MDC Questions

Question 1

A 60-year old Ghanaian man presents with a 3-month history of vague dyspepsia lassitude,
breathlessness, pallor, diarrheoa and weight loss. He is most likely to be suffering from:

a. Amoebic colitis
b. Diverticular diseases of the colon
c. Carcinoma of the right colon
d. Intestinal lymphogranuloma
e. Ulcerative colitis

Answer 1

A classic medical question!

Based on the symptoms presented, the most likely diagnosis is:

c. Carcinoma of the right colon

Here’s why:

• Vague dyspepsia, lassitude, and weight loss are non-specific symptoms that can be associated with various conditions, including malignancies.
• Breathlessness and pallor suggest anemia, which is a common complication of colorectal cancer due to chronic blood loss.
• Diarrhea can occur in colorectal cancer, especially if the tumor is located in the right colon, which can cause an imbalance in bowel habits.

The other options are less likely based on the symptoms:

• Amoebic colitis (a) typically presents with bloody diarrhea and abdominal pain.
• Diverticular disease of the colon (b) usually presents with left-sided abdominal pain and changes in bowel habits.
• Intestinal lymphogranuloma (d) is a rare condition that typically presents with intestinal obstruction, abdominal pain, and weight loss.
• Ulcerative colitis (e) typically presents with bloody diarrhea, abdominal pain, and weight loss, with a more acute onset than described in this scenario.

Please note that this is a hypothetical diagnosis and a thorough medical evaluation, including diagnostic tests such as colonoscopy, imaging studies, and laboratory tests, would be necessary to confirm the diagnosis.

Question 2

. A 55-year old Ghananian man present to you with a 2-week history of a mass in the left iliac fossa. He also complains of a history of passing bloody mucoid stools.

a. You would recommend sigmoid colectomy as a first step
b. You would advise pre-operative radiotherapy
c. You would prescribe a 5-day course of metronidazole initially
d. you would prescribe oral sulphasalazine
e. You would recommend a single oral dose of praziquantel 50mg/kg body weight.

Answer 2

C

Question 3

3. A 25-year old man is admitted with a 24-hour history of colicky abdominal pain, vomiting, abdominal distension and absolute constipation. He has a history of laparotomy for typhoid perforation a year ago.

a. You would prepare him for immediate laparotomy
b. You would prescribe pethidine 6 hourly and manage him conservatively
c. You would request an abdominal ultrasound scan to aid the diagnosis
d. The presence of a constant abdominal pain is a sign of strangulation
e. You would instruct the nurses to give him fan enema to relieve his symptoms

Answer 3

E

Question 4

In the management of peptic ulcer disease

a. Triple therapy is required in all cases
b. Antacids may be taken at the same time as the proton pump inhibitor
c. All the proton pump inhibitors are similar in their abilities to effectively heal peptic ulcers
d. Smoking and alcohol intake are no longer contraindications
e. 1% polidocanols is not beneficial in bleeding ulcers

Answer 4

E

Question 5

Five days after appendicectomy a 25-year old man complains of fever, anorexia, mucoid diarrhea, frequency of micturition and dysuria.

a. He is most likely to be suffering from urinary tract infection
b. A rectal examination will clinch the diagnosis
c. A fresh warm stool should be examined microscopically for E. hystolitica
d. An abdominal ultrasound scan will be unhelpful as bowel gas will interfere with this investigation
e. A plain abdominal X-ray is the investigation of choice

Answer 5

A

Question 6

Five days after appendicectomy a 25-year old man complains of fever, anorexia, mucoid diarrhea, frequency of micturition and dysuria.

a. He is most likely to be suffering from urinary tract infection
b. A rectal examination will clinch the diagnosis
c. A fresh warm stool should be examined microscopically for E. hystolitica
d. An abdominal ultrasound scan will be unhelpful as bowel gas will interfere with this investigation
e. A plain abdominal X-ray is the investigation of choice

Answer 6

A

Question 7

. A 55-year old man is admitted with a strangulated right inguinal hernia

a. It is most likely to be a direct inguinal hernia
b. You would request erect and supine abdominal X-rays to confirm intestinal obstruction
c. Your management will include estimation of his blood urea and electrolytes
d. You will administer Pethidine 100mg IM and then reduce the hernia
e. You will recommend McEvedy’s operation

Answer 7

C

Question 8

In the non-operative management of intestinal obstruction from intra-abdominal
adhesions, evidence of deterioration includes:
a. Colicky abdominal pain that becomes persistent
b. Rigid, tender and silent abdomen
c. Increasing abdominal distension
d. Passage of flatus
e. Visible peristaltic waves

Answer 8

D

Question 9

Clinical symptoms and signs of intestinal obstruction in a child does not include:
a. Vomiting
b. Constipation
c. Abdominal distension
d. Severe diarrhea
e. Colicky abdominal pain

Answer 9

D

Question 10

144. At operation for suspected intestinal obstruction, the small intestine was found to
     be blocked with large number of Ascaris worm. The safest treatment is:
     a. Resect the part of the intestine containing the worm and do anastomosis
     b. Do nothing, close the abdomen
     c. Close the laparotomy wound and later give antihelminthics
     d. Milk the worms into the large intestine and give antihelminthics postoperatively
     e. Open the part of the intestine containing the worms and remove them

Answer 10

D

Question 11

Which is not true about umbilical hernia in children?
a. Common in newborns
b. Usually, asymptomatic
c. Repair if hernia has ever become incarcerated
d. Surgery is the treatment of choice for all cases in children
e. Spontaneous resolution can occur up to ten(10) years

Answer 11

D

Question 12

147. Minimizing blood loss during surgery can be achieved by all of these except:
     a. Meticulous haemostasis
     b. Decreased operating time
     c. Improved surgical skills
     d. Administration of antibiotics at the start of the operation
     e. Good surgical knowledge

Answer 12

D

Question 13

Techniques to control bleeding at operation include:
a. Blood transfusion
b. Adequate hydration
c. Pressure with gauze over cut surfaces oozing blood
d. Parenteral adrenalin administration
e. Carefully picking bleeding points with needle holder

Answer 13

C & D

Question 14

Among the suturing materials below, the one that is absorbed fastest is
a. Chromic catgut
b. Polyglycolic Acid (Vicryl) suture
c. Stainless steel wire
d. Plain catgut
e. Monofilament nylon suture

Answer 14

A

Question 15

150. Non-absorbable braided suture is made from the following:
     a. Silk
     b. Cotton
     c. Linen
     d. All of above
     e. None of above

Answer 15

D

Question 16

153. The following is a risk factor for cancer
     a. Asbestos
     b. Aluminum roofing sheet
     c. Village hut roofed with grass
     d. Excessive intake of ascorbic acid containing fruits
     e. Adequate vitamin A intake

Answer 16

A

Question 17

Anybody entering the operating room for whatever reason must not do the
following:
a. Put on clean cloth
b. Put on impermeable mask to cover mouth and nose
c. Put on a cap or hood to cover all hair on head and face
d. Talk unnecessary
e. Wear pair of clean shoes or clean shoe cover

Answer 17

D

Question 18

When available, the imaging technique of choice for diagnosing appendicitis is:
a. Abdominal ultrasound
b. Rectal ultrasound
c. Plain x-ray of the abdomen
d. CT-scan of the abdomen
e. Barium enema

Answer 18

D

Question 19

156. The risk arising from animal bites include the following except:
     a. Direct tissue damage
     b. Bleeding
     c. Allergic reaction
     d. Infection
     e. Wound dehiscence

Answer 19

E

Question 20

157. First aid for managing animal bites include the following except:
     a. Treat allergic reactions with NSAID
     b. Wash wound to remove toxins
     c. Apply sterile dressing
     d. Provide antibiotic therapy
     e. Give anti-tetanus prophylaxis as indicated

Answer 20

A

Question 21

In performing surgery for hand infections:
a. Local anesthetic containing adrenaline is very useful
b. Incision along skin crease at the site of maximum tenderness and swelling is indicated
c. Incision across the skin crease at site of maximum tenderness and swelling is helpful
d. Antibiotics are indicated
e. Elevation of the hands is indicated

Question 22

Gastric outlet obstruction is a complication of:
a. Pancreatitis
b. Intra-abdominal adhesions
c. Peptic ulcer disease
d. Peritonitis
e. Stone in the bladder

Answer 22

C

Question 23

60. Erect radiograph of the abdomen showing free air under the diaphragm may
    indicate:
    a. Perforated intra-abdominal hollow viscous
    b. Severe kidney infection
    c. Ruptured spleen
    d. Intestinal obstruction
    e. Acute pancreatitis

Answer 23

A

Question 24

120. Without intervention, an ectopic tubal pregnancy can lead to which of the following?
     a. Tubal rupture
     b. Spontaneous resolution
     c. Expulsion of products of conception through the tubal fimbria
     d. Leakage of blood from the fimbrial end
     e. All of the above

Answer 24

E

Question 25

The following are signs of a venomous snake bite except A. multiple pairs of fang marks B. ptosis C. palpitations D .hematochesia E. tingling sensations

Answer 25

A

Question 26

Chronic complications of sickle cell disease include the following except A. cor pulmonale B. erectile dysfunction C. nephropathy D. priapism E. pulmonary hypertension

Answer 26

D

Question 27

Which of the following is a feature of prematurity? A. hypotonia B .IUGR C. abundant areas of balding D. simian crease E. tiny ears

Answer 27

A

Question 28

Xray findings in a 3-day history of osteomyelitis typically includes A. periosteal elevation B. Brodie’s abscess C. involucrum D. normal bones E. sequestrum

Answer 28

The correct answer is D. normal bones. In the early stages of osteomyelitis (typically within the first 2-3 weeks), X-ray findings may be normal or show non-specific changes. It may take 2-3 weeks for characteristic X-ray findings to appear. The other options are characteristic of osteomyelitis, but typically appear later in the course of the disease: A. Periosteal elevation: typically seen after 1-2 weeks B. Brodie's abscess: a chronic complication of osteomyelitis, typically seen after several months or years C. Involucrum: a layer of new bone that forms around the infected bone, typically seen after several weeks or months E. Sequestrum: a piece of dead bone that becomes separated from living bone, typically seen after several weeks or months So, in a 3-day history of osteomyelitis, X-ray findings are likely to be normal.

Question 29

195. Typical complications of nephrotic syndrome include all the following except A. DVT B. hypokalemia C. SBP D. hypercholesteronemia E. infections

Answer 29

B

Question 30

The following drugs are appropriately paired with their antidotes except A. morphine-MCS B. propranolol-glucagon C. organophosphate-atropine D.paracetamol-N-acetyl cysteine E. iron- desferrioxamine

Answer 30

A

Question 31

85. About age estimation in children A. a child with a patent posterior fontanelle is not up to 1 month old B. a child with an open anterior fontanelle is at most 1 year old C. a child with the cord stump fallen off is at least 5 days old D. a child who can say and mean one word everytime is at least 2 years old E. a child with good neck control is at most 3 months old

Answer 31

D

Question 32

83. The appropriate instrument for measuring the length of a child is called A. tape measure B. stadiometer C. anemometer D. Shaqir’s tape E. manometer

Answer 32

B

Question 33

182. The following features describe a febrile convulsion except A. it is not recurrent in a 24 hour period B. child is usually between 6 months and 6 years C. there is full recovery within 1 hour D. seizure could last beyond 15minutes E. temperature is elevated

Answer 33

D

Question 34

Which of the following may not put a child at risk of malnutrition? A. eating unsupervised B. sharing a bowl with siblings C. diarrhea D. spoon feeding E. eating from a personal bowl

Answer 34

E

Question 35

Which of the following is the most common congenital heart defect? A. Tetralogy of Fallot B. Ventricular septal defect (VSD) C. Atrial septal defect (ASD) D. Patent ductus arteriosus (PDA) E. Coarctation of the aorta

Answer 35

A

Question 36

A 6-month-old infant presents with difficulty breathing, poor feeding, and failure to thrive. On examination, there is a pan systolic murmur heard best at the lower left sternal border. Which congenital heart defect is most likely? A. Tetralogy of Fallot B. Atrial septal defect C. Ventricular septal defect D. Transposition of the great arteries E. Tricuspid atresia

Answer 36

B or C

Question 37

1. A 58 years old postmenopausal woman reported at the gynaecology clinic with a history of irregular vagina bleeding for one month. She is a known diabetic. On examination her general condition was satisfactory, had body mass index (BMI) of 36 kg/m2 and the abdomen was unremarkable. Pelvic examination revealed a 10 weeks size mobile uterus with smooth surface; there were no palpable adnexae masses. The vulva, vagina and the cervix were all normal. a. State the most likely diagnosis? b. State 4 differential diagnoses. c.What investigation will you do to confirm your diagnosis? d. If you were to do a transvaginal ultrasound scan for this woman, what will you look for, considering the diagnosis and differentials

Answer 37

A. Endometrial hyperplasia B.Endometrial polyps, Uterine fibroid, cervical cancer, cervicitis C. Pelvic ultrasound scan, trans vaginal scan, endometrial biopsy and pregnancy test D. Whether there is endometrial Lining or endometrial thickness Note: option says investigation not investigations So the question need only one investigation. Please answer option c again The with investigation for endometrial cancer transvaginal ultrasound is the main Endometrial biopsy Note: option says investigation not investigations So the question need only one investigation. Please answer option c again Option D add 1. Endometrial thickness 2. Uterine morphology 3. Adnexal structures 4. Fluid collection

Question 38

2. A 22-year-old young lady presents with fever of 38 degree celsius, lower abdominal pain, and a foul-smelling vaginal discharge. Her last menstrual period was a week prior to presentation. She admitted to having multiple sexual partners. There are no urinary or bowel symptoms. a. What is the most likely diagnosis? b. What investigation would be most helpful is arriving at the diagnosis and help in directing the choice of drug for the treatment? c. State six criteria that will qualify the patient to be managed as an in-patient case. d. State (4) complications associated with her condition

Answer 38

_a. Most likely diagnosis:_ Pelvic Inflammatory Disease (PID) _b. Investigation Vagina swab for culture and sensitivity _c. Criteria for in-patient management:_ 1. Severe symptoms 2. Suspected tubo-ovarian abscess 3. Inability to tolerate oral antibiotics 4. Pregnancy or suspected pregnancy 5. Immunocompromised state 6. Failure to respond to outpatient treatment _d. Complications associated with PID:_ 1. Tubo-ovarian abscess 2. Chronic pelvic pain 3. Infertility 4. Ectopic pregnancy

Question 39

Which of the following is NOT a feature of the Tetralogy of Fallot? A. Ventricular septal defect B. Overriding aorta C. Left ventricular hypertrophy D. Right ventricular hypertrophy E. Pulmonary stenosis

Answer 39

The correct answer is C. Left ventricular hypertrophy. The Tetralogy of Fallot is a congenital heart defect characterized by four main features: 1. Ventricular septal defect (VSD) - a hole in the wall between the two ventricles 2. Overriding aorta - the aorta is positioned over the VSD, receiving blood from both ventricles 3. Right ventricular hypertrophy - the muscle of the right ventricle is thickened due to increased workload 4. Pulmonary stenosis - narrowing of the pulmonary valve or main pulmonary arteries, which reduces blood flow to the lungs Left ventricular hypertrophy is not a typical feature of Tetralogy of Fallot. In fact, the left ventricle is often underdeveloped or smaller than normal in patients with Tetralogy of Fallot.

Question 40

4. An important sign of portal hypertension in a patient of cirrhosis of liver is * A. Gynaecomastia B. Splenomegaly C. Palmer erythema D. Spider angioma

Answer 40

B

Question 41

In a patient with centripetal obesity, acne and hirsutism. The most likely diagnosis is * A. Cushing's syndrome B. Diabetes mellitus C. Hypogonadism D. Hypothyroidism

Answer 41

A

Question 42

The following are drugs used in the treatment of hypokalemia in acute renal failure * A. Amiloride B. Amlodipine C. Captopril D. Insulin

Answer 42

A & D

Question 43

17. A woman presents with cold intolerance and weight gain. Examination reveals goiter, the most likely finding on central nervous system examination is * A. Ataxia B delayed relaxation of ankle jerk C. Hypotonia D. Hyper reflexia

Answer 43

B

Question 44

In a man with history of muscle and carpopedal spasm which of the following serum electrolytes level is most likely to be low * A. Calcium B. Chloride C. Magnesium D. Sodium

Answer 44

A

Question 45

In a man with history of shortness of breath, which of the following sign indicates left heart failure * A. Ascites B. Basal crepitations C. Dependent edema D 4th heart sound

Answer 45

B

Question 46

In a patient with history of haematemesis, the clinical feature which suggest that peptic ulcer is the underlying cause is * A. Ascites B. Drowsiness C. History of jaundice D. Tender epigastrium

Answer 46

D

Question 47

A newborn presents with cyanosis shortly after birth. Echocardiography reveals that the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. What is the diagnosis? A. Hypoplastic left heart syndrome B. Tetralogy of Fallot C. Transposition of the great arteries D. Total anomalous pulmonary venous return E. Truncus arteriosus

Answer 47

The correct answer is C. Transposition of the great arteries. Transposition of the great arteries (TGA) is a congenital heart defect where the two main arteries that carry blood out of the heart are reversed. In a normal heart, the aorta arises from the left ventricle and the pulmonary artery from the right ventricle. However, in TGA, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, as described in the scenario. This condition can lead to cyanosis (bluish discoloration of the skin) shortly after birth, as oxygenated blood is not being pumped efficiently to the body. The other options are incorrect because: A. Hypoplastic left heart syndrome involves underdevelopment of the left side of the heart. B. Tetralogy of Fallot involves four specific heart defects, including ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. D. Total anomalous pulmonary venous return involves abnormal connections between the pulmonary veins and the heart. E. Truncus arteriosus involves a single blood vessel arising from the heart, instead of the usual two separate vessels. Yes, I am sure. The description provided matches the diagnosis of Transposition of the Great Arteries (TGA). The key points that confirm this diagnosis are: - The aorta arises from the right ventricle. - The pulmonary artery arises from the left ventricle. This is a characteristic feature of TGA, which is a congenital heart defect.

Question 48

The shortest acting oral hypoglycemics is * A. Glipizide B. Glibenclamide C. Gliciazide D. Glimeperide

Answer 48

A

Question 49

. Secondary hyperaldosterone has all of the following except * A. Acidosis B. Hypokalemia C edema D. Hypertension

Answer 49

A

Question 50

The diagnosis of acute appendicitis is most difficult to establish in * A. Persons aged 60 and older B. Women aged 19 to 35 C infants younger than one year D pregnant women

Answer 50

D

Question 51

Epididymitis, either unilateral or bilateral in a prepubertal male * A. Is a rare phenomenon B is a major scrotal problem in this age group C. Can be dealt with on an outpatient basis D. Is a frequent diagnosis

Answer 51

A The correct answer is A. Is a rare phenomenon. Epididymitis, which is inflammation of the epididymis (a tube at the back of the testicle that stores and carries sperm), is relatively rare in prepubertal males. In prepubertal males, the most common causes of scrotal pain or swelling are: 1. Testicular torsion 2. Hydrocele 3. Varicocele 4. Trauma Epididymitis is more common in postpubertal males, particularly those who are sexually active, due to bacterial infections such as Chlamydia or Gonorrhea. Therefore, option A is the correct answer, as epididymitis is a rare phenomenon in prepubertal males.

Question 52

Epididymitis, either unilateral or bilateral in a prepubertal male * A. Is a rare phenomenon B is a major scrotal problem in this age group C. Can be dealt with on an outpatient basis D. Is a frequent diagnosis

Answer 52

A The correct answer is A. Is a rare phenomenon. Epididymitis, which is inflammation of the epididymis (a tube at the back of the testicle that stores and carries sperm), is relatively rare in prepubertal males. In prepubertal males, the most common causes of scrotal pain or swelling are: 1. Testicular torsion 2. Hydrocele 3. Varicocele 4. Trauma Epididymitis is more common in postpubertal males, particularly those who are sexually active, due to bacterial infections such as Chlamydia or Gonorrhea. Therefore, option A is the correct answer, as epididymitis is a rare phenomenon in prepubertal males.

Question 53

25. Acute appendicitis is most commonly associated with which of the following signs * A. High grade fever B. Frequent loose stools C. Anorexia, abdominal pain and right lower quadrant tenderness D none of the above

Answer 53

C

Question 54

Meckel's diverticulitis most often occur in the * A. Proximal jejunum B. Distal jejunum C. Proximal ileum D. Distal ileum

Answer 54

D Meckel's diverticulum is most commonly located in the distal ileum, which is the last part of the small intestine before it joins the large intestine. The distal ileum is the most common location for Meckel's diverticulum because it is the area where the vitelline duct, a embryological structure that forms during fetal development, is most likely to persist and form a diverticulum. Note: it can occur in the other site but is very rare

Question 55

Acute salpingitis occurs most often * A. After menopause B. In patients with unilateral lower abdominal pain C. During the menstrual cycle D. In patients with cervical tenderness and vaginal discharge

Answer 55

D

Question 56

Note: for exam purpose

Answer 56

NB highest Glasgow coma score 15/15 Lowest Glasgow come score 3/15 for exam purpose always write the denomerator

Question 57

THIS IS THE HISTORY A 19 old man on a motorcycle involved in RTA and was been rush to the E/R. On arrival vital signs was normal. There was multiple abrasion on body and minor cut on the posterior part of the head. He was confused, moved both hands and legs when apply pain, he also open eye when you mention his name. A. What are the components of G.C.S. B. How will u score this patient GCS c. What is the highest and the lowest score of GCS D. What will be ur management.

Answer 57

A. Components of GCS are: 1. Eye Opening (E) 2. Verbal Response (V) 3. Motor Response (M) B. the patient's GCS is E = 3 V = 4 M= 5 Total = 12 C. The highest GCS score is 15 (4+5+6) The lowest GCS score is 3 (1+1+1) D. 1. Admit the patient 2. Assess airway, ensure circulation and adequate breathing and expose 3. Secure IV and take sample for investigation like Full blood count, Blood grouping and cross matching. 4. Do a neurological assessment 5. Request for Order imaging studies, such as a head computed Tomography(CT)scan or magnetic resonance imaging(MRI) 6. Give adequate analysis such as Morphine. 7. Monitor vitals

Question 58

The most commonly used imaging method for diagnosis of acute cholecystitis is * A. CT of the abdomen B. Ultrasound sonography of the gallbladder C. Oral cholecystogram D. Radiomeclide scan of the gallbladder

Answer 58

B

Question 59

Scleroderma most commonly affect * A. Cardia of sphincter B. Pylorus C. Duodenum D. Oesophagus

Answer 59

D

Question 60

Common cause of malabsorption * A. Celiac disease B. Crohn's disease C. Whipple's disease D. Giardiasis

Answer 60

A

Question 61

An accurate method measuring fluid replacement following acute blood loss is to check the * A. Hematocrit B. Haemoglobin C. Blood D central venous pressure

Answer 61

A

Question 62

The following is common to all types of shock * A. Vasoconstriction B. Sepsis C. Hypotension D. Bradycardia

Answer 62

C

Question 63

34. Patient with severe acidosis is treated with * A. Ringers lactate B. Dextrose normal saline C. RoSeMal D. IV NaHco3

Answer 63

D

Question 64

Which of the following is not a typical symptom of appendicitis * A. Vomiting B.fever C. Nausea D. Hematochezia

Answer 64

D

Question 65

The most common type of hernia in inguinal region is * A. Direct inguinal B. Indirect inguinal C. Femoral D. Incisional

Answer 65

B

Question 66

Septic shock responds best to * A. Massive antibiotics B. Intravenous Infusion C. Adrenocortical steroids D. Drainage of septic collections

Answer 66

A

Question 67

Deslouphing in burns is generally complete by * A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks

Answer 67

C

Question 68

Burns associated ulcer is called * A. Cushing's ulcer B. Curling's ulcer C. Trophic ulcer D. Peptic ulcer

Answer 68

B

Question 69

The diagnosis of congenital megacolon is confirmed by * A. Clinical features B. Barium enema C. Rectal biopsy D. Recto-sigmoidoscopy

Answer 69

C A biopsy is considered the gold standard for confirming a diagnosis of Hirschsprung's disease because it allows for a direct examination of the tissue in the affected area of the colon. Here are some reasons why a biopsy is necessary to confirm the diagnosis !!! 1. Direct visualization of ganglion cells 2. Confirmation of aganglionosis 3. Ruling out other conditions 4. Assessment of the extent of the disease 5. Guiding treatment 6. Accurate diagnosis 7. Exclusion of other diagnoses 8. Determination of the level of aganglionosis

Question 70

In gastric outlet obstruction in a peptic ulcer patient, the site of obstruction is most likely to be * A. Antrum B. Duodenum C. Pylorus D. Pyloric canal

Answer 70

B

Question 71

Most common endocrine tumour of pancreas * A. Insulinoma B. Gastrinoma C. Lipoma D. Glucagonoma

Answer 71

A

Question 72

Regarding diabetes in pregnancy, overt means * A. Any sugar level higher before 24 weeks B. Any sugar level higher after 24 weeks C. Any sugar level between 10 - 15 D. A and B only

Answer 72

D

Question 73

The Management of uncomplicated malaria in 2nd trimester includes the following except * A. Oral quinine for 7 days B.oral artemether lumenfantrine for 3 days C. Oral artesunate amodiaquine for 3days D. Oral Clindamycin + oral quinine for 7 days

Answer 73

C

Question 74

A 68-year old business executive with no previous medical history, except for hypertension for which he was on regular treatment, is brought to the emergency room by relatives who said he had suddenly complained of chest pain and breathlessness and had coughed up blood within the last 2 hours, a day after returning from a trip to the far east. a. What specific questions would you ask him or his close relatives and how would these help in the diagnosis? b. List all likely conditions that could result in this clinical presentation. c. What 4 (four) most important investigations would you consider requesting and why? d. Outline your treatment for one of the conditions you consider most likely.

Answer 74

a . -Travel history: Ask about specific destinations, duration of stay, and any exposure to crowded areas or people with respiratory symptoms. . Onset of symptoms: Clarify the exact timing and nature of the chest pain, breathlessness, and hemoptysis (coughing up blood). . Hpt management: Ask about the patient's adherence to antihypertensive medication and any changes to the regimen. . Past medical history: Inquire about any previous illnesses, surgeries, or hospitalizations. . Family history: Ask about any family history of cardiovascular or respiratory diseases. . Drug history: Ask about any medications taken recently, including over-the-counter or herbal supplements. b: Likely conditions -Pulmonary embolism (PE) -Acute coronary syndrome : -Pneumonia: -Tuberculosis c: Important investigations . Chest CT: To evaluate for PE, pneumonia, or other pulmonary abnormalities. . Electrocardiogram: To assess for ACS or other cardiac arrhythmias. . FBC and blood biochemistry: To evaluate for signs of infection, inflammation, or cardiovascular disease. . D-dimer assay: To help diagnose or rule out PE. d: Treatment for pulmonary embolism (PE) If PE is suspected or confirmed, treatment may involve: .Anticoagulation: With heparin or low-molecular-weight heparin to prevent further clotting. - Thrombolytics: With medications like alteplase to dissolve the clot, if indicated. - Oxygen therapy: To improve oxygenation and reduce respiratory distress. - Pain management: With analgesics to control chest pain. -Monitoring: Close observation in the intensive care unit (ICU) to monitor for complications and adjust treatment as needed. -. Referral

Question 75

NEXT QUESTION A one week old infant is brought to the consulting room with history of swelling over the Right clavicle. a) List 3 additional bits of information you would like to find out in the history b) List 2 differential diagnoses? c) What four (4) additional investigations would you like to do? d) How would you manage this patient?

Answer 75

A. - what was the mode of delivery - was there any complications during the delivery A. History of trauma too is very important - was the pregnancy up to Term? B. - right Clavicular fracture - right clavicular malformation C. - Anterior posterior x Ray of the chest - Doplar ultrasound - Full blood Count - D. - re assure the mother - give analysis - encourage breastfeeding - educate the mother to avoid regular lifting the child Come for check up 3 months after

Question 76

NEXT QUESTION A 14months old baby was with the mother when the mother was eating roasted plantain and groundnut. Later the mother left the baby to attend to other chores and when she came back, she found out that child was having difficulty in breathing. She rushed to the hospital and SPO2 on room air was 92%, pulse 120bpm, respiration 40cpm. a) What is the most likely diagnosis? b) List 2 investigation you would carry out. c) Outline your management for this condition. d) How would you educate the mother on prevention of the above condition?

Answer 76

A. Foreign body aspiration B.Chest X-ray , full blood count C. Admit, call for help, assign roles, asses airway ,breathing, circulation, intranasal Oxygen, do back slaps, administer antibiotics if necessary, monitor vitals and refer to tertiary facility for further management.. D. Mother should always keep an eye on the child, Mother should always avoid the child from coming closer to grains such as groundnut, maize and beans. Mother should always take harmful substances away from the child Investigation Add. Laryngoscopy Plane abdominal X ray C. If u want give antibiotics, is just to prevent secondary infections so indicate it. And as a PA, these are the methods used can use to remove the foreign body or object 1. *Back slaps*: This is a first-line technique used to dislodge an object from the airway. The child is held upright and five quick back slaps are given between the shoulder blades to try to dislodge the object. 2. *Abdominal thrusts*: If the back slaps are unsuccessful, abdominal thrusts can be used. The child is held upright and the rescuer places their fist just above the child's navel and performs a quick upward thrust to try to dislodge the object. 3. *Finger sweep*: If the object is visible in the mouth or throat, a finger sweep can be used to remove it. The child is held upright and the rescuer uses their finger to sweep the object out of the airway.

Question 77

A 3day old neonate was brought to your unit with yellowish discoloration of the sclera and the working diagnosis you made was neonatal jaundice. a) What therapy would you do for this baby? b) After examination, you realized the baby was having poor feeding and a temperature of 38.6. What would be your new diagnosis? c) List 4 basic investigation you would carry out on this baby. d) List 2 drugs you would use in treating the baby and their route of adding

Answer 77

A. Phototherapy B. Neonatal sepsis C. Full blood, blood culture and sensitivity, Serum bilirubin, D. Ampicillin=Intravenous Cefuroxime= Intravenous Good 👍 🙏🙏. Prefect 1. Ur investigations were three D. There is fever in option b Drugs should be antibiotics —- intravenous and antipyretic—— intravenous Ur investigations u can add Chest X ray, bf for MPs, urine culture etc Lumber puncture if you suspect meningitis

Question 78

A 4year old boy was brought to your facility with severe pallor. a) List 4 causes of the above condition in our environment. b) List 4 basic investigation you would carry on this baby. c) How would you treat the severely paleness? d) List 2 side effects of blood transfusion.

Answer 78

A. Severe malaria. Sickle cell disease, G6PD deficiency, Malnutrition B. Full blood count, Blood film for malaria parasites, Sickling test, Blood group and cross-matching C. Transfuse with whole blood. D. Allergic reaction, febrile non-hemolytic reaction

Question 79

45. In multiple pregnancy , the following are true except * A. Dichorionic diamniotic is 38 weeks B. Monochorionic diamniotic is 36 weeks C.monochorionic monoamniotic is 34 weeks D. Monochorionic diamniotic is 40 weeks

Answer 79

The correct answer is D. Monochorionic diamniotic is 40 weeks. In multiple pregnancies, the gestational age at delivery varies depending on the type of twin pregnancy: - Dichorionic diamniotic (A): 38 weeks is correct, as these pregnancies tend to have a lower risk of complications. - Monochorionic diamniotic (B): 36 weeks is correct, as these pregnancies are at higher risk for complications due to shared placental circulation. - Monochorionic monoamniotic (C): 34 weeks is correct, as these pregnancies are at highest risk for complications, including cord entanglement and twin-to-twin transfusion syndrome. However, option D states that monochorionic diamniotic pregnancies typically deliver at 40 weeks, which is incorrect. Monochorionic diamniotic pregnancies usually deliver earlier, around 36 weeks, due to increased risk of complications.

Question 80

The following are complications of twin gestation except * A. Excessive vomiting B. Anaemia C. Antepartum haemorrhage D. Disseminated intravascular coagulation

Answer 80

The correct answer is A. Excessive vomiting. While excessive vomiting can occur in any pregnancy, it is not a complication that is unique or more common in twin gestations. The other options are all recognized complications of twin gestation: - B. Anaemia: Twin pregnancies are at higher risk for anaemia due to increased iron demands. - C. Antepartum haemorrhage: Twin pregnancies are at higher risk for bleeding complications, including placenta previa and placental abruption. - D. Disseminated intravascular coagulation (DIC): Twin pregnancies, especially monochorionic twin pregnancies, are at higher risk for DIC due to increased placental mass and shared circulation. Twin gestations are associated with several other complications, including: - Preterm birth - Low birth weight - Gestational hypertension - Preeclampsia - Twin-to-twin transfusion syndrome (in monochorionic twin pregnancies) So, option A is the correct answer, as excessive vomiting is not a unique complication of twin gestation.

Question 81

The gestational age of quickening mostly at which SP is given is * A. 17 weeks B. 16 weeks C. 18 weeks D. 20 weeks

Answer 81

The correct answer is B. 16 weeks. Quickening refers to the moment when a pregnant woman first feels the movements of her baby. This can be a thrilling experience for expectant mothers! The gestational age at which quickening is typically felt varies from woman to woman, but it usually occurs between 16 and 20 weeks of gestation. In general, women who have had previous pregnancies may feel quickening earlier, around 16-17 weeks, while first-time mothers may not feel it until around 18-20 weeks. So, option B (16 weeks) is the most commonly cited gestational age for quickening.

Question 82

Organic or structural causes of abnormal uterine bleeding includes the following except * A. Polyps B. Adenomyosis C. Leiomyoma D. Ovulatory dysfunction

Answer 82

D

Question 83

The following are clinical symptoms of pelvic inflammatory disease except * A. Bilateral lower abdominal pain B. Deep dyspareunia C. Lower abdominal tenderness D. Vaginal discharge

Answer 83

A

Question 84

51. Signs of pelvic inflammatory disease include the following except * A. Intermenstrual bleeding B. Low grade fever C. Lower abdominal tenderness D. Cervical motion tenderness

Answer 84

B

Question 85

52. In ectopic pregnancy, ultrasound scan will reveal * A. Adnexal mass attached to the ovary B. Bulky but full uterus C. Adnexal mass separate from ovary D. Echogenic fluid is not seen in the pouch of Douglas

Answer 85

C

Question 86

Ovarian cystic masses are divided into the following except * A. Functional ovarian cyst B. Endometriomas C. Ovarian cystic neoplasm D. Ovarian mass

Answer 86

D

Question 87

You diagnosed a Lady with pelvic inflammatory disease clinically, the following are possible differential diagnosis except * A. Endometriosis B. Ovarian cyst/tumour C. Appendicitis D. Acute kidney injury

Answer 87

D

Question 88

diagnosing polycystic ovarian syndrome, which of the following is part of the Rotterdam criteria * A. Hyperandrogenism B. Ovarian polyp Bleeding per vaginam C. Pool of blood in the pouch of Douglas D. A and B only

Answer 88

A

Question 89

56. A lady came to your consulting room with irregular menstrual bleeding, which medicine will be best to control her condition * A. Combined oral contraceptive pills B. Folic acid C. Progesterone D. Multivitamin

Answer 89

A

Question 90

These are the criteria The Rotterdam criteria for diagnosing Polycystic Ovary Syndrome (PCOS) are:

Answer 90

These are the criteria The Rotterdam criteria for diagnosing Polycystic Ovary Syndrome (PCOS) are: 1. hyperandrogenism 2. Oligomenorrhea or amenorrhea 3. Polycystic ovaries on ultrasound

Question 91

young lady came to your consulting room with lower abdominal pain with bleeding per the vagina, she has not seen her menses last month. You diagnosed her of ectopic pregnancy, what is your likely differential diagnosis * A. Pyelonephritis B. Acute abdomen C. Vaginitis D.severe malaria

Answer 91

B

Question 92

The drug of choice for the treatment of unruptured pregnancy is * A. Methotrexate B. Metotraxate C. Methotrati D.metotrixate

Answer 92

A

Question 93

60. In gestational hypertension, the following are present except * A. Gestational age is 20 weeks or more B. Urine protein is negative or trace C. There's evidence of end organ damage D. BP is 140/90 mmHg or more

Answer 93

C

Question 94

A 17year old girl who was pregnant at 16weeks and was not feeling well. She had fever, headache, joint pains and she reported to a CHPS compound but the facility had no light. The only finding on examination was temperature of 38.5. a) State the most common protozoan of the above condition and give one variant. b) What 1 investigation can you do at your facility to confirm your diagnosis. c) List 2 risk factors of the lady in the condition. d) State 4 complications of the condition on the fetus.

Answer 94

A) Plasmodium falciparum B) Rapid diagnostic test for malaria C)1. Pregnancy 2. Living in an endemic/rural area D)1. Congenital Malaria 2.Low birth weight 3. Preterm delivery 4.Miscarriage Let’s make this clear "Plasmodium" is a genus of protozoa that causes malaria. It's like a category or a group that includes several different species of protozoa that can cause malaria. "Plasmodium falciparum" is a specific species of protozoa within the Plasmodium genus. It's one of the most common and deadly species of malaria-causing protozoa. So, when I said "the most common protozoan causing the condition is Plasmodium", I was referring to the genus as a whole. And when I said "one variant is Plasmodium falciparum", I was referring to a specific species within that genus. But if I had to choose one answer, I would say "the most common protozoan causing the condition is Plasmodium falciparum", because it's a specific species that is commonly associated with malaria.

Question 95

A lady who is in her second stage of labor and they infiltrated the perineum with lidocaine before an incision was made at the perineum to help the woman to deliver. a) What is the name of that incision and state one type? b) List 2 indications for the incision made. c) List 2 complications of the above incision. d) State the process involved in repairing the incision that has been made.

Answer 95

A. Episiotomy Midian episiotomy Medio-lateral episiotomy B. -Prolonged second stage of labor - fetal distress C. - infection - hemorrhage D. The area is cleaned Lidocaine is administered to reduce pain during the closure The incision is closed using sutures layer by layer a. Episiotomy, midline incision. b. Rigid perineum, imminent perineal tear. C. Perineal pain, damage to perineal nerves. D. Prepare the equipment needed(Suture, gauze, scissors, forceps, lidocaine), Clean the perineum. Inject the lidocaine, Get a good light source. Start suturing from the vaginal mucosa, muscle and then skin.

Question 96

61. Regarding pre-eclampsia the following are true except * A. BP is 140/90 mmHg B. Gestational age is 20 weeks or more Urine protein is significant or +1 D. There's no evidence of end organ damage

Answer 96

D

Question 97

World diabetes day is celebrated in * A. 15 November B. 16 November C. 14 November D. 25 April

Answer 97

C

Question 98

Pneumococcal conjugated vaccine is given at * A. 6, 9 and 14 weeks B. 6,9 and 15 weeks C. 6, 10 and 14 weeks D. 6, 11 and 14 weeks

Answer 98

C

Question 99

child of 2 years had a cut on the left lower leg, which of the following treatment you will NOT give * A. Antibiotics prophylaxis B. Dress wound C. Give tetanus toxoid D. Admit child

Answer 99

C

Question 100

A days old child was born with jaundice, pallor, dyspnea, you examine the liver and spleen and feel a mass which is tender. What will be your diagnosis * A. Enterocolitis B. Abdominal aorta aneurysm C. Splenic sequestration in a sickle cell patient D. Nephroblastom

Answer 100

C