GMDC MOCK 3 /80 26 Quiz 1 / 80 The main tissues which provide support to the uterus include: Broad ligaments and the Uterosacral ligaments Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments Round ligament and the Broad ligaments 2 / 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 Left ventricular failure Carcinoma of the bronchus Tuberculosis 3 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Immediate evacuation should be done once the diagnosis is made 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 Disseminated intra-vascular coagulation may occur as a sequele of missed abortion 4 / 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 5 / 80 Molding of the fetal head: Does NOT have time to occur in breech delivery. Usually cause brain damage. Increase the difficulty of delivery. Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. 6 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Scirrhous breast carcinoma Duct ectasia Chronic breast abscess Intraductal comedo-carcinoma 7 / 80 The prime cause of a venous leg ulcer is: Stasis in the deep veins Varicosity of the long (greater) saphenous vein High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins 8 / 80 An ectopic pregnancy: Can only be treated surgically Usually presents with pain before bleeding Gives an increased risk of Hyperemisis Gravidarium Occurs only in the fallopian tubes Pain always presents before the bleeding 9 / 80 Antenatal booking investigations include all of the following, EXCEPT: Stool routine examination Urine routine examination Thyroid function Complete blood count Hepatitis screening 10 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Placenta. Corpus luteum. Endometrium. Adrenal glands. Corpus albicans. 11 / 80 Causes of macrocephaly include the following except fetal alcohol syndrome thalassaemia hydrocephalus mucopolysaccharidosis achondroplasia 12 / 80 Which of the following is NOT a characteristic of normal labour: Moderate pain. Progressive cervical dilation. Moderate bleeding. Uterine relaxation between contractions. Increasing intensity of contractions. 13 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Via the payer's patches to the mesenteric lymph nodes. The genitourinary mucosa-urethra and bladder. Directly to the lung tissue establishing a Primary Complex (Gohn focus) Through the tonsils to the cervical lymph nodes. 14 / 80 Stroke due involving the right middle cerebral artery pathology in most people usually causes the symptoms and signs below EXCEPT Motor aphasia May cause incontinence of urine No effect on the muscles in the upper part of the face. Paralysis of lower facial muscles on the left. 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 Age of the patient Preoperative showering for the patient 16 / 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 17 / 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 18 / 80 Stages of labour The first stage commences at the time of membrane rupture 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) 19 / 80 The management of retroexposed babies include zidovudine for six months cotrimoxazole at birth lamivudine and zidovudine for 6 weeks for high risk babies PCR at 6 weeks of age mixed feeding at 1 month 20 / 80 The following are causes of spastic paraparesis except; Disc prolapse Potts disease Guillain Barre syndrome Transverse myelitis 21 / 80 These are causes of acute stridor except diphtheria laryngomalacia bacterial tracheitis croup acute epiglottitis 22 / 80 Adverse effects of corticosteroids include all EXCEPT Osteomalacia Euphoria Cataract Avascular necrosis of the hip. 23 / 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. 24 / 80 The second stage of labour involves: Effacement of the cervix. Expulsion of the fetus. Separation of the placenta. Dilation of the cervix. Expulsion of the placenta. 25 / 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 26 / 80 Cause of ptosis include the following except horner syndrome 4th nerve palsy tick paralysis botulism myasthenia gravis 27 / 80 Neonatal resuscitation clearing airway preceeds keeping baby warm chest compression is initiated when heart rate is below 100 bpm most effective action is ventilation of the baby's lungs involves administration of iv aminophylline to preterms atropine is administered when heart rate is below 100 bpm 28 / 80 The commonest site for carcinoma of the tongue is the: Lateral margin Posterior one-third Tip Dorsum 29 / 80 These are gross motor skills except steadiness of head when placed in supported position stands alone sits with support transfers object from hand to hand walks up stairs with help 30 / 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 31 / 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 32 / 80 The following are contraindications for lumbar puncture except Coagulopathy skin infection at or near the site of the lumbar puncture Raised intracranial pressure Acute spinal cord injury Cervical spondylosis 33 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Acromian. Mentum. Occiput. Sacrum. Sinciput. 34 / 80 The most effective surgical procedure in stress ulceration is: Vogotomy and pyloroplasty with suturing of bleeding points Polya partial gastrectomy Total gastrectomy Vogitomy and hemigastrectomy 35 / 80 For adequate and stable haemostasis the following should obtain: Increased pressure within the injured vessel Endothelial cell secretion of factor VIII Retraction of the injured vessel A minimum platelet count of 90,000 per mm3 36 / 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 Scleroderma Diffuse spasm of the oesophageal muscles Bulbar paralysis 37 / 80 Cause of neonatal seizures include the following except intracranial hemorrhage hypermagnesaemia hypoxic ischaemic encephalopathy pyridoxine deficiency bilirubin encephalopathy 38 / 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 39 / 80 The following are treatment for simple malaria except artesunate - amodiaquine artemether - lumefantrine dihydroartemisinin - piperaquine oral quinine dihydroartemisinin - lumefantrine 40 / 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? Viral hepatitis Acute bacterial endocarditis Sub acute bacterial endocarditis Acute rheumatic carditis. 41 / 80 This is not true about autism commoner in males than in females with a male:female ratio of 3:1 there is severe language and speech developmental disorder it is pervasive developmental disorder it's characterised by restricted and repetitive behavior most cases have normal intelligence 42 / 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 43 / 80 Malignant degeneration of a healing wound is most likely to occur: When iodophor antiseptics are used for dressing. When wounds are exposed to heat. When a patient is on cytotoxic agents. When a state of chronicity from (e.g) recurrent infection prevails. 44 / 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 postero-lateral diaphragmatic hernia (stabilized) Emphysematous bullae Congenital cystic lung disease 45 / 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. 46 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Liver function test is not required Worsen in missed abortion Urine for culture and sensitivity is not important Is a complication of multiple pregnancy Not known to happen in molar pregnancy 47 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except galactosemia sepsis breast milk jaundice torch infections biliary atresia 48 / 80 These are chronic complications associated with sickle cell disease except congestive heart failure aseptic necrosis of the hip or shoulder leg ulcers chronic lung disease priapism 49 / 80 The heart rate of a normal fetus at term is: 160-180 bpm. There is no baseline heart rate. 120-160 bpm. 80-100 bpm. 100-120 bpm. 50 / 80 On assessment of Semen Fluid Analysis: Asthenozoospermia indicates abnormal forms Teratozoospermia indicates abnormal motility Abstinence should be maintained for 3 days prior to production of the sample Azoospermia indicates a sperm count more than 5 million/ml Abstinence should be maintained for 10 days prior to "production" of the sample 51 / 80 Features found in nephrotic syndrome include the following EXCEPT: Hypoalbuminsemia Normal renal function Hypertriglyceridemia Oedema 52 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Descending colon Terminal ileum Caecum Transverse colon 53 / 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 Post-renal renal failure Pre-renal renal failure Acute tubular necrosis 54 / 80 Which one of the drugs or measures do not worsen uraemia? Gentamycin Paracetamol Diarrhoea Hypotension 55 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is associated with trophoblastic disease May be cured by admission to hospital Is associated with urinary tract infection Is commonest in the third trimester Associated with multiple pregnancy 56 / 80 In normal pregnancy, the value of ß-hCG doubles every: 2 days. 14 days. 10 days. 4 days. 8 days. 57 / 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 Respiratory rate> 30 per minute Confusion 58 / 80 About severe acute malnutrition (SAM). There is usually unilateral pitting pedal oedema ORS is the fluid of choice for correcting dehydration sensory stimulation is not helpful Diagnostic features include mid upper arm circumference < 115mm Hypoglycaemia is present when the blood glucose is <4mmol/l 59 / 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 Encysted hydrocele of the cord Sebaceous cyst of the scrotum 60 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: None of the above. Presentation. Attitude. Lie. Position. 61 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Nordrenaline Thyroxine Brain naturetic protein Aldosterone 62 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Pioglitazone Metformin Glibenclamide DPP4 inhibitors 63 / 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 Supracondylar fracture Dislocation of the elbow Fracture of the olecranon process 64 / 80 In bronchiolitis, all these are true except most commonly caused by respiratory syncytial virus it's usually a self-limiting disease primarily affects children less than 2 years old may present with with low grade fever drug of choice is acyclovir 65 / 80 The risk of postpartum uterine atony is associated with: Hypotension. Twin pregnancy. Labour associated with an active rate of change of 1 cm per hour. Epidural anesthesia. Median episiotomy. 66 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? Shock . Severe crushing pain in the precordium Sharp piercing pain in the left which worsens with breathing No chest pain in an elderly female diabetic 67 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 23. March 27. March 28. April 23. April 7. 68 / 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 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. 69 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. shagreen patch and tuberous sclerosis cortical tuber in neurofibromatosis adenoma sebaceum and tuberous sclerosis café - au-lait spots and neurofibromatosis port wine stain and sturge weber syndrome 70 / 80 In hypopituitarism all these hormones may be deficient except Adrenocorticotropic hormone Growth hormone Cholecystokinin Prolactin Follicle stimulating hormone 71 / 80 The following are associated with oral candidiasis except; Malignancy Retroviral infection Lymphoma Glucose 6 Phosphate Dehydrogenase 72 / 80 Concerning febrile seizures Overall, 30% develop epilepsy 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. They usually have a poor prognosis 73 / 80 All these conditions cause hypokalemia in children except pyloric stenosis acute tubular necrosis gastroenteritis frusemide renal tubular acidosis type 1 74 / 80 Which of these discriptions adequately describe malena stools? Dark stools Loose very shining black stools Black tarry or sticky stools Black stools 75 / 80 The pelvis includes which of the following bones: Trochanter, hip socket, ischium, sacrum and pubis. Trochanter, sacrum, coccyx, ilium and pubis Ilium, ischium, pubis, sacrum and coccyx. Ilium, scapula, ischium and pubis. Sacrum, Tibia, ilium and pubis. 76 / 80 Facial features of fetal alcohol syndrome include the following except thick upper lip smooth philtrum short palpebral tissue ptosis microcephaly 77 / 80 This is not a cause of hypoglycaemia in newborns hypoinsulinaemia infant of a diabetic mother intrauterine growth retardate sepsis prematurity 78 / 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 Amoebic liver abscess Carcinoma of the stomach Primary liver cell carcinoma Carcinoma of the body of the pancreas 79 / 80 Which of the following patients should you prescribe aspirin if there is no contraindication. Select the MOST appropriate All the answers below Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. Any patient with hypertension and aged over 50 years Any patient with severe hypertension and 50 years and cardiovascular disease 80 / 80 The features listed below may be associated with migraine headache EXCEPT Photophobia. Nausea Neck stiffness may be present Pulsatile or throbbing headache Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback