GMDC MOCK 3 /80 26 Quiz 1 / 80 The most effective surgical procedure in stress ulceration is: Polya partial gastrectomy Total gastrectomy Vogitomy and hemigastrectomy Vogotomy and pyloroplasty with suturing of bleeding points 2 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Thyroxine Aldosterone Brain naturetic protein Nordrenaline 3 / 80 On assessment of Semen Fluid Analysis: 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 Asthenozoospermia indicates abnormal forms 4 / 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? Haemolysis Renal stone Urinary tract infection Drug induced 5 / 80 The second stage of labour involves: Expulsion of the placenta. Separation of the placenta. Effacement of the cervix. Dilation of the cervix. Expulsion of the fetus. 6 / 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 him on nifedipine XL 30 mg once a day Start amlodipine therapy. 7 / 80 These are causes of acute stridor except acute epiglottitis diphtheria laryngomalacia croup bacterial tracheitis 8 / 80 Concerning febrile seizures They usually have a poor prognosis Overall risk for recurrence is 3-4% Main risk factor for recurrence is the temperature at time of seizure. Overall, 30% develop epilepsy Complex features is not a risk factor for recurrence 9 / 80 The following are contraindications for lumbar puncture except Acute spinal cord injury Cervical spondylosis Raised intracranial pressure Coagulopathy skin infection at or near the site of the lumbar puncture 10 / 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 Failure of valves of the perforating and deep veins Stasis in the deep veins 11 / 80 Adverse effects of corticosteroids include all EXCEPT Osteomalacia Avascular necrosis of the hip. Euphoria Cataract 12 / 80 The pelvis includes which of the following bones: Trochanter, sacrum, coccyx, ilium and pubis Ilium, scapula, ischium and pubis. Sacrum, Tibia, ilium and pubis. Ilium, ischium, pubis, sacrum and coccyx. Trochanter, hip socket, ischium, sacrum and pubis. 13 / 80 The commonest site for carcinoma of the tongue is the: Tip Dorsum Posterior one-third Lateral margin 14 / 80 Cause of ptosis include the following except botulism myasthenia gravis horner syndrome tick paralysis 4th nerve palsy 15 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Ultrasound should be done to confirm the diagnosis Per vaginal bleeding may be one of the presenting symptom Immediate evacuation should be done once the diagnosis is made Patient may present with loss of the symptoms of pregnancy 16 / 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. All the answers below Any patient with hypertension and aged over 50 years Any patient with severe hypertension and 50 years and cardiovascular disease 17 / 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 18 / 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 iodophor antiseptics are used for dressing. When a state of chronicity from (e.g) recurrent infection prevails. 19 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. port wine stain and sturge weber syndrome café - au-lait spots and neurofibromatosis cortical tuber in neurofibromatosis adenoma sebaceum and tuberous sclerosis shagreen patch and tuberous sclerosis 20 / 80 These are chronic complications associated with sickle cell disease except chronic lung disease aseptic necrosis of the hip or shoulder leg ulcers priapism congestive heart failure 21 / 80 Which of the following is NOT a characteristic of normal labour: Progressive cervical dilation. Increasing intensity of contractions. Moderate pain. Uterine relaxation between contractions. Moderate bleeding. 22 / 80 In bronchiolitis, all these are true except most commonly caused by respiratory syncytial virus drug of choice is acyclovir primarily affects children less than 2 years old may present with with low grade fever it's usually a self-limiting disease 23 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Caecum Transverse colon Terminal ileum Descending colon 24 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Attitude. Position. Lie. None of the above. Presentation. 25 / 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 Blockage of the appropriate intercostal nerve and active physiotherapy Watchful administration of adequate doses of systemic analgesic agent 26 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Occiput. Sacrum. Acromian. Mentum. Sinciput. 27 / 80 About severe acute malnutrition (SAM). ORS is the fluid of choice for correcting dehydration Hypoglycaemia is present when the blood glucose is <4mmol/l There is usually unilateral pitting pedal oedema Diagnostic features include mid upper arm circumference < 115mm sensory stimulation is not helpful 28 / 80 Which one of the drugs or measures do not worsen uraemia? Gentamycin Hypotension Diarrhoea Paracetamol 29 / 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 Bulbar paralysis Myasthenia gravis Diffuse spasm of the oesophageal muscles 30 / 80 Stages of labour The third stage end with the delivery of the placenta and membranes 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 Forceps or ventose may be useful in slow progress of the late 1st stage 31 / 80 In burns: There is initial vasodilatation followed by vasoconstriction in the burnt tissue. The maximum oedema fluid obtainable is about 10% of the body weight or 50% of total E.C.F. The rate of fluid exudation from the capillaries is highest in the first 4 hours and falls in 48 hours. The increased capillary permeability is restricted to the burnt area. 32 / 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 Post renal obstruction Rapidly progressively glomerulonephriitis Renal artery stenosis 33 / 80 Features found in nephrotic syndrome include the following EXCEPT: Oedema Hypoalbuminsemia Normal renal function Hypertriglyceridemia 34 / 80 The thyroid gland in thyrotoxicosis: If primary is uniformly enlarged and rather soft or firm In over 95 percent has a thrill and a bruit over it Is enlarged in all patients so affected If secondary is firm and multinodular in all patients 35 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is commonest in the third trimester Is associated with urinary tract infection Associated with multiple pregnancy May be cured by admission to hospital Is associated with trophoblastic disease 36 / 80 Antenatal booking investigations include all of the following, EXCEPT: Hepatitis screening Thyroid function Stool routine examination Complete blood count Urine routine examination 37 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? DPP4 inhibitors Pioglitazone Metformin Glibenclamide 38 / 80 Which of these discriptions adequately describe malena stools? Black stools Loose very shining black stools Black tarry or sticky stools Dark stools 39 / 80 The following are causes of spastic paraparesis except; Guillain Barre syndrome Disc prolapse Potts disease Transverse myelitis 40 / 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 Acute rheumatic carditis. Viral hepatitis Sub acute bacterial endocarditis 41 / 80 The following are associated with oral candidiasis except; Retroviral infection Malignancy Lymphoma Glucose 6 Phosphate Dehydrogenase 42 / 80 Facial features of fetal alcohol syndrome include the following except microcephaly smooth philtrum short palpebral tissue ptosis thick upper lip 43 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Liver function test is not required Worsen in missed abortion Not known to happen in molar pregnancy Is a complication of multiple pregnancy Urine for culture and sensitivity is not important 44 / 80 These are gross motor skills except walks up stairs with help steadiness of head when placed in supported position sits with support stands alone transfers object from hand to hand 45 / 80 In normal pregnancy, the value of ß-hCG doubles every: 8 days. 4 days. 10 days. 14 days. 2 days. 46 / 80 The management of retroexposed babies include cotrimoxazole at birth PCR at 6 weeks of age lamivudine and zidovudine for 6 weeks for high risk babies zidovudine for six months mixed feeding at 1 month 47 / 80 The heart rate of a normal fetus at term is: 120-160 bpm. There is no baseline heart rate. 80-100 bpm. 160-180 bpm. 100-120 bpm. 48 / 80 Molding of the fetal head: Becomes progressively easier as gestational age increase. Usually cause brain damage. Increase the difficulty of delivery. Does not happen when maternal pelvis is adequate. Does NOT have time to occur in breech delivery. 49 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus luteum. Placenta. Corpus albicans. Adrenal glands. Endometrium. 50 / 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 high intestinal obstruction Acute gastritis Gastro-enteritis 51 / 80 The following are treatment for simple malaria except dihydroartemisinin - piperaquine artemether - lumefantrine dihydroartemisinin - lumefantrine oral quinine artesunate - amodiaquine 52 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 27. March 28. April 7. April 23. March 23. 53 / 80 Causes of macrocephaly include the following except fetal alcohol syndrome mucopolysaccharidosis thalassaemia hydrocephalus achondroplasia 54 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except galactosemia biliary atresia breast milk jaundice sepsis torch infections 55 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? No chest pain in an elderly female diabetic Severe crushing pain in the precordium Sharp piercing pain in the left which worsens with breathing Shock . 56 / 80 For adequate and stable haemostasis the following should obtain: Endothelial cell secretion of factor VIII Retraction of the injured vessel Increased pressure within the injured vessel A minimum platelet count of 90,000 per mm3 57 / 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 stomach Carcinoma of the body of the pancreas Primary liver cell carcinoma 58 / 80 All these conditions cause hypokalemia in children except gastroenteritis renal tubular acidosis type 1 acute tubular necrosis frusemide pyloric stenosis 59 / 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 Injury to sacral nerve plexus Post renal uraemia 60 / 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. Respiratory rate> 30 per minute Heart rate >100 Confusion 61 / 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) The genitourinary mucosa-urethra and bladder. Through the tonsils to the cervical lymph nodes. 62 / 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 cystic lung disease Emphysematous bullae Congenital postero-lateral diaphragmatic hernia (stabilized) Congital cyanotic heart disease 63 / 80 An ectopic pregnancy: Occurs only in the fallopian tubes Usually presents with pain before bleeding Can only be treated surgically Gives an increased risk of Hyperemisis Gravidarium Pain always presents before the bleeding 64 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Duct ectasia Scirrhous breast carcinoma Intraductal comedo-carcinoma Chronic breast abscess 65 / 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. Motor aphasia No effect on the muscles in the upper part of the face. May cause incontinence of urine 66 / 80 This is not true about autism 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 it is pervasive developmental disorder 67 / 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 68 / 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 Tuberculosis Left ventricular failure 69 / 80 The features listed below may be associated with migraine headache EXCEPT Neck stiffness may be present Nausea Photophobia. Pulsatile or throbbing headache 70 / 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) Preoperative showering for the patient Glove puncture in the course of surgery Age of the patient Bacterial content of the wound at end of operation 71 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Follicle stimulating hormone Cholecystokinin Prolactin Adrenocorticotropic hormone 72 / 80 The main tissues which provide support to the uterus include: Perineal body and the Broad ligaments Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Broad ligaments and the Uterosacral ligaments Round ligament and the Broad ligaments 73 / 80 The risk of postpartum uterine atony is associated with: Hypotension. Median episiotomy. Labour associated with an active rate of change of 1 cm per hour. Twin pregnancy. Epidural anesthesia. 74 / 80 Cause of neonatal seizures include the following except bilirubin encephalopathy pyridoxine deficiency hypermagnesaemia hypoxic ischaemic encephalopathy intracranial hemorrhage 75 / 80 Neonatal resuscitation clearing airway preceeds keeping baby warm most effective action is ventilation of the baby's lungs 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 76 / 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 Supracondylar fracture Monteggia fracture dislocation Dislocation of the elbow Fracture of the olecranon process 77 / 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 Irreducible incomplete inguinal hernia, probably containing omentum Sebaceous cyst of the scrotum Encysted hydrocele of the cord 78 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Nitrazine test. Observing amniotic fluid drain through the cervix during speculum examination. Pooling of amniotic fluid on speculum examination. Contractions seen on the CTG. Positive Fern test. 79 / 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: Pre-renal renal failure Acute tubular necrosis Acute renal failure Post-renal renal failure 80 / 80 This is not a cause of hypoglycaemia in newborns hypoinsulinaemia intrauterine growth retardate sepsis prematurity infant of a diabetic mother Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback