GMDC MOCK 3 /80 26 Quiz 1 / 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: Scleroderma Diffuse spasm of the oesophageal muscles Myasthenia gravis Bulbar paralysis 2 / 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 Dislocation of the elbow Fracture of the olecranon process Supracondylar fracture 3 / 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: Strapping of the affected side of the chest External fixation Watchful administration of adequate doses of systemic analgesic agent Blockage of the appropriate intercostal nerve and active physiotherapy 4 / 80 For adequate and stable haemostasis the following should obtain: Retraction of the injured vessel A minimum platelet count of 90,000 per mm3 Endothelial cell secretion of factor VIII Increased pressure within the injured vessel 5 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: April 7. March 28. April 23. March 27. March 23. 6 / 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 bacterial endocarditis Viral hepatitis Sub acute bacterial endocarditis Acute rheumatic carditis. 7 / 80 Stages of labour 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) Forceps or ventose may be useful in slow progress of the late 1st stage The first stage commences at the time of membrane rupture The cervix dilates at consistent rate of 3 cm per hour in the first stage 8 / 80 Which of the following is not part of the criteria considered for CURB 65 used to determine the severity of community pneumonia. Diastolic pressure <60 mm Hg. Confusion Respiratory rate> 30 per minute Heart rate >100 9 / 80 This is not true about autism most cases have normal intelligence it's characterised by restricted and repetitive behavior it is pervasive developmental disorder there is severe language and speech developmental disorder commoner in males than in females with a male:female ratio of 3:1 10 / 80 The commonest site for carcinoma of the tongue is the: Tip Dorsum Lateral margin Posterior one-third 11 / 80 The following are associated with oral candidiasis except; Malignancy Lymphoma Glucose 6 Phosphate Dehydrogenase Retroviral infection 12 / 80 The risk of postpartum uterine atony is associated with: Labour associated with an active rate of change of 1 cm per hour. Median episiotomy. Twin pregnancy. Hypotension. Epidural anesthesia. 13 / 80 Cause of ptosis include the following except myasthenia gravis botulism tick paralysis 4th nerve palsy horner syndrome 14 / 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 ? Rapidly progressively glomerulonephriitis Acute tubular necrosis Renal artery stenosis Post renal obstruction 15 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is associated with trophoblastic disease Associated with multiple pregnancy Is associated with urinary tract infection May be cured by admission to hospital Is commonest in the third trimester 16 / 80 On assessment of Semen Fluid Analysis: Azoospermia indicates a sperm count more than 5 million/ml Abstinence should be maintained for 3 days prior to production of the sample Teratozoospermia indicates abnormal motility Asthenozoospermia indicates abnormal forms Abstinence should be maintained for 10 days prior to "production" of the sample 17 / 80 Which of these discriptions adequately describe malena stools? Loose very shining black stools Black tarry or sticky stools Black stools Dark stools 18 / 80 Facial features of fetal alcohol syndrome include the following except smooth philtrum microcephaly thick upper lip short palpebral tissue ptosis 19 / 80 In hypopituitarism all these hormones may be deficient except Adrenocorticotropic hormone Cholecystokinin Prolactin Growth hormone Follicle stimulating hormone 20 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except sepsis galactosemia breast milk jaundice torch infections biliary atresia 21 / 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 hypertension and aged over 50 years Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. Any patient with severe hypertension and 50 years and cardiovascular disease 22 / 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 Drug induced Renal stone Haemolysis 23 / 80 The features listed below may be associated with migraine headache EXCEPT Photophobia. Neck stiffness may be present Pulsatile or throbbing headache Nausea 24 / 80 The second stage of labour involves: Expulsion of the fetus. Expulsion of the placenta. Effacement of the cervix. Separation of the placenta. Dilation of the cervix. 25 / 80 Antenatal booking investigations include all of the following, EXCEPT: Complete blood count Urine routine examination Thyroid function Hepatitis screening Stool routine examination 26 / 80 The management of retroexposed babies include zidovudine for six months lamivudine and zidovudine for 6 weeks for high risk babies mixed feeding at 1 month cotrimoxazole at birth PCR at 6 weeks of age 27 / 80 These are chronic complications associated with sickle cell disease except leg ulcers aseptic necrosis of the hip or shoulder priapism chronic lung disease congestive heart failure 28 / 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. 