GMDC MOCK 3 /80 26 Quiz 1 / 80 For adequate and stable haemostasis the following should obtain: Retraction of the injured vessel Increased pressure within the injured vessel Endothelial cell secretion of factor VIII A minimum platelet count of 90,000 per mm3 2 / 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 stomach Carcinoma of the body of the pancreas 3 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Nitrazine test. Observing amniotic fluid drain through the cervix during speculum examination. Contractions seen on the CTG. Pooling of amniotic fluid on speculum examination. Positive Fern test. 4 / 80 The most effective surgical procedure in stress ulceration is: Polya partial gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Vogitomy and hemigastrectomy Total gastrectomy 5 / 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 Fracture of the olecranon process Supracondylar fracture Monteggia fracture dislocation 6 / 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? Staphylococcus aureus Klebsiella pneumoniae Mycoplasma pneumonia Streptococcus pneumoniae 7 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: May be cured by admission to hospital Is associated with trophoblastic disease Is commonest in the third trimester Is associated with urinary tract infection Associated with multiple pregnancy 8 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Follicle stimulating hormone Prolactin Cholecystokinin Adrenocorticotropic hormone 9 / 80 Adverse effects of corticosteroids include all EXCEPT Cataract Avascular necrosis of the hip. Osteomalacia Euphoria 10 / 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 Is the commonest malignant tumour of the anus Usually presents as a localized ulcer with sloping edges 11 / 80 The thyroid gland in thyrotoxicosis: Is enlarged in all patients so affected If secondary is firm and multinodular in all patients In over 95 percent has a thrill and a bruit over it If primary is uniformly enlarged and rather soft or firm 12 / 80 The following are contraindications for lumbar puncture except Coagulopathy skin infection at or near the site of the lumbar puncture Acute spinal cord injury Raised intracranial pressure Cervical spondylosis 13 / 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? Irreducible incomplete inguinal hernia, probably containing omentum Encysted hydrocele of the cord Sebaceous cyst of the scrotum Cyst of the epididymis 14 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Immediate evacuation should be done once the diagnosis is made Patient may present with loss of the symptoms of pregnancy Per vaginal bleeding may be one of the presenting symptom Ultrasound should be done to confirm the diagnosis 15 / 80 Which of the following is not part of the criteria considered for CURB 65 used to determine the severity of community pneumonia. Confusion Heart rate >100 Respiratory rate> 30 per minute Diastolic pressure <60 mm Hg. 16 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? No chest pain in an elderly female diabetic Severe crushing pain in the precordium Sharp piercing pain in the left which worsens with breathing Shock . 17 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Intraductal comedo-carcinoma Chronic breast abscess Duct ectasia Scirrhous breast carcinoma 18 / 80 About severe acute malnutrition (SAM). Hypoglycaemia is present when the blood glucose is <4mmol/l There is usually unilateral pitting pedal oedema sensory stimulation is not helpful ORS is the fluid of choice for correcting dehydration Diagnostic features include mid upper arm circumference < 115mm 19 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. café - au-lait spots and neurofibromatosis port wine stain and sturge weber syndrome shagreen patch and tuberous sclerosis cortical tuber in neurofibromatosis adenoma sebaceum and tuberous sclerosis 20 / 80 An ectopic pregnancy: Pain always presents before the bleeding Usually presents with pain before bleeding Occurs only in the fallopian tubes Can only be treated surgically Gives an increased risk of Hyperemisis Gravidarium 21 / 80 Malignant degeneration of a healing wound is most likely to occur: When a patient is on cytotoxic agents. When a state of chronicity from (e.g) recurrent infection prevails. When wounds are exposed to heat. When iodophor antiseptics are used for dressing. 22 / 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 Acute rheumatic carditis. Viral hepatitis Sub acute bacterial endocarditis 23 / 80 The following are treatment for simple malaria except oral quinine artesunate - amodiaquine dihydroartemisinin - piperaquine dihydroartemisinin - lumefantrine artemether - lumefantrine 24 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Metformin Pioglitazone DPP4 inhibitors Glibenclamide 25 / 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: Pre-renal renal failure Post-renal renal failure Acute renal failure Acute tubular necrosis 26 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Through the tonsils to the cervical lymph nodes. 