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