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