DIRECTIONS TO CANDIDATES

Paper 1 – Medical Sciences

h Time allowed: 2 HOURS

h Before you commence the Examination check that you

have been provided with two pencils, an eraser, a
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Sciences’. If these items are not on your desk please
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h On completion of each examination paper, the

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2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 1

 h The following questions are A-type
(single-best answer).

h To answer these questions fill in ONE

box on the answer sheet provided,
corresponding to the alternative which
you consider to be the best answer.

h Do NOT mark any other box.

h Each correct answer scores one mark

and each incorrect answer zero.

h In the questions, values appearing within

[ ] refer to normal ranges.

h When visual material has been turned on

its side, an arrow on the page indicates
the orientation of the visual material.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 2

QUESTION 1

Which of the following is the most common precipitating illness leading to the Guillain-Barre
syndrome?

A. Campylobacter jejuni gastroenteritis.

B. Herpes simplex infection.

C. Epstein-Barr virus infection.

D. Mycoplasma pneumonia.

E. Cytomegalovirus infection

QUESTION 2

Symptom-limited treadmill exercise testing is often done in the weeks after ST elevation myocardial
infarction to identify those at low risk of death. Which of the following parameters at exercise testing
most strongly indicates a good prognosis with medical treatment?

A. Absence of ST depression.

B. % predicted maximal heart rate achieved.

C. Absence of chest pain.

D. Absence of ventricular arrythmias.

E. Above average exercise capacity.

QUESTION 3

X-linked dominant inheritance is distinguished by:

A. females often being more variably and mildly affected than males.

B. affected males having affected daughters and healthy sons.

C. affected females having affected daughters and healthy sons.

D. males often being more variably and mildly affected than females.

E. healthy females having affected sons and healthy daughters.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 3

QUESTION 4

A 50 kg person is given gentamicin 320 mg daily IV. The serum concentration measured one hour
post the infusion is 20 mg/L and the serum concentration six hours post infusion is 5 mg/L. Using this
data, what is the best estimate of the serum gentamicin clearance in this person?

A. 37 mg/hour.

B. 12.5 mg/hour.

C. 1 L/hour.

D. 3.5 L/hour.

E. 3 mg/L/hour.

QUESTION 5

Which of the following counter-regulatory factors is released earliest in response to hypoglycaemia?

A. Adrenaline.

B. Cortisol.

C. Noradrenaline.

D. Growth hormone.

E. Glucagon.

QUESTION 6

Which of the following is the main risk factor for the development of delirium in older people?

A. Surgery.

B. Dementia.

C. Polypharmacy.

D. Indwelling catheter.

E. Sensory impairment.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 4

QUESTION 7

A randomized, double-blind controlled trial compared the rate of major coronary events in diabetic
patients treated with fenofibrate or placebo and followed for up to six years. The trial was negative on
intention-to-treat analysis (event rates 5.2% and 5.9% respectively, p=0.16). The figure shows drop-
out from and drop-in to other lipid-modifying treatment during the trial.

Assuming fenofibrate is efficacious, which of the following is most likely to explain the negative trial
result?

A. The study was too small.

B. The drop-out rate was too high.

C. The drop-in rate was imbalanced.

D. The event rate was too low.

E. Treatment groups were not matched at entry.

QUESTION 8

In which of the following conditions is ursodeoxycholic acid most likely to relieve symptoms?

A. Primary sclerosing cholangitis.

B. Massive choledocholithiasis.

C. Primary biliary cirrhosis.

D. Microlithiasis associated pancreatitis.

E. Cholecystolithiasis in a poor surgical candidate.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 5

QUESTION 9

In a clinical trial presenting two survival curves, the absolute benefit of treatment is best described by
which of the following?

A. The median increase in survival time.

B. The relative risk reduction.

C. The hazard ratio.

D. The number needed to treat.

E. The absolute risk reduction.

QUESTION 10

In a patient with vasculitis whose serum contains perinuclear anti-neutrophil cytoplasmic antibodies (p-
ANCA), what is the most likely target antigen for this antibody?