29 / 80 Which one of the drugs or measures do not worsen uraemia? Gentamycin Paracetamol Diarrhoea Hypotension 30 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Is a complication of multiple pregnancy Liver function test is not required Not known to happen in molar pregnancy Urine for culture and sensitivity is not important Worsen in missed abortion 31 / 80 Molding of the fetal head: Usually cause brain damage. Does NOT have time to occur in breech delivery. Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. Increase the difficulty of delivery. 32 / 80 The prime cause of a venous leg ulcer is: Failure of valves of the perforating and deep veins High venous pressure in the leg veins generally Varicosity of the long (greater) saphenous vein Stasis in the deep veins 33 / 80 Cause of neonatal seizures include the following except hypermagnesaemia pyridoxine deficiency intracranial hemorrhage hypoxic ischaemic encephalopathy bilirubin encephalopathy 34 / 80 These are gross motor skills except stands alone steadiness of head when placed in supported position walks up stairs with help transfers object from hand to hand sits with support 35 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Attitude. None of the above. Position. Presentation. Lie. 36 / 80 Malignant degeneration of a healing wound is most likely to occur: When a patient is on cytotoxic agents. When wounds are exposed to heat. When a state of chronicity from (e.g) recurrent infection prevails. When iodophor antiseptics are used for dressing. 37 / 80 Concerning febrile seizures Overall, 30% develop epilepsy Complex features is not a risk factor for recurrence Overall risk for recurrence is 3-4% Main risk factor for recurrence is the temperature at time of seizure. They usually have a poor prognosis 38 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypoalbuminsemia Normal renal function Hypertriglyceridemia Oedema 39 / 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 Acute gastritis Gastro-enteritis Acute high intestinal obstruction 40 / 80 The following are causes of spastic paraparesis except; Transverse myelitis Disc prolapse Guillain Barre syndrome Potts disease 41 / 80 Adverse effects of corticosteroids include all EXCEPT Euphoria Cataract Osteomalacia Avascular necrosis of the hip. 42 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Via the payer's patches to the mesenteric lymph nodes. Directly to the lung tissue establishing a Primary Complex (Gohn focus) Through the tonsils to the cervical lymph nodes. The genitourinary mucosa-urethra and bladder. 43 / 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 Hypovolaemia Post renal uraemia Injury to sacral nerve plexus 44 / 80 This is not a cause of hypoglycaemia in newborns infant of a diabetic mother sepsis intrauterine growth retardate prematurity hypoinsulinaemia 45 / 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? Cyst of the epididymis Sebaceous cyst of the scrotum Encysted hydrocele of the cord Irreducible incomplete inguinal hernia, probably containing omentum 46 / 80 These are causes of acute stridor except acute epiglottitis croup bacterial tracheitis diphtheria laryngomalacia 47 / 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 Carcinoma of the body of the pancreas Primary liver cell carcinoma Carcinoma of the stomach Amoebic liver abscess 48 / 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 Klebsiella pneumoniae Staphylococcus aureus Streptococcus pneumoniae 49 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Thyroxine Brain naturetic protein Nordrenaline Aldosterone 50 / 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 him on nifedipine XL 30 mg once a day to observe his blood pressure for a further 10 months before initiating treatment . Refer him to the specialist for investigations. Start amlodipine therapy. 51 / 80 Which of the following is NOT a characteristic of normal labour: Increasing intensity of contractions. Moderate pain. Progressive cervical dilation. Moderate bleeding. Uterine relaxation between contractions. 52 / 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 53 / 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 Preoperative showering for the patient Bacterial content of the wound at end of operation 54 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Acromian. Occiput. Sacrum. Sinciput. Mentum. 