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) 27 / 80 Neonatal resuscitation most effective action is ventilation of the baby's lungs involves administration of iv aminophylline to preterms chest compression is initiated when heart rate is below 100 bpm atropine is administered when heart rate is below 100 bpm clearing airway preceeds keeping baby warm 28 / 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? Urinary tract infection Haemolysis Renal stone Drug induced 29 / 80 Cause of neonatal seizures include the following except hypoxic ischaemic encephalopathy bilirubin encephalopathy hypermagnesaemia intracranial hemorrhage pyridoxine deficiency 30 / 80 The following are associated with oral candidiasis except; Lymphoma Glucose 6 Phosphate Dehydrogenase Malignancy Retroviral infection 31 / 80 Causes of macrocephaly include the following except fetal alcohol syndrome thalassaemia hydrocephalus mucopolysaccharidosis achondroplasia 32 / 80 Features found in nephrotic syndrome include the following EXCEPT: Oedema Hypoalbuminsemia Normal renal function Hypertriglyceridemia 33 / 80 This is not a cause of hypoglycaemia in newborns sepsis infant of a diabetic mother hypoinsulinaemia intrauterine growth retardate prematurity 34 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Caecum Terminal ileum Descending colon Transverse colon 35 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except galactosemia torch infections sepsis biliary atresia breast milk jaundice 36 / 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: External fixation Strapping of the affected side of the chest Watchful administration of adequate doses of systemic analgesic agent Blockage of the appropriate intercostal nerve and active physiotherapy 37 / 80 Stages of labour The third stage end with the delivery of the placenta and membranes The cervix dilates at consistent rate of 3 cm per hour in the first stage Syntometrine is a combination of oxytocin and Ergometrine which is used in the treatment of secondary postpartum haemorrhage (PPH) Forceps or ventose may be useful in slow progress of the late 1st stage The first stage commences at the time of membrane rupture 38 / 80 Molding of the fetal head: 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. Usually cause brain damage. 39 / 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 40 / 80 The following are causes of spastic paraparesis except; Guillain Barre syndrome Transverse myelitis Potts disease Disc prolapse 41 / 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? Silicosis Carcinoma of the bronchus Left ventricular failure Tuberculosis 42 / 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 Renal artery stenosis Post renal obstruction Rapidly progressively glomerulonephriitis 43 / 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. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. The increased capillary permeability is restricted to the burnt area. 44 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Lie. None of the above. Presentation. Position. Attitude. 45 / 80 The management of retroexposed babies include cotrimoxazole at birth mixed feeding at 1 month zidovudine for six months lamivudine and zidovudine for 6 weeks for high risk babies PCR at 6 weeks of age 46 / 80 All these conditions cause hypokalemia in children except gastroenteritis renal tubular acidosis type 1 acute tubular necrosis frusemide pyloric stenosis 47 / 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: Diffuse spasm of the oesophageal muscles Scleroderma Myasthenia gravis Bulbar paralysis 48 / 80 These are causes of acute stridor except diphtheria laryngomalacia bacterial tracheitis croup acute epiglottitis 49 / 80 Concerning febrile seizures Main risk factor for recurrence is the temperature at time of seizure. Overall risk for recurrence is 3-4% Overall, 30% develop epilepsy Complex features is not a risk factor for recurrence They usually have a poor prognosis 50 / 80 These are chronic complications associated with sickle cell disease except chronic lung disease leg ulcers priapism aseptic necrosis of the hip or shoulder congestive heart failure 51 / 80 On assessment of Semen Fluid Analysis: 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 Asthenozoospermia indicates abnormal forms Teratozoospermia indicates abnormal motility Azoospermia indicates a sperm count more than 5 million/ml 52 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Is a complication of multiple pregnancy Worsen in missed abortion Not known to happen in molar pregnancy Liver function test is not required Urine for culture and sensitivity is not important 53 / 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 Paralysis of lower facial muscles on the left. Motor aphasia No effect on the muscles in the upper part of the face. 54 / 80 This is not true about autism it is pervasive developmental disorder most cases have normal intelligence it's characterised by restricted and repetitive behavior commoner in males than in females with a male:female ratio of 3:1 there is severe language and speech developmental disorder 55 / 80 Which one of the drugs or measures do not worsen uraemia? Diarrhoea Paracetamol Gentamycin Hypotension 56 / 80 In normal pregnancy, the value of ß-hCG doubles every: 8 days. 10 days. 14 days. 2 days. 4 days. 57 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Sinciput. Sacrum. Mentum. Occiput. Acromian. 58 / 80 Which of these discriptions adequately describe malena stools? Dark stools Loose very shining black stools Black stools Black tarry or sticky stools 59 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Endometrium. Placenta. Adrenal glands. Corpus luteum. Corpus albicans. 60 / 80 In bronchiolitis, all these are true except primarily affects children less than 2 years old drug of choice is acyclovir it's usually a self-limiting disease most commonly caused by respiratory syncytial virus may present with with low grade fever 61 / 80 Antenatal booking investigations include all of the following, EXCEPT: Stool routine examination Thyroid function Complete blood count Hepatitis screening Urine routine examination 62 / 80 Cause of ptosis include the following except horner syndrome myasthenia gravis tick paralysis botulism 4th nerve palsy 63 / 80 The features listed below may be associated with migraine headache EXCEPT Nausea Pulsatile or throbbing headache Photophobia. Neck stiffness may be present 64 / 80 The pelvis includes which of the following bones: Trochanter, hip socket, ischium, sacrum and pubis. Ilium, scapula, ischium and pubis. Trochanter, sacrum, coccyx, ilium and pubis Sacrum, Tibia, ilium and pubis. Ilium, ischium, pubis, sacrum and coccyx. 65 / 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? Post renal uraemia Atonic bladder Hypovolaemia Injury to sacral nerve plexus 66 / 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: Emphysematous bullae Congital cyanotic heart disease Congenital cystic lung disease Congenital postero-lateral diaphragmatic hernia (stabilized) 67 / 80 The second stage of labour involves: Dilation of the cervix. Expulsion of the fetus. Effacement of the cervix. Expulsion of the placenta. Separation of the placenta. 68 / 80 Facial features of fetal alcohol syndrome include the following except thick upper lip short palpebral tissue smooth philtrum microcephaly ptosis 69 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Aldosterone Thyroxine Nordrenaline Brain naturetic protein 70 / 80 The risk of postpartum uterine atony is associated with: Median episiotomy. Twin pregnancy. Labour associated with an active rate of change of 1 cm per hour. Hypotension. Epidural anesthesia. 71 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 23. April 7. March 27. April 23. March 28. 72 / 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 ? to observe his blood pressure for a further 10 months before initiating treatment . Start him on nifedipine XL 30 mg once a day Refer him to the specialist for investigations. Start amlodipine therapy. 73 / 80 The main tissues which provide support to the uterus include: Uterosacral ligaments and the Broad ligaments Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments 74 / 80 Which of the following patients should you prescribe aspirin if there is no contraindication. Select the MOST appropriate Any patient with severe hypertension and 50 years and cardiovascular disease Any patient with hypertension and aged over 50 years Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. All the answers below 75 / 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 Gastro-enteritis Acute pancreatitis Acute high intestinal obstruction Acute gastritis 76 / 80 Which of the following is NOT a characteristic of normal labour: Uterine relaxation between contractions. Moderate pain. Increasing intensity of contractions. Progressive cervical dilation. Moderate bleeding. 77 / 80 The commonest site for carcinoma of the tongue is the: Lateral margin Dorsum Posterior one-third Tip 78 / 80 The heart rate of a normal fetus at term is: 160-180 bpm. 100-120 bpm. 120-160 bpm. 80-100 bpm. There is no baseline heart rate. 79 / 80 These are gross motor skills except transfers object from hand to hand walks up stairs with help stands alone steadiness of head when placed in supported position sits with support 80 / 80 The prime cause of a venous leg ulcer is: Failure of valves of the perforating and deep veins High venous pressure in the leg veins generally Stasis in the deep veins Varicosity of the long (greater) saphenous vein Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback