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