GMDC MOCK 3 /80 26 Quiz 1 / 80 Neonatal resuscitation most effective action is ventilation of the baby's lungs involves administration of iv aminophylline to preterms clearing airway preceeds keeping baby warm atropine is administered when heart rate is below 100 bpm chest compression is initiated when heart rate is below 100 bpm 2 / 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: Scleroderma Diffuse spasm of the oesophageal muscles Bulbar paralysis Myasthenia gravis 3 / 80 Molding of the fetal head: Increase the difficulty of delivery. Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. Does NOT have time to occur in breech delivery. Usually cause brain damage. 4 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. café - au-lait spots and neurofibromatosis cortical tuber in neurofibromatosis port wine stain and sturge weber syndrome adenoma sebaceum and tuberous sclerosis shagreen patch and tuberous sclerosis 5 / 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 6 / 80 The following are causes of spastic paraparesis except; Transverse myelitis Guillain Barre syndrome Potts disease Disc prolapse 7 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Glibenclamide Metformin DPP4 inhibitors Pioglitazone 8 / 80 Adverse effects of corticosteroids include all EXCEPT Euphoria Avascular necrosis of the hip. Osteomalacia Cataract 9 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Terminal ileum Transverse colon Descending colon Caecum 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 Irreducible incomplete inguinal hernia, probably containing omentum Cyst of the epididymis 11 / 80 Cause of neonatal seizures include the following except bilirubin encephalopathy pyridoxine deficiency intracranial hemorrhage hypoxic ischaemic encephalopathy hypermagnesaemia 12 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except torch infections galactosemia breast milk jaundice sepsis biliary atresia 13 / 80 In bronchiolitis, all these are true except drug of choice is acyclovir most commonly caused by respiratory syncytial virus may present with with low grade fever primarily affects children less than 2 years old it's usually a self-limiting disease 14 / 80 Which one of the drugs or measures do not worsen uraemia? Paracetamol Diarrhoea Gentamycin Hypotension 15 / 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 16 / 80 Which of the following is NOT a characteristic of normal labour: Uterine relaxation between contractions. Increasing intensity of contractions. Moderate pain. Progressive cervical dilation. Moderate bleeding. 17 / 80 Causes of macrocephaly include the following except achondroplasia mucopolysaccharidosis hydrocephalus fetal alcohol syndrome thalassaemia 18 / 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 tubular necrosis Pre-renal renal failure Acute renal failure 19 / 80 These are causes of acute stridor except acute epiglottitis diphtheria croup laryngomalacia bacterial tracheitis 20 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Chronic breast abscess Intraductal comedo-carcinoma Scirrhous breast carcinoma Duct ectasia 21 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Sacrum. Occiput. Sinciput. Mentum. Acromian. 22 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Nordrenaline Thyroxine Brain naturetic protein Aldosterone 23 / 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 rheumatic carditis. Acute bacterial endocarditis Viral hepatitis 24 / 80 The main tissues which provide support to the uterus include: Round ligament and the Broad ligaments Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments Broad ligaments and the Uterosacral ligaments 25 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Urine for culture and sensitivity is not important Liver function test is not required Worsen in missed abortion Not known to happen in molar pregnancy Is a complication of multiple pregnancy 26 / 80 The following are treatment for simple malaria except dihydroartemisinin - lumefantrine artesunate - amodiaquine oral quinine dihydroartemisinin - piperaquine artemether - lumefantrine 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 Amoebic liver abscess Carcinoma of the body of the pancreas Carcinoma of the stomach 28 / 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? Atonic bladder Post renal uraemia Injury to sacral nerve plexus Hypovolaemia 29 / 80 Cause of ptosis include the following except myasthenia gravis botulism horner syndrome 4th nerve palsy tick paralysis 30 / 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 Any patient with hypertension and aged over 50 years All the answers below Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. 31 / 80 Facial features of fetal alcohol syndrome include the following except microcephaly thick upper lip smooth philtrum ptosis short palpebral tissue 32 / 80 The commonest site for carcinoma of the tongue is the: Posterior one-third Dorsum Tip Lateral margin 33 / 80 All these conditions cause hypokalemia in children except gastroenteritis renal tubular acidosis type 1 acute tubular necrosis pyloric stenosis frusemide 34 / 80 In hypopituitarism all these hormones may be deficient except Cholecystokinin Adrenocorticotropic hormone Follicle stimulating hormone Growth hormone Prolactin 35 / 80 The following are associated with oral candidiasis except; Malignancy Lymphoma Glucose 6 Phosphate Dehydrogenase Retroviral infection 36 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Associated with multiple pregnancy Is commonest in the third trimester May be cured by admission to hospital Is associated with trophoblastic disease Is associated with urinary tract infection 37 / 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. 38 / 80 About severe acute malnutrition (SAM). Diagnostic features include mid upper arm circumference < 115mm There is usually unilateral pitting pedal oedema Hypoglycaemia is present when the blood glucose is <4mmol/l ORS is the fluid of choice for correcting dehydration sensory stimulation is not helpful 39 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Fern test. Positive Nitrazine test. Observing amniotic fluid drain through the cervix during speculum examination. Contractions seen on the CTG. Pooling of amniotic fluid on speculum examination. 40 / 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. May cause incontinence of urine Motor aphasia Paralysis of lower facial muscles on the left. 41 / 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 42 / 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. Start him on nifedipine XL 30 mg once a day Refer him to the specialist for investigations. 43 / 80 The pelvis includes which of the following bones: Sacrum, Tibia, ilium and pubis. Trochanter, hip socket, ischium, sacrum and pubis. Ilium, ischium, pubis, sacrum and coccyx. Trochanter, sacrum, coccyx, ilium and pubis Ilium, scapula, ischium and pubis. 44 / 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 45 / 80 The heart rate of a normal fetus at term is: 80-100 bpm. 100-120 bpm. 120-160 bpm. 160-180 bpm. There is no baseline heart rate. 46 / 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 47 / 80 The second stage of labour involves: Expulsion of the placenta. Separation of the placenta. Effacement of the cervix. Expulsion of the fetus. Dilation of the cervix. 48 / 80 In burns: 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. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. 49 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Immediate evacuation should be done once the diagnosis is made Patient may present with loss of the symptoms of pregnancy Per vaginal bleeding may be one of the presenting symptom Ultrasound should be done to confirm the diagnosis Disseminated intra-vascular coagulation may occur as a sequele of missed abortion 50 / 80 Concerning febrile seizures 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 They usually have a poor prognosis 51 / 80 For adequate and stable haemostasis the following should obtain: Retraction of the injured vessel Endothelial cell secretion of factor VIII Increased pressure within the injured vessel A minimum platelet count of 90,000 per mm3 52 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypertriglyceridemia Hypoalbuminsemia Oedema Normal renal function 53 / 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 54 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Attitude. Position. None of the above. Presentation. Lie. 55 / 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 56 / 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 Urinary tract infection Drug induced Renal stone 57 / 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 cystic lung disease Congenital postero-lateral diaphragmatic hernia (stabilized) Emphysematous bullae 58 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: April 7. March 23. March 27. April 23. March 28. 59 / 80 Which of these discriptions adequately describe malena stools? Loose very shining black stools Black stools Black tarry or sticky stools Dark stools 60 / 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 61 / 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 patient is on cytotoxic agents. When a state of chronicity from (e.g) recurrent infection prevails. 62 / 80 These are chronic complications associated with sickle cell disease except congestive heart failure leg ulcers chronic lung disease priapism aseptic necrosis of the hip or shoulder 63 / 80 The following are contraindications for lumbar puncture except Cervical spondylosis skin infection at or near the site of the lumbar puncture Acute spinal cord injury Coagulopathy Raised intracranial pressure 64 / 80 An ectopic pregnancy: Usually presents with pain before bleeding Gives an increased risk of Hyperemisis Gravidarium Occurs only in the fallopian tubes Can only be treated surgically Pain always presents before the bleeding 65 / 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 66 / 80 Stages of labour The third stage end with the delivery of the placenta and membranes 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 first stage commences at the time of membrane rupture 67 / 80 The management of retroexposed babies include cotrimoxazole at birth zidovudine for six months lamivudine and zidovudine for 6 weeks for high risk babies PCR at 6 weeks of age mixed feeding at 1 month 68 / 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) Age of the patient Glove puncture in the course of surgery Preoperative showering for the patient Bacterial content of the wound at end of operation 69 / 80 The most effective surgical procedure in stress ulceration is: Total gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Polya partial gastrectomy Vogitomy and hemigastrectomy 70 / 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 Fracture of the olecranon process Supracondylar fracture 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 Rapidly progressively glomerulonephriitis Renal artery stenosis Post renal obstruction 72 / 80 The features listed below may be associated with migraine headache EXCEPT Nausea Pulsatile or throbbing headache Neck stiffness may be present Photophobia. 73 / 80 Squamous cell carcinoma of the anus: Usually presents as a localized ulcer with sloping edges Is the commonest malignant tumour 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 74 / 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. Hypotension. Twin pregnancy. Median episiotomy. 75 / 80 This is not a cause of hypoglycaemia in newborns infant of a diabetic mother intrauterine growth retardate sepsis prematurity hypoinsulinaemia 76 / 80 On assessment of Semen Fluid Analysis: Abstinence should be maintained for 3 days prior to production of the sample Teratozoospermia indicates abnormal motility Azoospermia indicates a sperm count more than 5 million/ml Asthenozoospermia indicates abnormal forms Abstinence should be maintained for 10 days prior to "production" of the sample 77 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus luteum. Corpus albicans. Placenta. Adrenal glands. Endometrium. 78 / 80 In normal pregnancy, the value of ß-hCG doubles every: 10 days. 14 days. 8 days. 2 days. 4 days. 79 / 80 Antenatal booking investigations include all of the following, EXCEPT: Stool routine examination Complete blood count Hepatitis screening Urine routine examination Thyroid function 80 / 80 This is not true about autism there is severe language and speech developmental disorder it is pervasive developmental disorder most cases have normal intelligence it's characterised by restricted and repetitive behavior commoner in males than in females with a male:female ratio of 3:1 Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback