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