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