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