A. Proteinase 3.

B. Myeloperoxidase.

C. Lactoferrin.

D. Cathepsin G.

E. Lyzosyme.

QUESTION 11

Which of the following is the most common mechanism of a Febrile Non-Haemolytic Transfusion
reaction (FNHTR) to transfusion of packed red cells?

A. Bacterial contamination of donor product.

B. Immediate hypersensitivity to proteins of donor origin.

C. Interaction between donor antibodies with recipient granulocytes.

D. Interaction between donor granulocytes with recipient antibodies.

E. Interaction between donor red cells with recipient red cell antibodies.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 6

QUESTION 12

A 45-year-old female with a ten-pack year history of cigarette smoking and a body mass index of 39
kg/m2, presents with a 12-month history of shortness of breath on exercise. An exercise test was
performed, with no evidence of myocardial ischaemia.

What is the most likely cause of the breathlessness and oxygen desaturation on exercise?

A. Chronic obstructive pulmonary disease.

B. Pulmonary vascular disease.

C. Morbid obesity.

D. Chronic asthma.

E. Beta-blockade.

QUESTION 13

Airline travel is undertaken by many patients with chronic cardio-respiratory disease.

When travelling with standard international commercial airlines currently, the partial pressure of
oxygen inflight approximates which sea-level FIO2 [Fraction of inspired oxygen]?

A. 5%.

B. 10%.

C. 15%.

D. 21%.

E. 25%.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 7

QUESTION 14

Adjuvant chemotherapy is given in many solid tumours. What is the main reason for doing this?

A. To shrink the primary tumour.

B. To improve survival by eradicating micrometastases.

C. To delay appearance of the secondary tumours.

D. To delay recurrence of primary tumour.

E. To reduce toxicity of the treatment regimen.

QUESTION 15

The principle mechanism of action by which inhaled nitric oxide can improve oxygenation in severe
hypoxemic respiratory failure is:

A. vasoconstriction of pulmonary vessels in non-ventilated lung.

B. decreased pulmonary vascular resistance.

C. vasodilatation of pulmonary vessels in ventilated lung.

D. bronchodilatation.

E. increase in cardiac output.

QUESTION 16

A 60-year-old man presents with nephrotic syndrome. He undergoes a renal biopsy. What is the most
likely histological finding?

A. Minimal change nephritis.

B. Focal and segmental glomerulosclerosis.

C. IgA (immunoglobulin A) nephropathy.

D. Membranous glomerulonephritis.

E. Amyloidosis.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 8

QUESTION 17

The following graph shows the effect of codeine against its concentration over the first eight hours
after ingestion.

3 hours
100
2 hours
4 hours
80
Effect (%)

60 6 hours 1 hour

40 30 minutes
8 hours
20 10 minutes

0
0 10 20 30 40 50 60 70 80
Blood concentration (mg/mL)

What is the best explanation for this unusual concentration-effect loop for this drug?

A. The drug has active metabolites.

B. There is rapid absorption of drug after oral administration.

C. Tachyphylaxis to the effects of the drug is occurring.

D. There is slow distribution of the drug to the site of action.

E. The drug irreversibly binds to its receptor.

QUESTION 18

Which of the following has the greatest effect on peak bone mass?

A. Pubertal age.

B. Childhood calcium intake.

C. Genetic factors.

D. Childhood physical activity.

E. Body weight.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 9

QUESTION 19

Which of the following factors is most strongly associated with risk of sudden death in the first six
months after myocardial infarction?

A. Persistent occlusion of the infarct-related artery.

B. Cigarette smoking.

C. 3-vessel coronary disease at angiography.

D. Low left ventricular ejection fraction.

E. High LDL (low density lipoprotein) cholesterol.

QUESTION 20

A new highly sensitive D-dimer assay has a sensitivity of 99.5% but a specificity of only 50%.
What is the likelhood ratio for a positive result nearest to?

A. 2.

B. 5.

C. 10.

D. 20.

E. 50.

QUESTION 21

A 74-year-old female presents with severe jaw pain following tooth extraction. The jaw is swollen and
disfigured. The X-ray shows extensive changes around the site of extraction consistent with
osteonecrosis. The medication most likely to cause this condition is:

A. ergocalciferol.

B. zolendronate.

C. calcitriol.

D. fluoride.

E. strontium.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 10

QUESTION 22

What is the most likely inheritance pattern in this family?

