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