GMDC MOCK 3 /80 26 Quiz 1 / 80 Cause of ptosis include the following except horner syndrome 4th nerve palsy tick paralysis botulism myasthenia gravis 2 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is commonest in the third trimester Is associated with urinary tract infection May be cured by admission to hospital Associated with multiple pregnancy Is associated with trophoblastic disease 3 / 80 The heart rate of a normal fetus at term is: 160-180 bpm. 100-120 bpm. 80-100 bpm. There is no baseline heart rate. 120-160 bpm. 4 / 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 5 / 80 Which one of the drugs or measures do not worsen uraemia? Paracetamol Gentamycin Hypotension Diarrhoea 6 / 80 All these conditions cause hypokalemia in children except frusemide pyloric stenosis acute tubular necrosis renal tubular acidosis type 1 gastroenteritis 7 / 80 The main tissues which provide support to the uterus include: Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Round ligament and the Broad ligaments Perineal body and the Broad ligaments Broad ligaments and the Uterosacral ligaments 8 / 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 9 / 80 In normal pregnancy, the value of ß-hCG doubles every: 14 days. 4 days. 8 days. 10 days. 2 days. 10 / 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 Blockage of the appropriate intercostal nerve and active physiotherapy Watchful administration of adequate doses of systemic analgesic agent Strapping of the affected side of the chest 11 / 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 There is usually unilateral pitting pedal oedema sensory stimulation is not helpful 12 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except biliary atresia galactosemia breast milk jaundice sepsis torch infections 13 / 80 The following are contraindications for lumbar puncture except skin infection at or near the site of the lumbar puncture Cervical spondylosis Acute spinal cord injury Raised intracranial pressure Coagulopathy 14 / 80 Neonatal resuscitation atropine is administered when heart rate is below 100 bpm involves administration of iv aminophylline to preterms most effective action is ventilation of the baby's lungs chest compression is initiated when heart rate is below 100 bpm clearing airway preceeds keeping baby warm 15 / 80 The following are treatment for simple malaria except artemether - lumefantrine artesunate - amodiaquine oral quinine dihydroartemisinin - piperaquine dihydroartemisinin - lumefantrine 16 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Contractions seen on the CTG. Pooling of amniotic fluid on speculum examination. Positive Nitrazine test. Observing amniotic fluid drain through the cervix during speculum examination. Positive Fern test. 17 / 80 Stages of labour 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 The third stage end with the delivery of the placenta and membranes 18 / 80 The prime cause of a venous leg ulcer is: High venous pressure in the leg veins generally Stasis in the deep veins Failure of valves of the perforating and deep veins Varicosity of the long (greater) saphenous vein 19 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. café - au-lait spots and neurofibromatosis adenoma sebaceum and tuberous sclerosis port wine stain and sturge weber syndrome shagreen patch and tuberous sclerosis cortical tuber in neurofibromatosis 20 / 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 severe hypertension and 50 years and cardiovascular disease Any patient with hypertension and aged over 50 years Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. 21 / 80 The most effective surgical procedure in stress ulceration is: Vogitomy and hemigastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Total gastrectomy Polya partial gastrectomy 22 / 80 On assessment of Semen Fluid Analysis: Azoospermia indicates a sperm count more than 5 million/ml Teratozoospermia indicates abnormal motility Abstinence should be maintained for 10 days prior to "production" of the sample Asthenozoospermia indicates abnormal forms Abstinence should be maintained for 3 days prior to production of the sample 23 / 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: Bulbar paralysis Scleroderma Myasthenia gravis Diffuse spasm of the oesophageal muscles 24 / 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. Acute bacterial endocarditis Viral hepatitis Sub acute bacterial endocarditis 25 / 80 Features found in nephrotic syndrome include the following EXCEPT: Normal renal function Hypertriglyceridemia Oedema Hypoalbuminsemia 26 / 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 it's characterised by restricted and repetitive behavior it is pervasive developmental disorder there is severe language and speech developmental disorder 27 / 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? Silicosis Carcinoma of the bronchus Left ventricular failure Tuberculosis 28 / 80 In bronchiolitis, all these are true except drug of choice is acyclovir primarily affects children less than 2 years old it's usually a self-limiting disease may present with with low grade fever most commonly caused by respiratory syncytial virus 29 / 80 The pelvis includes which of the following bones: Ilium, ischium, pubis, sacrum and coccyx. Ilium, scapula, ischium and pubis. Sacrum, Tibia, ilium and pubis. Trochanter, sacrum, coccyx, ilium and pubis Trochanter, hip socket, ischium, sacrum and pubis. 30 / 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 Monteggia fracture dislocation Fracture of the olecranon process Dislocation of the elbow Supracondylar fracture 31 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Brain naturetic protein Thyroxine Aldosterone Nordrenaline 32 / 80 These are chronic complications associated with sickle cell disease except leg ulcers congestive heart failure chronic lung disease aseptic necrosis of the hip or shoulder priapism 33 / 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 Preoperative showering for the patient Age of the patient 34 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Is a complication of multiple pregnancy Liver function test is not required Not known to happen in molar pregnancy Urine for culture and sensitivity is not important Worsen in missed abortion 35 / 80 The features listed below may be associated with migraine headache EXCEPT Neck stiffness may be present Nausea Pulsatile or throbbing headache Photophobia. 36 / 80 This is not a cause of hypoglycaemia in newborns intrauterine growth retardate hypoinsulinaemia infant of a diabetic mother sepsis prematurity 37 / 80 The management of retroexposed babies include mixed feeding at 1 month lamivudine and zidovudine for 6 weeks for high risk babies cotrimoxazole at birth zidovudine for six months PCR at 6 weeks of age 38 / 80 The second stage of labour involves: Effacement of the cervix. Dilation of the cervix. Expulsion of the placenta. Separation of the placenta. Expulsion of the fetus. 39 / 80 Antenatal booking investigations include all of the following, EXCEPT: Urine routine examination Hepatitis screening Stool routine examination Complete blood count Thyroid function 40 / 80 In hypopituitarism all these hormones may be deficient except Cholecystokinin Adrenocorticotropic hormone Prolactin Growth hormone Follicle stimulating hormone 41 / 80 These are causes of acute stridor except laryngomalacia croup bacterial tracheitis diphtheria acute epiglottitis 42 / 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 Drug induced Haemolysis Renal stone 43 / 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 44 / 80 Causes of macrocephaly include the following except fetal alcohol syndrome hydrocephalus mucopolysaccharidosis achondroplasia thalassaemia 45 / 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 46 / 80 Adverse effects of corticosteroids include all EXCEPT Euphoria Osteomalacia Cataract Avascular necrosis of the hip. 47 / 80 Which of the following is NOT a characteristic of normal labour: Increasing intensity of contractions. Moderate bleeding. Progressive cervical dilation. Uterine relaxation between contractions. Moderate pain. 48 / 80 Facial features of fetal alcohol syndrome include the following except ptosis thick upper lip smooth philtrum short palpebral tissue microcephaly 49 / 80 The risk of postpartum uterine atony is associated with: Median episiotomy. Labour associated with an active rate of change of 1 cm per hour. Epidural anesthesia. Hypotension. Twin pregnancy. 50 / 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 51 / 80 For adequate and stable haemostasis the following should obtain: A minimum platelet count of 90,000 per mm3 Endothelial cell secretion of factor VIII Retraction of the injured vessel Increased pressure within the injured vessel 52 / 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 Diastolic pressure <60 mm Hg. Heart rate >100 Confusion 53 / 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? Cyst of the epididymis Irreducible incomplete inguinal hernia, probably containing omentum Sebaceous cyst of the scrotum Encysted hydrocele of the cord 54 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 28. April 23. March 23. April 7. March 27. 55 / 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 a patient is on cytotoxic agents. When wounds are exposed to heat. 56 / 80 Cause of neonatal seizures include the following except pyridoxine deficiency intracranial hemorrhage hypoxic ischaemic encephalopathy bilirubin encephalopathy hypermagnesaemia 57 / 80 Which of these discriptions adequately describe malena stools? Dark stools Black tarry or sticky stools Loose very shining black stools Black stools 58 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus albicans. Placenta. Adrenal glands. Corpus luteum. Endometrium. 59 / 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 60 / 80 An ectopic pregnancy: Occurs only in the fallopian tubes Can only be treated surgically Usually presents with pain before bleeding Pain always presents before the bleeding Gives an increased risk of Hyperemisis Gravidarium 61 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? Shock . Severe crushing pain in the precordium No chest pain in an elderly female diabetic Sharp piercing pain in the left which worsens with breathing 62 / 80 Squamous cell carcinoma of the anus: 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 Bleeds but does not cause pain on defaecation 63 / 80 The commonest site for carcinoma of the tongue is the: Lateral margin Tip Dorsum Posterior one-third 64 / 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) 65 / 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 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 66 / 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 Pre-renal renal failure Acute tubular necrosis Acute renal failure 67 / 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 Injury to sacral nerve plexus Post renal uraemia Hypovolaemia 68 / 80 The following are associated with oral candidiasis except; Lymphoma Malignancy Glucose 6 Phosphate Dehydrogenase Retroviral infection 69 / 80 Concerning febrile seizures 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% Overall, 30% develop epilepsy 70 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Attitude. Position. Lie. None of the above. Presentation. 71 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Mentum. Occiput. Sacrum. Sinciput. Acromian. 72 / 80 Molding of the fetal head: Usually cause brain damage. Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. Increase the difficulty of delivery. Does NOT have time to occur in breech delivery. 73 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: 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) Via the payer's patches to the mesenteric lymph nodes. 74 / 80 The following are causes of spastic paraparesis except; Disc prolapse Potts disease Transverse myelitis Guillain Barre syndrome 75 / 80 Stroke due involving the right middle cerebral artery pathology in most people usually causes the symptoms and signs below EXCEPT Motor aphasia Paralysis of lower facial muscles on the left. May cause incontinence of urine No effect on the muscles in the upper part of the face. 76 / 80 In burns: There is initial vasodilatation followed by vasoconstriction in the burnt tissue. 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. The maximum oedema fluid obtainable is about 10% of the body weight or 50% of total E.C.F. 77 / 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 Staphylococcus aureus Mycoplasma pneumonia Streptococcus pneumoniae 78 / 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 79 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Glibenclamide DPP4 inhibitors Metformin Pioglitazone 80 / 80 These are gross motor skills except stands alone sits with support steadiness of head when placed in supported position transfers object from hand to hand walks up stairs with help Your score is LinkedIn Facebook VKontakte 0% Restart quiz Send feedback