55 / 80 The heart rate of a normal fetus at term is: 120-160 bpm. 160-180 bpm. There is no baseline heart rate. 80-100 bpm. 100-120 bpm. 56 / 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) Congital cyanotic heart disease Congenital cystic lung disease Emphysematous bullae 57 / 80 The most effective surgical procedure in stress ulceration is: Vogotomy and pyloroplasty with suturing of bleeding points Total gastrectomy Polya partial gastrectomy Vogitomy and hemigastrectomy 58 / 80 All these conditions cause hypokalemia in children except gastroenteritis renal tubular acidosis type 1 frusemide acute tubular necrosis pyloric stenosis 59 / 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 Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Ultrasound should be done to confirm the diagnosis Patient may present with loss of the symptoms of pregnancy 60 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Pioglitazone Glibenclamide Metformin DPP4 inhibitors 61 / 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 62 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Adrenal glands. Placenta. Corpus albicans. Endometrium. Corpus luteum. 63 / 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 Acute tubular necrosis Pre-renal renal failure Acute renal failure 64 / 80 The thyroid gland in thyrotoxicosis: If primary is uniformly enlarged and rather soft or firm If secondary is firm and multinodular in all patients Is enlarged in all patients so affected In over 95 percent has a thrill and a bruit over it 65 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Duct ectasia Chronic breast abscess Scirrhous breast carcinoma Intraductal comedo-carcinoma 66 / 80 The following are treatment for simple malaria except artemether - lumefantrine dihydroartemisinin - piperaquine oral quinine dihydroartemisinin - lumefantrine artesunate - amodiaquine 67 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Descending colon Transverse colon Terminal ileum Caecum 68 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? Shock . Sharp piercing pain in the left which worsens with breathing No chest pain in an elderly female diabetic Severe crushing pain in the precordium 69 / 80 Stroke due involving the right middle cerebral artery pathology in most people usually causes the symptoms and signs below EXCEPT Paralysis of lower facial muscles on the left. May cause incontinence of urine Motor aphasia No effect on the muscles in the upper part of the face. 70 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Nitrazine test. Contractions seen on the CTG. Pooling of amniotic fluid on speculum examination. Observing amniotic fluid drain through the cervix during speculum examination. Positive Fern test. 71 / 80 Neonatal resuscitation involves administration of iv aminophylline to preterms atropine is administered when heart rate is below 100 bpm clearing airway preceeds keeping baby warm most effective action is ventilation of the baby's lungs chest compression is initiated when heart rate is below 100 bpm 72 / 80 The following are contraindications for lumbar puncture except Coagulopathy Raised intracranial pressure Cervical spondylosis Acute spinal cord injury skin infection at or near the site of the lumbar puncture 73 / 80 About severe acute malnutrition (SAM). Hypoglycaemia is present when the blood glucose is <4mmol/l ORS is the fluid of choice for correcting dehydration sensory stimulation is not helpful Diagnostic features include mid upper arm circumference < 115mm There is usually unilateral pitting pedal oedema 74 / 80 Causes of macrocephaly include the following except thalassaemia fetal alcohol syndrome hydrocephalus mucopolysaccharidosis achondroplasia 75 / 80 The main tissues which provide support to the uterus include: Cardinal ligaments and the Uterosacral ligaments Round ligament and the Broad ligaments Uterosacral ligaments and the Broad ligaments Perineal body and the Broad ligaments Broad ligaments and the Uterosacral ligaments 76 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. café - au-lait spots and neurofibromatosis adenoma sebaceum and tuberous sclerosis port wine stain and sturge weber syndrome shagreen patch and tuberous sclerosis cortical tuber in neurofibromatosis 77 / 80 In normal pregnancy, the value of ß-hCG doubles every: 10 days. 4 days. 14 days. 2 days. 8 days. 78 / 80 The pelvis includes which of the following bones: Trochanter, hip socket, ischium, sacrum and pubis. Ilium, ischium, pubis, sacrum and coccyx. Sacrum, Tibia, ilium and pubis. Ilium, scapula, ischium and pubis. Trochanter, sacrum, coccyx, ilium and pubis 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? Left ventricular failure Carcinoma of the bronchus Tuberculosis Silicosis 80 / 80 In bronchiolitis, all these are true except most commonly caused by respiratory syncytial virus it's usually a self-limiting disease primarily affects children less than 2 years old drug of choice is acyclovir may present with with low grade fever Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback