GMDC MOCK 3 /80 26 Quiz 1 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 23. March 28. April 7. April 23. March 27. 2 / 80 In hypopituitarism all these hormones may be deficient except Prolactin Cholecystokinin Follicle stimulating hormone Growth hormone Adrenocorticotropic hormone 3 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Through the tonsils to the cervical lymph nodes. Via the payer's patches to the mesenteric lymph nodes. The genitourinary mucosa-urethra and bladder. Directly to the lung tissue establishing a Primary Complex (Gohn focus) 4 / 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 involves administration of iv aminophylline to preterms atropine is administered when heart rate is below 100 bpm 5 / 80 Stages of labour 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 The third stage end with the delivery of the placenta and membranes 6 / 80 On assessment of Semen Fluid Analysis: Abstinence should be maintained for 3 days prior to production of the sample Asthenozoospermia indicates abnormal forms Abstinence should be maintained for 10 days prior to "production" of the sample Teratozoospermia indicates abnormal motility Azoospermia indicates a sperm count more than 5 million/ml 7 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Endometrium. Adrenal glands. Corpus albicans. Corpus luteum. Placenta. 8 / 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 9 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Chronic breast abscess Intraductal comedo-carcinoma Scirrhous breast carcinoma Duct ectasia 10 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? DPP4 inhibitors Metformin Glibenclamide Pioglitazone 11 / 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 Retraction of the injured vessel Endothelial cell secretion of factor VIII 12 / 80 Causes of macrocephaly include the following except achondroplasia fetal alcohol syndrome hydrocephalus mucopolysaccharidosis thalassaemia 13 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? No chest pain in an elderly female diabetic Sharp piercing pain in the left which worsens with breathing Shock . Severe crushing pain in the precordium 14 / 80 The features listed below may be associated with migraine headache EXCEPT Photophobia. Pulsatile or throbbing headache Nausea Neck stiffness may be present 15 / 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: Diffuse spasm of the oesophageal muscles Myasthenia gravis Scleroderma Bulbar paralysis 16 / 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 17 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. shagreen patch and tuberous sclerosis adenoma sebaceum and tuberous sclerosis café - au-lait spots and neurofibromatosis port wine stain and sturge weber syndrome cortical tuber in neurofibromatosis 18 / 80 This is not a cause of hypoglycaemia in newborns sepsis infant of a diabetic mother prematurity hypoinsulinaemia intrauterine growth retardate 19 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Descending colon Terminal ileum Caecum Transverse colon 20 / 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 Acute bacterial endocarditis Viral hepatitis 21 / 80 Which of these discriptions adequately describe malena stools? Black tarry or sticky stools Loose very shining black stools Black stools Dark stools 22 / 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. 23 / 80 In normal pregnancy, the value of ß-hCG doubles every: 10 days. 14 days. 8 days. 2 days. 4 days. 24 / 80 The following are causes of spastic paraparesis except; Potts disease Disc prolapse Guillain Barre syndrome Transverse myelitis 25 / 80 The following are contraindications for lumbar puncture except Acute spinal cord injury Raised intracranial pressure Coagulopathy skin infection at or near the site of the lumbar puncture Cervical spondylosis 26 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Mentum. Sinciput. Occiput. Acromian. Sacrum. 27 / 80 Squamous cell carcinoma of the anus: Is the commonest malignant tumour of the anus Is treated by abdomino-perineal resection of the rectum and anus in all patients Usually presents as a localized ulcer with sloping edges Bleeds but does not cause pain on defaecation 28 / 80 Cause of ptosis include the following except botulism 4th nerve palsy myasthenia gravis tick paralysis horner syndrome 29 / 80 Adverse effects of corticosteroids include all EXCEPT Osteomalacia Avascular necrosis of the hip. Euphoria Cataract 30 / 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 Hypovolaemia Post renal uraemia Atonic bladder 31 / 80 Cause of neonatal seizures include the following except hypoxic ischaemic encephalopathy pyridoxine deficiency hypermagnesaemia bilirubin encephalopathy intracranial hemorrhage 32 / 80 This is not true about autism it is pervasive developmental disorder there is severe language and speech developmental disorder most cases have normal intelligence commoner in males than in females with a male:female ratio of 3:1 it's characterised by restricted and repetitive behavior 33 / 80 In burns: 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. The increased capillary permeability is restricted to the burnt area. 34 / 80 Which of the following is NOT a characteristic of normal labour: Moderate bleeding. Uterine relaxation between contractions. Increasing intensity of contractions. Moderate pain. Progressive cervical dilation. 35 / 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 Encysted hydrocele of the cord Sebaceous cyst of the scrotum 36 / 80 Concerning febrile seizures 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 Main risk factor for recurrence is the temperature at time of seizure. 37 / 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 38 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Liver function test is not required Is a complication of multiple pregnancy Not known to happen in molar pregnancy Worsen in missed abortion Urine for culture and sensitivity is not important 39 / 80 Which of the following is not part of the criteria considered for CURB 65 used to determine the severity of community pneumonia. Confusion Heart rate >100 Diastolic pressure <60 mm Hg. Respiratory rate> 30 per minute 40 / 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 Staphylococcus aureus Mycoplasma pneumonia Klebsiella pneumoniae 41 / 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 Refer him to the specialist for investigations. Start amlodipine therapy. 42 / 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 43 / 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: Blockage of the appropriate intercostal nerve and active physiotherapy External fixation Strapping of the affected side of the chest Watchful administration of adequate doses of systemic analgesic agent 44 / 80 The main tissues which provide support to the uterus include: Cardinal ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments Round ligament and the Broad ligaments Uterosacral ligaments and the Broad ligaments Broad ligaments and the Uterosacral ligaments 45 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Immediate evacuation should be done once the diagnosis is made Patient may present with loss of the symptoms of pregnancy Ultrasound should be done to confirm the diagnosis Per vaginal bleeding may be one of the presenting symptom 46 / 80 Which one of the drugs or measures do not worsen uraemia? Hypotension Paracetamol Gentamycin Diarrhoea 47 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: May be cured by admission to hospital Associated with multiple pregnancy Is commonest in the third trimester Is associated with urinary tract infection Is associated with trophoblastic disease 48 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Lie. Attitude. Presentation. Position. None of the above. 49 / 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 Rapidly progressively glomerulonephriitis Post renal obstruction Acute tubular necrosis 50 / 80 All these conditions cause hypokalemia in children except gastroenteritis renal tubular acidosis type 1 pyloric stenosis frusemide acute tubular necrosis 51 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Nordrenaline Aldosterone Brain naturetic protein Thyroxine 52 / 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 No effect on the muscles in the upper part of the face. Paralysis of lower facial muscles on the left. 53 / 80 These are causes of acute stridor except croup acute epiglottitis laryngomalacia bacterial tracheitis diphtheria 54 / 80 The following are treatment for simple malaria except artemether - lumefantrine dihydroartemisinin - piperaquine oral quinine dihydroartemisinin - lumefantrine artesunate - amodiaquine 55 / 80 Antenatal booking investigations include all of the following, EXCEPT: Hepatitis screening Stool routine examination Thyroid function Complete blood count Urine routine examination 56 / 80 The most effective surgical procedure in stress ulceration is: Polya partial gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Total gastrectomy Vogitomy and hemigastrectomy 57 / 80 About severe acute malnutrition (SAM). Diagnostic features include mid upper arm circumference < 115mm sensory stimulation is not helpful 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 58 / 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 Fracture of the olecranon process Monteggia fracture dislocation Dislocation of the elbow Supracondylar fracture 59 / 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 60 / 80 The risk of postpartum uterine atony is associated with: Median episiotomy. Epidural anesthesia. Hypotension. Labour associated with an active rate of change of 1 cm per hour. Twin pregnancy. 61 / 80 These are gross motor skills except stands alone walks up stairs with help transfers object from hand to hand sits with support steadiness of head when placed in supported position 62 / 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 Renal stone Drug induced Haemolysis 63 / 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 64 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypertriglyceridemia Oedema Normal renal function Hypoalbuminsemia 65 / 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 66 / 80 Which of the following patients should you prescribe aspirin if there is no contraindication. Select the MOST appropriate Any patient with severe hypertension and 50 years and cardiovascular disease 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. 67 / 80 The prime cause of a venous leg ulcer is: Stasis in the deep veins Varicosity of the long (greater) saphenous vein High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins 68 / 80 The pelvis includes which of the following bones: Trochanter, hip socket, ischium, sacrum and pubis. Trochanter, sacrum, coccyx, ilium and pubis Sacrum, Tibia, ilium and pubis. Ilium, scapula, ischium and pubis. Ilium, ischium, pubis, sacrum and coccyx. 69 / 80 The second stage of labour involves: Expulsion of the placenta. Separation of the placenta. Dilation of the cervix. Expulsion of the fetus. Effacement of the cervix. 70 / 80 The thyroid gland in thyrotoxicosis: If secondary is firm and multinodular in all patients 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 71 / 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 72 / 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 73 / 80 The heart rate of a normal fetus at term is: 100-120 bpm. 120-160 bpm. 160-180 bpm. There is no baseline heart rate. 80-100 bpm. 74 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except torch infections biliary atresia breast milk jaundice sepsis galactosemia 75 / 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. 76 / 80 The following are associated with oral candidiasis except; Lymphoma Glucose 6 Phosphate Dehydrogenase Malignancy Retroviral infection 77 / 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 Fern test. Positive Nitrazine test. Observing amniotic fluid drain through the cervix during speculum examination. 78 / 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 may present with with low grade fever drug of choice is acyclovir 79 / 80 Facial features of fetal alcohol syndrome include the following except thick upper lip microcephaly smooth philtrum ptosis short palpebral tissue 80 / 80 The commonest site for carcinoma of the tongue is the: Tip Lateral margin Posterior one-third Dorsum Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback