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