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