Guidelines for foreign trained doctors sitting for the Ghana Medical &Dental Council Pre-Registration Examination.

Do not hesitate to contact if you have any question (do not send sms )..

Good luck.

2008

INTRODUCTION Please note that this material is not from the Ghana Medical and Dental

Council. One has no right to contact the council in case a question arises with respect in using this material.

This material is compiled up after careful and thorough investigations as far as our environment and the need to pass the pre-registration exam is concerned.

The content of this material is liable to change without prior notice hence it is to your own interest to contact the above doctor from time to time for up dates.

To pass this exam is not only about what you know. Is all about following instructions, exhibiting your ability to stand pressure ,think and link ideas diversely and frustrations etc.

“What you need to know before sitting for the exam, how to answer the questions, what the professors are expecting from you etc”, feel free to contact :

Dr.Boateng

Dr.E.Boateng,2008

Materials Standard treatment and guidelines. Remember to ask for

the latest edition. You have to chew this book. A copy can be obtain at the Human resource opposite tema station. Or ask from MDC

A hand book for medical emergencies: a hand book for house officers by korlebu teaching hospital medical dept.

Protocol for house officers in surgery produce by Mr. Aduful-consultant surgeon -4th floor ,Korlebu TH.

A hand book for house officers in paediatricsA handbook for obs & gynae by kwame Aryee,or Ten

teachersA short text book of public health for the tropicsOxford handbook of clinical medicine, surgery.

Dr.E.Boateng,2008

Problem solving This carry 110 marks out of 200 and it takes the greatest

score.If you failed in the problem solving automatically you have

failed the exam. The other way is said to be trueYou have to pay particular attention to investigations.Questions on management do NOT necessary require you

to provide specific drug dosages such as tab paracetamol 20mg,but in broad terms such as = Analgesics .However if you know the specifics you can provide them in the exam but Remember it will go against you should you get it wrong.

Look very fast than never before during the exams.Answer all questions-PARTICULARLY the short cases

section.

Dr.E.Boateng,2008

VIVA Don’t let fear rub you off all that you have toiled for. This part of the exam can frustrate

you but grit your teeth and be a man once for a life time. Be confident and boost yourself up before you enter the room. It’s not the place to ask

questions or make friends. Never crack jokes. They will laugh to let you feel bad if you dare say something wrong, so the simple rule is:

Do not attempt to answer a question you are not clear with . If you don’t know ask them to change the question for you. Don’t ponder over questions. It will go against you.

You try and slow the rate at which you answer your questions to beat time and avoid more questions. i.e. if you know the answer

Remember most of the questions in the viva are to insult your intelligence and test your IQ .

**Remember to read referral letters and notes first: to take history ,next examine patient and order for investigations. Then seek review by senior colleague. *****

Always advocate the examiner. Let them feel they know all that medicine is about even if they are wrong.

You will have 18 min to face the panel. 3 min for each subject. Don’t panic when the bell is rang. Talk and talk till the bell is gone for a change over.

Don’t explain anything if you are not asked to do so. Define,state,list etc. Listen carefully to the examiner to make a rightful judgment. The answers can be

deduced from the scenario they give .

Dr. E.Boateng,2008

Past questionsRemember to read over and over again what your

“forefathers” left behind. Another powerful instrument as long as passing this exam is concerned.

Is now your turn to leave something behind for someone else. Don’t be a curse “forefather”.

GOOD LUCK!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Dr.E.Boateng,2008

Preclinical topics Please contact for solutions to some of the questions/topics

outlined below: ANATOMY: - Inguinal canal: boundries,content in males & females - femoral canal - cervical canal

GENETICS: Pay attention to :-trisomes – 21=down syndrome 13= Edward syndrome 18= paten syndromeTheir features, characteristics

- Turner’s syndrome- Kleifelter’s syndrome

EMBRYOLOGYPay attention to :Birth Defects- Neural tube defects:- spina bifida, microanenchaphaly, anenchaphaly (+

their intrauterine/pre-natal diagnosis) = do amniocenteses

- **elevated levels of alpha feto protein in amniotic fluid.**

- Down syndrome –prenatal diagnosis = low level of alpha feto protein in maternal blood

- Respiratory Distress – in neonates & premature babies- - causes + role of surfactant deficiency:

Dr .E.Boateng,2008

surfactant deficiencyDiagnosis of lung maturation prenatally=Ans: Amniotic fluid examination for splingomyelin ratio i.e.

leathin/ splingomyelin ratio > 2 = adequate amount of surfactant, hence adequate lung maturation.

