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