GMDC MOCK 3 /80 26 Quiz 1 / 80 A 25 year old man who falls on the outstretched right arm complains of pain around the elbow and it is found that the olecranon is unusually prominent. The line from the midial epicondyle through the tip of the olecranon to the latual epicandgle is angulated. The most likely clinical diagnosis is Dislocation of the elbow Supracondylar fracture Fracture of the olecranon process Monteggia fracture dislocation 2 / 80 A 27 year old man who is in good health has a persistently raised blood pressure of between 145/92 mmHg and 149/92 both at the poly clinic and in the home for 6 months. What will be the MOST appropriate management ? Refer him to the specialist for investigations. Start him on nifedipine XL 30 mg once a day Start amlodipine therapy. to observe his blood pressure for a further 10 months before initiating treatment . 3 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Via the payer's patches to the mesenteric lymph nodes. The genitourinary mucosa-urethra and bladder. Directly to the lung tissue establishing a Primary Complex (Gohn focus) Through the tonsils to the cervical lymph nodes. 4 / 80 These are chronic complications associated with sickle cell disease except congestive heart failure aseptic necrosis of the hip or shoulder chronic lung disease leg ulcers priapism 5 / 80 Malignant degeneration of a healing wound is most likely to occur: When a patient is on cytotoxic agents. When wounds are exposed to heat. When iodophor antiseptics are used for dressing. When a state of chronicity from (e.g) recurrent infection prevails. 6 / 80 Which of the following is NOT a characteristic of normal labour: Uterine relaxation between contractions. Moderate bleeding. Moderate pain. Increasing intensity of contractions. Progressive cervical dilation. 7 / 80 The prime cause of a venous leg ulcer is: Varicosity of the long (greater) saphenous vein High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins Stasis in the deep veins 8 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is associated with trophoblastic disease Is commonest in the third trimester May be cured by admission to hospital Is associated with urinary tract infection Associated with multiple pregnancy 9 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Position. Lie. Presentation. None of the above. Attitude. 10 / 80 A 40 year old woman complains of difficulty in swallowing for 3 months. During the interview, it was observed that she has difficulty in speaking after a few sentences. She also has drooping of the eyelids. She is most likely suffering from: Myasthenia gravis Bulbar paralysis Scleroderma Diffuse spasm of the oesophageal muscles 11 / 80 A man of 40 complains of epigastric discomfort, progressive weight loss, anorexia malaise and intermittent pyrexia of 6 weeks duration. He looks ill, anaemic but not jaundiced and has a tender palpable liver; free fluid is detectable in the abdomen. The most likely clinical diagnosis is Primary liver cell carcinoma Amoebic liver abscess Carcinoma of the body of the pancreas Carcinoma of the stomach 12 / 80 Which of these discriptions adequately describe malena stools? Dark stools Black stools Black tarry or sticky stools Loose very shining black stools 13 / 80 On assessment of Semen Fluid Analysis: Azoospermia indicates a sperm count more than 5 million/ml Asthenozoospermia indicates abnormal forms Abstinence should be maintained for 10 days prior to "production" of the sample Abstinence should be maintained for 3 days prior to production of the sample Teratozoospermia indicates abnormal motility 14 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? No chest pain in an elderly female diabetic Shock . Severe crushing pain in the precordium Sharp piercing pain in the left which worsens with breathing 15 / 80 Concerning febrile seizures Overall risk for recurrence is 3-4% Complex features is not a risk factor for recurrence Main risk factor for recurrence is the temperature at time of seizure. Overall, 30% develop epilepsy They usually have a poor prognosis 16 / 80 The following are causes of spastic paraparesis except; Disc prolapse Guillain Barre syndrome Transverse myelitis Potts disease 17 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Endometrium. Placenta. Corpus albicans. Corpus luteum. Adrenal glands. 18 / 80 For a 75 year old man with a single rib fracture as the sole injury in a Road Traffic Accident the best treatment is: Strapping of the affected side of the chest Blockage of the appropriate intercostal nerve and active physiotherapy Watchful administration of adequate doses of systemic analgesic agent External fixation 19 / 80 Stages of labour Syntometrine is a combination of oxytocin and Ergometrine which is used in the treatment of secondary postpartum haemorrhage (PPH) The cervix dilates at consistent rate of 3 cm per hour in the first stage Forceps or ventose may be useful in slow progress of the late 1st stage The third stage end with the delivery of the placenta and membranes The first stage commences at the time of membrane rupture 20 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Nitrazine test. Pooling of amniotic fluid on speculum examination. Positive Fern test. Observing amniotic fluid drain through the cervix during speculum examination. Contractions seen on the CTG. 21 / 80 A 20 year old man has a tense, fluctuant, non-tender, ovoid, swelling without a cough impulse in the left groin which moves with traction on the testis. What is the most likely diagnosis? Encysted hydrocele of the cord Irreducible incomplete inguinal hernia, probably containing omentum Sebaceous cyst of the scrotum Cyst of the epididymis 22 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except sepsis galactosemia biliary atresia torch infections breast milk jaundice 23 / 80 This is not a cause of hypoglycaemia in newborns intrauterine growth retardate infant of a diabetic mother hypoinsulinaemia prematurity sepsis 24 / 80 The pelvis includes which of the following bones: Ilium, scapula, ischium and pubis. Trochanter, sacrum, coccyx, ilium and pubis Ilium, ischium, pubis, sacrum and coccyx. Sacrum, Tibia, ilium and pubis. Trochanter, hip socket, ischium, sacrum and pubis. 25 / 80 The following are treatment for simple malaria except artemether - lumefantrine dihydroartemisinin - piperaquine oral quinine dihydroartemisinin - lumefantrine artesunate - amodiaquine 26 / 80 The risk of postpartum uterine atony is associated with: Median episiotomy. Epidural anesthesia. Hypotension. Twin pregnancy. Labour associated with an active rate of change of 1 cm per hour. 27 / 80 Antenatal booking investigations include all of the following, EXCEPT: Thyroid function Complete blood count Stool routine examination Urine routine examination Hepatitis screening 28 / 80 Molding of the fetal head: Usually cause brain damage. Does not happen when maternal pelvis is adequate. Becomes progressively easier as gestational age increase. Increase the difficulty of delivery. Does NOT have time to occur in breech delivery. 29 / 80 A71 year old man present with rapidly developing fever, cough productive of rust-clouded sputum which grew gram positive diplococci. His chest X-ray show lobar consolidation. He responds to treatment with amoxicillin . Which is the MOST likely organism for her infection? Mycoplasma pneumonia Streptococcus pneumoniae Klebsiella pneumoniae Staphylococcus aureus 30 / 80 Twenty-four hours after partial gastrectomy, a 50 year old man has passed only 200mls of urine; catherization yield a further 100m of urine. Your provisional diagnosis is: Acute renal failure Pre-renal renal failure Acute tubular necrosis Post-renal renal failure 31 / 80 Cause of neonatal seizures include the following except hypermagnesaemia intracranial hemorrhage bilirubin encephalopathy hypoxic ischaemic encephalopathy pyridoxine deficiency 32 / 80 The features listed below may be associated with migraine headache EXCEPT Neck stiffness may be present Pulsatile or throbbing headache Nausea Photophobia. 33 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Urine for culture and sensitivity is not important Not known to happen in molar pregnancy Is a complication of multiple pregnancy Liver function test is not required Worsen in missed abortion 34 / 80 In bronchiolitis, all these are true except drug of choice is acyclovir it's usually a self-limiting disease most commonly caused by respiratory syncytial virus primarily affects children less than 2 years old may present with with low grade fever 35 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. adenoma sebaceum and tuberous sclerosis café - au-lait spots and neurofibromatosis shagreen patch and tuberous sclerosis port wine stain and sturge weber syndrome cortical tuber in neurofibromatosis 36 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 23. March 27. April 23. March 28. April 7. 37 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Adrenocorticotropic hormone Cholecystokinin Follicle stimulating hormone Prolactin 38 / 80 Which one of the drugs or measures do not worsen uraemia? Hypotension Gentamycin Diarrhoea Paracetamol 39 / 80 In normal pregnancy, the value of ß-hCG doubles every: 8 days. 14 days. 2 days. 4 days. 10 days. 40 / 80 These are gross motor skills except sits with support walks up stairs with help steadiness of head when placed in supported position transfers object from hand to hand stands alone 41 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Brain naturetic protein Aldosterone Nordrenaline Thyroxine 42 / 80 The second stage of labour involves: Effacement of the cervix. Dilation of the cervix. Expulsion of the fetus. Expulsion of the placenta. Separation of the placenta. 43 / 80 The following are associated with oral candidiasis except; Glucose 6 Phosphate Dehydrogenase Retroviral infection Lymphoma Malignancy 44 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Occiput. Mentum. Sinciput. Sacrum. Acromian. 45 / 80 Which of the underlisted factors has been shown by critical analysis to be the most important influence on the genesis of Surgical Site Infection (SSI) Glove puncture in the course of surgery Preoperative showering for the patient Age of the patient Bacterial content of the wound at end of operation 46 / 80 The thyroid gland in thyrotoxicosis: If secondary is firm and multinodular in all patients If primary is uniformly enlarged and rather soft or firm Is enlarged in all patients so affected In over 95 percent has a thrill and a bruit over it 47 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Intraductal comedo-carcinoma Scirrhous breast carcinoma Chronic breast abscess Duct ectasia 48 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? DPP4 inhibitors Glibenclamide Pioglitazone Metformin 49 / 80 About severe acute malnutrition (SAM). There is usually unilateral pitting pedal oedema Hypoglycaemia is present when the blood glucose is <4mmol/l sensory stimulation is not helpful ORS is the fluid of choice for correcting dehydration Diagnostic features include mid upper arm circumference < 115mm 50 / 80 Features found in nephrotic syndrome include the following EXCEPT: Normal renal function Hypertriglyceridemia Oedema Hypoalbuminsemia 51 / 80 Squamous cell carcinoma of the anus: Bleeds but does not cause pain on defaecation Is treated by abdomino-perineal resection of the rectum and anus in all patients Usually presents as a localized ulcer with sloping edges Is the commonest malignant tumour of the anus 52 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Terminal ileum Transverse colon Descending colon Caecum 53 / 80 The commonest site for carcinoma of the tongue is the: Posterior one-third Lateral margin Dorsum Tip 54 / 80 A 55 year old man who has been working for many years blasting stones for building purposes presents with progressive dypsnoea on exertion, dry cough and progressive tiredness. On examination breath sounds were vesicular. There were medium crepitations on inspiration Percussion was resonant in all areas. Chest X ray showed diffuse milliary pattern in the upper lung fields. What is the MOST likely diagnosis? Carcinoma of the bronchus Tuberculosis Left ventricular failure Silicosis 55 / 80 In an acute abdomen a history of frequent copious vomiting, the vomitus being clear initially, then bile-stained and finally brown in colour, is most suggestive of Acute gastritis Gastro-enteritis Acute pancreatitis Acute high intestinal obstruction 56 / 80 A 31 year old drug addict who uses intravenous drugs presents to your clinic with a 4 day history fever with temperatures in tween 38.5 and 40 degree Celsius, chills,sweats. headaches progressive weakness, dypsnoea and cough.Examination confirms high fever, pulse rate of 116 beats per minute, newly diagnosed pansystolic murmur. Fine crepitations were heard at the lung bases. The eyes had a lemon yellow tinge and there were macular rash in the palms. What is the MOST likely diagnosis? Acute bacterial endocarditis Sub acute bacterial endocarditis Viral hepatitis Acute rheumatic carditis. 57 / 80 In burns: The rate of fluid exudation from the capillaries is highest in the first 4 hours and falls in 48 hours. The maximum oedema fluid obtainable is about 10% of the body weight or 50% of total E.C.F. The increased capillary permeability is restricted to the burnt area. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. 58 / 80 All these conditions cause hypokalemia in children except renal tubular acidosis type 1 pyloric stenosis acute tubular necrosis gastroenteritis frusemide 59 / 80 Cause of ptosis include the following except tick paralysis botulism 4th nerve palsy horner syndrome myasthenia gravis 60 / 80 A child of four presents with shortness of breath on exertion, dyspnoea after meals and failure to thrive. On examination cyanosis is evident soon after exertion and the (L) side of the chest is tympanitic. Plain x-ray of the chest shows a cystic shadow in the left hemithorax. The most likely diagnosis is: Congital cyanotic heart disease Emphysematous bullae Congenital postero-lateral diaphragmatic hernia (stabilized) Congenital cystic lung disease 61 / 80 Which of the following