2002 FRACP Written Examination

Paediatrics & Child Health

Paper 1 – Medical Sciences

Introduction
Format

Paper 1 – Medical Sciences: 70 questions; time allowed: 2 hours

Paper 2 – Clinical Applications: 100 questions; time allowed: 3 hours

All questions are in the A-type multiple-choice format, that is, the single best answer of the five options given.

In the questions, values appearing within [ ] refer to normal ranges.

When visual material has been turned on its side, an arrow on the page indicates the orientation of the visual
material.

Questions do not necessarily appear in the order in which they were first printed.

Answers

A table of answers is located at the end of each paper.

Scoring

A correct answer will score one mark and an incorrect answer zero. There is no negative marking in the
FRACP Written Examination.

Queries

Contact the Executive Officer, Examinations Section, Department of Training and Assessment via e-mail:
exams@racp.edu.au.

Please note that with changes in medical knowledge, some of the information may no longer be current.

Copyright © 2004 by The Royal Australasian College of Physicians

All Written Examination papers are copyright. They may not be reproduced in whole or part without written
permission from The Royal Australasian College of Physicians, 145 Macquarie Street, Sydney, Australia.
 2 P102

QUESTION 1

Where is sodium maximally reabsorbed in the kidney?

A. Collecting ducts.

B. Distal tubule.

C. Glomerulus.

D. Loop of Henle.

E. Proximal tubule.

QUESTION 2

A child is known to have pulmonary atresia. The oxygen saturations obtained at cardiac catheterisation are
displayed on the diagram shown below.

What is the ratio of pulmonary to systemic blood flow (Qp:Qs ratio) based on the data supplied?

A. 0.2:1

B. 1:1

C. 4:1

D. 5:1

E. Incalculable based on the data supplied.

Copyright © 2004 by The Royal Australasian College of Physicians

 3 P102

QUESTION 3

A five-year-old is investigated with a fasting study for suspected hypoglycaemia.

Which combination of plasma glucose, insulin, beta hydroxybutyrate (β-OH-butyrate), lactate and cortisol can
best be described as a normal metabolic response to fasting after 18 hours in a five-year-old?

The non-fasting normal range values are shown in [ ] brackets.

Plasma glucose Insulin β-OH-butyrate Lactate Cortisol

[3.5-8.0 mmol/L] [15-120 pmol/L] [0.1-0.3 mmol/L] [0.3-2.0 mmol/L] [150-450 mmol/L]

A. 3.1 10 1.5 0.5 500

B. 3.1 10 0.3 0.5 420

C. 3.3 15 1.4 3.8 450

D. 2.4 10 2.1 1.0 650

E. 2.9 15 1.8 1.0 90

QUESTION 4

Which one of the following diagnoses is most likely to be associated with the presence of fatty acid crystals
on faecal microscopy?

A. Acute pancreatitis.

B. Chronic cholestasis.

C. Cystic fibrosis.

D. Giardiasis.

E. Intestinal lymphangiectasia.

QUESTION 5

Newborn screening programs around the world carry out programs reflecting local prevalence and need.

Which one of the following congenital conditions has the highest prevalence in Australia and New Zealand?

A. Bilateral hearing impairment.

B. Cystic fibrosis.

C. Galactosaemia.

D. Hypothyroidism.

E. Neuroblastoma.

Copyright © 2004 by The Royal Australasian College of Physicians

 4 P102

QUESTION 6

Which one of the following types of mutation is most likely to lead to the introduction of a premature stop
codon?

A. 1 base pair insertion in an exon.

B. 1 base pair insertion in the promoter.

C. 2 base pair duplication in an intron.

D. 3 base pair deletion in an exon.

E. 3 base pair inversion in an exon.

QUESTION 7

Dendritic cells are distinguished by an exceptional ability to carry out which one of the following immune
functions?

A. Antigen presentation.

B. Chemokine secretion.

C. Cytokine secretion.

D. Immunoglobulin secretion.

E. Phagocytosis.

QUESTION 8

Which one of the following poses the greatest threat to validity in a longitudinal cohort study?

A. Confounding.

B. Data collection intervals too long.

C. Data collection intervals too short.

D. Loss to follow-up.

E. Selection bias.

QUESTION 9

Which one of the following vaccines is contraindicated in a child on maintenance therapy for acute
leukaemia?

A. Hepatitis A.

B. Hepatitis B.

C. Influenza.

D. Pneumococcal polysaccharide.

E. Varicella.

Copyright © 2004 by The Royal Australasian College of Physicians

 5 P102

QUESTION 10

The use of artificial surfactant has been shown to reduce the incidence of which one of the following
complications of prematurity?

A. Chronic lung disease.

B. Periventricular haemorrhage.

C. Pneumothorax.

D. Retinopathy of prematurity.

E. Symptomatic patent ductus arteriosus.

QUESTION 11

A 14-year-old girl is out hiking on a school camp. She has been carrying a heavy backpack for about four
hours during the day. She wakes the next morning with pain across her right shoulder and upper arm. The
pain persists for about a day and she then develops arm weakness.

Examination shows weakness of abduction at the shoulder and of flexion at the elbow. She has a depressed
biceps deep tendon reflex and sensory loss on the lateral aspect of her arm at the insertion of the deltoid
muscle.

The most likely site of injury is to the:

A. accessory nerve.

B. axillary nerve.

C. brachial plexus.

D. C7/C8 spinal roots.

E. radial nerve.

QUESTION 12

A bioavailability study has been performed to compare a proposed new generic capsule, in a strength of 50
mg, with a marketed tablet preparation in a strength of 100 mg. The active ingredient is a drug with linear
kinetics. A cross-over design was used, with each subject receiving, in random order and with an adequate
wash-out period, a single oral dose of one tablet on one occasion and one capsule on the other. The mean
results for the area under the plasma concentration versus time curve (AUC) are 300 mg.hour/L for the
capsule, and 500 mg.hour/L for the tablet.

The best estimate of the relative bioavailability of the capsule with respect to the tablet is:

A. 0.3

B. 0.6

C. 1.2

D. 1.7

E. 3.3

Copyright © 2004 by The Royal Australasian College of Physicians

 6 P102

QUESTION 13

The correlation between television violence and aggressive behaviour has been shown to be highest for
which one of the following age groups?

A. Pre-school.

B. Primary school.

C. Early adolescence.

D. Late adolescence.

E. Young adults.

QUESTION 14

A couple wants to start a family. There is a vague history of thalassaemia in both families. Which one of the
following combinations would be of least concern?

The woman is a carrier for: The man is a carrier for:

A. β-thalassaemia β-thalassaemia

B. αo-thalassaemia αo-thalassaemia

C. α+-thalassaemia αo-thalassaemia

D. haemoglobin E β-thalassaemia

E. αo-thalassaemia β-thalassaemia

Legend:

β = beta
αo = absent alpha chain production
α+ = decreased alpha chain production

QUESTION 15

A substance used to measure glomerular filtration rate must satisfy all of the following criteria except:

A. it is freely filtered by the glomerulus.

B. it is neither excreted nor reabsorbed by the kidney.

C. it is neither metabolised nor synthesised by the kidney.

D. its concentration in the glomerular filtrate must be greater than that in plasma water.

E. it should not be bound to plasma proteins.

Copyright © 2004 by The Royal Australasian College of Physicians

 7 P102

QUESTION 16

The rhythm strip shown above was obtained from an otherwise well five-year-old who had been noted to
have an irregular pulse.

Which one of the following is the most likely diagnosis?

A. Blocked atrial ectopics.

B. Complete heart block.

C. Mobitz type I block (Wenkebach).

D. Mobitz type II block.

E. Sinus arrhythmia.

QUESTION 17

Which one of the following biologically active components of the complement cascade is most directly
responsible for the formation of transmembrane channels leading to cell lysis?

A. C3a.

B. C3b.

C. C4a.

D. C5a.

E. C5-9.

QUESTION 18

Which one of the following chemotherapeutic agents has activity in the S phase of the cell cycle only?

A. Cisplatin.

B. Etoposide (VP-16).

C. Ifosfamide.

D. Prednisolone.

E. Vinblastine.

Copyright © 2004 by The Royal Australasian College of Physicians

 8 P102

QUESTION 19

A three-month-old infant with short bowel syndrome is receiving a 24-hour continuous nasogastric feeding
with a casein hydrolysate infant formula, which is administered at 5 mL/hr. Compared to bolus feeding,
continuous enteral feeding at a constant rate is most likely to be associated with an increase in:

A. feeding-induced thermogenesis.

B. functional adaptation of the distal small intestine.

C. gastric emptying rate.

D. gastrin secretion.

E. small intestinal enzyme secretion.

QUESTION 20

If one identical twin develops schizophrenia, what is the lifetime risk that the other twin will also develop
schizophrenia?

A. 25%.

B. 50%.

C. 75%.

D. 90%.

E. >99%.

QUESTION 21

You are providing safety advice to the parents of a six-year-old child of average height and weight.

Which one of the following is the most appropriate car seating arrangement for this child, in order to
decrease the chance of injury in a motor vehicle accident?

A. Back seat; booster; seat belt.

B. Back seat; no booster; seat belt.

C. Front or back seat; booster; seat belt.

D. Front seat; booster; seat belt.

E. Front seat; no booster; seat belt.

Copyright © 2004 by The Royal Australasian College of Physicians

 9 P102

QUESTION 22

The diagram below shows cumulative quantal dose-response curves for a hypothetical drug (drug X). The
Y-axis represents the percentage of the population studied who: for curve (a) achieved the desired
therapeutic effect at a given dose; and for curve (b) experienced the most important toxic effect at a given
dose.

Based on this information, the best estimate of the therapeutic index of drug X is approximately:

A. 0

B. 0.3

C. 0.7

D. 1.0

E. 3.0

QUESTION 23

Which one of the following common infectious diseases does not warrant exclusion from school or day care
centre?

A. Coxsackieviral hand-foot-and-mouth infection.

B. Herpes simplex virus type 1 gingivostomatitis.

C. Parvovirus B19 slapped cheek syndrome.

D. Rotavirus associated gastroenteritis.

E. Rubella.

Copyright © 2004 by The Royal Australasian College of Physicians

 10 P102

QUESTION 24

The predominant mechanism by which 1,25-dihydroxycholecalciferol increases plasma calcium is by:

A. decreasing calcitonin synthesis.

B. increasing calcium absorption from bone.

C. increasing parathyroid hormone synthesis.

D. increasing renal tubular absorption of calcium.

E. increasing small intestinal absorption of calcium.

QUESTION 25

The impact of an intervention in clinical trials and in systematic reviews can be expressed in a number of
ways. One increasingly used format is the number needed to treat (NNT) which indicates how many patients
have to be treated with the intervention of interest compared to the control intervention in order to achieve
one successful outcome.

In a systematic review of optimal home-management for asthma, the intervention was found to produce a
50% reduction in hospitalisation for asthma. Approximately 10% of patients in the control group required
hospitalisation compared to approximately 5% of those who received optimal home-management.

Which one of the following is the best estimate of the NNT for this intervention?

A. 2.

B. 5.

C. 10.

D. 20.

E. 50.

QUESTION 26

A previously well term infant develops multifocal clonic seizures at 72 hours of age. Examination reveals a
bulging fontanelle. A cranial ultrasound shows a large intraventricular haemorrhage. Investigation of the
clotting profile shows:

platelet count 200 x 109/L [150-400]

prothrombin time (PT) 100 seconds [10-24]
activated partial thromboplastin time (APTT) 35 seconds [28-79]

The most likely diagnosis is:

A. haemorrhagic disease of the newborn.

B. factor VII deficiency.

C. factor VIII deficiency.

D. factor XII deficiency.

E. von Willebrand disease.

Copyright © 2004 by The Royal Australasian College of Physicians

 11 P102

QUESTION 27

A four-month-old baby of Chinese descent, bottle-fed with a cows’ milk-based formula, has a history of
diarrhoea and positive faecal reducing substances. He has normal bowel motions when changed to soy
formula. He is inadvertently given a cows’ milk-based formula and ten minutes later he has profuse watery
diarrhoea and rapidly becomes shocked.

Which one of the following is the most likely explanation for the above response?

A. Delayed hypersensitivity T cell reaction.

B. Food protein-induced enterocolitis.

C. IgE-mediated immediate-onset food sensitivity.

D. IgG immune complex formation.

E. Lactase deficiency.

QUESTION 28

The following arterial blood gas results are obtained.

pH 7.31 [7.36-7.44]
PaCO2 29 mmHg [35-45]
PaO2 80 mmHg [80-100]
Bicarbonate 14 mmol/L [22-26]

The best explanation for these results is:

A. acute respiratory acidosis.

B. chronic respiratory acidosis.

C. chronic respiratory alkalosis.

D. metabolic acidosis.

E. metabolic alkalosis.

QUESTION 29

Inappropriate antidiuretic hormone secretion is best characterised by:

Serum sodium Serum creatinine Urinary osmolality Urinary sodium

A. Low Low Low Low

B. Low Normal Low Low

C. Low Normal High High

D. Low High High High

E. Normal Low High High

Copyright © 2004 by The Royal Australasian College of Physicians

 12 P102

QUESTION 30

The chromosomal abnormality shown above is best described as:

A. aneuploidy.

B. euploidy.

C. translocation.

D. triploidy.

E. trisomy.

QUESTION 31

In the human foetus near term, the ratio of the output of the right ventricle compared to the left ventricle is
closest to:

A. 1:2

B. 1:1.5

C. 1:1

D. 2:1

E. 4:1

Copyright © 2004 by The Royal Australasian College of Physicians

 13 P102

QUESTION 32

Which one of the following pharmacokinetic parameters is most important in the optimal prescribing of beta-
lactam antibiotics?

A. The peak concentration/minimum inhibitory concentration (MIC) ratio.

B. Area under the plasma concentration versus time curve (AUC).

C. The AUC/MIC ratio.

D. Time above the MIC.

E. Both AUC/MIC ratio and peak concentration/MIC ratio.

QUESTION 33

Anorexia nervosa is accompanied by significant hormonal changes. Which one of the following is least likely
to be found in an adolescent girl with anorexia nervosa?

A. Increased plasma cortisol.

B. Increased plasma growth hormone.

C. Increased plasma oestradiol.

D. Normal plasma prolactin.

E. Normal plasma thyroxine (T4).

QUESTION 34

A five-year-old boy was successfully treated for a testicular germ cell tumour at two years of age. Therapy
consisted of cisplatin, etoposide (VP-16) and bleomycin. The most likely long-term complication of the
therapy is:

A. high tone hearing deficit.

B. pulmonary fibrosis.

C. renal failure.

D. secondary leukaemia.

E. sterility.

QUESTION 35

Which one of the following is least likely to present with acute flaccid paralysis?

A. Bacterial meningitis.

B. Enterovirus 71 meningoencephalitis.

C. Guillain-Barré syndrome.

D. Infant botulism.

E. Poliomyelitis.

Copyright © 2004 by The Royal Australasian College of Physicians

 14 P102

QUESTION 36

Which one of the following is the most important determinant of oxygenation during high frequency
oscillatory ventilation?

A. Endotracheal tube size.

B. Frequency.

C. Inspiratory time.

D. Mean airway pressure.

E. Oscillatory amplitude.

QUESTION 37

If blood is taken 72 hours following a significant paracetamol overdose, which one of the following tests will
allow the best prediction of death or need for liver transplantation?

A. Blood ammonia.

B. Prothrombin time-international normalised ratio (PT-INR).

C. Serum alanine aminotransferase (ALT).

D. Serum albumin.

E. Serum bilirubin.

QUESTION 38

A 38-week gestation male infant is delivered by caesarean section because of concerns regarding foetal growth.
The baby weighs 1850 g at birth but is otherwise normal.

He is at increased risk of developing the following in adult life except:

A. hypertension.

B. inflammatory bowel disease.

C. ischaemic heart disease.

D. short stature.

E. type 2 (non-insulin-dependent) diabetes mellitus.

QUESTION 39

IgE-mediated hypersensitivity reactions may resolve over time, due to loss of IgE antibodies. For which one
of the following is this least likely to occur?

A. Bee venom.

B. Egg.

C. Peanut.

D. Penicillin.

E. Soya bean.

Copyright © 2004 by The Royal Australasian College of Physicians

 15 P102

QUESTION 40

The diagram below shows the relationship between the plasma concentration of a drug and the effect of that
drug over time, in a single individual given one dose of the drug. The direction of change over time is shown
by the arrows. The relationship is described by an anti-clockwise hysteresis loop. The numbers on the loop
indicate the number of hours after the dose was given.

The best explanation of this phenomenon is that:

A. the drug is active itself but has no active metabolites.

B. the drug is binding irreversibly to its target receptor.

C. there is a delay in the absorption of the drug from the gastrointestinal tract.

D. there is a delay in the distribution of the drug from plasma to its site of action.

E. there is down-regulation of the drug’s target receptor over time.

QUESTION 41

The chronic administration of a thiazide diuretic is associated with all of the following except:

A. hypercalciuria.

B. hyperglycaemia.

C. hyperuricaemia.

D. hypochloraemic alkalosis.

E. normal serum magnesium.

Copyright © 2004 by The Royal Australasian College of Physicians

 16 P102

QUESTION 42

Which one of the following conditions is most likely to cause iron deficiency in the absence of chronic blood
loss?

A. Chronic osteomyelitis.

B. Chronic pancreatitis.

C. Coeliac disease.

D. Cystic fibrosis.

E. Hyperthyroidism.

QUESTION 43

After a careful evaluation of the academic and social difficulties faced by a seven-year-old boy you
recommend a trial of dexamphetamine in conjunction with parental guidance and classroom support. His
mother is concerned about possible side-effects of the drug.

Which one of the following is the least common adverse effect of dexamphetamine?

A. Abdominal pain.

B. Headaches.

C. Motor incoordination.

D. Tearfulness.

E. Tics.

QUESTION 44

Which one of the following capsular polysaccharides of Neisseria meningitidis is least immunogenic?

A. A.

B. B.

C. C.

D. W-135.

E. Y.

Copyright © 2004 by The Royal Australasian College of Physicians

 17 P102

QUESTION 45

A previously well child presents with a two-day history of ataxia, vomiting and mild papilloedema.

A computed tomography (CT) scan of his brain is performed and is shown below.

Which one of the following is not seen in his scan?

A. Dilated 3rd ventricle.

B. Dilated 4th ventricle.

C. Dilated lateral ventricles.

D. Oedema of frontal horns.

E. Swollen cerebellum.

QUESTION 46

Following tetralogy of Fallot repair a child is noted to have a widely split second heart sound.

The most likely aetiology for this is:

A. anomalous pulmonary venous return.

B. aortic stenosis.

C. left superior vena cava draining to the coronary sinus.

D. residual patent foramen ovale.

E. right bundle branch block.

Copyright © 2004 by The Royal Australasian College of Physicians

 18 P102

QUESTION 47

In the pedigree shown below, the boy (indicated by the arrow) has been shown to have an autosomal
recessive biochemical disorder. The causative gene has not been identified. His parents are obligate
carriers and do not exhibit any biochemical abnormalities. His sister also has normal biochemical studies.
The carrier frequency in this population is 10%.

In the absence of consanguinity, what is the risk of the sister having a child with the biochemical
abnormality?

A. 1 in 40.

B. 1 in 60.

C. 1 in 80.

D. 1 in 100.

E. 1 in 120.

QUESTION 48

Which one of the following children is least likely to have language skills in the normal range at age five
years?

A. 14 months old; conductive hearing loss (pure tone average 30db hearing loss bilaterally) at
successive hearing tests aged 10 and 13 months; no words.

B. 18 months old; no words.

C. 24 months old; 40 single words; no two-word combinations.

D. 30 months old; acquired severe hearing loss due to meningitis aged 24 months; normal intelligence.

E. 36 months old; many words; not using grammatical markers of tense and person.

QUESTION 49

Which one of the following is the major cause of physiologic neonatal jaundice?

A. Decreased bilirubin uptake by the hepatocyte.

B. Decreased hepatic bilirubin conjugation.

C. Decreased hepatic excretion of bilirubin.

D. Increased de novo bilirubin synthesis.

E. Increased enterohepatic circulation.

Copyright © 2004 by The Royal Australasian College of Physicians

 19 P102

QUESTION 50

In X-linked severe combined immunodeficiency (SCID), the affected gene codes for the common cytokine
receptor gamma chain whose principal function is:

A. nuclear regulation in T and B cells.

B. rearrangement of the T and B cell receptors.

C. signal transduction in T and B cell receptors.

D. T cell-induced immunoglobulin isotype switching.

E. transduction of gamma C-chain-dependent intracellular signals.

QUESTION 51

Cisapride can cause prolonged Q-T interval and cardiac arrhythmia when used in combination with other
drugs. Which one of the following drugs would be most likely to cause arrhythmias in a patient taking
cisapride?

A. Amoxycillin.

B. Cefaclor.

C. Erythromycin.

D. Metronidazole.

E. Trimethoprim-sulfamethoxazole.

QUESTION 52

One of two siblings is diagnosed with type 1 (insulin-dependent) diabetes mellitus (IDDM). There is no family
history of IDDM. What is the approximate risk that the other sibling will develop IDDM?

A. 1%.

B. 6%.

C. 12%.

D. 25%.

E. 50%.

QUESTION 53

The mechanism of penicillin resistance in pneumococcal infections is most likely to be due to which one of
the following?

A. Altered permeability to penicillin.

B. Chromosome-mediated beta lactamase production.

C. Decreased affinity of penicillin-binding proteins.

D. Plasmid-mediated beta lactamase production.

E. Plasmid-mediated penicillinase production.

Copyright © 2004 by The Royal Australasian College of Physicians

 20 P102

QUESTION 54

A Southern blot on tumour tissue from a patient with Burkitt lymphoma is shown above. The signal in the
tumour tissue indicates which one of the following?

A. Amplified DNA.

B. Amplified messenger RNA.

C. Amplified protein.

D. Increased half-life of DNA.

E. Increased half-life of messenger RNA.

Copyright © 2004 by The Royal Australasian College of Physicians

 21 P102

QUESTION 55

The electrocardiogram (ECG) shown above was obtained from a three-year-old girl with a systolic murmur.

Which one of the following is the most likely diagnosis?

A. Perimembranous ventricular septal defect.

B. Persistent ductus arteriosus.

C. Primum atrial septal defect.

D. Pulmonary valve stenosis.

E. Subaortic stenosis.

QUESTION 56

There is still a risk of infection with human immunodeficiency virus (HIV) from a screened blood transfusion
due to the infectious window period of HIV.

This risk is closest to:

A. 1 in 25,000.

B. 1 in 100,000.

C. 1 in 250,000.

D. 1 in 500,000.

E. 1 in 1,000,000.

Copyright © 2004 by The Royal Australasian College of Physicians

 22 P102

QUESTION 57

Which one of the following anticonvulsants increases the half-life of lamotrigine?

A. Carbamazepine.

B. Clonazepam.

C. Gabapentin.

D. Sodium valproate.

E. Vigabatrin.

QUESTION 58

A new test may be useful as a screening test for Disease A. It is trialed with 100 patients attending a clinic,
10% of whom actually have Disease A, with the following results:

Disease A
Yes No

+ 9 23 32
Test
Results
– 1 67 68

10 90 100

Based on these results, it is next trialed in a community population in which the prevalence of Disease A is
1%.

Which one of the following is most likely to fall?

A. The sensitivity.

B. The specificity.

C. The positive predictive value.

D. The negative predictive value.

E. The number needed to treat (NNT).

QUESTION 59

In general, compared with autosomal dominant disorders, autosomal recessive disorders are:

A. more severe more variable within families more likely to be due to new mutations

B. more severe more variable within families less likely to be due to new mutations

C. more severe less variable within families less likely to be due to new mutations

D. less severe more variable within families more likely to be due to new mutations

E. less severe less variable within families less likely to be due to new mutations

Copyright © 2004 by The Royal Australasian College of Physicians

 23 P102

QUESTION 60

Which one of the following is the least important cause of impaired gas exchange in meconium aspiration
syndrome?

A. Alveolar oedema.

B. Bacterial infection.

C. Bronchiolar obstruction.

D. Pulmonary hypertension.

E. Surfactant dysfunction.

QUESTION 61

Retinal haemorrhages are known to occur in all of the following except:

A. late-onset haemorrhagic disease of the newborn.

B. meningococcal meningitis.

C. moderate head injury in a child with von Willebrand disease.

D. pertussis.

E. sudden infant death syndrome.

QUESTION 62

A 900 g, 26-week gestation neonate receiving neonatal-intensive care develops systemic sepsis on day
seven. Klebsiella pneumoniae is grown from the blood cultures with the following sensitivities:

ampicillin resistant
cefotaxime resistant
imipenem sensitive
gentamicin resistant
amikacin sensitive

The most likely mode of resistance of this organism is:

A. altered binding proteins.

B. chromosomally-mediated resistance.

C. extended spectrum beta lactamase production.

D. inducible beta lactamase production.

E. intrinsic resistance.

Copyright © 2004 by The Royal Australasian College of Physicians

 24 P102

QUESTION 63

The following pharmacokinetic data are provided for five drugs.

Drug Volume of distribution (L) Plasma half-life (hr)

A 1190 21
B 4620 600
C 70 22
D 7 6
E 126 11

Which of the drugs is most likely to have the slowest rate of clearance from plasma?

A. Drug A.

B. Drug B.

C. Drug C.

D. Drug D.

E. Drug E.

QUESTION 64

A 16-year-old girl with schizophrenia has been commenced on risperidone.

Which one of the following is the least likely side-effect?

A. Increased dream activity.

B. Menstrual irregularities.

C. Muscle stiffness.

D. Somnolence.

E. Weight loss.

QUESTION 65

T lymphocytes expressing both CD4 and CD8 on the cell surface are most likely to be found in which one of
the following anatomical locations in healthy individuals?

A. Bone marrow.

B. Lymph nodes.

C. Peripheral blood.

D. Spleen.

E. Thymus.

Copyright © 2004 by The Royal Australasian College of Physicians

 25 P102

QUESTION 66

Which one of the following cardiac conditions is most commonly associated with neurofibromatosis?

A. Aortic root dilatation.

B. Cardiac rhabdomyomata.

C. Coarctation of the aorta.

D. Pulmonary stenosis.

E. Supravalvular aortic stenosis.

QUESTION 67

Which one of the following alterations in DNA sequence within a gene is most likely to result in an absent or
non-functional protein?

A. A base pair change that does not alter the amino acid encoded by that codon.

B. A single base pair substitution.

C. A three base pair deletion within an exon.

D. A three base pair deletion within an intron.

E. A two base pair deletion within an exon.

QUESTION 68

For males entering puberty at an average age and height, the increase in height (cm) from the onset of
puberty to final height is closest to:

A. 17.

B. 21.

C. 25.

D. 29.

E. 33.

QUESTION 69

Which immunological mechanism is the major cause of the destruction of the small intestinal villous
architecture in coeliac disease?

A. Activation of B lymphocytes.

B. Activation of T lymphocytes.

C. Secretion of anti-endomysial antibodies.

D. Secretion of antigliadin antibodies.

E. Secretion of tissue transglutaminase antibodies.

Copyright © 2004 by The Royal Australasian College of Physicians

 26 P102

QUESTION 70

A mother brings her daughter to a paediatrician because of concerns about her daughter’s eyes (shown
above). The only significant past history is of a difficult delivery due to large gestational size.

Which one of the following is the most likely diagnosis?

A. Left Horner syndrome.

B. Left oculomotor nerve palsy.

C. Left proptosis.

D. Right congenital ptosis.

E. Right Horner syndrome.

Copyright © 2004 by The Royal Australasian College of Physicians

 27 P102

2002 FRACP Written Examination

Paediatrics & Child Health

Paper 1 – Medical Sciences

Answers

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

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