GMDC MOCK 3 /80 26 Quiz 1 / 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 Renal artery stenosis Post renal obstruction Rapidly progressively glomerulonephriitis 2 / 80 The main tissues which provide support to the uterus include: Round ligament and the Broad ligaments Uterosacral ligaments and the Broad ligaments Perineal body and the Broad ligaments Broad ligaments and the Uterosacral ligaments Cardinal ligaments and the Uterosacral ligaments 3 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Position. Attitude. Presentation. None of the above. Lie. 4 / 80 These are causes of acute stridor except bacterial tracheitis diphtheria acute epiglottitis croup laryngomalacia 5 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? Severe crushing pain in the precordium Shock . Sharp piercing pain in the left which worsens with breathing No chest pain in an elderly female diabetic 6 / 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. 7 / 80 Cause of neonatal seizures include the following except hypoxic ischaemic encephalopathy bilirubin encephalopathy pyridoxine deficiency hypermagnesaemia intracranial hemorrhage 8 / 80 The following are associated with oral candidiasis except; Retroviral infection Malignancy Lymphoma Glucose 6 Phosphate Dehydrogenase 9 / 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 Cyst of the epididymis Irreducible incomplete inguinal hernia, probably containing omentum Encysted hydrocele of the cord 10 / 80 The features listed below may be associated with migraine headache EXCEPT Nausea Neck stiffness may be present Pulsatile or throbbing headache Photophobia. 11 / 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. 12 / 80 Features found in nephrotic syndrome include the following EXCEPT: Normal renal function Oedema Hypertriglyceridemia Hypoalbuminsemia 13 / 80 Adverse effects of corticosteroids include all EXCEPT Avascular necrosis of the hip. Euphoria Osteomalacia Cataract 14 / 80 Which of the following patients should you prescribe aspirin if there is no contraindication. Select the MOST appropriate All the answers below 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. 15 / 80 The following are treatment for simple malaria except dihydroartemisinin - piperaquine artemether - lumefantrine oral quinine dihydroartemisinin - lumefantrine artesunate - amodiaquine 16 / 80 These are gross motor skills except walks up stairs with help transfers object from hand to hand steadiness of head when placed in supported position sits with support stands alone 17 / 80 Molding of the fetal head: Usually cause brain damage. Increase the difficulty of delivery. Does NOT have time to occur in breech delivery. Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. 18 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Acromian. Occiput. Sinciput. Sacrum. Mentum. 19 / 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. 20 / 80 This is not a cause of hypoglycaemia in newborns hypoinsulinaemia sepsis intrauterine growth retardate prematurity infant of a diabetic mother 21 / 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 22 / 80 Which one of the drugs or measures do not worsen uraemia? Gentamycin Paracetamol Diarrhoea Hypotension 23 / 80 In normal pregnancy, the value of ß-hCG doubles every: 8 days. 4 days. 2 days. 10 days. 14 days. 24 / 80 Concerning febrile seizures They usually have a poor prognosis Overall risk for recurrence is 3-4% Main risk factor for recurrence is the temperature at time of seizure. Overall, 30% develop epilepsy Complex features is not a risk factor for recurrence 25 / 80 Causes of macrocephaly include the following except hydrocephalus mucopolysaccharidosis achondroplasia thalassaemia fetal alcohol syndrome 26 / 80 In bronchiolitis, all these are true except most commonly caused by respiratory syncytial virus primarily affects children less than 2 years old drug of choice is acyclovir it's usually a self-limiting disease may present with with low grade fever 27 / 80 The most effective surgical procedure in stress ulceration is: Total gastrectomy Vogitomy and hemigastrectomy Polya partial gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points 28 / 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 Monteggia fracture dislocation Supracondylar fracture Fracture of the olecranon process 29 / 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 30 / 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) Glove puncture in the course of surgery Bacterial content of the wound at end of operation Age of the patient Preoperative showering for the patient 31 / 80 Facial features of fetal alcohol syndrome include the following except ptosis thick upper lip short palpebral tissue smooth philtrum microcephaly 32 / 80 Which of the following is not part of the criteria considered for CURB 65 used to determine the severity of community pneumonia. Respiratory rate> 30 per minute Heart rate >100 Diastolic pressure <60 mm Hg. Confusion 33 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Directly to the lung tissue establishing a Primary Complex (Gohn focus) Through the tonsils to the cervical lymph nodes. Via the payer's patches to the mesenteric lymph nodes. The genitourinary mucosa-urethra and bladder. 34 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except biliary atresia galactosemia breast milk jaundice torch infections sepsis 35 / 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 36 / 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 37 / 80 Malignant degeneration of a healing wound is most likely to occur: When wounds are exposed to heat. When a state of chronicity from (e.g) recurrent infection prevails. When a patient is on cytotoxic agents. When iodophor antiseptics are used for dressing. 38 / 80 Neonatal resuscitation involves administration of iv aminophylline to preterms clearing airway preceeds keeping baby warm most effective action is ventilation of the baby's lungs atropine is administered when heart rate is below 100 bpm chest compression is initiated when heart rate is below 100 bpm 39 / 80 The management of retroexposed babies include lamivudine and zidovudine for 6 weeks for high risk babies zidovudine for six months cotrimoxazole at birth mixed feeding at 1 month PCR at 6 weeks of age 40 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 28. April 7. March 23. April 23. March 27. 41 / 80 The following are contraindications for lumbar puncture except Acute spinal cord injury Cervical spondylosis Raised intracranial pressure Coagulopathy skin infection at or near the site of the lumbar puncture 42 / 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 43 / 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 Acute tubular necrosis Pre-renal renal failure Post-renal renal failure 44 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is associated with trophoblastic disease Is associated with urinary tract infection Associated with multiple pregnancy Is commonest in the third trimester May be cured by admission to hospital 45 / 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? Staphylococcus aureus Mycoplasma pneumonia Klebsiella pneumoniae Streptococcus pneumoniae 46 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Liver function test is not required Worsen in missed abortion Is a complication of multiple pregnancy Not known to happen in molar pregnancy Urine for culture and sensitivity is not important 47 / 80 These are chronic complications associated with sickle cell disease except priapism chronic lung disease congestive heart failure leg ulcers aseptic necrosis of the hip or shoulder 48 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Nitrazine test. Contractions seen on the CTG. Pooling of amniotic fluid on speculum examination. Observing amniotic fluid drain through the cervix during speculum examination. Positive Fern test. 49 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Placenta. Adrenal glands. Endometrium. Corpus albicans. Corpus luteum. 50 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Descending colon Terminal ileum Caecum Transverse colon 51 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. port wine stain and sturge weber syndrome cortical tuber in neurofibromatosis shagreen patch and tuberous sclerosis adenoma sebaceum and tuberous sclerosis café - au-lait spots and neurofibromatosis 52 / 80 Antenatal booking investigations include all of the following, EXCEPT: Hepatitis screening Stool routine examination Urine routine examination Complete blood count Thyroid function 53 / 80 The thyroid gland in thyrotoxicosis: If primary is uniformly enlarged and rather soft or firm 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 54 / 80 In hypopituitarism all these hormones may be deficient except Cholecystokinin Adrenocorticotropic hormone Prolactin Growth hormone Follicle stimulating hormone 55 / 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? Left ventricular failure Tuberculosis Silicosis Carcinoma of the bronchus 56 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? DPP4 inhibitors Pioglitazone Metformin Glibenclamide 57 / 80 On assessment of Semen Fluid Analysis: 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 Teratozoospermia indicates abnormal motility Abstinence should be maintained for 3 days prior to production of the sample 58 / 80 The prime cause of a venous leg ulcer is: Stasis in the deep veins High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins Varicosity of the long (greater) saphenous vein 59 / 80 The pelvis includes which of the following bones: Trochanter, sacrum, coccyx, ilium and pubis Ilium, ischium, pubis, sacrum and coccyx. Trochanter, hip socket, ischium, sacrum and pubis. Sacrum, Tibia, ilium and pubis. Ilium, scapula, ischium and pubis. 60 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Brain naturetic protein Thyroxine Nordrenaline Aldosterone 61 / 80 This is not true about autism most cases have normal intelligence commoner in males than in females with a male:female ratio of 3:1 there is severe language and speech developmental disorder it is pervasive developmental disorder it's characterised by restricted and repetitive behavior 62 / 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 63 / 80 About severe acute malnutrition (SAM). Diagnostic features include mid upper arm circumference < 115mm Hypoglycaemia is present when the blood glucose is <4mmol/l ORS is the fluid of choice for correcting dehydration sensory stimulation is not helpful There is usually unilateral pitting pedal oedema 64 / 80 Stroke due involving the right middle cerebral artery pathology in most people usually causes the symptoms and signs below EXCEPT No effect on the muscles in the upper part of the face. Motor aphasia May cause incontinence of urine Paralysis of lower facial muscles on the left. 65 / 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 Acute rheumatic carditis. Viral hepatitis Sub acute bacterial endocarditis 66 / 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 67 / 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 Acute gastritis Gastro-enteritis Acute high intestinal obstruction 68 / 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: External fixation Watchful administration of adequate doses of systemic analgesic agent Blockage of the appropriate intercostal nerve and active physiotherapy Strapping of the affected side of the chest 69 / 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: Emphysematous bullae Congital cyanotic heart disease Congenital postero-lateral diaphragmatic hernia (stabilized) Congenital cystic lung disease 70 / 80 Cause of ptosis include the following except tick paralysis myasthenia gravis botulism horner syndrome 4th nerve palsy 71 / 80 Which of these discriptions adequately describe malena stools? Dark stools Black tarry or sticky stools Loose very shining black stools Black stools 72 / 80 The second stage of labour involves: Expulsion of the placenta. Expulsion of the fetus. Effacement of the cervix. Separation of the placenta. Dilation of the cervix. 73 / 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 Scleroderma Myasthenia gravis Bulbar paralysis 74 / 80 All these conditions cause hypokalemia in children except frusemide renal tubular acidosis type 1 acute tubular necrosis pyloric stenosis gastroenteritis 75 / 80 The commonest site for carcinoma of the tongue is the: Dorsum Lateral margin Tip Posterior one-third 76 / 80 Stages of labour 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 third stage end with the delivery of the placenta and membranes 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 77 / 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 78 / 80 The following are causes of spastic paraparesis except; Disc prolapse Transverse myelitis Guillain Barre syndrome Potts disease 79 / 80 Which of the following is NOT a characteristic of normal labour: Uterine relaxation between contractions. Moderate bleeding. Progressive cervical dilation. Increasing intensity of contractions. Moderate pain. 80 / 80 For adequate and stable haemostasis the following should obtain: Endothelial cell secretion of factor VIII A minimum platelet count of 90,000 per mm3 Increased pressure within the injured vessel Retraction of the injured vessel Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback