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