GMDC MOCK 3 /80 26 Quiz 1 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Sacrum. Sinciput. Occiput. Acromian. Mentum. 2 / 80 The thyroid gland in thyrotoxicosis: In over 95 percent has a thrill and a bruit over it If secondary is firm and multinodular in all patients Is enlarged in all patients so affected If primary is uniformly enlarged and rather soft or firm 3 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Observing amniotic fluid drain through the cervix during speculum examination. Contractions seen on the CTG. Positive Nitrazine test. Positive Fern test. Pooling of amniotic fluid on speculum examination. 4 / 80 This is not a cause of hypoglycaemia in newborns prematurity intrauterine growth retardate hypoinsulinaemia infant of a diabetic mother sepsis 5 / 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 Preoperative showering for the patient Age of the patient Bacterial content of the wound at end of operation 6 / 80 Which of these discriptions adequately describe malena stools? Loose very shining black stools Dark stools Black tarry or sticky stools Black stools 7 / 80 An ectopic pregnancy: Pain always presents before the bleeding Occurs only in the fallopian tubes Gives an increased risk of Hyperemisis Gravidarium Can only be treated surgically Usually presents with pain before bleeding 8 / 80 In normal pregnancy, the value of ß-hCG doubles every: 10 days. 2 days. 4 days. 14 days. 8 days. 9 / 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 Rapidly progressively glomerulonephriitis Renal artery stenosis 10 / 80 The management of retroexposed babies include PCR at 6 weeks of age cotrimoxazole at birth lamivudine and zidovudine for 6 weeks for high risk babies mixed feeding at 1 month zidovudine for six months 11 / 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 Carcinoma of the stomach Carcinoma of the body of the pancreas Amoebic liver abscess Primary liver cell carcinoma 12 / 80 The most effective surgical procedure in stress ulceration is: Vogitomy and hemigastrectomy Polya partial gastrectomy Total gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points 13 / 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 Paralysis of lower facial muscles on the left. May cause incontinence of urine 14 / 80 For adequate and stable haemostasis the following should obtain: Increased pressure within the injured vessel Endothelial cell secretion of factor VIII A minimum platelet count of 90,000 per mm3 Retraction of the injured vessel 15 / 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 Congenital cystic lung disease Congital cyanotic heart disease Congenital postero-lateral diaphragmatic hernia (stabilized) 16 / 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 Viral hepatitis Acute rheumatic carditis. 17 / 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 18 / 80 Stages of labour The first stage commences at the time of membrane rupture 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 cervix dilates at consistent rate of 3 cm per hour in the first stage 19 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Chronic breast abscess Duct ectasia Scirrhous breast carcinoma Intraductal comedo-carcinoma 20 / 80 These are causes of acute stridor except croup acute epiglottitis diphtheria laryngomalacia bacterial tracheitis 21 / 80 All these conditions cause hypokalemia in children except frusemide renal tubular acidosis type 1 pyloric stenosis acute tubular necrosis gastroenteritis 22 / 80 The following are associated with oral candidiasis except; Malignancy Glucose 6 Phosphate Dehydrogenase Retroviral infection Lymphoma 23 / 80 The following are causes of spastic paraparesis except; Transverse myelitis Disc prolapse Potts disease Guillain Barre syndrome 24 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 23. March 27. April 7. April 23. March 28. 25 / 80 Antenatal booking investigations include all of the following, EXCEPT: Hepatitis screening Thyroid function Urine routine examination Complete blood count Stool routine examination 26 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypertriglyceridemia Hypoalbuminsemia Normal renal function Oedema 27 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Via the payer's patches to the mesenteric lymph nodes. Through the tonsils to the cervical lymph nodes. The genitourinary mucosa-urethra and bladder. Directly to the lung tissue establishing a Primary Complex (Gohn focus) 28 / 80 The following are contraindications for lumbar puncture except skin infection at or near the site of the lumbar puncture Coagulopathy Raised intracranial pressure Cervical spondylosis Acute spinal cord injury 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 Acute tubular necrosis Pre-renal renal failure Post-renal renal failure 30 / 80 About severe acute malnutrition (SAM). ORS is the fluid of choice for correcting dehydration sensory stimulation is not helpful Hypoglycaemia is present when the blood glucose is <4mmol/l Diagnostic features include mid upper arm circumference < 115mm There is usually unilateral pitting pedal oedema 31 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Terminal ileum Descending colon Transverse colon Caecum 32 / 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? Urinary tract infection Renal stone Drug induced Haemolysis 33 / 80 Cause of neonatal seizures include the following except bilirubin encephalopathy pyridoxine deficiency hypoxic ischaemic encephalopathy hypermagnesaemia intracranial hemorrhage 34 / 80 The risk of postpartum uterine atony is associated with: Twin pregnancy. Epidural anesthesia. Labour associated with an active rate of change of 1 cm per hour. Median episiotomy. Hypotension. 35 / 80 Facial features of fetal alcohol syndrome include the following except short palpebral tissue ptosis smooth philtrum microcephaly thick upper lip 36 / 80 Which of the following is NOT a characteristic of normal labour: Progressive cervical dilation. Increasing intensity of contractions. Uterine relaxation between contractions. Moderate pain. Moderate bleeding. 37 / 80 Adverse effects of corticosteroids include all EXCEPT Cataract Euphoria Osteomalacia Avascular necrosis of the hip. 38 / 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. Confusion Respiratory rate> 30 per minute Heart rate >100 39 / 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% 40 / 80 Cause of ptosis include the following except horner syndrome tick paralysis 4th nerve palsy myasthenia gravis botulism 41 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? DPP4 inhibitors Metformin Glibenclamide Pioglitazone 42 / 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 Strapping of the affected side of the chest Blockage of the appropriate intercostal nerve and active physiotherapy Watchful administration of adequate doses of systemic analgesic agent 43 / 80 On assessment of Semen Fluid Analysis: 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 Azoospermia indicates a sperm count more than 5 million/ml 44 / 80 In bronchiolitis, all these are true except most commonly caused by respiratory syncytial virus primarily affects children less than 2 years old may present with with low grade fever drug of choice is acyclovir it's usually a self-limiting disease 45 / 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 high intestinal obstruction Gastro-enteritis Acute gastritis 46 / 80 Which one of the drugs or measures do not worsen uraemia? Hypotension Gentamycin Diarrhoea Paracetamol 47 / 80 The second stage of labour involves: Effacement of the cervix. Separation of the placenta. Expulsion of the placenta. Expulsion of the fetus. Dilation of the cervix. 48 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Position. Presentation. Lie. Attitude. None of the above. 49 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Brain naturetic protein Aldosterone Thyroxine Nordrenaline 50 / 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 commoner in males than in females with a male:female ratio of 3:1 it's characterised by restricted and repetitive behavior 51 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except galactosemia torch infections sepsis breast milk jaundice biliary atresia 52 / 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 Supracondylar fracture Dislocation of the elbow Fracture of the olecranon process Monteggia fracture dislocation 53 / 80 Causes of macrocephaly include the following except achondroplasia fetal alcohol syndrome thalassaemia hydrocephalus mucopolysaccharidosis 54 / 80 Molding of the fetal head: Increase the difficulty of delivery. Usually cause brain damage. Does NOT have time to occur in breech delivery. Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. 55 / 80 The features listed below may be associated with migraine headache EXCEPT Pulsatile or throbbing headache Nausea Neck stiffness may be present Photophobia. 56 / 80 These are chronic complications associated with sickle cell disease except chronic lung disease aseptic necrosis of the hip or shoulder leg ulcers priapism congestive heart failure 57 / 80 The commonest site for carcinoma of the tongue is the: Tip Lateral margin Dorsum Posterior one-third 58 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Ultrasound should be done to confirm the diagnosis Patient may present with loss of the symptoms of pregnancy Immediate evacuation should be done once the diagnosis is made Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Per vaginal bleeding may be one of the presenting symptom 59 / 80 In burns: 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. The rate of fluid exudation from the capillaries is highest in the first 4 hours and falls in 48 hours. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. 60 / 80 The following are treatment for simple malaria except artemether - lumefantrine dihydroartemisinin - piperaquine artesunate - amodiaquine oral quinine dihydroartemisinin - lumefantrine 61 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Liver function test is not required Is a complication of multiple pregnancy Not known to happen in molar pregnancy Worsen in missed abortion Urine for culture and sensitivity is not important 62 / 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 Tuberculosis Silicosis Left ventricular failure 63 / 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 Bulbar paralysis Diffuse spasm of the oesophageal muscles Myasthenia gravis 64 / 80 Neonatal resuscitation atropine is administered when heart rate is below 100 bpm most effective action is ventilation of the baby's lungs clearing airway preceeds keeping baby warm involves administration of iv aminophylline to preterms chest compression is initiated when heart rate is below 100 bpm 65 / 80 The prime cause of a venous leg ulcer is: Varicosity of the long (greater) saphenous vein Stasis in the deep veins High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins 66 / 80 Malignant degeneration of a healing wound is most likely to occur: When iodophor antiseptics are used for dressing. When a state of chronicity from (e.g) recurrent infection prevails. When wounds are exposed to heat. When a patient is on cytotoxic agents. 67 / 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? Klebsiella pneumoniae Streptococcus pneumoniae Mycoplasma pneumonia Staphylococcus aureus 68 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus luteum. Corpus albicans. Endometrium. Adrenal glands. Placenta. 69 / 80 The heart rate of a normal fetus at term is: 100-120 bpm. There is no baseline heart rate. 120-160 bpm. 160-180 bpm. 80-100 bpm. 70 / 80 The pelvis includes which of the following bones: Trochanter, sacrum, coccyx, ilium and pubis Trochanter, hip socket, ischium, sacrum and pubis. Sacrum, Tibia, ilium and pubis. Ilium, ischium, pubis, sacrum and coccyx. Ilium, scapula, ischium and pubis. 71 / 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 . Refer him to the specialist for investigations. Start him on nifedipine XL 30 mg once a day Start amlodipine therapy. 72 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? No chest pain in an elderly female diabetic Shock . Severe crushing pain in the precordium Sharp piercing pain in the left which worsens with breathing 73 / 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 All the answers below Any patient with hypertension and aged over 50 years Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. 74 / 80 These are gross motor skills except sits with support walks up stairs with help steadiness of head when placed in supported position stands alone transfers object from hand to hand 75 / 80 Squamous cell carcinoma of the anus: Is the commonest malignant tumour of the anus Usually presents as a localized ulcer with sloping edges Bleeds but does not cause pain on defaecation Is treated by abdomino-perineal resection of the rectum and anus in all patients 76 / 80 The main tissues which provide support to the uterus include: Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments 77 / 80 In hypopituitarism all these hormones may be deficient except Adrenocorticotropic hormone Prolactin Growth hormone Follicle stimulating hormone Cholecystokinin 78 / 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? Encysted hydrocele of the cord Irreducible incomplete inguinal hernia, probably containing omentum Sebaceous cyst of the scrotum Cyst of the epididymis 79 / 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 Associated with multiple pregnancy Is commonest in the third trimester Is associated with trophoblastic disease 80 / 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 Post renal uraemia Atonic bladder Injury to sacral nerve plexus Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback