GMDC MOCK 3 /80 26 Quiz 1 / 80 Molding of the fetal head: Usually cause brain damage. Does not happen when maternal pelvis is adequate. Does NOT have time to occur in breech delivery. Increase the difficulty of delivery. Becomes progressively easier as gestational age increase. 2 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? 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 Liver function test is not required 3 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Transverse colon Descending colon Caecum Terminal ileum 4 / 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 Scleroderma Myasthenia gravis Bulbar paralysis 5 / 80 Concerning febrile seizures They usually have a poor prognosis Overall risk for recurrence is 3-4% Main risk factor for recurrence is the temperature at time of seizure. Overall, 30% develop epilepsy Complex features is not a risk factor for recurrence 6 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except sepsis biliary atresia breast milk jaundice torch infections galactosemia 7 / 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: Pre-renal renal failure Post-renal renal failure Acute renal failure Acute tubular necrosis 8 / 80 The prime cause of a venous leg ulcer is: Stasis in the deep veins Failure of valves of the perforating and deep veins Varicosity of the long (greater) saphenous vein High venous pressure in the leg veins generally 9 / 80 The second stage of labour involves: Expulsion of the fetus. Dilation of the cervix. Separation of the placenta. Expulsion of the placenta. Effacement of the cervix. 10 / 80 An ectopic pregnancy: Pain always presents before the bleeding Usually presents with pain before bleeding Can only be treated surgically Gives an increased risk of Hyperemisis Gravidarium Occurs only in the fallopian tubes 11 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Placenta. Corpus albicans. Endometrium. Adrenal glands. Corpus luteum. 12 / 80 These are chronic complications associated with sickle cell disease except leg ulcers chronic lung disease priapism aseptic necrosis of the hip or shoulder congestive heart failure 13 / 80 The heart rate of a normal fetus at term is: 120-160 bpm. 100-120 bpm. 160-180 bpm. There is no baseline heart rate. 80-100 bpm. 14 / 80 Causes of macrocephaly include the following except thalassaemia mucopolysaccharidosis hydrocephalus achondroplasia fetal alcohol syndrome 15 / 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. 16 / 80 In normal pregnancy, the value of ß-hCG doubles every: 2 days. 14 days. 10 days. 4 days. 8 days. 17 / 80 Stages of labour The first stage commences at the time of membrane rupture Syntometrine is a combination of oxytocin and Ergometrine which is used in the treatment of secondary postpartum haemorrhage (PPH) Forceps or ventose may be useful in slow progress of the late 1st stage 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 18 / 80 The commonest site for carcinoma of the tongue is the: Posterior one-third Lateral margin Tip Dorsum 19 / 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 Renal artery stenosis Post renal obstruction Acute tubular necrosis 20 / 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 Amoebic liver abscess Primary liver cell carcinoma Carcinoma of the body of the pancreas 21 / 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 Age of the patient Glove puncture in the course of surgery Preoperative showering for the patient 22 / 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 23 / 80 These are causes of acute stridor except acute epiglottitis bacterial tracheitis diphtheria croup laryngomalacia 24 / 80 This is not true about autism commoner in males than in females with a male:female ratio of 3:1 most cases have normal intelligence there is severe language and speech developmental disorder it is pervasive developmental disorder it's characterised by restricted and repetitive behavior 25 / 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 26 / 80 Facial features of fetal alcohol syndrome include the following except thick upper lip microcephaly short palpebral tissue ptosis smooth philtrum 27 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Intraductal comedo-carcinoma Duct ectasia Chronic breast abscess Scirrhous breast carcinoma 28 / 80 Adverse effects of corticosteroids include all EXCEPT Avascular necrosis of the hip. Cataract Euphoria Osteomalacia 29 / 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 30 / 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 31 / 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 Dislocation of the elbow Supracondylar fracture Fracture of the olecranon process Monteggia fracture dislocation 32 / 80 About severe acute malnutrition (SAM). 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 ORS is the fluid of choice for correcting dehydration 33 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Metformin DPP4 inhibitors Glibenclamide Pioglitazone 34 / 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? Sebaceous cyst of the scrotum Encysted hydrocele of the cord Cyst of the epididymis Irreducible incomplete inguinal hernia, probably containing omentum 35 / 80 Cause of ptosis include the following except botulism horner syndrome 4th nerve palsy tick paralysis myasthenia gravis 36 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: Directly to the lung tissue establishing a Primary Complex (Gohn focus) The genitourinary mucosa-urethra and bladder. Through the tonsils to the cervical lymph nodes. Via the payer's patches to the mesenteric lymph nodes. 37 / 80 The risk of postpartum uterine atony is associated with: Twin pregnancy. Hypotension. Epidural anesthesia. Median episiotomy. Labour associated with an active rate of change of 1 cm per hour. 38 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: March 27. March 28. April 23. April 7. March 23. 39 / 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 Respiratory rate> 30 per minute Confusion Diastolic pressure <60 mm Hg. 40 / 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 cystic lung disease Emphysematous bullae Congital cyanotic heart disease Congenital postero-lateral diaphragmatic hernia (stabilized) 41 / 80 The pelvis includes which of the following bones: Trochanter, sacrum, coccyx, ilium and pubis Ilium, ischium, pubis, sacrum and coccyx. Ilium, scapula, ischium and pubis. Sacrum, Tibia, ilium and pubis. Trochanter, hip socket, ischium, sacrum and pubis. 42 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Attitude. Presentation. Lie. None of the above. Position. 43 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Positive Fern test. Pooling of amniotic fluid on speculum examination. Positive Nitrazine test. Contractions seen on the CTG. Observing amniotic fluid drain through the cervix during speculum examination. 44 / 80 Squamous cell carcinoma of the anus: Is treated by abdomino-perineal resection of the rectum and anus in all patients Usually presents as a localized ulcer with sloping edges Bleeds but does not cause pain on defaecation Is the commonest malignant tumour of the anus 45 / 80 The following are contraindications for lumbar puncture except Raised intracranial pressure Coagulopathy Acute spinal cord injury skin infection at or near the site of the lumbar puncture Cervical spondylosis 46 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: May be cured by admission to hospital Associated with multiple pregnancy Is associated with trophoblastic disease Is associated with urinary tract infection Is commonest in the third trimester 47 / 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. 48 / 80 Features found in nephrotic syndrome include the following EXCEPT: Oedema Normal renal function Hypertriglyceridemia Hypoalbuminsemia 49 / 80 The management of retroexposed babies include zidovudine for six months cotrimoxazole at birth PCR at 6 weeks of age mixed feeding at 1 month lamivudine and zidovudine for 6 weeks for high risk babies 50 / 80 The most effective surgical procedure in stress ulceration is: Total gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Vogitomy and hemigastrectomy Polya partial gastrectomy 51 / 80 In burns: 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. 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. 52 / 80 Antenatal booking investigations include all of the following, EXCEPT: Stool routine examination Urine routine examination Hepatitis screening Thyroid function Complete blood count 53 / 80 On assessment of Semen Fluid Analysis: Asthenozoospermia indicates abnormal forms Teratozoospermia indicates abnormal motility 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 Azoospermia indicates a sperm count more than 5 million/ml 54 / 80 Which of these discriptions adequately describe malena stools? Black tarry or sticky stools Dark stools Loose very shining black stools Black stools 55 / 80 Which of the following is NOT a characteristic of normal labour: Moderate bleeding. Increasing intensity of contractions. Uterine relaxation between contractions. Progressive cervical dilation. Moderate pain. 56 / 80 This is not a cause of hypoglycaemia in newborns hypoinsulinaemia infant of a diabetic mother intrauterine growth retardate sepsis prematurity 57 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Ultrasound should be done to confirm the diagnosis Immediate evacuation should be done once the diagnosis is made Patient may present with loss of the symptoms of pregnancy Per vaginal bleeding may be one of the presenting symptom 58 / 80 The following are treatment for simple malaria except dihydroartemisinin - lumefantrine oral quinine dihydroartemisinin - piperaquine artemether - lumefantrine artesunate - amodiaquine 59 / 80 The following are causes of spastic paraparesis except; Transverse myelitis Disc prolapse Guillain Barre syndrome Potts disease 60 / 80 All these conditions cause hypokalemia in children except gastroenteritis pyloric stenosis renal tubular acidosis type 1 acute tubular necrosis frusemide 61 / 80 The features listed below may be associated with migraine headache EXCEPT Nausea Photophobia. Neck stiffness may be present Pulsatile or throbbing headache 62 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Sacrum. Occiput. Sinciput. Mentum. Acromian. 63 / 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 64 / 80 The following are associated with oral candidiasis except; Glucose 6 Phosphate Dehydrogenase Malignancy Lymphoma Retroviral infection 65 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. shagreen patch and tuberous sclerosis café - au-lait spots and neurofibromatosis port wine stain and sturge weber syndrome adenoma sebaceum and tuberous sclerosis cortical tuber in neurofibromatosis 66 / 80 The main tissues which provide support to the uterus include: Round ligament and the Broad ligaments Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments Broad ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments 67 / 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 Paralysis of lower facial muscles on the left. No effect on the muscles in the upper part of the face. 68 / 80 Cause of neonatal seizures include the following except intracranial hemorrhage pyridoxine deficiency hypoxic ischaemic encephalopathy hypermagnesaemia bilirubin encephalopathy 69 / 80 The thyroid gland in thyrotoxicosis: If secondary is firm and multinodular in all patients Is enlarged in all patients so affected In over 95 percent has a thrill and a bruit over it If primary is uniformly enlarged and rather soft or firm 70 / 80 For adequate and stable haemostasis the following should obtain: Increased pressure within the injured vessel Retraction of the injured vessel Endothelial cell secretion of factor VIII A minimum platelet count of 90,000 per mm3 71 / 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: Blockage of the appropriate intercostal nerve and active physiotherapy Strapping of the affected side of the chest Watchful administration of adequate doses of systemic analgesic agent External fixation 72 / 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 Gastro-enteritis Acute high intestinal obstruction Acute pancreatitis 73 / 80 Which one of the drugs or measures do not worsen uraemia? Diarrhoea Paracetamol Hypotension Gentamycin 74 / 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 75 / 80 In bronchiolitis, all these are true except it's usually a self-limiting disease may present with with low grade fever most commonly caused by respiratory syncytial virus primarily affects children less than 2 years old drug of choice is acyclovir 76 / 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? Drug induced Urinary tract infection Haemolysis Renal stone 77 / 80 These are gross motor skills except walks up stairs with help sits with support steadiness of head when placed in supported position stands alone transfers object from hand to hand 78 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Prolactin Follicle stimulating hormone Cholecystokinin Adrenocorticotropic hormone 79 / 80 Neonatal resuscitation clearing airway preceeds keeping baby warm chest compression is initiated when heart rate is below 100 bpm 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 80 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Brain naturetic protein Nordrenaline Aldosterone Thyroxine Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback