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