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