2000 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 © 2003 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 P100
Question 1

During her first pregnancy, a woman develops chickenpox at 16 weeks gestation.

Which one of the following represents the closest approximation to the risk that the baby will develop congenital
varicella syndrome?

A. 0.01%.

B. 2%.

C. 15%.

D. 50%.

E. 80%.

Question 2

Which one of the following would be least appropriate for the assessment of a 36-month-old infant with
suspected neuro-developmental delay?

A. Bailey scale.

B. Griffith’s scale.

C. McCarthy scale.

D. Peabody picture vocabulary test.

E. Wechsler intelligence scale for children.

Question 3

The mean pulmonary artery (capillary) wedge pressure most closely approximates which one of the following
pressures?

A. Left atrial mean.

B. Pulmonary artery diastolic.

C. Pulmonary vein wedge mean.

D. Right atrial mean.

E. Right ventricular end-diastolic.

Copyright © 2003 by The Royal Australasian College of Physicians

 3 P100
Question 4

A well 14-year-old girl is travelling to Zimbabwe and Malawi on an exchange program for three months. She
leaves in six weeks. She plans to visit villages and attend school.

Which one of the following plans is most appropriate for preventing hepatitis A virus (HAV) infection during her
visit?

A. HAV vaccination and immunoglobulin given now.

B. HAV vaccination given now.

C. HAV vaccination now, test for antibody titres before departure and if negative administer
immunoglobulin.

D. HAV vaccination within one week of departure.

E. Immunoglobulin administered as close as practical to the time of her departure.

Question 5

The reabsorption of most bicarbonate (HCO3) from the glomerular ultrafiltrate is by:

A. diffusion of carbon dioxide (CO2).

B. intercellular transport.

C. pinocytosis.

D. primary active transport.

E. transcellular aquapores.

Question 6

Which area of the lung has the highest ventilation/perfusion (V/Q) ratio in the erect position?

A. Anterior.

B. Diaphragmatic.

C. Middle.

D. Posterior.

E. Upper.

Copyright © 2003 by The Royal Australasian College of Physicians

 4 P100
Question 7

Drug X is given intravenously using two different regimens, to the same patient on two different occasions. Both
times there is no measurable amount of the drug in plasma prior to its administration. On both occasions the
volume of distribution of X is 0.85 L/kg and the plasma half-life is six hours.

Regimen A: Continuous intravenous infusion of 10 mg/kg/hr, with no loading dose.

Regimen B: A loading dose of 50 mg/kg given rapidly intravenously, then a continuous

intravenous infusion of 10 mg/kg/hr.

Using regimen A, the plasma concentration of X after 48 hours was 100 mg/L.

One compartment, first order pharmacokinetics can be assumed.

The plasma concentration of X, after 48 hours, using regimen B is closest to:

A. 50 mg/L.

B. 75 mg/L.

C. 100 mg/L.

D. 125 mg/L.

E. 150 mg/L.

Question 8

In acute lymphoblastic leukaemia, which cytogenetic feature carries the worst prognosis?

A. Hyperdiploidy.

B. Normal chromosome number.

C. Translocation (1;19).

D. Translocation (9;22).

E. Translocation (12;21).

Question 9

Which one of the following autoantibodies is most specific for coeliac disease?

A. IgA endomysial.

B. IgA gliadin.

C. IgA gluten.

D. IgA reticulin.

E. IgG gluten.

Copyright © 2003 by The Royal Australasian College of Physicians

 5 P100
Question 10

Which one of the following modes of transmission of hepatitis B virus (HBV) resulting in hepatitis B infection,
in the absence of active or passive immunisation, is most likely to result in chronic carrier status in the
recipient?

A. A bite to a two-year-old in day care by a chronic carrier.

B. Blood transfusion from a chronic carrier to a 10-year-old child.

C. ‘Horizontal’ transmission of HBV from a chronic carrier to their five-year-old sibling.

D. Needle-stick injury to a one-year-old from a contaminated needle.

E. ‘Vertical’ transmission of HBV from a pregnant carrier to her newborn baby.

Question 11

Which one of the following is most commonly found in obesity?

A. Mutation of the β3 adrenergic receptor.

B. Mutation of the insulin receptor.

C. Raised blood glucose.

D. Raised serum C-peptide.

E. Reduced serum leptin.

Question 12

A 15-year-old boy dislocated his right shoulder while playing football. This was reduced in the emergency
room and he was discharged after observation. After removal of his sling he had problems in abducting his
arm. Examination showed weakness of abduction at the shoulder and sensory loss on the lateral aspect of
his arm at the insertion of the deltoid muscle.

The nerve involved is the:

A. accessory.

B. axillary.

C. musculocutaneous.

D. radial.

E. suprascapular.

Question 13

The autoantibody most specific for systemic lupus erythematosus is:

A. antihistone.

B. antinuclear.

C. anti-ribonucleoprotein.

D. anti-Ro (SS-A).

E. anti-Sm.

Copyright © 2003 by The Royal Australasian College of Physicians

 6 P100
Question 14

I:1 and his wife I:2 take part in a Tay-Sachs carrier screening program and are both shown to be carriers. Their
children have not been tested. The frequency of the heterozygous state is 1 in 30 in the particular population from
which all these individuals in this pedigree are drawn.

The risk that the foetus III:1 will be affected with Tay-Sachs disease is closest to:

A. 1 in 240.

B. 1 in 180.

C. 1 in 120.

D. 1 in 60.

E. 1 in 30.

Question 15

A 12-month-old girl is referred to you for assessment and advice/management of her obesity.

Her birthweight was 3600 g (75th percentile) and her length was 51 cm (75th percentile). Now, her weight is
12.5 kg (1 kg >97th percentile) and her length is 78 cm (90th percentile). Neither parent is obese.
Developmentally she is normal and you can find no pathological reason for her obesity.

What is the approximate likelihood that she will be obese in her 20s?

A. 15%.

B. 30%.

C. 45%.

D. 60%.

E. 75%.

Copyright © 2003 by The Royal Australasian College of Physicians

 7 P100
Question 16

What is the most important mechanism by which the drug omeprazole exerts its effect on the gastric mucosa in
the treatment of peptic ulcer disease?

A. Binds to the prostaglandin E2 receptor.

B. Binds to the hydrogen potassium ATPase pump.

C. Blocks H1 receptors.

D. Blocks H2 receptors.

E. Blocks secretion of gastric intrinsic factor.

Question 17

Which one of the following is not an essential feature for a diagnosis of autism?

A. Communication difficulties.

B. Impairment of social interaction.

C. Intellectual deficit.

D. Onset prior to age three years.

E. Repetitive and stereotyped behaviours.

Question 18

A male infant has pulmonary atresia/ventricular septal defect. After undergoing a systemic to pulmonary
artery shunt his arterial saturation is 90%. Assuming a mixed venous saturation of 70% and a pulmonary
venous saturation of 95%, the pulmonary to systemic flow ratio (Qp:Qs) is:

A. incalculable without a known haemoglobin.

B. incalculable without a known oxygen consumption.

C. 0.2:1.

D. 1:1.25.

E. 4:1.

Question 19

Your region has a birth rate of about 50,000 babies per year. About 50 preschool children are diagnosed
each year with "crumblitis", a rare gastrointestinal disorder, the cause of which is unknown. You hypothesise
that this condition is related to maternal ingestion of orange rhubarb during pregnancy.

Which one of the following is the most appropriate research design to test your hypothesis?

A. Case-control study.

B. Cohort study.

C. Own control (crossover) trial.

D. Prevalence (cross-sectional) survey.

E. Randomised controlled trial.

Copyright © 2003 by The Royal Australasian College of Physicians

 8 P100
Question 20

Which one of the following is an endothelium-derived vasodilator?

A. Angiotensin II.

B. Endothelin 1.

C. Prostacyclin.

D. Prostaglandin H2.

E. Thromboxane A2.

Question 21

A drug X has a half-life of four hours and a volume of distribution of 0.8 L/kg.

First order, one compartment pharmacokinetics can be assumed.

The drug is administered by continuous intravenous infusion in a dose of Y mg/hr, starting at time zero.

After 24 hours the continuous infusion rate is halved to Y/2 mg/hr. At time 44 hours the plasma concentration
of X is approaching the new steady state concentration, B (within 3%).

If, at time 24 hours, the continuous infusion rate had been reduced to Y/4 mg/hr, instead of Y/2 mg/hr, the time
at which the plasma concentration of X falls to within 3% of the new steady state concentration, C, would be
closest to:

A. 40 hours.

B. 44 hours.

C. 48 hours.

D. 64 hours.

E. 88 hours.

Copyright © 2003 by The Royal Australasian College of Physicians

 9 P100
Question 22

Folinic acid is used to “rescue” cells from the cytotoxic effect of which one of the following chemotherapeutic
agents?

A. Adriamycin.

B. Asparaginase.

C. Cisplatin.

D. Cyclophosphamide.

E. Methotrexate.

Question 23

IgE-mediated hypersensitivity reactions may resolve over years, 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. Soybean.

Question 24

A newborn infant with severe hyaline membrane disease is receiving mechanical ventilation. Different
methods of ventilation are used sequentially to achieve the same oxygenation and carbon dioxide removal.
There is no change in lung compliance over this period. The FiO2 is 1.0.

The pressure swings at alveolar level will be smallest during which one of the following methods of
ventilation?

A. Assist-control mode conventional ventilation.

B. High frequency oscillatory ventilation.

C. Intermittent mandatory ventilation with paralysis.

D. Intermittent mandatory ventilation without paralysis.

E. Synchronised intermittent mandatory ventilation.

Question 25

Which one of the following target autoantigens is least likely to be associated with type 1 (insulin-dependent)
diabetes mellitus?

A. Double-stranded DNA.

B. Endomysial antigen.

C. Glutamic acid decarboxylase.

D. Thyroid peroxidase.

E. 21-hydroxylase.

Copyright © 2003 by The Royal Australasian College of Physicians

 10 P100
Question 26

You are asked to consult on the aerial transfer of a sick infant with bronchiolitis. By what amount will you
expect the alveolar oxygen to drop when the plane is pressurised at an altitude of 5000 feet?

(The atmospheric pressure at 5000 feet is 647 mmHg. The carbon dioxide level is 45 mmHg, the respiratory
quotient is 0.8 and the water vapour pressure is 47 mmHg. These values remain constant. The flight will
begin at sea level where the atmospheric pressure is 760 mmHg.)

A. 5-10 mmHg.

B. 11-15 mmHg.

C. 16-20 mmHg.

D. 21-25 mmHg.

E. 26-30 mmHg.

Question 27

Which one of the following vaccines is most likely to be damaged by freezing?

A. Haemophilus influenzae type b conjugate.

B. Hepatitis B.

C. Measles-mumps-rubella.

D. Meningococcal polysaccharide.

E. Oral polio.

Question 28

A one-month-old infant presents with failure to thrive. There is a three-week history of progressive
tachypnoea, sweating and feeding difficulties. The respiratory rate is 60/minute with moderate recession. The
liver is palpable 5 cm below the costal margin. The praecordium is active and a grade 3/6 systolic ejection
murmur and a grade 3/6 apical mid-diastolic rumble are audible. An echocardiogram demonstrates a large,
non-restrictive perimembranous ventricular septal defect.

Which one of the following most accurately reflects the anticipated pulmonary blood flow (PBF), pulmonary
vascular resistance (PVR) and pulmonary artery systolic pressure (PSP)?

PBF PVR PSP

A. high high subsystemic

B. high normal subsystemic

C. high normal systemic

D. normal high subsystemic

E. normal normal systemic

Note:

systemic: equal to systemic systolic pressure

subsystemic: less than systemic systolic pressure

Copyright © 2003 by The Royal Australasian College of Physicians

 11 P100
Question 29

The laboratory telephones you with the following test results of blood taken from a 16-year-old male student
who had requested hepatitis B screening.

HBsAg (surface antigen) negative

Anti-HBs (surface antibody) positive
Anti-HBc (core antibody) positive

The most likely explanation for these results is:

A. acute hepatitis B infection.

B. chronic hepatitis B infection.

C. hepatitis D superinfection.

D. past hepatitis B vaccination.

E. previous hepatitis B infection.

Question 30

Which one of the following is the most common cause of familial thrombophilia (deep vein thrombosis and
pulmonary emboli)?

A. Activated protein C resistance.

B. Antithrombin III deficiency.

C. Protein C deficiency.

D. Protein S deficiency.

E. Prothrombin gene mutation.

Question 31

A four-year-old girl is thought to have Prader-Willi syndrome. To confirm the clinical diagnosis, DNA samples from
the child and her parents have been studied. The results shown below are obtained after probing a Southern blot
with a DNA probe located within the region of chromosome 15 that is commonly deleted in this syndrome. This
probe detects a restriction fragment length polymorphism with two alleles in men and women in the normal
population.

Copyright © 2003 by The Royal Australasian College of Physicians

 12 P100
Question 31 (continued)

What is the molecular basis of Prader-Willi syndrome in this girl?

A. Deletion of the maternally-derived chromosome 15.

B. Disomy of both parental chromosomes.

C. Partial deletion of both parental chromosomes 15.

D. Uniparental disomy of the maternally-derived chromosome 15.

E. Uniparental disomy of the paternally-derived chromosome 15.

Question 32

Interleukin 1 (IL-1) is primarily produced by which one of the following cell types?

A. B cells.

B. Large granular lymphocytes.

C. Macrophages.

D. Neutrophils.

E. T cells.

Question 33

The standard deviation of a set of ‘n’ observations, which are normally distributed, is best described as an
estimate of the:

A. accuracy of the calculated mean.

B. deviation from the median.

C. effect of outlier values.

D. interquartile range.

E. variation of values within the set.

Question 34

When assessing the response of small airways to bronchodilators, the best test is:

A. forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio.

B. functional residual capacity (FRC).

C. inspiratory capacity.

D. iso volume forced expiratory flow (FEF25-75).

E. peak flow.

Copyright © 2003 by The Royal Australasian College of Physicians

 13 P100
Question 35

A patient with pancreatic insufficiency refuses to take enzyme replacement and later presents with renal calculi.

Increased excretion of which one of the following is the most likely cause of calculus formation?

A. Bicarbonate.

B. Cysteine.

C. Oxalate.

D. Phosphate.

E. Urate.

Question 36

10 0
A
% of
m axim u m
effe ct
B

L og [X ]

Curve A represents the log dose-response curve for drug X when given alone.

Curve B represents the log dose-response curve for drug X in the presence of a fixed concentration of another
drug, Y.

The most likely explanation for these findings is that:

A. X is a competitive antagonist of Y.

B. X is a non-competitive antagonist of Y.

C. Y is a competitive antagonist of X.

D. Y is a non-competitive antagonist of X.

E. Y is a partial agonist.

Copyright © 2003 by The Royal Australasian College of Physicians

 14 P100
Question 37

An eight-year-old boy presents with a presumed stroke. He has a profound right hemiparesis involving the
face, arm and leg.

Which one of the following clinical signs would suggest that the cerebral cortex is involved?

A. Aphasia.

B. Dense sensory loss to pinprick and touch.

C. Dystonic posture.

D. Equal involvement of the face, arm and leg.

E. Eye deviation.

Question 38

A newborn infant is found to be hypothyroid on a new born screening test.

Which one of the following is the most likely cause?

A. Defective thyroglobulin iodination.

B. Deficiency of thyroid-stimulating hormone.

C. Impaired foetal iodine transport.

D. Maternal autoantibodies.

E. Thyroid dysgenesis.

Question 39

In the neonatal syndrome of "persistent foetal circulation" (persistent pulmonary hypertension of the newborn),
which one group of physiological ratios is usually seen?

PAP/SAP QP/QS RP/RS

A. 1 <1 >1

B. >1 1 1

C. 1 <1 1

D. 1 <1 <1

E. 1 1 <1

Note:

PAP = pulmonary arterial pressure

SAP = systemic arterial pressure
QP = pulmonary blood flow
QS = systemic blood flow
RP = pulmonary arteriolar resistance
RS = systemic arteriolar resistance

Copyright © 2003 by The Royal Australasian College of Physicians

 15 P100
Question 40

Which one of the following diseases is not considered to be mediated by antigens acting as "super-antigens"?

A. Kawasaki disease.

B. Rheumatic fever.

C. Scarlet fever.

D. Staphylococcal toxic shock syndrome.

E. Streptococcal toxic shock syndrome.

Question 41

In which one of the following is an increased ionised serum calcium most likely to occur?

A. Alkalosis.

B. Autoimmune polyglandular syndrome.

C. Hypoalbuminaemia.

D. Vitamin D deficiency.

E. Williams syndrome.

Question 42

The half-life of factor IX is closest to which one of the following?

A. 8 hours.

B. 12 hours.

C. 24 hours.

D. 48 hours.

E. 72 hours.

Question 43

A 34-week gestation infant is diagnosed as having mild hyaline membrane disease. The resident places an
umbilical line to facilitate blood gas analysis.

A sample is taken from this catheter for blood gas measurement. The FiO2 is 0.6. An oximeter placed on the
infant’s foot reads 100%. You have suspicions that the catheter is misplaced.

If the catheter was in the umbilical vein rather than the umbilical artery the catheter blood PO2 measurement
would be closest to:

A. 200 mmHg.

B. 150 mmHg.

C. 100 mmHg.

D. 50 mmHg.

E. 20 mmHg.

Copyright © 2003 by The Royal Australasian College of Physicians

 16 P100
Question 44

A three-year-old boy presents with acute hepatocellular injury secondary to viral hepatitis.

Which one of the following tests most accurately assesses his current liver synthetic function?

A. Alanine aminotransferase.

B. Ammonia.

C. Conjugated bilirubin level.

D. Gamma glutamyltransferase.

E. Prothrombin time following parenteral vitamin K.

Question 45

Which one of the following statements explains the greatest proportion of the 12-13 cm difference in final adult
height between males and females?

A. Birth size is greater in males.

B. The average age of onset of puberty is later in males.

C. The average height gain from birth to age 10 is greater in males.

D. The peak growth velocity occurs later during puberty in males.

E. The pubertal growth spurt is greater in males.

Question 46

An eight-year-old has had a cough and rattly respirations for six months. The following respiratory signs are
found:

respiratory rate is 30/minute;

trachea deviated to the right;
apex beat 1 cm medial to the midclavicular line on the left 6th intercostal space;
dull percussion note over the right posterior lower chest;
inspiratory and expiratory wheezes or rhonchi on the right side predominantly.

Which one of the following is the best explanation for these signs?

A. Chronic large airway obstruction on right side.

B. Chronic small airway obstruction on right side.

C. Consolidation on right side.

D. Effusion on right side.

E. Hyperinflation of left lung.

Copyright © 2003 by The Royal Australasian College of Physicians

 17 P100
Question 47

The pedigree shown below is consistent with several different modes of inheritance.

Which one of the following modes is the most likely?

A. Autosomal dominant with incomplete penetrance.

B. Autosomal recessive with high heterozygote frequency.

C. Mitochondrial inheritance.

D. Multifactorial inheritance.

E. X-linked dominant with partial penetrance in the female.

Question 48

Four cytokines produced by T cells are listed:

interleukin 2 (IL-2)
interleukin 4 (IL-4)
interleukin 5 (IL-5)
interferon gamma (IFNγ)

Which one of the following combinations would best reflect a Th2 type T cell immune response?

A. IL-2, IFNγ.

B. IL-2, IL-4.

C. IL-4, IFNγ.

D. IL-4, IL-5.

E. IL-5, IFNγ.

Copyright © 2003 by The Royal Australasian College of Physicians

 18 P100
Question 49

The anticoagulant effect of the coumarin derivative warfarin is most likely to be enhanced by which one of the
following?

A. Carbamazepine.

B. Erythromycin.

C. Oral contraceptive.

D. Phenytoin.

E. Vitamin K.

Question 50

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

Test + 9 23 32
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 51

If the full immunisation schedule has been properly administered to a two-year-old, which one of the following
gives the least effective protection?

A. Diphtheria.

B Haemophilus influenzae type b.

C. Measles.

D. Pertussis.

E. Rubella.

Copyright © 2003 by The Royal Australasian College of Physicians

 19 P100
Question 52

In alpha-1-antitrypsin deficiency, the common genotype PiZZ results in:

A. defective production of protein Z by Kupffer cells.

B. defective secretion of protein Z from the hepatocyte.

C. failure of synthesis and secretion of alpha-1-antitrypsin from Ito cells.

D. inhibition of alpha-1-antitrypsin activity by neutrophil elastase.

E. secretion of normal amounts of a defective alpha-1-antitrypsin glycoprotein.

Question 53

The cough associated with the use of angiotensin-converting enzyme (ACE) inhibitors is mediated through
which one of the following?

A. Aldosterone.

B. Angiotensin I.

C. Angiotensin II.

D. Bradykinin.

E. Gamma aminobutyric acid.

Question 54

Which one of the following is least toxic to bone marrow?

A. Carboplatin.

B. Cyclophosphamide.

C. Doxorubicin.

D. Etoposide (VP-16).

E. Vincristine.

Question 55

A clear preference for using the left hand at 12 months of age is most likely a manifestation of which one of the
following?

A. Brachial plexus injury.

B. Cerebral palsy.

C. Family history of left handedness.

D. Normal variation.

E. Osteomyelitis.

Copyright © 2003 by The Royal Australasian College of Physicians

 20 P100
Question 56

A two-year-old boy with Duchenne muscular dystrophy (DMD) has an identified mutation within the DMD gene.
Although his mother does not have this mutation in the blood and there is no clinical or biochemical evidence to
suggest that she is a carrier, there is still a low recurrence risk among his male siblings.

Which one of the following mechanisms is the most likely explanation for these recurrences?

A. An unstable triplet repeat mutation.

B. Autosomal recessive inheritance.

C. Gonadal mosaicism.

D. Incomplete penetrance.

E. Polygenic inheritance.

Question 57

During a phase 1 clinical trial, a drug was administered as single doses to the same patient, on two different
occasions. On the first occasion it was given by rapid intravenous infusion, and on the second occasion the
same dose was given by the oral route. The two plasma concentration versus time curves are shown above.
Both graphs have the same scale. Area A (intravenous) is five times greater than area B (oral).

Which one of the following statements is not consistent with these findings?

A. The drug has a high hepatic extraction ratio.

B. The drug is a well-absorbed, controlled-release preparation.

C. The oral bioavailability of the drug is poor.

D. There is a significant first pass effect.

E. There is metabolic degradation of the drug by the gut mucosa.

Question 58

Which one of the following results in improved unloading of oxygen from oxy-haemoglobin molecules?

A. Decreased carbon dioxide levels.

B. Decreased haemoglobin levels.

C. Decreased temperature.

D. Increased pH.

E. Increased 2,3-diphosphoglycerate.

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 21 P100
Question 59

A previously well eight-year-old boy presents to his paediatrician with recent onset left-sided facial weakness.

Which one of the following would suggest that this is not a Bell's palsy?

A. Frontalis weakness.

B. Hyperacusis.

C. Impaired lacrimation.

D. Loss of taste to the posterior third of the tongue.

E. Subjective sensory disturbance of the face.

Question 60

The following data were obtained at cardiac catheterisation from a patient with a ventricular septal defect.

Site Oxygen Saturation

Superior vena cava 70%

Inferior vena cava 70%
Right atrium 70%
Left pulmonary artery 85%
Left atrium 95%
Aorta 95%

Oxygen consumption 150 mL/minute

Oxygen content 100 mL/L

The cardiac output is:

A. 4 L/minute.

B. 6 L/minute.

C. 8 L/minute.

D. 10 L/minute.

E. incalculable.

Question 61

An eight and a half-year-old girl is referred for assessment of obesity. Her weight is 45 kg, her height is 123
cm and her surface area is 1.1 m².

Her body mass index (BMI) is closest to:

A. 30.

B. 32.

C. 34.

D. 36.

E. 38.

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 22 P100
Question 62

The principal mode of action of parathyroid hormone with respect to the regulation of serum calcium is to:

A. decrease tubular reabsorption of calcium.

B. decrease tubular reabsorption of phosphate.

C. directly increase intestinal absorption of calcium.

D. increase the rate of bone resorption.

E. increase the rate of transcription of hepatic vitamin-D-25 hydroxylase.

Question 63

A frameshift mutation is best described as a:

A. missing base or set of bases which results in a premature stop codon.

B. mutation which alters the codons downstream of its location.

C. mutation which alters the normal splicing of an intron.

D. sequence alteration which occurs at or near regulatory sequences in the 5' untranslated region of the
gene.

E. single base change which alters that codon to one which now reads stop.

Question 64

An infant is born at 28 weeks gestation. There is no perinatal asphyxia, but she develops moderate
respiratory distress requiring ventilation and subsequently experiences some problems with feed intolerance
and recurring apnoeic episodes.

Which one of the following neurological problems is most likely to be present on long-term follow-up?

A. Athetoid cerebral palsy.

B. Global developmental delay.

C. Hemiplegia.

D. Spastic diplegia.

E. Spastic quadriplegia.

Question 65

A drug with a narrow therapeutic index is highly protein-bound and cleared by oxidative metabolism followed by
urinary excretion of the inactive metabolite.

The most common mechanism of drug interaction likely to cause toxicity of this type of drug is:

A. displacement of the drug from plasma proteins.

B. inhibition of cytochrome P450 enzymes.

C. inhibition of glucuronyltransferase.

D. inhibition of renal tubular secretory mechanisms.

E. reduction in glomerular filtration rate.

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 23 P100
Question 66

The most accurate measure of glomerular filtration rate is provided by:

51
A. Cr EDTA clearance.

B. creatinine clearance.

C. Schwartz formula.

D. urea clearance.
99
E. Tc MAG-3 clearance.

Question 67

In the given section of a developmental record form following, P means that the child can do this item, F
means that the child cannot do this item. Assuming that this child is developmentally “average”, about how
old is he/she?

A. 1 year 3 months.

B. 2 years.

C. 2 years 9 months.

D. 3 years 6 months.

E. 4 years 3 months.

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 24 P100
Question 67 (continued)

Copyright © 2003 by The Royal Australasian College of Physicians

 25 P100
Question 68

Interpret the flow volume loop shown below.

The findings are characteristic of which one of the following?

A. Interstitial disease.

B. Large airway obstruction.

C. Poor effort.

D. Skeletomuscular disease.

E. Small airway obstruction.

Copyright © 2003 by The Royal Australasian College of Physicians

 26 P100
Question 69

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.

Question 70

Which one of the following primary immunodeficiency disorders is most likely to be associated with anaphylaxis to
blood products?

A. Ataxia-telangiectasia.

B. Common variable immunodeficiency.

C. IgG subclass deficiency.

D. Selective IgA deficiency.

E. X-linked agammaglobulinaemia.

Copyright © 2003 by The Royal Australasian College of Physicians

 27 P100

2000 FRACP Written Examination

Paediatrics & Child Health

Paper 1 – Medical Sciences

Answers

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

Copyright © 2003 by The Royal Australasian College of Physicians