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