GMDC MOCK 2 34 ALL THE BEST THANK YOU Quiz 1 / 40 A 2-year-old presents with a three day history of refusal to bear weight on the left leg. The temperature on admission is 39°C. Initial blood work shows Haemoglobin 9.6g/dl, WBC 15 x 109/l, platelets 470 x 109/L and ESR 60mm/hr. The most likely diagnosis is Tuberculosis of the bone Multiple myeloma None of the above Septic arthritis of the left hip joint Fracture of the left femur 2 / 40 Acetaminophen-induced toxicity most commonly affects the Lungs Liver Bone marrow Kidneys Heart 3 / 40 A 34-year-old G4P4 woman is immediately postpartum from delivery of a 4.0kg baby girl at 39 weeks' gestation. Time elapsed from the onset of labor to delivery of the placenta was 6 hours. Delivery was complicated by a second-degree perineal tear. Postpartum vital signs are within normal limits when the patient begins to hemorrhage vaginally. Estimated blood loss is 300 mL so far. Bimanual examination reveals a soft, enlarged, "boggy" uterus. Which of the following is the most appropriate first step in treatment? Ergot Speculum examination Hysterectomy Bimanual uterine massage Oxytocin infusion 4 / 40 Contraindication to medical therapy (Methotrexate) in tubal pregnancy is Desire for future fertility. No fetal heart motion on ultrasound. Absence of active bleeding. History of active hepatic and renal disease. Size of the ectopic gestational sac is 3cm for less. 5 / 40 What is wrong about vaginal hematoma after delivery? An incision on the site if pain is severe and hematoma enlarges Mattress suturing the bed of hematoma Observation if hematoma is small Vulvar hematoma can occur after improper episiotomy repair Pressure dressing should be applied on the hematoma bed for 12-24 hours 6 / 40 What is not a reason of oligohydramnios in a woman at gestational age of 35W2D with IUGR in pregnancy? Reduced placental perfusion Reduced fetal urine Severe preeclampsia may be a cause Increased swallowing of the fetus due to asphyxia Reduced fetal renal blood perfusion 7 / 40 What is your management of a 32 years old woman G1P0, GA of 6 weeks with an empty gestational sac, no heart beat and empty uterus on Ultrasound? Methotrexate and leukovorin Evacuation of the uterus by a specialist Hysteroscopy Methotrexate and folic acid and iron supplement Laparotomy and salpingectomy and follow up 8 / 40 During a sharp curettage of an incomplete abortion, the uterine was perforated. What is the first step of management? Curettage should be continued by a specialist only Curettage should be completed and patient should remain under observation Administration of antibiotic If there is no hemorrhage in the first 24 hours after operation, the patient can be discharged Laparotomy 9 / 40 A 19 year old woman is hospitalized for abdominal pain. Serum progesterone is 15ng/mL. Which is a true statement about her illness? Ectopic pregnancy is ruled out Ectopic can be ruled out by careful physical examination Ectopic pregnancy and intrauterine pregnancy cannot be ruled out Ectopic pregnancy and intrauterine pregnancy are ruled out Ectopic pregnancy risk is about 90% 10 / 40 Low birth weight is defined as Below the 10th percentile for gestational age None of the above Below 2500g Below the average weight for the age and parity of the mother Below -2 z-score for gestational age 11 / 40 A 42-year-old woman comes to the physician because of increasingly heavy menstrual periods during the past 2 years. Menses occur at regular intervals and last 8 days with heavy flow during the first 3 days. She takes no medications. She is sexually active with one partner and uses a diaphragm consistently. Pelvic examination shows a uterus consistent in size with a 14- week gestation. Examination of an endometrial biopsy specimen obtained 5 days before her last menstrual period shows secretory endometrium. Which of the following is the most likely diagnosis? Endometritis Anovulatory bleeding Leiomyomata uteri Endometrial polyps Pregnancy 12 / 40 A 9-month-old girl may Know the names of items in a picture book Have temper tantrums Be afraid of strangers Stand on tiptoe Build a tower of four or more blocks 13 / 40 Haemorrhagic cystitis is a recognized complication of Adriamycin Methotrexate Cyclophosphamide Cisplatin VIncristine 14 / 40 A 20-year-old primigravida, 32 weeks gestation, presents with profuse vaginal bleeding with pain and tenderness per abdomen. The most probable diagnosis: Marginal sinus bleed. Abruptio placenta. Placenta praevia. Vaginitis. Uterine rupture. 15 / 40 The risk of acute bilirubin encephalopathy in a newborn is increased with the use of Phenytoin Gentamycin Ceftriaxone Phenobarbitone Ampicillin 16 / 40 What is the diagnosis and treatment of a non-tender mass near the urethral opening in a 4 year old girl? Skene gland abscess - antibiotic and evacuation Muluscum - analgesics and steroids Prolapse of the urethra - topical estrogen Bartholin's gland abscess - gland excision Condylomata acuminate - TCA acid 17 / 40 In the fetal circulation, the INCORRECT statement is: Prostaglandins maintain patency of ductus arteriosus. The blood is shifted from the right atrium to the left atrium via the foramen ovale. There are two umbilical veins and one umbilical artery. The ductus venous connects the umbilical vein with inferior vena cava. The inferior vena cava contains both oxygenated and deoxygenated blood. 18 / 40 In the diagnosis of minimal change nephrotic syndrome, the following tests would be useful except Urinalysis Doppler ultrasound of the lower limbs Liver function tests Serum complement levels Fasting lipid profile 19 / 40 A 33-year-old nulligravid woman with primary infertility comes for a follow-up examination. She has been unable to conceive for 5 years; analysis of her husband's semen showed normal sperm counts. Menses occur at regular 28-day intervals and last 5 to 6 days. She is asymptomatic except for severe dysmenorrhea. An endometrial biopsy specimen 5 days before menses shows secretory endometrium. Hysterosalpingography 6 months ago showed normal findings. Pelvic examination shows a normal vagina and cervix. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses. Rectal examination is unremarkable. Which of the following is the most likely diagnosis? Anovulation Intrauterine synechiae Male factor Endometriosis Tubal obstruction 20 / 40 The following diseases are associated with the Epstein Barr virus except Hodgkin's lymphoma Post-transplant lymphoproliferative disease Nasopharyngeal carcinoma Burkitt's lymhpoma Wilm's tumour 21 / 40 Non-steroidal anti-inflammatory drugs are not generally used for long term tocolysis because they: Are too expensive. Are ineffective Are associated with lactic acidosis. May cause premature closure of fetal ductus arteriosus. Produce marked hypertension. 22 / 40 A 30year old woman G3P2, gestational age of 35 weeks and BP of 190/110 is in seizure. What is the best way to control her seizure? Labetalol IV Phenytoin Diazepam MgSO4 Phenobarbital 23 / 40 A pregnant woman G2P1, GA of 39 weeks has the chief complaint of vaginal spotting. There is no sign of abruption or previa by ultrasound. What is the best management? Tranexamic acid to control bleeding Discharge home Termination of pregnancy Blood transfusion is a must Observation 24 / 40 Which is true about placental abruption? Abruption occurs after placental delivery The chance of repeated abruption is not different Fetal assessment techniques can predict abruption with good precision There is no means to predict abruption The chance of repeated abruption is twice 25 / 40 The following are characteristics of simple febrile seizures Occur only once or twice in a twenty-four-hour period Last for thirty minutes or less Commonly caused by cerebral malaria Rate of epilepsy is higher than in the general population Initially focal with secondary generalization 26 / 40 Which of the following diseases is caused by a virus? Pneumocystis jirovecii pneumonia Amyloidosis Diphtheria Histoplasmosis Lassa fever 27 / 40 In determining the Apgar score of a newborn, the following would be assessed except Respiratory effort Oxygen saturation Muscle tone Skin colour Response to stimulation 28 / 40 Which of the following drugs IS NOT used to inhibit premature labour? Nifedipine. Magnesium sulfate. Indomethacin. Ritodrine Phenobarbital. 29 / 40 In Preeclampsia all are correct EXCEPT: It is a significant cause of maternal mortality. The condition is more common in women who smoke cigarettes. Development of epigastric pain is a serious sign. Regular full blood count are helpful in monitoring the progress of the condition. Is more common with women with a first degree relative who has preeclampsia. 30 / 40 A low weight for height in a three-year-old child indicates Wasting Kwashiorkor Marasmus Stunting Underweight 31 / 40 This is false about diabetic ketoacidosis deep sighing respiration is present ketonemia and ketonuria are characteristic blood glucose is usually greater than 11.0 mmol/l serum bicarbonate level is more than 18mEq/l blood ph is less than 7.3 32 / 40 A child born in Ghana in 2016 will routinely receive the following vaccinations except Pneumococcus Rotavirus Rubella Meningococcus Mumps 33 / 40 Clinical features of childhood acute lymphoblastic leukaemia include Gum hyperplasia Proptosis Dental anarchy Bone pain Chloromas 34 / 40 The following are features of prematurity in a neonate except Abundant lanugo Empty scrotum Thick ear cartilage Flat areola No creases on sole 35 / 40 An innocent murmur is likely to be Loudest at the left sternal border Diastolic Non-radiating Associated with a thrill Persistent into early adulthood 36 / 40 Which is not among pathophysiological changes of preeclampsia? Increased thromboxane A2 Increased resistance to angiotensin DIC Reduction in prostacyclin Platelet dysfunction 37 / 40 Which of the following would be most appropriate in the immediate management of a 10-month-old infant with diarrhea and severe dehydration Stat dose of broad spectrum intravenous antibiotics Oral rehydration solution if the child can drink Intravenous Ringer's lactate Intravenous Dextrose saline Immediate intraosseous access for rehydration 38 / 40 The most likely finding in the initial stages of septic shock is Absent femoral pulses Tachypnoea Hyperpnoea Abnormally low blood pressure Delayed capillary refill 39 / 40 ECG changes associated with hypokalemia include Shortened PR interval Appearance of a U wave Upright T wave ST segment elevation Right axis deviation 40 / 40 A child with severe haemophilia A would have an abnormal Blood film morphology Platelet count None of the above All of the above Prothrombin time Your score is The average score is 63% LinkedIn Facebook Twitter 0%