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