GMDC MOCK 3 /80 26 Quiz 1 / 80 The following are causes of spastic paraparesis except; Guillain Barre syndrome Transverse myelitis Disc prolapse Potts disease 2 / 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 him on nifedipine XL 30 mg once a day to observe his blood pressure for a further 10 months before initiating treatment . Start amlodipine therapy. Refer him to the specialist for investigations. 3 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Is a complication of multiple pregnancy Urine for culture and sensitivity is not important Not known to happen in molar pregnancy Liver function test is not required Worsen in missed abortion 4 / 80 The heart rate of a normal fetus at term is: There is no baseline heart rate. 160-180 bpm. 100-120 bpm. 120-160 bpm. 80-100 bpm. 5 / 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% 6 / 80 The most effective surgical procedure in stress ulceration is: Vogotomy and pyloroplasty with suturing of bleeding points Vogitomy and hemigastrectomy Polya partial gastrectomy Total gastrectomy 7 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Scirrhous breast carcinoma Chronic breast abscess Duct ectasia Intraductal comedo-carcinoma 8 / 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 Age of the patient Preoperative showering for the patient Glove puncture in the course of surgery 9 / 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 Motor aphasia No effect on the muscles in the upper part of the face. Paralysis of lower facial muscles on the left. 10 / 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 11 / 80 These are causes of acute stridor except laryngomalacia diphtheria bacterial tracheitis croup acute epiglottitis 12 / 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 13 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Fern test. Observing amniotic fluid drain through the cervix during speculum examination. Positive Nitrazine test. Pooling of amniotic fluid on speculum examination. Contractions seen on the CTG. 14 / 80 The prime cause of a venous leg ulcer is: Failure of valves of the perforating and deep veins Stasis in the deep veins Varicosity of the long (greater) saphenous vein High venous pressure in the leg veins generally 15 / 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 high intestinal obstruction Acute pancreatitis Acute gastritis 16 / 80 Which of these discriptions adequately describe malena stools? Black tarry or sticky stools Loose very shining black stools Black stools Dark stools 17 / 80 The risk of postpartum uterine atony is associated with: Labour associated with an active rate of change of 1 cm per hour. Epidural anesthesia. Median episiotomy. Hypotension. Twin pregnancy. 18 / 80 The second stage of labour involves: Dilation of the cervix. Expulsion of the fetus. Effacement of the cervix. Expulsion of the placenta. Separation of the placenta. 19 / 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? Haemolysis Renal stone Urinary tract infection Drug induced 20 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Through the tonsils to the cervical lymph nodes. The genitourinary mucosa-urethra and bladder. Via the payer's patches to the mesenteric lymph nodes. Directly to the lung tissue establishing a Primary Complex (Gohn focus) 21 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypertriglyceridemia Hypoalbuminsemia Normal renal function Oedema 22 / 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 23 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Lie. Position. Attitude. None of the above. Presentation. 24 / 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? Carcinoma of the bronchus Silicosis Left ventricular failure Tuberculosis 25 / 80 Cause of neonatal seizures include the following except hypoxic ischaemic encephalopathy intracranial hemorrhage bilirubin encephalopathy pyridoxine deficiency hypermagnesaemia 26 / 80 An ectopic pregnancy: Gives an increased risk of Hyperemisis Gravidarium Occurs only in the fallopian tubes Can only be treated surgically Pain always presents before the bleeding Usually presents with pain before bleeding 27 / 80 The pelvis includes which of the following bones: Sacrum, Tibia, ilium and pubis. Trochanter, hip socket, ischium, sacrum and pubis. Trochanter, sacrum, coccyx, ilium and pubis Ilium, scapula, ischium and pubis. Ilium, ischium, pubis, sacrum and coccyx. 28 / 80 This is not a cause of hypoglycaemia in newborns prematurity hypoinsulinaemia intrauterine growth retardate infant of a diabetic mother sepsis 29 / 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 Post-renal renal failure Pre-renal renal failure Acute tubular necrosis 30 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Pioglitazone Glibenclamide DPP4 inhibitors Metformin 31 / 80 All these conditions cause hypokalemia in children except acute tubular necrosis renal tubular acidosis type 1 gastroenteritis frusemide pyloric stenosis 32 / 80 The following are associated with oral candidiasis except; Lymphoma Malignancy Glucose 6 Phosphate Dehydrogenase Retroviral infection 33 / 80 Cause of ptosis include the following except tick paralysis myasthenia gravis 4th nerve palsy botulism horner syndrome 34 / 80 These are chronic complications associated with sickle cell disease except leg ulcers chronic lung disease congestive heart failure priapism aseptic necrosis of the hip or shoulder 35 / 80 The management of retroexposed babies include zidovudine for six months lamivudine and zidovudine for 6 weeks for high risk babies cotrimoxazole at birth mixed feeding at 1 month PCR at 6 weeks of age 36 / 80 About severe acute malnutrition (SAM). ORS is the fluid of choice for correcting dehydration Diagnostic features include mid upper arm circumference < 115mm sensory stimulation is not helpful There is usually unilateral pitting pedal oedema Hypoglycaemia is present when the blood glucose is <4mmol/l 37 / 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 Post renal obstruction Renal artery stenosis Acute tubular necrosis 38 / 80 This is not true about autism it is pervasive developmental disorder it's characterised by restricted and repetitive behavior there is severe language and speech developmental disorder commoner in males than in females with a male:female ratio of 3:1 most cases have normal intelligence 39 / 80 Facial features of fetal alcohol syndrome include the following except short palpebral tissue ptosis smooth philtrum microcephaly thick upper lip 40 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Ultrasound should be done to confirm the diagnosis Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Patient may present with loss of the symptoms of pregnancy Immediate evacuation should be done once the diagnosis is made Per vaginal bleeding may be one of the presenting symptom 41 / 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 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 All the answers below 42 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Cholecystokinin Prolactin Follicle stimulating hormone Adrenocorticotropic hormone 43 / 80 Which of the following is NOT a characteristic of normal labour: Increasing intensity of contractions. Moderate bleeding. Progressive cervical dilation. Moderate pain. Uterine relaxation between contractions. 44 / 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 Diffuse spasm of the oesophageal muscles Myasthenia gravis Scleroderma 45 / 80 In burns: 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. The increased capillary permeability is restricted to the burnt area. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. 46 / 80 The features listed below may be associated with migraine headache EXCEPT Photophobia. Pulsatile or throbbing headache Nausea Neck stiffness may be present 47 / 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 bacterial endocarditis Sub acute bacterial endocarditis Acute rheumatic carditis. Viral hepatitis 48 / 80 Which one of the drugs or measures do not worsen uraemia? Paracetamol Hypotension Gentamycin Diarrhoea 49 / 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 body of the pancreas Carcinoma of the stomach Amoebic liver abscess 50 / 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. 51 / 80 These are gross motor skills except stands alone steadiness of head when placed in supported position sits with support transfers object from hand to hand walks up stairs with help 52 / 80 Stages of labour The cervix dilates at consistent rate of 3 cm per hour in the first stage 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 third stage end with the delivery of the placenta and membranes The first stage commences at the time of membrane rupture 53 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. café - au-lait spots and neurofibromatosis cortical tuber in neurofibromatosis shagreen patch and tuberous sclerosis adenoma sebaceum and tuberous sclerosis port wine stain and sturge weber syndrome 54 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 28. March 27. March 23. April 23. April 7. 55 / 80 In normal pregnancy, the value of ß-hCG doubles every: 8 days. 2 days. 14 days. 4 days. 10 days. 56 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except sepsis galactosemia torch infections biliary atresia breast milk jaundice 57 / 80 The following are contraindications for lumbar puncture except Cervical spondylosis skin infection at or near the site of the lumbar puncture Raised intracranial pressure Acute spinal cord injury Coagulopathy 58 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Brain naturetic protein Thyroxine Aldosterone Nordrenaline 59 / 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 External fixation Blockage of the appropriate intercostal nerve and active physiotherapy Strapping of the affected side of the chest 60 / 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 61 / 80 Antenatal booking investigations include all of the following, EXCEPT: Thyroid function Complete blood count Hepatitis screening Urine routine examination Stool routine examination 62 / 80 In bronchiolitis, all these are true except primarily affects children less than 2 years old most commonly caused by respiratory syncytial virus drug of choice is acyclovir it's usually a self-limiting disease may present with with low grade fever 63 / 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 64 / 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 Shock . Severe crushing pain in the precordium No chest pain in an elderly female diabetic 65 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Transverse colon Descending colon Terminal ileum Caecum 66 / 80 Molding of the fetal head: Usually cause brain damage. Becomes progressively easier as gestational age increase. Increase the difficulty of delivery. Does not happen when maternal pelvis is adequate. Does NOT have time to occur in breech delivery. 67 / 80 On assessment of Semen Fluid Analysis: Abstinence should be maintained for 3 days prior to production of the sample Teratozoospermia indicates abnormal motility Asthenozoospermia indicates abnormal forms Azoospermia indicates a sperm count more than 5 million/ml Abstinence should be maintained for 10 days prior to "production" of the sample 68 / 80 The commonest site for carcinoma of the tongue is the: Lateral margin Dorsum Posterior one-third Tip 69 / 80 The thyroid gland in thyrotoxicosis: If primary is uniformly enlarged and rather soft or firm If secondary is firm and multinodular in all patients Is enlarged in all patients so affected In over 95 percent has a thrill and a bruit over it 70 / 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 Hypovolaemia Post renal uraemia 71 / 80 Neonatal resuscitation chest compression is initiated when heart rate is below 100 bpm atropine is administered when heart rate is below 100 bpm most effective action is ventilation of the baby's lungs involves administration of iv aminophylline to preterms clearing airway preceeds keeping baby warm 72 / 80 The following are treatment for simple malaria except oral quinine dihydroartemisinin - lumefantrine dihydroartemisinin - piperaquine artemether - lumefantrine artesunate - amodiaquine 73 / 80 The main tissues which provide support to the uterus include: Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments Uterosacral ligaments and the Broad ligaments Perineal body and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments 74 / 80 Adverse effects of corticosteroids include all EXCEPT Avascular necrosis of the hip. Cataract Euphoria Osteomalacia 75 / 80 Causes of macrocephaly include the following except fetal alcohol syndrome mucopolysaccharidosis achondroplasia thalassaemia hydrocephalus 76 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Sinciput. Occiput. Acromian. Mentum. Sacrum. 77 / 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 78 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus albicans. Placenta. Corpus luteum. Adrenal glands. Endometrium. 79 / 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 Sebaceous cyst of the scrotum Irreducible incomplete inguinal hernia, probably containing omentum Encysted hydrocele of the cord 80 / 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 Klebsiella pneumoniae Streptococcus pneumoniae Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback