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