= Affected
= Male

= Female

A. Dominant inheritance with anticipation.

B. Dominant inheritance with variable expressivity.

C. Dominant inheritance with paternal imprinting.

D. Dominant inheritance with maternal imprinting.

E. Dominant inheritance with incomplete penetrance.

QUESTION 23

Recurrent infections with which of the following organisms is most characteristic of a disorder of
neutrophil phagocytic function (such as chronic granulomatous disease)?

A. Non-tuberculous mycobacteria.

B. Pseudomonas aeruginosa.

C. Nocardia species.

D. Pneumocystis jiroveci (carinii).

E. Staphylococcus aureus.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 11

QUESTION 24

The diagram below shows the time-course of a typical ventricular myocyte action potential (Figure 1).
Figure 1b shows the principal cation currents between the intra and extra-cellular space concurrent
with phase 0-3 of the action potential shown in Figure 1a. The direction and size of the arrows in
Figure 1b indicate whether the current is inward-directed or outward-directed and the relative current
strengths of the ion identified by a letter at the base of the arrow.

Figure 1

From the table below, select the cations that BEST represent X, Y, and Z in Figure 1b.

+ 2+ +
A. X = Na Y = Ca Z=K
+ + 2+
B. X=K Y = Na Z = Ca
2+ + +
C. X = Ca Y=K Z = Na
+ + 2+
D. X = Na Y=K Z = Ca
2+ + +
E. X = Ca Y = Na Z=K

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 12

QUESTION 25

The risk factor with the greatest impact on development of esophageal cancer is:

A. achalasia.

B. Barrett’s oesophagus.

C. low fibre diet.

D. smoking.

E. reflux.

QUESTION 26

The emergence of a pandemic strain of influenza is best explained by which of the following
mechanisms?

A. Antigenic drift in H and N proteins of influenza A.

B. Antigenic shift in H and N proteins of influenza A.

C. Point mutations in the M proteins of influenza A.

D. Development of neuraminidase resistance.

E. Recombination of influenza A and B haemagglutinins.

QUESTION 27

Cholinesterase inhibitors are widely used to improve cognitive function in Alzheimers disease. Which
of the following urinary symptoms would be the most likely type A (dose-dependent) adverse drug
reaction?

A. Increased urinary frequency.

B. Reduced urine output.

C. Increased urine output.

D. Urinary retention.

E. Stress incontinence.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 13

QUESTION 28
A 33-year-old male presents to hospital with recurrent episodes of breathlessness and wheeze. Flow-
volume loops are shown during (A) and between (B) episodes.

The most likely cause of the episodes are:

A. hyperventilation syndrome.

B. paroxysmal vocal cord dysfunction.

C. acute asthma.

D. tracheobronchomalacia.

E. respiratory bronchiolitis.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 14

QUESTION 29

Which of the following is the greatest cause of mortality occurring more than 100 days following
allogeneic peripheral blood cell stem transplantation for acute leukaemia?

A. Hepatic veno-occlusive disease.

B. Graft-versus-host disease.

C. Transplantation-related lung injury.

D. Transplantation-related infection.

E. Recurrent leukaemia.

QUESTION 30

A 30-year-old woman has known Sjogren’s syndrome and a past history of a single renal calculus.
She presents with a metabolic acidosis, with hyperchloraemia. The plasma anion gap is normal.
There is no bicarbonate in the urine and the urine pH is 5.7. What is the most likely cause of her
presentation?

A. Proximal renal tubular acidosis.

B. Osteomalacia.

C. Chronic diarrhoea.

D. Distal renal tubular acidosis.

E. Type 4 renal tubular acidosis.

QUESTION 31

Which of the following tests is most specific for a diagnosis of rheumatoid arthritis?

A. Anti-cyclic citrullinated peptide antibody.

B. Rheumatoid factor.

C. Antinuclear antibody.

D. Anti-Ro antibody.

E. Anti-neutrophil cytoplasmic antibody.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 15

QUESTION 32

Many HIV (human immunodeficiency virus) protease inhibitors are marketed in a combination that
includes a small dose of ritonavir eg. Lopinavir 133mg-ritonavir 233mg. Which of the following
provides the best rationale for the use of such combinations?

A. Enhancement of anti-HIV activity.

B. Improved patient compliance.

C. Improved pharmacokinetic profile.

D. Reduction of metabolic side effects.

E. Reduction in development of HIV drug resistance.

QUESTION 33

The graph below shows the estimated concentrations of pralidoxime in a typical patient over the first
th
two days when given as one gram 8 hourly.
300
Pralidoxime[µM]

200

100

0
0 8 16 24 32 40 48
hours

If it was given as a two gram bolus followed by an infusion of 500 mg/hour, the best estimate of the
time until the drug is in steady state is:

A. 3 hours.

B. 8 hours.

C. 16 hours.

D. 24 hours.

E. 40 hours.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 16

QUESTION 34

What is the most likely consequence of inheriting a mutated, maternally imprinted gene?

A. 100% of the children of a carrier mother will be affected.

B. 50% of the children of a carrier mother will be affected.

C. None of the children of a carrier mother will be affected.

D. 100% of the children of a carrier father will be affected.

E. None of the children of a carrier father will be affected.

QUESTION 35

Absorption of which of the following is most likely to be impaired in untreated coeliac disease?

A. Vitamin K.

B. Iron.

C. Vitamin B12.

D. Folate.

E. Calcium.

QUESTION 36

A 16-year-old male presents with short stature. Which of the following findings is most suggestive of
growth hormone deficiency?

A. Reduced growth velocity.

B. Decreased bone age.

rd
C: Height below the 3 centile.

D. Delayed puberty.

E. Increased body weight.

QUESTION 37

In a patient with rheumatic mixed mitral valve disease, for which of the following procedures is there
the strongest indication for antibiotic prophylaxis?

A. Flexible bronchoscopy.

B. Cardiac catheterisation.

C. Colonoscopy without biopsy.

D. Oesophageal dilatation.

E. Gastroscopy.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 17

QUESTION 38

Which class of drugs has been shown to be most closely associated with the risk of falling in older
people?

A. Beta blockers.

B. Selective serotonin re-uptake inhibitors.

C. Non steroidal anti-inflammatory drugs.

D. Calcium channel blockers.

E. Diuretics.

QUESTION 39

Secretion of which of the following cytokines is most characteristic of T helper cells from patients with
cell-mediated immune disorders such as multiple sclerosis?

A. Interleukin - 4 (IL-4).

B. Interleukin - 10 (IL-10).

C. Interleukin - 12 (IL-12).

D. Interferon - gamma (IFN-γ).

E. Interferon - beta (IFN-β).

QUESTION 40

Patients infected with strains of Staphylococcus aureus which secrete the Panton-Valentine
Leucocidin (PVL) toxin are most likely to present with which of the following?

A. Endocarditis.

B. Toxic shock syndrome.

C. Pyogenic skin infections.

D. Stevens-Johnson syndrome.

E. Intravenous catheter sepsis.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 18

QUESTION 41
What is the most likely cause of the abnormalities in the lung function tests shown from a 22-year old
asymptomatic non-smoking male?
2
BMI: 20.17 kg/m
PRE-BRONCH POST-BRONCH
Pred. Actual %Pred. Actual %Pred. %Chng
Lung Mechanics
FVC (L) 3.50 1.77 51 1.80 51 2
(Forced vital capacity)
FEV1 (L) 3.15 1.34 43 1.40 44 4
(Forced expiratory volume
in 1 second)
FEV1/FVC (%) 90 76 78 3
FEF MAX (L/sec) 8.17 3.01 37 2.89 35 -4
(Forced expiratory flow)
FEF 25-75% (L/sec) 4.59 1.07 23 1.26 28 18
(Forced expiratory flow
between 25 and 75% of
FVC)
MEP (cmH2O) 108
(maximal expiratory
pressure)
MIP (cmH2O) -95
(maximal inspiratory
pressure)

Lung Volumes
SVC (L) 3.64 1.76 48
(Slow vital capacity)
IC (L) 2.06 1.48 72
(Inspiratory capacity)
ERV (L) 1.58 0.28 18
(Expiratory reserve
volume)
TGV (Pleth) (L) 2.52 1.65 65
(Thoracic gas volume)
RV (Pleth) (L) 1.17 1.37 117
(Residual volume)
TLC (Pleth) (L) 4.59 3.13 68
(Total lung capacity)
RV/TLC (Pleth) (%) 23 44

Lung Diffusion
DLCOunc (ml/min/mmHg) 26.09 11.95 46
(Diffusing capacity for
Carbon Monoxide)
Alveolar Volume (L) 4.59 1.98 46
DL/VA (ml/min/mmHg/L) 6.53 6.02 92

Blood Gases
Inspired O2 (%) 21.00
Ph 7.40 7.41
PaCO2 (mmHg) 38-42 38
PaO2 (mmHg) 98.0
HCO3 (mEq/L) 24.0
Base Excess -1.0
SaO2 Calculated(%) 97.0

A. Kyphoscoliosis.

B. Goodpastures syndrome.

C. Myasthenia Gravis.

D. Alpha-1 anti-trypsin deficiency.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 19

E. Chronic asthma.
QUESTION 42

A trial comparing two antiplatelet treatments for the prevention of vascular events randomizes 11000
patients into two equal groups, followup for up to six years. Event rates are 8.6% for drug A and 8.3%
for drug B. The p value for the comparison is 0.051.

Which statement most accurately describes the interpretation of the p value?

A. The result is statistically and clinically significant .

B. There is a trend to a positive result.

C. In a trial of this size, such a p value is not significant.

D. The result is statistically but not clinically significant.

E. The result is clinically but not statistically significant.

QUESTION 43

Small interfering RNAs (also called “micro-RNAs”) influence gene expression. The mechanism of
action is best explained by their effect on:

A. gene promoter activation.

B. gene promoter repression.

C. RNA synthesis rate.

D. RNA degradation rate.

E. chromatin compaction.

QUESTION 44

The main reason for bone loss in patients treated for metastatic prostate cancer with the luteinising
hormone releasing hormone (LHRH) agonist goserelin and the antiandrogen flutamide is:

A. oestrogen deficiency due to goserelin.

B. androgen deficiency due to goserelin.

C. oestrogen deficiency due to flutamide.

D. androgen blockade due to flutamide.

E. multiple bony metastases.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 20

QUESTION 45

A patient presenting to the Emergency Department is thought to have acute intermittent porphyria.
Which of the following is most suggestive of an alternative diagnosis?

A. Ileus.

B. Hypertension.

C. Fever.

D. Urinary retention.

E. Tachycardia.

QUESTION 46

Memory loss in Alzheimers disease most closely correlates with changes in which brain region?

A. Cingulate gyrus.

B. Thalamus.

C. Frontal lobe.

D. Amygdala.

E. Hippocampus.

QUESTION 47

A certain autosomal recessive disorder affects 1 in 1600 people; the carrier frequency is 5%. A DNA
assay can identify the mutation in 80% of carriers; the false-positive rate of this assay is zero.

What is the best estimate of the positive predictive value (PPV) and negative predictive value (NPV) of
this assay in screening the population for carriers?

PPV NPV
A 20% 100%
B 80% 80%
C 100% 80%
D 100% 99%
E 100% 100%

QUESTION 48

In a normal person, which of the following is most likely to cause a decrease in circulating growth
hormone concentration?

A. Slow wave sleep.

B. Hyperglycaemia.

C. Protein meal.

D. Exercise.

E. Sepsis.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 21

QUESTION 49

What is the most distinguishing feature of loss of imprinting of a growth-promoting imprinted gene?

A. Restoration of normal methylation patterns.

B. Inhibition of cell growth.

C. Reduced expression of the imprinted gene product.

D. Activation of the normally silent allele.

E. Ablation of biallelic gene expression.

QUESTION 50

Which of the following is the most likely initial site of involvement in primary osteoarthritis of the knee?

A. Medial tibiofemoral cartilage.

B. Lateral tibiofemoral cartilage.

C. Patellofemoral cartilage.

D. Intercondylar cartilage.

E. All of the above.

QUESTION 51

Which of the following most increases the risk of hepatotoxicity of paracetamol when taken in
overdose?

A. Cigarette smoking.

B. Old age.

C. Chronic Alcohol ingestion.

D. Acute Alcohol ingestion.

E. Hepatitis B Virus (HBV) infection.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 22

QUESTION 52

A man is diagnosed with a rare autosomal recessive disorder. His pedigree is shown below.

Unaffected male Affected male

Unaffected female

What is the best estimate of the risk of his cousin (indicated on the diagram by an arrow) developing
the same disorder?

A. 1/2.

B. 1/4.

C. 1/8.

D. 1/16.

E. 1/32.

QUESTION 53

Desensitisation is most likely to be effective in individuals who have had which of the following
reactions to penicillin?

A. Haemolytic anaemia.

B. Laryngeal oedema.

C. Stevens-Johnson Syndrome.

D. Toxic epidermal necrolysis.

E. Immune complex reactions.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 23

QUESTION 54

A 68-year-old diabetic has chest pain and T wave inversion in the precordial chest leads. In this
patient, elevation of which biomarker is most predictive of an adverse outcome?

A. B natriuretic peptide.

B. Myeloperoxidase.

C. Blood glucose.

D. High-sensitity C-reactive protein.

E. Troponin.

QUESTION 55

Cyclosporin has very low bioavailability. It is a lipid soluble drug and a major route of metabolism is by
the CYP3A4 enzyme in the liver. However, removal by the liver accounts for only approximately half of
the low bioavailability. The best explanation for the other cause of low bioavailability is:

A. poor dissolution of tablets.

B. nucleophilic attack by stomach acids.

C. destruction by coliform bacteria.

D. metabolism in the small intestine.

E. circulating esterases in portal blood.

QUESTION 56

An 18-year-old gives a history of recurrent morning myoclonus and absences after sleep deprivation.
The most likely epilepsy syndrome is:

A. juvenile myoclonic epilepsy.

B. benign myoclonic epilepsy.

C. petit mal epilepsy.

D. benign Rolandic epilepsy.

E. absence epilepsy.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 24

QUESTION 57

A novel therapeutic agent is developed which increases numbers of CD4+ CD25+ regulatory T cells.
For which of the following conditions is there the most potential for benefit from treatment with this
agent?

A. Alzheimer’s disease.

B. HIV (human immunodeficiency virus) infection.

C. Idiopathic CD4 lymphopenia.

D. Hodgkin’s disease.

E. Multiple sclerosis.

QUESTION 58

All of the following drugs have clinically significant variation in response due to genetic polymorphisms.
For which of the following drugs is the variation in effect most related to pharmacodynamic (as
opposed to pharmacokinetic) response?

A. Warfarin.

B. Carvedilol.

C. Azathioprine.

D. Phenytoin.

E. Isoniazid.

QUESTION 59

Differentiation between cardiogenic and non-cardiogenic pulmonary edema is most reliably performed
by measurement of:

A. left ventricular end diastolic pressure.

B. left ventricular peak systolic pressure.

C. pulmonary artery peak systolic pressure.

D. pulmonary artery diastolic pressure.

E. pulmonary artery mean pressure.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 25

QUESTION 60

The primary factor leading to the accumulation of ascites in patients with chronic liver disease is?

A. Excessive abdominal lymph formation.

B. Splanchnic vasodilatation.

C. Hypoalbuminaemia.

D. Increased aldosterone secretion.

E. Expansion of plasma volume.

QUESTION 61

Which clinical feature of delirium is most useful for differentiating it from dementia?

A. Inability to count backwards from 30.

B. Failure to recall 3 items after a three-minute delay.

C. Disorientation in time and place but not person.

D. Paranoid delusions.

E. Sleep-wake disturbance with nocturnal wandering.

QUESTION 62

In a patient with Type 2 diabetes which of the following co-existing clinical situations is the strongest
contraindication to the use of a thiazolidinedione drug?

A: Serum creatinine 200µmol/L.

B: Proliferative diabetic retinopathy.

C: Severe congestive cardiac failure.

D: Peripheral vascular disease.

E: Fatty liver disease.

QUESTION 63

The first manifestation of illness in a patient with new variant Creutzfeldt-Jacob Disease (nvCJD) is
most likely to be which of the following?

A. Psychiatric.

B. Myoclonus.

C. Ataxia.

D. Slurred speech.

E. Epilepsy.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 26

QUESTION 64

Genetic variation in the thiopurine methyltransferase gene is most likely to lead to increased toxicity
following administration of:

A. oxaliplatin.

B. allopurinol.

C. azathioprine.

D. cyclophosphamide.

E. 5-fluorouracil.

QUESTION 65

The aura in migraine is most likely to be due to:

A. neurogenic inflammation.

B. neuronal dysfunction.

C. cerebral vasoconstriction.

D. cerebral vasodilatation.

E. central sensitisation.

QUESTION 66

Oral medications, Drugs A and B, have the following properties in healthy individuals.

Drug A Drug B
Absorption 100% 100%
Bioavailability 2% 90%
Volume of distribution 350 L 50 L
Renal Clearance 2 L/hr 1 L/hr
Hepatic clearance 10 L/hr 2 L/hr
Protein Binding 75% 25%

Compared to healthy individuals, patients with cirrhosis have a much higher concentration of drug A
than drug B. The best explanation for this is the difference in:

A. bioavailability.

B. volume of distribution.

C. renal clearance.

D. hepatic clearance.

E. protein binding.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 27

QUESTION 67

Human papilloma virus (HPV) is a well-recognised causal factor for cancer of the cervix. For which of
the following other cancers is there the strongest association with HPV?

A. Uterine.

B. Anal.

C. Rectal.

D. Oral.

E. Vulval.

QUESTION 68

Which of the following best describes the mechanism of action of the hirudin class of anticoagulant
drugs (lepirudin, bivalirudin)?

A. Direct thrombin inhibition.

B. Factor Xa inhibition.

C. Cycloxygenase antagonism.

D. Antithrombin-mediated thrombin inhibiton.

E. Inhibition of prothrombin γ-carboxylation.

QUESTION 69

The most common pathology underlying temporal lobe epilepsy is:

A. temporal neuronal migration abnormality.

B. temporal dysembryoplastic neuroepithelial tumour (DNET).

C. mesial temporal sclerosis.

D. temporal lobe dysplasia.

E. temporal demyelination.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 28

QUESTION 70

A 70-year-old man is admitted with general malaise, nausea and vomiting. He had recently suffered
from gastroenteritis with three days of diarrhoea. He has longstanding hypertension and osteoarthritis
of his knees. He is taking Bendrofluazide, Enalapril, Aspirin, Codeine and Ibuprofen.

Serum biochemistry shows:

Sodium 132 mmol/L [137-147]
Potassium 8.4 mmol/L [3.5-5.0]
Creatinine 0.32 mmol/L [0.5-1.0]
Urea 17.8 mmol/L [3.5-6.5]
Bicarbonate 14.5 mmol/L [22.0-28.0]

His ECG is shown below.

Which is the most appropriate initial treatment?

A. Calcium gluconate.

B. Magnesium sulphate.

C. Sodium bicarbonate.

D. Amiodarone.

E. Lignocaine.

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 29

 Adult Medicine

Paper 1 – Medical Sciences

Answers

1 A 25 B 49 D
2 E 26 B 50 A
3 A 27 A 51 C
4 D 28 B 52 D
5 E 29 E 53 B
6 B 30 D 54 E
7 C 31 A 55 D
8 C 32 C 56 A
9 A 33 A 57 E
10 B 34 C 58 B
11 D 35 B 59 A
12 B 36 A 60 B
13 C 37 D 61 A
14 B 38 B 62 C
15 C 39 D 63 A
16 D 40 C 64 C
17 A 41 A 65 B
18 C 42 C 66 A
19 D 43 D 67 B
20 A 44 A 68 A
21 B 45 C 69 C
22 D 46 E 70 A
23 E 47 D
24 A 48 B

2007 FRACP Written Examination Paper 1 - Medical Sciences Adult Medicine 30