GMDC MOCK 3 /80 26 Quiz 1 / 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 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? Post renal uraemia Injury to sacral nerve plexus Atonic bladder Hypovolaemia 3 / 80 For adequate and stable haemostasis the following should obtain: Retraction of the injured vessel Increased pressure within the injured vessel A minimum platelet count of 90,000 per mm3 Endothelial cell secretion of factor VIII 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: Myasthenia gravis Scleroderma Bulbar paralysis Diffuse spasm of the oesophageal muscles 5 / 80 Molding of the fetal head: Becomes progressively easier as gestational age increase. Does not happen when maternal pelvis is adequate. Usually cause brain damage. Does NOT have time to occur in breech delivery. Increase the difficulty of delivery. 6 / 80 This is not a cause of hypoglycaemia in newborns prematurity intrauterine growth retardate hypoinsulinaemia sepsis infant of a diabetic mother 7 / 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 8 / 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 Fracture of the olecranon process Monteggia fracture dislocation Supracondylar fracture 9 / 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 Drug induced Renal stone Urinary tract infection 10 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: None of the above. Lie. Presentation. Attitude. Position. 11 / 80 In burns: 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. There is initial vasodilatation followed by vasoconstriction in the burnt tissue. The increased capillary permeability is restricted to the burnt area. 12 / 80 Cause of ptosis include the following except tick paralysis 4th nerve palsy botulism myasthenia gravis horner syndrome 13 / 80 The following are treatment for simple malaria except dihydroartemisinin - lumefantrine artemether - lumefantrine dihydroartemisinin - piperaquine artesunate - amodiaquine oral quinine 14 / 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. 15 / 80 These are chronic complications associated with sickle cell disease except congestive heart failure priapism leg ulcers chronic lung disease aseptic necrosis of the hip or shoulder 16 / 80 Malignant degeneration of a healing wound is most likely to occur: When a patient is on cytotoxic agents. When a state of chronicity from (e.g) recurrent infection prevails. When iodophor antiseptics are used for dressing. When wounds are exposed to heat. 17 / 80 The prime cause of a venous leg ulcer is: Varicosity of the long (greater) saphenous vein High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins Stasis in the deep veins 18 / 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. Sub acute bacterial endocarditis Acute bacterial endocarditis Viral hepatitis 19 / 80 In bronchiolitis, all these are true except it's usually a self-limiting disease primarily affects children less than 2 years old drug of choice is acyclovir may present with with low grade fever most commonly caused by respiratory syncytial virus 20 / 80 Features found in nephrotic syndrome include the following EXCEPT: Normal renal function Oedema Hypoalbuminsemia Hypertriglyceridemia 21 / 80 The pelvis includes which of the following bones: Trochanter, hip socket, ischium, sacrum and pubis. Trochanter, sacrum, coccyx, ilium and pubis Sacrum, Tibia, ilium and pubis. Ilium, scapula, ischium and pubis. Ilium, ischium, pubis, sacrum and coccyx. 22 / 80 The following are contraindications for lumbar puncture except Acute spinal cord injury Raised intracranial pressure Coagulopathy Cervical spondylosis skin infection at or near the site of the lumbar puncture 23 / 80 On assessment of Semen Fluid Analysis: Abstinence should be maintained for 10 days prior to "production" of the sample Teratozoospermia indicates abnormal motility Azoospermia indicates a sperm count more than 5 million/ml Abstinence should be maintained for 3 days prior to production of the sample Asthenozoospermia indicates abnormal forms 24 / 80 Which of these discriptions adequately describe malena stools? Loose very shining black stools Dark stools Black tarry or sticky stools Black stools 25 / 80 Antenatal booking investigations include all of the following, EXCEPT: Thyroid function Complete blood count Stool routine examination Hepatitis screening Urine routine examination 26 / 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 27 / 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) Preoperative showering for the patient Glove puncture in the course of surgery Bacterial content of the wound at end of operation Age of the patient 28 / 80 The following are associated with oral candidiasis except; Lymphoma Retroviral infection Malignancy Glucose 6 Phosphate Dehydrogenase 29 / 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 pancreatitis Gastro-enteritis Acute gastritis Acute high intestinal obstruction 30 / 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? Tuberculosis Left ventricular failure Carcinoma of the bronchus Silicosis 31 / 80 The heart rate of a normal fetus at term is: 160-180 bpm. 120-160 bpm. 80-100 bpm. There is no baseline heart rate. 100-120 bpm. 32 / 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. Complex features is not a risk factor for recurrence Overall, 30% develop epilepsy 33 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Pioglitazone Glibenclamide DPP4 inhibitors Metformin 34 / 80 Adverse effects of corticosteroids include all EXCEPT Osteomalacia Avascular necrosis of the hip. Euphoria Cataract 35 / 80 The second stage of labour involves: Effacement of the cervix. Dilation of the cervix. Separation of the placenta. Expulsion of the fetus. Expulsion of the placenta. 36 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Intraductal comedo-carcinoma Chronic breast abscess Scirrhous breast carcinoma Duct ectasia 37 / 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) Emphysematous bullae Congital cyanotic heart disease Congenital cystic lung disease 38 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Aldosterone Thyroxine Nordrenaline Brain naturetic protein 39 / 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. Paralysis of lower facial muscles on the left. Motor aphasia May cause incontinence of urine 40 / 80 Which one of the drugs or measures do not worsen uraemia? Diarrhoea Paracetamol Gentamycin Hypotension 41 / 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 Watchful administration of adequate doses of systemic analgesic agent External fixation 42 / 80 Causes of macrocephaly include the following except fetal alcohol syndrome hydrocephalus thalassaemia mucopolysaccharidosis achondroplasia 43 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? 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 Worsen in missed abortion 44 / 80 In normal pregnancy, the value of ß-hCG doubles every: 10 days. 4 days. 14 days. 2 days. 8 days. 45 / 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 Streptococcus pneumoniae Mycoplasma pneumonia Klebsiella pneumoniae 46 / 80 Neonatal resuscitation chest compression is initiated when heart rate is below 100 bpm involves administration of iv aminophylline to preterms most effective action is ventilation of the baby's lungs atropine is administered when heart rate is below 100 bpm clearing airway preceeds keeping baby warm 47 / 80 Stages of labour The cervix dilates at consistent rate of 3 cm per hour in the first stage The first stage commences at the time of membrane rupture 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 third stage end with the delivery of the placenta and membranes 48 / 80 Which of the following is NOT a characteristic of normal labour: Moderate pain. Uterine relaxation between contractions. Moderate bleeding. Progressive cervical dilation. Increasing intensity of contractions. 49 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Acromian. Mentum. Sacrum. Sinciput. Occiput. 50 / 80 About severe acute malnutrition (SAM). There is usually unilateral pitting pedal oedema Hypoglycaemia is present when the blood glucose is <4mmol/l sensory stimulation is not helpful Diagnostic features include mid upper arm circumference < 115mm ORS is the fluid of choice for correcting dehydration 51 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Per vaginal bleeding may be one of the presenting symptom Patient may present with loss of the symptoms of pregnancy Ultrasound should be done to confirm the diagnosis Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Immediate evacuation should be done once the diagnosis is made 52 / 80 Facial features of fetal alcohol syndrome include the following except microcephaly smooth philtrum ptosis thick upper lip short palpebral tissue 53 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: 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. Through the tonsils to the cervical lymph nodes. 54 / 80 The features listed below may be associated with migraine headache EXCEPT Pulsatile or throbbing headache Photophobia. Neck stiffness may be present Nausea 55 / 80 These are causes of acute stridor except diphtheria laryngomalacia bacterial tracheitis croup acute epiglottitis 56 / 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 Anyone with hypertension, over 50 years and has cardiovascular risk of <20% over 20 years. All the answers below Any patient with severe hypertension and 50 years and cardiovascular disease 57 / 80 In intestinal obstruction at the sigmoid colon due to stenosis, perforation is most likely to occur in the Descending colon Caecum Terminal ileum Transverse colon 58 / 80 The most effective surgical procedure in stress ulceration is: Total gastrectomy Vogitomy and hemigastrectomy Polya partial gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points 59 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except breast milk jaundice galactosemia torch infections sepsis biliary atresia 60 / 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 ? Refer him to the specialist for investigations. 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 61 / 80 An ectopic pregnancy: Occurs only in the fallopian tubes Usually presents with pain before bleeding Can only be treated surgically Pain always presents before the bleeding Gives an increased risk of Hyperemisis Gravidarium 62 / 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. Positive Fern test. Observing amniotic fluid drain through the cervix during speculum examination. 63 / 80 The main tissues which provide support to the uterus include: Uterosacral ligaments and the Broad ligaments Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments Cardinal ligaments and the Uterosacral ligaments Perineal body and the Broad ligaments 64 / 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 Post renal obstruction Rapidly progressively glomerulonephriitis Renal artery stenosis 65 / 80 The thyroid gland in thyrotoxicosis: If primary is uniformly enlarged and rather soft or firm 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 66 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: April 7. March 23. March 28. March 27. April 23. 67 / 80 This is not true about autism it's characterised by restricted and repetitive behavior most cases have normal intelligence 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 68 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Associated with multiple pregnancy Is associated with urinary tract infection May be cured by admission to hospital Is commonest in the third trimester Is associated with trophoblastic disease 69 / 80 The commonest site for carcinoma of the tongue is the: Lateral margin Tip Dorsum Posterior one-third 70 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Placenta. Corpus albicans. Adrenal glands. Endometrium. Corpus luteum. 71 / 80 All these conditions cause hypokalemia in children except acute tubular necrosis gastroenteritis renal tubular acidosis type 1 frusemide pyloric stenosis 72 / 80 In hypopituitarism all these hormones may be deficient except Growth hormone Prolactin Follicle stimulating hormone Adrenocorticotropic hormone Cholecystokinin 73 / 80 The risk of postpartum uterine atony is associated with: Epidural anesthesia. Median episiotomy. Labour associated with an active rate of change of 1 cm per hour. Hypotension. Twin pregnancy. 74 / 80 These are gross motor skills except steadiness of head when placed in supported position stands alone walks up stairs with help transfers object from hand to hand sits with support 75 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. café - au-lait spots and neurofibromatosis cortical tuber in neurofibromatosis adenoma sebaceum and tuberous sclerosis port wine stain and sturge weber syndrome shagreen patch and tuberous sclerosis 76 / 80 Cause of neonatal seizures include the following except pyridoxine deficiency hypoxic ischaemic encephalopathy hypermagnesaemia intracranial hemorrhage bilirubin encephalopathy 77 / 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 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 body of the pancreas Carcinoma of the stomach Primary liver cell carcinoma 79 / 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 Is the commonest malignant tumour of the anus Bleeds but does not cause pain on defaecation 80 / 80 The following are causes of spastic paraparesis except; Potts disease Transverse myelitis Disc prolapse Guillain Barre syndrome Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback