A 9-year-old child had primary pulmonary tuberculosis several years ago and remained clinically well without progressive disease. A later chest radiograph shows a small calcified pulmonary focus together with calcified regional hilar lymph nodes. Which term best describes this healed lesion?

Options:

Correct Answer: Ranke complex

Explanation: Healing of a primary Ghon complex by fibrosis and calcification produces a Ranke complex, reflecting contained previous primary infection.

Question:

A 38-year-old man with advanced pulmonary tuberculosis develops persistent fever, severe weight loss and progressive respiratory symptoms. Chest imaging shows innumerable tiny nodules distributed throughout both lungs, and similar lesions are later detected in other organs. Which route of spread best explains this pattern?

Options:

Correct Answer: Hematogenous dissemination

Explanation: Miliary TB results when bacilli enter the bloodstream and disseminate widely, producing numerous small lesions in the lungs and other organs.

Question:

Histological examination of a lung lesion shows epithelioid macrophages and multinucleated giant cells surrounding necrotic material. Some giant cells have nuclei arranged near the cell periphery. Which interpretation of this finding is most appropriate?

Options:

Correct Answer: The cells are Langhans-type giant cells but are not disease-specific

Explanation: Peripheral nuclear arrangement describes Langhans-type giant cells, which may occur in TB granulomas but are not specific enough to diagnose TB alone.

Question:

A 63-year-old man completed treatment for cavitary pulmonary tuberculosis. Two years later he develops recurrent hemoptysis. CT chest reveals a rounded mobile mass lying within a residual upper-lobe cavity. Which complication best explains the new finding?

Options:

Correct Answer: Fungal colonization of a healed cavity

Explanation: A residual tuberculous cavity may later become colonized by Aspergillus, forming a fungus ball that can cause recurrent hemoptysis.

Question:

A 35-year-old woman with suspected sarcoidosis undergoes lung biopsy. Granulomas are concentrated along bronchovascular bundles, interlobular septa and subpleural regions. Which distribution best characterizes this pattern?

Options:

Correct Answer: Perilymphatic distribution

Explanation: Pulmonary sarcoid granulomas characteristically track along lymphatic routes, especially bronchovascular bundles, septa and subpleural connective tissue.

Question:

A patient with pulmonary sarcoidosis has persistent granulomatous inflammation for several years. Follow-up imaging shows increasing architectural distortion and reduced lung volumes. Which pathological outcome most likely accounts for this progression?

Options:

Correct Answer: Progressive pulmonary fibrosis

Explanation: Persistent granulomatous inflammation in sarcoidosis may stimulate fibrosis, causing permanent architectural distortion and progressive impairment of lung function.

Question:

A 41-year-old farmer with chronic hypersensitivity pneumonitis continues working in the same antigen-rich environment despite recurrent symptoms. Which long-term pulmonary change is most likely if exposure persists?

Options:

Correct Answer: Progressive interstitial fibrosis

Explanation: Continued antigen exposure can convert recurrent hypersensitivity pneumonitis into chronic fibrotic interstitial lung disease with irreversible functional impairment.

Question:

A 27-year-old man develops cough, dyspnea and pulmonary infiltrates several days after starting a new medication. Peripheral eosinophilia is present. There is no relevant occupational exposure and microbiological studies are negative. Which etiological category should be considered first?

Options:

Correct Answer: Drug-associated pulmonary eosinophilia

Explanation: Pulmonary eosinophilia is a syndrome with several causes; a close temporal relationship to a new medication makes a drug reaction an important etiological possibility.

Question:

A patient with drug-susceptible pulmonary tuberculosis is prescribed isoniazid as part of combination therapy. The drug must first be activated within the bacillus before it interferes with synthesis of an essential cell-wall component. Which component is primarily affected?

Options:

Correct Answer: Mycolic acids

Explanation: Activated isoniazid inhibits mycolic-acid synthesis, damaging a distinctive and essential lipid component of the mycobacterial cell wall.

Question:

During initial treatment of pulmonary tuberculosis, ethambutol is included while full susceptibility information is being established. Which bacterial process is inhibited by this drug?

Options:

Correct Answer: Arabinogalactan cell-wall synthesis

Explanation: Ethambutol inhibits arabinosyl transferases involved in synthesis of arabinogalactan, an important component of the mycobacterial cell wall.

Question:

A patient is receiving standard initial therapy for drug-susceptible tuberculosis. One drug is particularly useful against bacilli surviving in acidic intracellular and inflammatory environments and contributes important sterilizing activity early in treatment. Which drug has this role?

Options:

Correct Answer: Pyrazinamide

Explanation: Pyrazinamide is particularly active in acidic intracellular or inflammatory environments and provides important early sterilizing activity.

Question:

A man with resistant tuberculosis is started on a second-line drug. Several weeks later he develops marked anxiety, behavioral disturbance and a generalized seizure. Which drug most likely contributed to these manifestations?

Options:

Correct Answer: Cycloserine

Explanation: Cycloserine interferes with bacterial cell-wall synthesis but is limited by important CNS toxicity, including neuropsychiatric symptoms and seizures.

Question:

A patient being treated for drug-resistant tuberculosis develops progressive dark reddish-brown discoloration of the skin but has no visual impairment or peripheral neuropathy. Which agent is the most likely cause?

Options:

Correct Answer: Clofazimine

Explanation: Clofazimine can produce striking red-brown or dark skin discoloration and gastrointestinal adverse effects during prolonged therapy.

Question:

A newly diagnosed patient completes the intensive phase of conventional treatment for drug-susceptible pulmonary tuberculosis with good clinical and microbiological response. Which regimen represents the standard continuation phase?

Options:

Correct Answer: Isoniazid plus rifampicin for four months

Explanation: The conventional 6-month regimen uses 2 months of HRZE followed by 4 months of isoniazid and rifampicin as the continuation phase.

Question:

Sputum microscopy from a patient with chronic cough shows acid-fast bacilli. The physician explains that microscopy alone cannot reliably establish that the organism is specifically Mycobacterium tuberculosis. Which additional investigation is most useful for definitive isolation and more complete susceptibility assessment?

Options:

Correct Answer: Mycobacterial culture

Explanation: Culture permits isolation of the organism and enables broader phenotypic susceptibility testing, although the slow growth of mycobacteria delays results.

Question:

A 56-year-old man with diabetes mellitus is exposed to a family member with infectious pulmonary tuberculosis. Compared with an otherwise healthy exposed adult, which component of the epidemiological triad is represented by his diabetes?

Options:

Correct Answer: Host factor increasing progression risk

Explanation: Diabetes is a host determinant that impairs effective immune control and increases the risk that TB infection will progress to active disease.

Question:

A district TB programme has reliable diagnosis, uninterrupted medicines and strong treatment support, but cannot determine its cure rates, defaults or treatment failures because individual outcomes are not consistently documented. Which core control function needs strengthening?

Options:

Correct Answer: Systematic recording and outcome evaluation

Explanation: DOTS includes standardized recording and reporting so programmes can measure treatment outcomes and identify failures in TB control.

Question:

A public-health team redesigns its tuberculosis programme to combine early diagnosis and effective treatment with prevention, patient-centred care, management of drug-resistant disease, stronger health systems and research. Which strategy is most closely reflected by this broader approach?

Options:

Correct Answer: End TB Strategy

Explanation: The End TB approach extends beyond treatment delivery to prevention, patient-centred services, resistant TB, health-system strengthening and research.

Question:

A 44-year-old woman has persistent cough, constitutional symptoms and multiple pulmonary granulomas on biopsy. Repeated microbiological tests for tuberculosis are inconclusive, and the clinician is uncertain whether the process represents TB, sarcoidosis or another granulomatous disorder. Which management step is most appropriate in primary care?

Options:

Correct Answer: Arrange specialist referral for diagnostic clarification

Explanation: Significant diagnostic uncertainty between infectious and non-infectious granulomatous disease is an appropriate indication for specialist evaluation before potentially harmful therapy is started.

Question:

Resistance testing in a patient with pulmonary tuberculosis demonstrates rifampicin resistance together with resistance to a fluoroquinolone. Isoniazid resistance is also present. Which resistance category best describes this pattern before considering resistance to additional key drugs?

Options:

Correct Answer: Pre-XDR tuberculosis

Explanation: Pre-XDR-TB refers to MDR/RR-TB with additional resistance to a fluoroquinolone; further resistance to key Group A drugs is required for XDR-TB classification.