GMDC MOCK 3 /80 26 Quiz 1 / 80 The prime cause of a venous leg ulcer is: Stasis in the deep veins High venous pressure in the leg veins generally Failure of valves of the perforating and deep veins Varicosity of the long (greater) saphenous vein 2 / 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? Streptococcus pneumoniae Klebsiella pneumoniae Mycoplasma pneumonia Staphylococcus aureus 3 / 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 Tuberculosis Carcinoma of the bronchus Left ventricular failure 4 / 80 The source of progesterone that maintains the pregnancy during early 1st trimester is: Corpus luteum. Placenta. Endometrium. Adrenal glands. Corpus albicans. 5 / 80 These are chronic complications associated with sickle cell disease except leg ulcers priapism congestive heart failure chronic lung disease aseptic necrosis of the hip or shoulder 6 / 80 In bronchiolitis, all these are true except may present with with low grade fever drug of choice is acyclovir primarily affects children less than 2 years old it's usually a self-limiting disease most commonly caused by respiratory syncytial virus 7 / 80 In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis: Occiput. Sacrum. Acromian. Sinciput. Mentum. 8 / 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 9 / 80 An ectopic pregnancy: Gives an increased risk of Hyperemisis Gravidarium Occurs only in the fallopian tubes Can only be treated surgically Pain always presents before the bleeding Usually presents with pain before bleeding 10 / 80 The second stage of labour involves: Separation of the placenta. Expulsion of the fetus. Expulsion of the placenta. Effacement of the cervix. Dilation of the cervix. 11 / 80 The management of retroexposed babies include PCR at 6 weeks of age cotrimoxazole at birth lamivudine and zidovudine for 6 weeks for high risk babies mixed feeding at 1 month zidovudine for six months 12 / 80 Malignant degeneration of a healing wound is most likely to occur: When a patient is on cytotoxic agents. When wounds are exposed to heat. When a state of chronicity from (e.g) recurrent infection prevails. When iodophor antiseptics are used for dressing. 13 / 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 14 / 80 Which of the following is not part of the criteria considered for CURB 65 used to determine the severity of community pneumonia. Confusion Respiratory rate> 30 per minute Diastolic pressure <60 mm Hg. Heart rate >100 15 / 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 Diffuse spasm of the oesophageal muscles Myasthenia gravis Scleroderma 16 / 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 ? Renal artery stenosis Acute tubular necrosis Rapidly progressively glomerulonephriitis Post renal obstruction 17 / 80 This is not a cause of hypoglycaemia in newborns infant of a diabetic mother intrauterine growth retardate hypoinsulinaemia prematurity sepsis 18 / 80 Stroke due involving the right middle cerebral artery pathology in most people usually causes the symptoms and signs below EXCEPT May cause incontinence of urine Paralysis of lower facial muscles on the left. Motor aphasia No effect on the muscles in the upper part of the face. 19 / 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 Increased pressure within the injured vessel Retraction of the injured vessel 20 / 80 Which of the of the following is a LEAST likely presentations of myocardial infarction ? Sharp piercing pain in the left which worsens with breathing Shock . No chest pain in an elderly female diabetic Severe crushing pain in the precordium 21 / 80 In burns: 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 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. 22 / 80 Causes of macrocephaly include the following except hydrocephalus achondroplasia mucopolysaccharidosis thalassaemia fetal alcohol syndrome 23 / 80 This is not true about autism 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 there is severe language and speech developmental disorder 24 / 80 Stages of labour 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) 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 25 / 80 The following are treatment for simple malaria except oral quinine dihydroartemisinin - lumefantrine artemether - lumefantrine artesunate - amodiaquine dihydroartemisinin - piperaquine 26 / 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 27 / 80 A bloody nipple discharge in a 35 year old West African is most likely to be caused by: Duct ectasia Intraductal comedo-carcinoma Chronic breast abscess Scirrhous breast carcinoma 28 / 80 Cause of neonatal seizures include the following except hypermagnesaemia intracranial hemorrhage pyridoxine deficiency bilirubin encephalopathy hypoxic ischaemic encephalopathy 29 / 80 Squamous cell carcinoma of the anus: Bleeds but does not cause pain on defaecation 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 30 / 80 In hypopituitarism all these hormones may be deficient except Follicle stimulating hormone Adrenocorticotropic hormone Prolactin Growth hormone Cholecystokinin 31 / 80 Antenatal booking investigations include all of the following, EXCEPT: Hepatitis screening Complete blood count Thyroid function Stool routine examination Urine routine examination 32 / 80 Facial features of fetal alcohol syndrome include the following except short palpebral tissue ptosis smooth philtrum thick upper lip microcephaly 33 / 80 In normal pregnancy, the value of ß-hCG doubles every: 10 days. 4 days. 8 days. 2 days. 14 days. 34 / 80 Cause of ptosis include the following except botulism tick paralysis myasthenia gravis 4th nerve palsy horner syndrome 35 / 80 These are causes of acute stridor except acute epiglottitis diphtheria croup bacterial tracheitis laryngomalacia 36 / 80 Which one of the drugs or measures do not worsen uraemia? Paracetamol Diarrhoea Hypotension Gentamycin 37 / 80 The risk of postpartum uterine atony is associated with: Hypotension. Twin pregnancy. Median episiotomy. Labour associated with an active rate of change of 1 cm per hour. Epidural anesthesia. 38 / 80 All these conditions cause hypokalemia in children except gastroenteritis acute tubular necrosis pyloric stenosis frusemide renal tubular acidosis type 1 39 / 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 high intestinal obstruction Acute gastritis Gastro-enteritis Acute pancreatitis 40 / 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 41 / 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 Acute renal failure Post-renal renal failure Pre-renal renal failure 42 / 80 The relationship of the long axis of the fetus to the long axis of the mother is called: Lie. Position. None of the above. Presentation. Attitude. 43 / 80 The following statement are all TRUE about vomiting in pregnancy, EXCEPT: Is commonest in the third trimester Associated with multiple pregnancy Is associated with trophoblastic disease Is associated with urinary tract infection May be cured by admission to hospital 44 / 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. 45 / 80 Adverse effects of corticosteroids include all EXCEPT Avascular necrosis of the hip. Cataract Osteomalacia Euphoria 46 / 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 rheumatic carditis. Acute bacterial endocarditis Viral hepatitis 47 / 80 Which of these pairs does not match with regards to neurocutaneous disorders. cortical tuber in neurofibromatosis port wine stain and sturge weber syndrome adenoma sebaceum and tuberous sclerosis shagreen patch and tuberous sclerosis café - au-lait spots and neurofibromatosis 48 / 80 The following are associated with oral candidiasis except; Retroviral infection Lymphoma Glucose 6 Phosphate Dehydrogenase Malignancy 49 / 80 Regarding Hyperemesis gravidarum, which one of the following items is TRUE? Is a complication of multiple pregnancy Not known to happen in molar pregnancy Liver function test is not required Worsen in missed abortion Urine for culture and sensitivity is not important 50 / 80 Neuro hormones which are activated in cardiac failure include all EXCEPT: Aldosterone Brain naturetic protein Thyroxine Nordrenaline 51 / 80 The commonest site for carcinoma of the tongue is the: Posterior one-third Dorsum Lateral margin Tip 52 / 80 All these conditions cause conjugated hyperbilirubinemia in newborns except sepsis biliary atresia galactosemia breast milk jaundice torch infections 53 / 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 Carcinoma of the body of the pancreas Primary liver cell carcinoma 54 / 80 The most common route of primary infection with Mycobacterium Tuberculosis is: 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. The genitourinary mucosa-urethra and bladder. 55 / 80 The features listed below may be associated with migraine headache EXCEPT Neck stiffness may be present Photophobia. Nausea Pulsatile or throbbing headache 56 / 80 The heart rate of a normal fetus at term is: 80-100 bpm. 160-180 bpm. There is no baseline heart rate. 100-120 bpm. 120-160 bpm. 57 / 80 Regarding missed abortion, all of the following are CORRECT, EXCEPT: Per vaginal bleeding may be one of the presenting symptom Immediate evacuation should be done once the diagnosis is made Ultrasound should be done to confirm the diagnosis Disseminated intra-vascular coagulation may occur as a sequele of missed abortion Patient may present with loss of the symptoms of pregnancy 58 / 80 Features found in nephrotic syndrome include the following EXCEPT: Normal renal function Oedema Hypertriglyceridemia Hypoalbuminsemia 59 / 80 Which of these discriptions adequately describe malena stools? Black stools Loose very shining black stools Black tarry or sticky stools Dark stools 60 / 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 61 / 80 Which of the following anti diabetic drugs increases insulin sensitivity? Glibenclamide Metformin Pioglitazone DPP4 inhibitors 62 / 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 Congenital cystic lung disease Congital cyanotic heart disease 63 / 80 About severe acute malnutrition (SAM). sensory stimulation is not helpful ORS is the fluid of choice for correcting dehydration There is usually unilateral pitting pedal oedema Diagnostic features include mid upper arm circumference < 115mm Hypoglycaemia is present when the blood glucose is <4mmol/l 64 / 80 The thyroid gland in thyrotoxicosis: Is enlarged in all patients so affected In over 95 percent has a thrill and a bruit over it If secondary is firm and multinodular in all patients If primary is uniformly enlarged and rather soft or firm 65 / 80 The most effective surgical procedure in stress ulceration is: Vogitomy and hemigastrectomy Total gastrectomy Vogotomy and pyloroplasty with suturing of bleeding points Polya partial gastrectomy 66 / 80 These are gross motor skills except walks up stairs with help transfers object from hand to hand stands alone sits with support steadiness of head when placed in supported position 67 / 80 The last menstrual period was June 20th. The expected date of delivery (EDD) is approximately: April 23. April 7. March 23. March 27. March 28. 68 / 80 Rupture of membranes is suspected with all of the followings EXCEPT: Observing amniotic fluid drain through the cervix during speculum examination. Positive Nitrazine test. Pooling of amniotic fluid on speculum examination. Contractions seen on the CTG. Positive Fern test. 69 / 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 Monteggia fracture dislocation Supracondylar fracture Fracture of the olecranon process 70 / 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. 71 / 80 Concerning febrile seizures They usually have a poor prognosis 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 Overall risk for recurrence is 3-4% 72 / 80 Neonatal resuscitation clearing airway preceeds keeping baby warm chest compression is initiated when heart rate is below 100 bpm involves administration of iv aminophylline to preterms atropine is administered when heart rate is below 100 bpm most effective action is ventilation of the baby's lungs 73 / 80 Which of the following patients should you prescribe aspirin if there is no contraindication. Select the MOST appropriate 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 All the answers below Any patient with hypertension and aged over 50 years 74 / 80 On assessment of Semen Fluid Analysis: Teratozoospermia indicates abnormal motility Azoospermia indicates a sperm count more than 5 million/ml 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 Asthenozoospermia indicates abnormal forms 75 / 80 Molding of the fetal head: Does NOT have time to occur in breech delivery. Becomes progressively easier as gestational age increase. Usually cause brain damage. Does not happen when maternal pelvis is adequate. Increase the difficulty of delivery. 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 Renal stone Urinary tract infection Haemolysis 77 / 80 The main tissues which provide support to the uterus include: Perineal body and the Broad ligaments Round ligament and the Broad ligaments Broad ligaments and the Uterosacral ligaments Uterosacral ligaments and the Broad ligaments Cardinal ligaments and the Uterosacral ligaments 78 / 80 The following are contraindications for lumbar puncture except skin infection at or near the site of the lumbar puncture Coagulopathy Raised intracranial pressure Acute spinal cord injury Cervical spondylosis 79 / 80 Which of the following is NOT a characteristic of normal labour: Progressive cervical dilation. Increasing intensity of contractions. Moderate pain. Uterine relaxation between contractions. Moderate bleeding. 80 / 80 The following are causes of spastic paraparesis except; Disc prolapse Guillain Barre syndrome Transverse myelitis Potts disease Your score is LinkedIn Facebook Twitter 0% Restart quiz Send feedback