FETAL BLOOD CIRCULATION & HEMODYNAMIC CHANGES THAT OCCURS AFTER BIRTH & STRUCTURAL CHANGES eg:

Ductus arteriosusForamen ovale=fossa ovaleUmbilical vesselsPatent ductus arteriosus,early conservative management

=INDOMETHACIN.

Dr .E.Boateng,2008

PHARMACOLOGYDefinition of pharmacology, pharmacokinetics; pharmacodynamic; clinical trialsGeneral pharmacological principlesReceptor mechanisms

Dr .E.Boateng,2008

CONGENITAL HEART DISEASE-VSD, ASD,TOFRead all you can about this topic.

PHYSIOLOGY=general physiological principles

-osmosis

-diffusion, perfusion

permeability- Shock

Dr .E.Boateng,2008

MICROBIOLOGYDefinitions of:-immunological principles: Primary immunity secondary immunity acquired immunity innate immunity active immunity passive immunity gram + & gram –ve organisms vaccination

Dr .E.Boateng,2008

VACCINATIONPay attention to terminology in this sectionVaccination schedules –pay attention to this -

very very important HIV/AIDS:WHO classifications or stages.

Test ,Medications.

Dr .E.Boateng,2008

PATHOLOGYGeneral pathological principles- inflammation-features;- -pain, redness, oedema, heat, hyperemia,- Necrosis(types)= coagulation, colliquative

- ***based on my own observation, it’s found out that the preclinical topics cut across the MCQs**

Dr .E.Boateng,2008

clinicalPUBLIC HEALTH/PRIMARY HEALTH CARE

& DELIVERY:Public health features *very importantly* in

the entire examination.Biostatistics: i. SENSITIVITY- of a test is its ability to

identify individuals with the disease or condition. S= true positive(TP)/TP + False Negative(FN)

ii. SPECIFICITY - of a test is defined as its ability to defined those who do not have the disease.

SP=FN/FN +TP

VITAL STATISTICSBirth rateInfant mortality rateNeonatal mortality rateMaternal mortality rateUnder five mortality rateIncidence – occurrence of new casesIncidence rate= incidence /tot pop @ risk X 1000Prevalence = number of existing cases at a given point in

time in a given population

Dr.E.Boateng,2008

VITAL STATISTICS Epidemiology + its method( cohort or prospective study, case control

study or retrospective)

Epidemiology= study of human population with respect to size, density, distribution and structure.

Methods: i. cohort study ii.case control studyRead about the methods**

Endemic = the constant presence of a disease within a given geographical area.

Epidemic = occurrence of disease in excess of normal expectancy

Accuracy = t he degree of veracity

Reliability= consistency and repeatability of a set of measurement

PREVENTIONS(primary,2ndary,tertiary):

Secondary prevention

Tertiary preventionInvolves rehabilitation.

**1.prevention of susceptible host, 2.elimination of vectors 3.interruption of route of transmission 1,2,3 conforms to the levels of preventions

discussed above respectively.

Dr. Boateng,2008

quizIn an outbreak of cholera what will you do as a

doctor??Very high yield important question!!!!Ans: think around the level of prevention we just discussed and

answer it yourself. If fumbling you can contact for help. Don’t pass by this question. you will regret.

Define:- Notifiable disease- Infectious disease- Communicable disease- Contagious diseases

Dr. Boateng,2008

Define and give examples Zoo noses Ornithoses

Very high yield – obligatory topic to learn thoroughly:-life cycle of malaria parasite-life cycle of schistosomiasis ankylostoma & others- Helminthes- Note clearly – the group of worms that inhabit the lungs as part of their life cycle- Group of worm that pass through the liver in their life cycle

- Onchocerciases

- Filarial worms

Dr. Boateng,2008

quizzzzzzzzzCold chainMalnutritionGuinea wormRefuse disposalKVIP & pit latrineBirds Immigration & typesCan road traffic accident(RTA) be considered as

EPIDEMIC? The Ans is YES. You should be able to explain based on the

definition given previously.

Dr. E.Boateng,2008

Obstetrics + GynaecologyAntenatal careSigns and symptoms of pregnancyAbortion definition +types: expulsion of the fetus before the 28th week of pregnancy is termed as abortion. types:1. spontaneous; -threaten - incomplete -complete -inevitable - missed2. induced; - therapeutic -criminal

Dr. Boateng,2008

Obs + gynaeAPH= antepartum haemorrhagePPH=post partum haemorrhagePIH = pregnancy induce hypertension i.e. pre – eclampsia= high BP+ proteinuria +

oedema eclampsia= pre eclampsia + fit

- Contraception- Emergency contraception + indications- Rh –incompatibility- Anaemia in pregnancy- Multiple pregnancies- Polyhydramnios- Oligohydramnios

Dr Boateng, 2008

Obs + gynaeEctopic pregnanciesCervical cerclage in cervical incompetencePlacental insufficiencyBirth injuries: -caput succedaneum -cephalhaematoma -Erb’s palsy(involves C5-C6) -Klumpke’s palsy(involves C7-C8 +Th1)

Menstarl cycle- physiology, phases, hormones involved, the axes= hypothalamo –pituitary –ovarian axis

quizHow would you diagnose pregnancy?Ans: A. clinically - symptoms=morning

sickness,amenorrhia,breast engorgement etc -signs= linear nigra,bluish discoloration of

the vulva + vagina, FHS etcB . By investigation: UPT,USG,Beta HCG etc

Dr. E.Boateng,2008

quizFibroid = definition,causes,management.Do you know Ghana is the country that started the

treatment of eclampsia with magnesium sulphate and one of the best countries when it comes to the management of hypertension?

Pre eclampsia, eclampsia. Signs, symptoms ,diagnosis, management.

Compare and contrast abruptio placenta ,placenta praevia and vasa praevia.

Dysmenorrheal .definition, types and treatment.A pregnant woman in your office .What tests will you do

and why?GOOD LUCK!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Dr.Boateng,2008

MDC feb ,2008. obs+gynae50 year old female presented with abdominal

distension. Give 6 causesA 25 yr old hypertensive pregnant woman

bleeding per vagina at 30 week .10 causes. Diagnose

Unconscious after successful delivery.10 causes?A 29 yr old female has just missed her period and

started bleeding p/v. Causes. How will you manage her?

For answers feel free to contact

Dr. Boateng, 2008

paediatrics Neonatology : - breast feeding.*read all you can about this topic* -formation of breast milk Types of breast milk= 1. colostrums 2.mature breast milk Breast milk composition i.e.= - carbohydrate 6.7 - protein 1.25 (casein,lactoglobulin,lactalbumin) - lipid 3.5 - water 87 -mineral (Na, ca, K,Cl) - vitamins

Dr. E. Boateng,2008

Breast feedingAdvantages of breast milk = -mother child bond is assured -contraceptive effect -prevent breast cancer -antiviral/bacterial effect etcWeaning- programme or scheduleCow milk( formula feeds) - advantages- Disadvantages- Their composition i.e. constituents as above.- !!!this topic features quite prominently !!!!!

- Dr. Boateng ,2008

Respiratory distress syndrome(RDS)

RDS :causes ,signs, symptoms

Neonatal jaundice Neonatal sepsis Neonatal tetanus Failure to thrive Congenital heart disease Otitis media Cerebral palsy Malaria + complication Pharyngitis Tonsillitis Anaemia Diarrhea + complication Meningitis diagnosis = lumbar puncture. Note CSF changes Signs of meningitis = neck stiffness, kerning's +ve,brudzenski +ve and others

Dr. Boateng , 2008

Febrile convulsionDefinition + causes What would you do at the emergency dept. when a child is brought in

convulsing??Ans: - 1st take RBS=random blood sugar-next tipped with water if temperature is high-if unconscious evaluate the level of consciousness with Blantyre coma scale- Next of paramouncy is =control of convulsion with anticonvulsants and

the drug of choice is DIAZEPAM per rectum/ IV- Take history from mother, - Examine the child thoroughly- Order for investigation- Seek review by senior colleague as and when necessary.

- Dr. Boateng,2008

Sickle cell diseaseSigns + symptomsCrisis : 1. VOC= vaso oclusive crisis(pain + mild jaundice) 2. Haemolytic crisis( 1 + anaemia+severe jaundice) 3. Aplastic crisis( severe anaemia) 4. Sequestration crisis( hepatosplenomegaly )Complications: sc dactylitis, osteomyelitis,swelling of the hand + feet, priapism, spleenic infarction,

brain infarction-stroke, heart failure etcManagement: - relief Pain with analgesics - rehydrate with IVF -Blood transfusion if indicated - oxygen if hypoxic - cover infection = antimalaria or Rx for precipitants

Dr. Boateng ,2008

Ca Burkits lymphoma – the most common malignancy in children in

the tropics Hodgkin's lymphoma Typhoid fever(enteric fever):drug of choice in Ghana now is

ciprofloxacin according to sensitivity. Chloramphenicol is used at regions where salmonella is sensitive to it

GMDC , Feb 2008.paediatricsNeonatal jaudice.Causes,2 most important test to do,

treatment.-causes:-physiological if >1d old but <6d old-neonatal sepsis-blood, Rh incompatibility-hypothyroidismObstructive jaundice-galactosaemia etcInvestigation: -SBR,comb test of child -blood group of mother and child, blood culture etc write as many as you can

Treatment : -phototherapy - exchange transfusion.

Dr. Boateng, 2008

GMDC , Feb 2008. paediatricsA mother presented with asthmatic child. What will

you ask the mother? Immediate management of this child?

Ans:-diurnal variation in PEF-Exercise tolerance-sleep disturbances-other atopic diseases-the home(esp. bed rooms, sitting room etc)-medication etcTreatment:-give humidified oxygen-nebulized salbutamol-IVF if necessary.

Dr. Boateng,2008

GMDC , Feb 2008. paediatrics A child looks dull as compare to his friends during sports activities and squat during family walks.

Diagnosis. What other signs will you find?Ans:Diagnose: congenital heart disease( Tetralogy of fallot)Other signs: pansystolic murmur, cyanosis, failure to thrive etc.

**do well and read about all the topics discussed above. Your viva ,mcq, problem solving will be from these topics**

Red typed means answer /s to the asked question but you are encouraged to read more about the said topics. The answers were provided to guide you as to how to answer the questions.

Never write notes/essay!!!!!!!

Dr. Boateng,2008

Surgery Fluid & electrolyte balance = daily fluid requirements in the

tropics. Check this up from Archampong & Jaja’s Book on surgery Blood transfusion & transfusion reactions The acute abdomen Acute appendicitis Acute cholecystitis Pancreatitis Intestinal obstruction: causes:- hernia(*strangulated)- adhesion and band- vulvulus- intussusceptions - constipation/ faecal compaction- intestinal worms- malignancy- PUD( peptic ulcer disease) Typhoid perforation **HIGH YIELD** note differential from appendicitis .Pay attention to the

history of preceding fever. Upper & lower GI bleeding. Causes ,management. Hernia- classification Surgical jaundice Haemorrhoids

Surgery Wound +wound healing. Classification Urinary retention . Note causes + management Haematuria . Note cause and management Haematemesis . Note causes and management. Refer to GI bleeding. Burns classification(the rule of 9’s) Buruli ulcer Postoperative care

Dr. Boateng , 2008

Gmdc ,Feb. 2008.surgeryHaematuria. Cause? How would you manage any 1 of the causes? A boy presented at the emergency dept. with swollen elbow after a fall on

hand outstretched. Diagnose , management, give 4 early and late complications.

Fracture of the tibia and fibular. Give 4 early and late complications. How would you manage it?

A 70 yr old woman unable to stand after a fall. Her right leg is shorten. Diagnose? How would you manage her. Give 6 early and late complications.

Dr. Boateng, 2008

Medicine Heart failure Congestive heart failure Oedema( chf, nephrotic, liver, malnutrition) Bacterial endocarditis ACE inhibitors – side effect Hypertension Cardiac murmurs Malaria + its complications such as cerebral malaria DVT/PE Cellulitis DKA Shock TB Pneumonia Aphasia Addisonian crisis Acute renal failure Poisoning and intoxication Bites and stings

Dr. Boateng, 2008

Medicine Anaphylactic reactions and shock Brown – Sequad syndrome: Partial cord lesion. Features:- loss of pain and temperature below specific dermatome levels- loss of proprioception and discrimination to touch - limb weakness Causes of hepatosplenomegaly Sickle cell crisis Status asthmaticus Status epilepticus Pneumothorax Consolidation Pleural effusion

Dr. Boateng, 2008.

Gmdc feb.2008.medicine Compare and contrast malaria and Typhoid fever. Which one will you Rx first based

on incubation period. Write your regime. In a tabular form compare CCF, nephritic, liver, adult malnutrition oedema

TB + management (it’s preamble and you have to deduce it.)

CCF. managent. (it’s preamble and you have to deduce it.)

Dr.Boateng, 2008

how to answer the questions The questions in this exams are set or asked vaguely in the viva and in the problem solving.

Understanding the principles in answering such questions is the key. We take example 1. You enter the room , sit before the panel and you are asked ‘ACUTE ABDOMEN’.it looks simple, Right? I tell you just a single word you’ll say can fail you but knowing the single word to

say will pass you.In such vague questions the single word is DIFFERENCIALS/causes of acute abdomen in order of

importance. The answer is differential diagnosis. Just list them. Then after commence on management if time permits

you to do so. Which will include:- Resuscitation - Analgesics half strength(to avoid diminishing of the pain before the review by resident

or consultant) , IVF, - History, examination- Order for investigation- Seek review by consultant or resident. And Go according to their instructions.

- QUESTN:- 1. Kidney and Splenic mass- 2. pleural effusion- **answer 1= clinical signs to differentiate between the two.- *Answer 2= clinical signs** look for them. - These are some of the questions I had in the viva.

- Dr. Boateng, 2008

Example 2Unconscious patient?Your approach in such cases is ‘causes/differentials. You can use the mnemonics

below (hide seeds)list them. don’t explain :H - hypogycaemiaI - infectionsD - diabetic + its complicationsE- epilepsyS - strokeE - encephalitisE – electrolytes disturbanceD- drugss –subarachnoid bleed/ space occupying lesion

Your next step is management / resuscitation: -check ABC( airway, breathing and circulation)- Next ‘check RBS (random blood sugar) very important and correct deficits- Secure IV access ,infuse/transfuse or give oxygen as and when needed- Access level of consciousness with GCS( Glasgow coma scale)- Monitor urine output by catheterization- Take history, examination, order for investigation- Seek review by resident / consultant./rule out possible cause and treat.- The above is a question I had in the viva. You may be the next.

- Dr. Boateng, 2008

VIVA prominent questions. have these on your finger tips & you’ll be 80% via the exam

medicine OBS/ GYNAE

surgery paediatrics Public health

1.Diabetic + comp eg DKA2.DVT3.Cellulitis4.Pneumonia5. TB6.GI bleeding7.Hypertension8.PUD9.Splen & kidney mass10.Unconscious patient11.stroke/ CVA12.Status epilepticus13.Dehydration + signs14. CCF15.CHD16.Oedema17.Malnutrition18. Malaria19. Typhoid20. Dyspnea21.Astma22.Endocarditis23.Pericarditis24.STD’s25.Upper/lower motor neuron lesion26.hypo/hyperthyroidism

1. PPH2. APH3. Abruptio placenta4. Placenta Praevia5. Vasa praevia6. Post partum

pyrexia7. Abortion8. Ectopic pregnancy9. PIH10. PID11. Diagnosis of

pregnancy12. Labour13. PROM14. Infertility15. Fibroids16. Shoulder dystosia17. Ca cervix18. Anaemia in

pregnancy

1.Fractures2.Acute abdomen3.Haematuria4.BPH5.Urinary retention6.Appendicitis7.Goo(gastric outlet obstruction)8.Hernia9.DVT10. Cellulitis11.Tetanus12.Gasgan grene13.Jaundice pt14.Haemorrhoids15.Fissura in ani16 .intestinal obstruction17.GI bleeding18.Rectal prolapse19.colle’s fracture20 orthopaedics21 .RIF mass(right iliac fossa mass)

1.Neonatal jaundice2. Convulsion3.Meningitis4.Dehydration +signs5.SCD6.CHD7.Pneumonia8.Immunization + schedule9.Otitis media10.Cerebral palsy11.Neonatal sepsis12.malaria/cerebral malaria13.RDS14.Measles15.Chicken pox16.Malnutrition

Read the ‘juju ‘+ the already discussed questions.

PAST QUESTIONS1.A Whiteman presented with Haematuria. He had swam in

lake bosomtwe 4 months ago & lake volta.What is your diagnose? in which lake did he acquire the disease & your treatment.

2.PUD3. A child presents with Hb of 4 g/dl. Looks pale & feverish.

What is the most important thing to do?4.A child presents with abdominal pain. Differential

diagnose?5.Signs of dehydration6.Typhoid fever7.Acute epiglottitis8. Meningitis: causes , signs and symptoms, management9. the unconscious child : causes, general management10. contraindication of lumbar puncture11.subphrenic abscess, management

PAST QUESTIONS12. complication of pregnancy with IUCD in sito 13.A woman come to you with IUCD in sito and want to keep her pregnancy ,what

would you do? 14. after 24hrs gastrectomy a patient comes with difficulty in

breathing.Diagnose,Treatment. 15. menopause, climacteric: signs & symptoms. Treatment. 16. A farmer presented with tremor & spasm of muscles after receiving a minor

injury. What would be your diagnose and management? 17. signs of meningeal irritation 18. Maternal care 19. shoulder dystocia & management 20. uterovaginal prolapse 21. distribution of iron in pregnancy 22.Diagnose of pregnancy 23. Antenatal care 24. Anaemia : signs & symptoms 25. lower & upper motor neuron lesions 26. posterior motor neuron lesions & cerebella syndrome

PAST QUESTIONS27. indications for blood transfusion 28. complications of sickle cell disease 29.cardiomyopathy 30. Ectopic pregnancy 31. septic abortion ,management 32. dysmenorrheal: signs & symptoms 33.post partum pyrexia 34. an elderly person complains of headaches ,dizziness and unable to stand on

the feet. On examination BP is high .What is the diagnosis and where will the lesion be? What other signs will you find in in the physical examination?

35.differentiate b/n peripheral and central motor neuron lesion 36. treatment of TB 37. causes of PPH 38.A girl presented with bone pain. The sister was recently

transfused .Diagnose and treatment? 39.Burns: classifications, signs n symptoms 40. Pneumothorax, pleural effusion,empyema, lobar consolidation in pneumonia 41. gas gangrene, management 42. Anaemia in Pregnancy

PAST QUESTIONS43. Monteux test negative. Give 3 conditions to show negativity? 44.Goo:causes, problems ,Treatment 45.Mention 10 characteristics of febrile convulsion 46. differential diagnosis of a mass in the LIF 47.Demography 48.a Patient started experiencing numbness & tickling of the arm after subtotal thyroidectomy.What is the

possible cause and management? 49. differential diagnosis of a mass in the RIF 50. Acute abdomen 51.New born: screening, Average 52.complications of radiotherapy in Cervix Ca. Treatment 51. hyperemesis Gravidium 52.major cause of maternal mortality in Ghana 53. A pregnant woman undergoing radiotherapy. Which organ of the fetus would be affected. 54.Emergency contraceptive + types 55.Ectopic pregnancy 56.what is your diagnosis & management of a woman who delivered 2 days ago & presented with fever,

general weakness and offensive vaginal discharge 57.Painless ulcer on the penis: diagnose & treatment 58. painful ulcer on the penis 59.clinical features of chronic renal failure 60.A child comes with painful limb. Give differential diagnose 61.Failure to thrive. Give causes 62.pre operation preparation of the jaundiced patient.

AddendumWishing you the best of luck!!!!Contact me for answers and further

explanations to some of the problems outlined here. 90% of the questions will come from the cases discussed above. Be prudent.

Dr.E.Boateng+233-249856723 doc_ boat1@yahoo.comStay blessed.

Solutions to the past questions