patients should you prescribe aspirin if there is no contraindication. Select the MOST appropriate Any patient with hypertension and aged over 50 years Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. Any patient with severe hypertension and 50 years and cardiovascular disease All the answers below 62 / 80 Stroke due involving the right middle cerebral artery pathology in most people usually causes the symptoms and signs below EXCEPT May cause incontinence of urine No effect on the muscles in the upper part of the face. Motor aphasia Paralysis of lower facial muscles on the left. 63 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Immediate evacuation should be done once the diagnosis is made Ultrasound should be done to confirm the diagnosis Per vaginal bleeding may be one of the presenting symptom Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Patient may present with loss of the symptoms of pregnancy 64 / 80 The heart rate of a normal fetus at term is: There is no baseline heart rate. 100-120 bpm. 120-160 bpm. 80-100 bpm. 160-180 bpm. 65 / 80 The most effective surgical procedure in stress ulceration is: Vogitomy and hemigastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Polya partial gastrectomy Total gastrectomy 66 / 80 These are causes of acute stridor except croup acute epiglottitis laryngomalacia bacterial tracheitis diphtheria 67 / 80 The management of retroexposed babies include mixed feeding at 1 month cotrimoxazole at birth PCR at 6 weeks of age lamivudine and zidovudine for 6 weeks for high risk babies zidovudine for six months 68 / 80 The main tissues which provide support to the uterus include: Cardinal ligaments and the Uterosacral ligaments Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments Uterosacral ligaments and the Broad ligaments Perineal body and the Broad ligaments 69 / 80 You are called to see a 67 year old man 30 hours after a major abdominal surgery with oligourea. Investigation shows blood urea 15 mold/l, creatinine 122mmol/l serum potassium 5.1 mold/ l and urinary sodium 10mmol/l (normal is 25 to 250 mom/l) What is the most likely diagnosis? Injury to sacral nerve plexus Post renal uraemia Hypovolaemia Atonic bladder 70 / 80 Neonatal resuscitation chest compression is initiated when heart rate is below 100 bpm atropine is administered when heart rate is below 100 bpm involves administration of iv aminophylline to preterms most effective action is ventilation of the baby's lungs clearing airway preceeds keeping baby warm 71 / 80 For adequate and stable haemostasis the following should obtain: A minimum platelet count of 90,000 per mm3 Increased pressure within the injured vessel Retraction of the injured vessel Endothelial cell secretion of factor VIII 72 / 80 The following are contraindications for lumbar puncture except Acute spinal cord injury Raised intracranial pressure Coagulopathy skin infection at or near the site of the lumbar puncture Cervical spondylosis 73 / 80 Facial features of fetal alcohol syndrome include the following except ptosis smooth philtrum microcephaly thick upper lip short palpebral tissue 74 / 80 An ectopic pregnancy: Occurs only in the fallopian tubes Gives an increased risk of Hyperemisis Gravidarium Pain always presents before the bleeding Can only be treated surgically Usually presents with pain before bleeding 75 / 80 A 55 year old man undergoes a CT abdominal scan with contrast. Following the scan his renal function has progressively deteriorated. What is the MOSTlikely diagnosis ? Acute tubular necrosis Post renal obstruction Renal artery stenosis Rapidly progressively glomerulonephriitis 76 / 80 This is not true about autism commoner in males than in females with a male:female ratio of 3:1 there is severe language and speech developmental disorder it's characterised by restricted and repetitive behavior most cases have normal intelligence it is pervasive developmental disorder 77 / 80 Causes of macrocephaly include the following except mucopolysaccharidosis achondroplasia hydrocephalus fetal alcohol syndrome thalassaemia 78 / 80 Adverse effects of corticosteroids include all EXCEPT Avascular necrosis of the hip. Cataract Osteomalacia Euphoria 79 / 80 Which of the following is not part of the criteria considered for CURB 65 used to determine the severity of community pneumonia. Respiratory rate> 30 per minute Heart rate >100 Confusion Diastolic pressure <60 mm Hg. 80 / 80 A 16 year old boy from a deprived area of Accra who is undergoing treatment for pulmonary TB reports that his urine has become 'bloody'. Which one of the following is the MOST likely diagnosis? Drug induced Urinary tract infection Haemolysis Renal stone Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback