GMDC MOCK 3 /80 26 Quiz 1 / 80 Which of these discriptions adequately describe malena stools? Loose very shining black stools Dark stools Black tarry or sticky stools Black stools 2 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? Severe crushing pain in the precordium Sharp piercing pain in the left which worsens with breathing Shock . No chest pain in an elderly female diabetic 3 / 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 renal failure Acute tubular necrosis Pre-renal renal failure 4 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: The genitourinary mucosa-urethra and bladder. Through the tonsils to the cervical lymph nodes. Directly to the lung tissue establishing a Primary Complex (Gohn focus) Via the payer's patches to the mesenteric lymph nodes. 5 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Prolactin Follicle stimulating hormone Cholecystokinin Adrenocorticotropic hormone 6 / 80 These are gross motor skills except transfers object from hand to hand steadiness of head when placed in supported position sits with support walks up stairs with help stands alone 7 / 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 amlodipine therapy. to observe his blood pressure for a further 10 months before initiating treatment . Start him on nifedipine XL 30 mg once a day Refer him to the specialist for investigations. 8 / 80 Which of the following is NOT a characteristic of normal labour: Uterine relaxation between contractions. Moderate bleeding. Moderate pain. Increasing intensity of contractions. Progressive cervical dilation. 9 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypoalbuminsemia Hypertriglyceridemia Oedema Normal renal function 10 / 80 About severe acute malnutrition (SAM). ORS is the fluid of choice for correcting dehydration sensory stimulation is not helpful There is usually unilateral pitting pedal oedema Hypoglycaemia is present when the blood glucose is <4mmol/l Diagnostic features include mid upper arm circumference < 115mm 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 Primary liver cell carcinoma Amoebic liver abscess 12 / 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 Preoperative showering for the patient Bacterial content of the wound at end of operation Glove puncture in the course of surgery 13 / 80 The following are treatment for simple malaria except oral quinine dihydroartemisinin - piperaquine dihydroartemisinin - lumefantrine artemether - lumefantrine artesunate - amodiaquine 14 / 80 The prime cause of a venous leg ulcer is: Varicosity of the long (greater) saphenous vein Failure of valves of the perforating and deep veins Stasis in the deep veins High venous pressure in the leg veins generally 15 / 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. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. The increased capillary permeability is restricted to the burnt area. 16 / 80 Which one of the drugs or measures do not worsen uraemia? Hypotension Gentamycin Diarrhoea Paracetamol 17 / 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 18 / 80 These are chronic complications associated with sickle cell disease except leg ulcers aseptic necrosis of the hip or shoulder priapism chronic lung disease congestive heart failure 19 / 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. 20 / 80 Antenatal booking investigations include all of the following, EXCEPT: Complete blood count Urine routine examination Stool routine examination Thyroid function Hepatitis screening 21 / 80 This is not true about autism there is severe language and speech developmental disorder commoner in males than in females with a male:female ratio of 3:1 it is pervasive developmental disorder most cases have normal intelligence it's characterised by restricted and repetitive behavior 22 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: April 23. March 27. April 7. March 28. March 23. 23 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is associated with urinary tract infection Is commonest in the third trimester Associated with multiple pregnancy May be cured by admission to hospital Is associated with trophoblastic disease 24 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Attitude. Position. Lie. Presentation. None of the above. 25 / 80 The heart rate of a normal fetus at term is: 100-120 bpm. 80-100 bpm. 120-160 bpm. There is no baseline heart rate. 160-180 bpm. 26 / 80 The thyroid gland in thyrotoxicosis: 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 In over 95 percent has a thrill and a bruit over it 27 / 80 The risk of postpartum uterine atony is associated with: Hypotension. Epidural anesthesia. Twin pregnancy. Labour associated with an active rate of change of 1 cm per hour. Median episiotomy. 28 / 80 An ectopic pregnancy: Pain always presents before the bleeding Gives an increased risk of Hyperemisis Gravidarium Can only be treated surgically Occurs only in the fallopian tubes Usually presents with pain before bleeding 29 / 80 The main tissues which provide support to the uterus include: Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Uterosacral ligaments and the Broad ligaments 30 / 80 In bronchiolitis, all these are true except most commonly caused by respiratory syncytial virus drug of choice is acyclovir may present with with low grade fever primarily affects children less than 2 years old it's usually a self-limiting disease 31 / 80 Facial features of fetal alcohol syndrome include the following except microcephaly thick upper lip ptosis short palpebral tissue smooth philtrum 32 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus albicans. Endometrium. Corpus luteum. Placenta. Adrenal glands. 33 / 80 This is not a cause of hypoglycaemia in newborns prematurity infant of a diabetic mother intrauterine growth retardate hypoinsulinaemia sepsis 34 / 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 35 / 80 Concerning febrile seizures Overall, 30% develop epilepsy Overall risk for recurrence is 3-4% Main risk factor for recurrence is the temperature at time of seizure. Complex features is not a risk factor for recurrence They usually have a poor prognosis 36 / 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 37 / 80 The following are contraindications for lumbar puncture except Coagulopathy skin infection at or near the site of the lumbar puncture Acute spinal cord injury Cervical spondylosis Raised intracranial pressure 38 / 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 Renal stone Drug induced 39 / 80 The pelvis includes which of the following bones: Sacrum, Tibia, ilium and pubis. Trochanter, sacrum, coccyx, ilium and pubis Ilium, scapula, ischium and pubis. Ilium, ischium, pubis, sacrum and coccyx. Trochanter, hip socket, ischium, sacrum and pubis. 40 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Pioglitazone Glibenclamide Metformin DPP4 inhibitors 41 / 80 The following are associated with oral candidiasis except; Retroviral infection Malignancy Glucose 6 Phosphate Dehydrogenase Lymphoma 42 / 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: Myasthenia gravis Diffuse spasm of the oesophageal muscles Scleroderma Bulbar paralysis 43 / 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. Heart rate >100 Confusion Respiratory rate> 30 per minute 44 / 80 Cause of neonatal seizures include the following except bilirubin encephalopathy hypoxic ischaemic encephalopathy intracranial hemorrhage hypermagnesaemia pyridoxine deficiency 45 / 80 Squamous cell carcinoma of the anus: Usually presents as a localized ulcer with sloping edges Is treated by abdomino-perineal resection of the rectum and anus in all patients Bleeds but does not cause pain on defaecation Is the commonest malignant tumour of the anus 46 / 80 The second stage of labour involves: Dilation of the cervix. Expulsion of the fetus. Separation of the placenta. Effacement of the cervix. Expulsion of the placenta. 47 / 80 All these conditions cause hypokalemia in children except gastroenteritis acute tubular necrosis frusemide pyloric stenosis renal tubular acidosis type 1 48 / 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 Duct ectasia Chronic breast abscess 49 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Worsen in missed abortion Liver function test is not required Is a complication of multiple pregnancy Urine for culture and sensitivity is not important Not known to happen in molar pregnancy 50 / 80 Adverse effects of corticosteroids include all EXCEPT Cataract Osteomalacia Euphoria Avascular necrosis of the hip. 51 / 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 Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Immediate evacuation should be done once the diagnosis is made Patient may present with loss of the symptoms of pregnancy 52 / 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 53 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except torch infections biliary atresia breast milk jaundice galactosemia sepsis 54 / 80 Causes of macrocephaly include the following except achondroplasia fetal alcohol syndrome hydrocephalus mucopolysaccharidosis thalassaemia 55 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. cortical tuber in neurofibromatosis shagreen patch and tuberous sclerosis port wine stain and sturge weber syndrome adenoma sebaceum and tuberous sclerosis café - au-lait spots and neurofibromatosis 56 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Mentum. Acromian. Sacrum. Occiput. Sinciput. 57 / 80 The commonest site for carcinoma of the tongue is the: Lateral margin Dorsum Tip Posterior one-third 58 / 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 59 / 80 The most effective surgical procedure in stress ulceration is: Vogitomy and hemigastrectomy Total gastrectomy Polya partial gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points 60 / 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 Cyst of the epididymis Sebaceous cyst of the scrotum 61 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Thyroxine Nordrenaline Brain naturetic protein Aldosterone 62 / 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 high intestinal obstruction Acute gastritis 63 / 80 Cause of ptosis include the following except botulism tick paralysis horner syndrome myasthenia gravis 4th nerve palsy 64 / 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 The cervix dilates at consistent rate of 3 cm per hour in the first stage The third stage end with the delivery of the placenta and membranes Syntometrine is a combination of oxytocin and Ergometrine which is used in the treatment of secondary postpartum haemorrhage (PPH) 65 / 80 These are causes of acute stridor except diphtheria croup acute epiglottitis bacterial tracheitis laryngomalacia 66 / 80 Malignant degeneration of a healing wound is most likely to occur: When a state of chronicity from (e.g) recurrent infection prevails. When wounds are exposed to heat. When a patient is on cytotoxic agents. When iodophor antiseptics are used for dressing. 67 / 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 bacterial endocarditis Viral hepatitis Acute rheumatic carditis. 68 / 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 69 / 80 The management of retroexposed babies include mixed feeding at 1 month cotrimoxazole at birth zidovudine for six months lamivudine and zidovudine for 6 weeks for high risk babies PCR at 6 weeks of age 70 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Pooling of amniotic fluid on speculum examination. Positive Nitrazine test. Contractions seen on the CTG. Positive Fern test. Observing amniotic fluid drain through the cervix during speculum examination. 71 / 80 On assessment of Semen Fluid Analysis: Azoospermia indicates a sperm count more than 5 million/ml Teratozoospermia indicates abnormal motility Asthenozoospermia indicates abnormal forms Abstinence should be maintained for 3 days prior to production of the sample Abstinence should be maintained for 10 days prior to "production" of the sample 72 / 80 For adequate and stable haemostasis the following should obtain: Retraction of the injured vessel Increased pressure within the injured vessel Endothelial cell secretion of factor VIII A minimum platelet count of 90,000 per mm3 73 / 80 Molding of the fetal head: Does not happen when maternal pelvis is adequate. Becomes progressively easier as gestational age increase. Increase the difficulty of delivery. Usually cause brain damage. Does NOT have time to occur in breech delivery. 74 / 80 The features listed below may be associated with migraine headache EXCEPT Nausea Neck stiffness may be present Photophobia. Pulsatile or throbbing headache 75 / 80 Neonatal resuscitation atropine is administered when heart rate is below 100 bpm clearing airway preceeds keeping baby warm most effective action is ventilation of the baby's lungs involves administration of iv aminophylline to preterms chest compression is initiated when heart rate is below 100 bpm 76 / 80 The following are causes of spastic paraparesis except; Disc prolapse Potts disease Transverse myelitis Guillain Barre syndrome 77 / 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: Strapping of the affected side of the chest Blockage of the appropriate intercostal nerve and active physiotherapy External fixation Watchful administration of adequate doses of systemic analgesic agent 78 / 80 In normal pregnancy, the value of ß-hCG doubles every: 8 days. 4 days. 2 days. 10 days. 14 days. 79 / 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 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 80 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Descending colon Terminal ileum Transverse colon Caecum Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback