2006 FRACP Written Examination Paediatrics & Child

2006 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 Examinations Section, Education Department via e-mail: [email protected].

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

Copyright © 2007 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 Macquarie Street, Sydney, Australia.


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QUESTION 1 There is considerable variation in the age at which teeth erupt. Which of the following are usually the first teeth to erupt? A.

Lower central incisors.

B.

Lower first molars.

C.

Lower lateral incisors.

D.

Upper central incisors.

E.

Upper lateral incisors.

QUESTION 2 The epithelial sodium channel channel located in the collecting duct is regulated by which of the following? A.

Adrenocorticotrophic Adrenocortic otrophic hormone (ACTH).

B.

Aldosterone.

C.

Amiloride.

D.

Cyclic AMP.

E.

Renin.

QUESTION 3 Telomeres are best defined as: A.

cis-acting DNA elements responsible responsible for segregation segregation of chromosomes chromosomes at mitosis and meiosis.

B.

proteins which bind to promotor elements to initiate transcription transcript ion of a gene.

C.

specialised structures which "cap" the ends of chromosomes. chromosomes.

D.

the major non-DNA component of chromatin.

E.

the sites at which crossovers occur during pachytene.

QUESTION 4 The embryonic gonad is bipotential. Which of the following hormones determine early differentiation towards the male phenotype? A.

Activin.

B.

Antimüllerian Antimülleri an hormone.

C.

Dihydrotestosterone.

D.

Human chorionic gonadotropin.

E.

Inhibin.


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QUESTION 5 Pyloric stenosis is a disorder with polygenic inheritance. The male to female ratio is about 4:1. Who of the following is most likely to develop pyloric stenosis? A.

The brother of an affected boy.

B.

The daughter of an affected woman.

C.

The daughter of an affected man.

D.

The son of an affected man.

E.

The son of an affected woman.

QUESTION 6 Which of the following blood group combinations is most frequently associated with isoimmune haemolytic disease of the newborn? Mother

Neonate

A.

A Rhesus-negative Rhesus-negati ve

O Rhesus-negative Rhesus-negati ve

B.

A Rhesus-negative Rhesus-negati ve

O Rhesus-positive Rhesus-posit ive

C.

AB Rhesus-negative Rhesus-negative

A Rhesus-positive Rhesus-positive

D.

O Rhesus-negative Rhesus-negati ve

B Rhesus-positive Rhesus-posit ive

E.

O Rhesus-negative Rhesus-negativ e

A Rhesus-positive Rhesus-posi tive

QUESTION 7 The major objective of a phase III clinical trial is to determine which one of the following? A.

Cost effectiveness.

B.

Efficacy of an experimental therapy.

C.

Efficacy of a standard therapy.

D.

Maximum tolerated dose.

E.

Toxicity profile.


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QUESTION 8 Renin release from juxtaglomerular cells is stimulated by: A

beta sympathetic blockade.

B

cortisol.

C

increased plasma chloride.

D

increased vagal activity. activity .

E

sodium depletion.

QUESTION 9 An otherwise normal five-year-old child is brought to see you because of recurrent generalised convulsions. The child had his first febrile convulsion at 12 months of age, and subsequently subsequently has had six afebrile seizures. seizures. He is on anticonvulsant anticonvulsant therapy. therapy. There is no family family history of febrile febrile convulsions convulsions or epilepsy. His mother asks about risk for sudden, unexplained [unexpected] death due to epilepsy (SUDEP). Which of the following is the greatest risk factor for SUDEP? A.

Idiopathic epilepsy.

B.

Male sex.

C.

Neurological Neurological deficit.

D.

Symptomatic epilepsy.

E.

Young age.

QUESTION 10 Which of the following best describes the mode of action of aminoglycoside antibiotics? antibiotics? A.

Disruption of cytoplasmic cytoplasm ic membrane function.

B.

Inhibition of bacterial DNA gyrase.

C.

Inhibition of cell wall synthesis.

D.

Inhibition of protein synthesis.

E.

Interference Interference with bacterial folic acid metabolism.


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QUESTION 11 Pulse oximetry is widely utilised in clinical practice to measure the oxygen saturation of haemoglobin. In which of the following situations is the measured saturation saturation likely to be falsely elevated? A.

Carbon dioxide retention.

B.

Methaemoglobinaemia.

C.

Persistent fetal haemoglobin. haemoglobin.

D.

Profound anaemia.

E.

Sickle cell anaemia.

QUESTION 12 Which of the following anticonvulsants is most likely to decrease the half-life of lamotrigine in a clinically significant manner? A.

Carbamazepine.

B.

Clonazepam.

C.

Gabapentin.

D.

Sodium valproate.

E.

Vigabatrin.

QUESTION 13 Infants and children with a large patent ductus arteriosus will develop significant cardiomegaly. The mechanism of this is: A.

pressure loading of left ventricle.

B.

pressure loading of right ventricle.

C.

volume loading of left ventricle.

D.

volume loading of left and right ventricle.

E.

volume loading of right ventricle. ventricl e.

QUESTION 14 Many challenging behaviours of children are best understood in terms of the developmental phase the child is negotiating. Which of Erikson's developmental developmental stages best explains toddler tantrums? A.

Autonomy.

B.

Identity.

C.

Industry.

D.

Initiative.

E.

Trust.


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QUESTION 15 A study is comparing the bioavailability of a new oral preparation of a drug (100 mg tablet) with the marketed intravenous preparation (50 mg in 2 mLs). In this crossover study, healthy volunteers were given in random order one 100 mg tablet or 50 mg intravenously intravenousl y (IV). The drug has linear kinetics within the range of concentrations studied. The mean results are as follows:

Maximum concentration concentrati on (C max) (mg/L) Time to peak concentration concentrati on (Tmax) (hours) Area under the Curve (AUC) (mg/L.h) Elimination half life (t 1/2) (hours)

100 mg tablet 5 2 45 4

50 mg IV 12 0.25 25 3.8

Which of the following is the best estimate of the oral bioavailability of the tablet? A.

12.5%.

B.

40%.

C.

50%.

D.

90%.

E.

96%.

QUESTION 16 A four-month-old girl presents to the emergency department with a two day history of coryza and low grade fever. Her parents are concerned as they have noticed increasingly noisy breathing today and the baby is not feeding as well as usual. On examination the baby is miserable with a clear nasal discharge, intercostal recession, nasal flaring and grunting respirations. respirations. Which of the following best describes the physiological basis for the audible grunt in this patient? A.

Decreasing residual volume.

B.

Generation of negative end-expiratory pressure.

C.

Generation of positive end-expiratory pressure.

D.

Increasing tidal volume.

E.

Respiratory Respiratory muscle fatigue.

QUESTION 17 Metformin is the drug of choice in the treatment of Type 2 (non-insulin-dependent) diabetes mellitus in childhood and adolescence. adolescence. Which of the following is its most frequent side-effect? A.

Gastrointestinal Gastrointest inal disturbance.

B.

Hypoglycaemia.

C.

Rash.

D.

Taste disturbance. disturbance.

E.

Weight gain.


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QUESTION 18 A 20-month-old boy presents with an acute febrile illness. As part of his work-up he has a full blood examination. Results are as follows: Haemoglobin (Hb) Mean corpuscular volume (MCV) Mean corpuscular haemoglobin (MCH) White cell count (WCC) Platelet count

88 g/L 55 fL 19 pg 9 18 x 10 9 475 x 10 L

[110-140] [75-90] [24-30] /L [5-15] [50-400]

Blood film demonstrates hypochromia and microcytosis of the red blood cells, with an immature neutrophilia and some toxic granulations. Some atypical lymphocytes were also seen. Dietary history is notable for cow milk intake of over 1000mL/day, with little meat, chicken or fish. His parents are Indian. He was born in Australia. The next day he has some further investigations. His serum ferritin level is 11µg/L [8-160], and his Hb electrophoresis electrophoresis shows a HbA2 of 3.3% [1.8 - 3.5]. Which of the following is the most likely explanation for his anaemia? A.

Alpha thalassaemia thalassaemi a minor.

B.

Beta thalassaemia major.

C.

Beta thalassaemia thalassaemia minor.

D.

Iron deficiency anaemia.

E.

Iron deficiency anaemia and beta thalassaemia minor.

QUESTION 19 An eight-year-old boy presents to the emergency department with a three day history of double vision. Examination reveals that the two images are most separated when looking to the right. When looking to the right with the left eye covered, the more medial image disappears. The nerve involved is the: A.

left abducens.

B.

left oculomotor. oculomotor.

C.

left trochlear.

D.

right abducens.

E.

right oculomotor.


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QUESTION 20

The electrocardiogram (ECG) of a child with a history of frequent recurrent supraventricular tachycardia is shown above. Which of the following drugs should be avoided because of the increased risk of ventricular tachyarrhythmias secondary to enhanced conduction through the bypass tract? A.

Amiodarone.

B.

Digoxin.

C.

Flecainide.

D.

Propranolol.

E.

Sotolol.

QUESTION 21 Which of the following is the most frequent side-effect of selective serotonin reuptake inhibitor (SSRI) anti-depressants in children? A.

Behavioural activation. activati on.

B.

Insomnia.

C.

Nausea.

D.

Suicidal ideation.

E.

Tremor.


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QUESTION 22 The key event which directly initiates myocardial fibre contraction is: A.

active uptake of calcium into sarcoplasmic sarcoplasmic reticulum.

B.

rapid entry of sodium through fast ion specific channels.

C.

release of stored calcium from sarcoplasmic sarcoplasmic reticulum.

D.

slow inward calcium current.

E.

slow inward sodium current.

QUESTION 23 Genomic imprinting is best defined as: A.

a process by which there is selective expression of either the paternally paternally or maternally inherited allele of a gene.

B.

inheritance of both copies of a chromosome from one parent.

C.

massive amplification of a triplet repeat sequence within a gene.

D.

skewing of X-inactivation.

E.

the combined effect on a chromosomal locus of methylation of DNA and acetylation acetylati on of associated histones.

QUESTION 24 What is the major determinant of vocabulary size at age three years? A.

Amount of language stimulation. stimulati on.

B.

Child's birth weight.

C.

Child's sex.

D.

Maternal education level.

E.

Maternal IQ.

QUESTION 25 Which of the following is most strongly associated with substance abuse in adolescence? adolescence? A.

Adolescent anxiety disorder.

B.

Conduct disorder in childhood.

C.

Infantile Infantil e separation anxiety disorder.

D.

Learning disorder in childhood.

E.

Maternal smoking.


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QUESTION 26 Which of the following drugs is most likely to increase the serum levels of cyclosporin to toxic levels? A.

Cotrimoxazole.

B.

Erythromycin.

C.

Flucloxacillin.

D.

Ibuprofen.

E.

Rifampicin.

QUESTION 27 A previously well two-yeart wo-year-old old boy presents to his general practitioner with tonsillitis and a macular red rash over his body. He is treated with oral Penicillin V. After two days he is admitted with a sudden onset of fever (38.5°C), irritability and painful skin. On examination he is miserable; screams when touched; has erythema of the face, axillae, neck, buttocks and groin; and peeling skin at the tip of his penis. Rubbing the skin leads to wrinkling and erosions of the epidermis. He has crusting around the mouth and nose and mild conjunctivitis. On day two of admission he develops large flaccid bullae on areas of red skin as shown in the photographs below.

Investigations Investigations on admission include: Haemoglobin Platelets White Cell Count Neutrophils Serum creatinine C-Reactive Protein

136 g/L 9 434 x 10 9 15.9 x 10 9 10.8 x 10 30 µmol/L < 3mg/L

[100-140] /L [150-400] /L [6.0-13.0] /L [2.0-6.0] [27-62] [<8]

Gram stain of skin: No organisms seen. A skin biopsy from this patient would be expected to show a cleavage plane in the: A.

granular layer with a perivascular perivascul ar lymphocytic lymphocyti c and neutrophilic infiltrate. infiltrat e.

B.

granular granular layer with no inflammatory inflammatory cell infiltrate.

C.

subepidermal subepidermal layer with eosinophilic eosinophilic infiltration of the dermis.

D.

subepidermal subepidermal layer with full-thickness epidermal epidermal necrosis.

E.

subepidermal subepidermal layer with intense perivascular perivascular and interstitial mononuclear mononuclear cell infiltrate.


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QUESTION 28 Eczema is associated with a Th2 cytokine profile as evidenced by increased production of which one of the following? A.

Interferon alpha (IFN alpha).

B.

Interleukin-2.

C.

Interleukin-4.

D.

Tumour necrosis factor alpha (TNF alpha).

E.

Transforming growth factor beta (TGF beta).

QUESTION 29 BCG (Bacille Calmette-Guérin) Calmette-Guérin) vaccine is most likely to reduce the risk of: A.

cutaneous tuberculosis. tuberculosis .

B.

latent tuberculous tuberculous infection.

C.

pulmonary tuberculosis. tuberculosis.

D.

tuberculous adenitis.

E.

tuberculous tuberculous meningitis.

QUESTION 30 Widened splitting of the pulmonary and aortic components of the second heart sound during expiration is an auscultatory feature of: A.

atrial septal defect.

B.

pulmonary hypertension.

C.

severe aortic valve stenosis.

D.

severe pulmonary pulmonary valve stenosis.

E.

structurally structurall y normal heart.

QUESTION 31 The prevalence of Immunoglobulin A deficiency in the normal population is approximately: A.

1 in 100.

B.

1 in 500.

C.

1 in 1500.

D.

1 in 2500.

E.

1 in 5000.


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QUESTION 32 Parents with three children seek your advice. Their eldest son, now in his early twenties, has been diagnosed diagnosed with schizophrenia. schizophrenia. What is the likelihood likelihood that their youngest youngest son will will develop this disorder? A.

2%.

B.

5%.

C.

10%.

D.

20%.

E.

30%.

QUESTION 33 A 24-week gestation male infant weighing 600 grams is managed with nasopharyngeal continuous positive airways pressure. At 36 hours of age he is receiving 60ml/kg/day of 10% dextrose intravenously. intravenously. In addition an umbilical arterial line is running at 1ml/hr with 0.45% (half-normal) (half-normal) saline. His urine output is 0.5ml/kg/hour. 0.5ml/kg/hour. Analysis of an arterial blood sample reveals the following: Sodium Potassium Chloride Creatinine pH pCO2 pO2 Bicarbonate Base deficit

146 mmol/L 7.0 mmol/L 115 mmol/L 0.11 mmol/L 7.25 45 mmHg 65 mmHg 18 mmol/L -8

[135 - 145] [3.5 - 5.1] [98 - 110] [0.01 - 0.03] [7.34- 7.43] [31- 42] [50-90] [20-26] [-5 - +5]

The most appropriate management would be: A.

furosemide.

B.

glucose and insulin.

C.

increased intravenous intravenous fluids.

D.

resonium.

E.

sodium bicarbonate.

QUESTION 34 The 7-valent pneumococcal conjugate vaccine (Prevenar®) is likely to cover what percentage of invasive pneumococcal isolates in urban Australian and New Zealander children? A.

10%.

B.

25%.

C.

40%.

D.

60%.

E.

85%.


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QUESTION 35 Compared to term infants, premature infants are most likely to be deficient in which of the following components of the immune system? A.

B cell.

B.

Complement.

C.

Immunoglobulin.

D.

Neutrophils.

E.

T cells.

QUESTION 36 In sick preterm infants the most important variable affecting insensible fluid losses is: A.

gestation.

B.

incubator humidification. humidificat ion.

C.

phototherapy.

D.

radiant heating.

E.

tracheal intubation.

QUESTION 37 Apart from glucose, which other carbohydrate is absorbed by the intestinal sodium-glucose transporter 1 (SGLT-1)? A.

Fructose.

B.

Galactose.

C.

Lactose.

D.

Mannose.

E.

Sorbitol.

QUESTION 38 Intravenous infusion of which of the following blood components is most likely to be associated with a septic transfusion reaction? A.

Cryoprecipitate.

B.

Fresh frozen plasma.

C.

Platelet concentrate. concentrate.

D.

Pooled gammaglobulin.

E.

Red cell concentrate.


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QUESTION 39 Three children present to the emergency department with similar symptoms of nausea, severe vomiting, dizziness, and abdominal cramping. All of them had been at the same party two hours previously and had eaten the same potato salad. Analysis of the contaminated food is most likely to yield large numbers of which of the following organisms? A.

Bacillus cereus .

B.

Clostridium perfringens perfringens .

C.

Escherichia coli .

D.

Salmonella typhimurium .

E.

Staphylococcus aureus .

QUESTION 40 The major contribution to increased cardiac output in a healthy child when running is derived from: A.

decreased left ventricular ventricul ar end-diastolic volume.

B.

increased heart rate.

C.

increased left ventricular afterload.

D.

increased left ventricular preload.

E.

increased myocardial myocardial contractility.

QUESTION 41 Which of the following nutrients is predominantly absorbed in the duodenum and upper small intestine? A.

Bile salts.

B.

Calcium.

C.

Linoleic acid.

D.

Vitamin B12.

E.

Vitamin E.

B

QUESTION 42 Which of the following does not shift the oxyhaemoglobin oxyhaemoglobin dissociation curve to the left? A.

Decrease in 2,3 diphosphoglycerate diphosphoglycerat e in the red cell.

B.

Decrease in carbon dioxide tension.

C.

Decrease in pH.

D.

Decrease in temperature.

E.

Presence of carboxyhaemoglobin. carboxyhaemoglobi n.


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QUESTION 43 On average, what proportion of genetic material is shared (i.e. is identical by descent) between two first cousins? Assume the cousins are from an outbred population and there is no consanguinity in the family. A.

1/64.

B.

1/32.

C.

1/16.

D.

1/8.

E.

1/4.

QUESTION 44 A three-year-old boy is brought to the emergency department with alcohol intoxication following a family party at home. Which of the following best describes describes the primary primary hepatic metabolic pathway pathway for alcohol? A.

Conjugation with glucuronic acid.

B.

Oxidation by alcohol dehydrogenase.

C.

Oxidation by peroxisomal peroxisomal catalase.

D.

Oxidation by the microsomal ethanol-oxidizing ethanol-oxidiz ing system (MEOS).

E.

Reduction using nicotinamide-adenine nicotinami de-adenine dinucleotide phosphate (NADPH) as a cofactor.

QUESTION 45 The calculation of Respiratory Compliance (Crs) in infants can be undertaken using the single-breath occlusion method. method. When using this technique, technique, the most appropriate method of calculating calculating respiratory compliance is: A.

the pressure at the airway opening recorded during occlusion, divided by flow.

B.

the pressure at the airway opening recorded during occlusion, divided by total exhaled volume.

C.

the time constant divided by the total exhaled volume.

D.

the time constant divided by the airway opening pressure recorded during occlusion.

E.

the total exhaled volume divided by pressure at the airway opening recorded during occlusion.


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QUESTION 46 Which of the following is least likely to cross the placenta from mother to foetus? A.

Calcium.

B.

Glucose.

C.

Insulin.

D.

Thyroxine (T4).

E.

TSH receptor antibodies.

QUESTION 47 A breast-fed six-month-old boy presents with abdominal distension, loose stools up to six times daily and failure to thrive. He appears to be feeding well. His neonatal metabolic screening tests are all unremarkable. His full blood examination and liver function tests are normal. Faecal microscopy findings are shown below: Fat globules: Fatty acid crystals: Red blood cells: White blood cells: Chymotrypsin:

+++ negative negative negative negative

What is the most likely diagnosis? A.

Chronic liver disease.

B.

Cystic fibrosis.

C.

Food allergy.

D.

Gastroenteritis.

E.

Lymphangiectasia.


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QUESTION 48

An 18-month-old boy presents with cough and fever for three days. His X-rays are shown above. Which of the following best describes the area most affected in this child? A.

Anterior segment right upper lobe.

B.

Apical segment right upper lobe.

C.

Lateral segment right middle lobe.

D.

Posterior segment right upper lobe.

E.

Superior segment right lower lobe.


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QUESTION 49 A 26-week gestation infant, intubated and ventilated since delivery, is 12 hours old and has received two doses of surfactant. surfactant. The ventilation settings settings are as follows: Mode: synchronised intermittent mandatory mandatory ventilation ventilation (SIMV) Fractional inspired oxygen concentration concentrati on

1.0

Peak inspiratory inspiratory pressure (PIP) Positive Positiv e end-expiratory pressure (PEEP) Rate

28 cm H 2O 4 cm H 2O 60 breaths per minute

Inspiratory time

0.3 seconds

His chest X-ray shows diffuse lung disease and arterial blood gas is as follows: pH

7.29

[7.34-7.43]

PaCO2

56 mmHg

[31-42]

PaO2 bicarbonate

36 mmHg 27mmol/L

[45-60] [20-26]

base excess

-3.8

[-5.0-5.0]

Which of the following alterations to the ventilator settings would be the most appropriate to improve oxygenation? A.

Convert to assist control ventilation.

B.

Increase inspiratory time to 0.6 seconds.

C.

Increase PEEP to 6 cm H2O.

D.

Increase PIP to 32 cm H2O.

E.

Increase rate to 70 breaths per minute.

QUESTION 50 Absorption of gastrointestinal gastrointestinal calcium is primarily stimulated by which of the following hormones? A.

1,25-dihydroxyvitamin 1,25-dihydroxyvitamin D.

B.

Cortisol.

C.

Growth hormone.

D.

Parathyroid hormone (PTH).

E.

Thyroid hormone.


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QUESTION 51 The diagram below represents the bony features of the cervical spine found on radiography. Which of the marked lines best delineates the posterior boundary of the spinal canal?

A A.

A.

B.

B.

C.

C.

D.

D.

E.

E.

B

C

D

E


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QUESTION 52 In chronic granulomatous disease, the mechanism of abnormal phagocytic cell function is: A.

abnormalities of the mannose-binding lectin (MBL) pathway.

B.

cyclical variation in haematopoiesis. haematopoiesis.

C.

deficiency of myeloperoxidase myeloperoxidase within the phagocyte granules.

D.

failure to produce reactive oxygen intermediates. intermediates .

E.

lack of beta 2-integrin adhesion molecules on neutrophils.

QUESTION 53 Which one of the following viruses has not been associated with malignancy? A.

Cytomegalovirus Cytomegalovirus (CMV).

B.

Epstein-Barr virus (EBV).

C.

Human herpes virus-8 (HHV-8).

D.

Human immunodeficiency immunodeficiency virus (HIV).

E.

Human papilloma virus (HPV).

QUESTION 54 A 14-year-old obese girl with a long-standing history of migraine has been having increasing frequency and severity of her headaches. She misses approximately one day per week of school because of her headaches. Despite evaluation for triggering factors and the use of abortive therapy, her headaches continue at the same severity. You are considering the use of prophylactic therapy. Which of the following prophylactic medications medications is not usually associated with weight gain? A.

Amitriptyline.

B.

Cyproheptadine.

C.

Pizotifen.

D.

Propranolol.

E.

Sodium valproate.


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QUESTION 55 Which brain structure has been most consistently found on functional neuroimaging studies to be associated with the executive function deficits seen in attention deficit hyperactivity disorder? A.

Cerebellum.

B.

Limbic system.

C.

Pre-frontal cortex.

D.

Reticular activating system.

E.

Thalamus.

QUESTION 56 In developed countries, breast feeding of term infants is contra-indicated by which of the following maternal infections? A.

Cytomegalovirus.

B.

Hepatitis A.

C.

Hepatitis B.

D.

Hepatitis C.

E.

Human immunodeficiency immunodeficie ncy virus (HIV).

QUESTION 57 A new screening test is developed for Condition X. It is trialled in a population of 1100 children, of whom 100 have Condition X and the remainder do not. Of the 200 children who screen positive, 50 have Condition X. What is the specificity of the screening test? A.

0.15.

B.

0.25.

C.

0.50.

D.

0.85.

E.

0.94.


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QUESTION 58 Which biochemical abnormality abnormality is most consistently found in infants subjected to severe environmental environmental deprivation? A.

Decreased cortisol.

B.

Hyperglycaemia.

C.

Hypoglycaemia.

D.

Hypothyroidism.

E.

Increased cortisol.

QUESTION 59 A six-year-old boy presents with a six-month history of swallowing problems and speech change. His mother says that his speech is less clear and that fluids occasionally come out of his nose when he is drinking. A photograph of his mouth is shown below.

What is the most likely diagnosis? A.

Anterior horn cell disorder.

B.

Arnold-Chiari malformation.

C.

Cervical cord tumour.

D.

Myasthenia gravis.

E.

Myotonic dystrophy.


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QUESTION 60 Deficiency of which complement component is most associated with severe pyogenic infections? A.

C1 esterase inhibitor.

B.

C3.

C.

C4.

D.

C8.

E.

Properdin.

QUESTION 61 A three-year-old boy undergoing induction for acute lymphoblastic leukaemia is at risk of tumour lysis syndrome due to a high white cell count. Twelve hours following initial chemotherapy, the following investigations were obtained: Calcium 2.0 mmol/L Phosphate 3.0 mmol/L Lactate Dehydrogenase (LDH) 9800 U/L Uric Acid 0.4 mmol/L Urinary pH 7.8 Urinary specific gravity 1018 Urinary nitrates +3

[2.15-2.65] [1.3-2.3] [500-920] [0.1-0.3]

Which one of the following metabolites is most likely to precipitate within the renal tubules in the patient? A.

Allantoin.

B.

Calcium phosphate.

C.

Hypoxanthine.

D.

Sodium nitrate.

E.

Uric acid.

QUESTION 62 What is the most common side effect of mycophenolate mofetil? A.

Gastrointestinal Gastrointestinal disturbance. disturbance.

B.

Impaired renal function.

C.

Invasive cytomegalovirus cytomegalovirus infections.

D.

Leucopenia.

E.

Post-transplant Post-transpl ant lymphoproliferative lymphoprolif erative disease.


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QUESTION 63 Chronic lung disease of prematurity can affect later lung growth. In school-aged children, which part of the lung is most affected? A.

Alveoli.

B.

Bronchioles and acini.

C.

Interstitial tissue.

D.

Main bronchi.

E.

Trachea.

QUESTION 64 Which of the following anthropometric measures in the school-aged child is most specifically associated with level of long-term cardiovascular cardiovascular risk? A.

Body mass index.

B.

Height/weight Height/weight ratio.

C.

Skin fold thickness.

D.

Waist circumference. circumference.

E.

Weight.

QUESTION 65 The parents of a child in the Intensive Care unit with a terminal illness make a choice not to pursue further treatment for their child's condition. Medical advice has been that there is little hope that any intervention would prolong the child's life. In this situation, which of the following should not be withheld? A.

Adequate sedation and analgesia.

B.

Antibiotics.

C.

Artificial hydration and nutrition.

D.

Ionotrophic medications. medications.

E.

Red Cell transfusion. transfusion.


25

P 106

QUESTION 66 The following table shows the results of the primary endpoint of a study of a new treatment for asthma, “Micoffstop”. Patients were recruited recruited in a tertiary referral hospital after Intensive Intensive Care Unit admission. Treatment Number with ICU admission or death in the next five years

Micoffstop Micoffs top n=200

Placebo n=200

20

40

If the same treatment and endpoint was used in a trial in a group of patients with non-ICU hospital admission for asthma, which of these measures of treatment effect is most likely to remain approximately approximately the same? A.

Absolute risk reduction.

B.

Cost-benefit Cost-benefit analysis.

C.

Number needed to treat.

D.

Relative risk reduction.

E.

Risk-benefit analysis.

QUESTION 67 Which biochemical abnormality is typical for the 'refeeding syndrome' which occurs due to the reintroduction of food after a period of prolonged undernutrition? A.

Hypercalcaemia.

B.

Hyperphosphataemia.

C.

Hypocalcaemia.

D.

Hypophosphataemia.

E.

Hypotriglyceridaemia.

QUESTION 68 You admit an eight-year-old eight-year-old girl to the Intensive Care Unit with septic shock. A randomised controlled controlled trial recently showed that a new drug reduces mortality. In the study, 33 of 110 control patients (30%) died, compared to 30 of 120 (25%) in the treatment group. It costs $2,000 per treatment course. In order to save one life using this new drug, about how much would your hospital have to spend? A.

$2,500

B.

$40,000

C.

$50,000

D.

$60,000

E.

$66,000


26

P 106

QUESTION 69 An eight-year-old girl is brought to the emergency department with a facial rash of one day's duration, as pictured below. She has been febrile and systemically unwell with nausea, but no vomiting. Her 9 9 white blood cell count is 29.4 x 10 /L [5.50 - 11.0] with a neutrophil count of 26.46 x 10 /L [1.8 - 7.0].

Which of the following is the most likely causative agent? A.

Haemophilus Haemophilus influenzae .

B.

Pseduomonas aerogiroisa .

C.

Staphylococcus aureus .

D.

Staphylococcus pneumoniae .

E.

Streptococcus pyogenes .

QUESTION 70 The mucopolysaccharidoses are a group of disorders caused by: A.

abnormal accumulation of substrate in lysosomes.

B.

abnormal processing of polysaccharide polysacchar ide side chains of glycoproteins. glycoprotei ns.

C.

dysfunction dysfuncti on of membrane ion channels.

D.

dysfunction of the mitochondrial mitochondrial respiratory chain.

E.

failure of assembly of peroxisomes.


27

P 106

2006 FRACP Written Examination Paediatrics & Child Health Paper 1 – Medical Sciences Answers 1.

A

25.

B

49.

C

2.

B

26.

B

50.

A

3.

C

27.

B

51.

B

4.

B

28.

C

52.

D

5.

E

29.

E

53.

A

6.

B

30.

C

54.

D

7.

B

31.

B

55.

C

8.

E

32.

C

56.

E

9.

C

33.

C

57.

D

10.

D

34.

E

58.

E

11.

B

35.

C

59.

A

12.

A

36.

A

60.

B

13.

C

37.

B

61.

B

14.

A

38.

C

62.

A

15.

D

39.

E

63.

B

16.

C

40.

B

64.

D

17.

A

41.

B

65.

A

18.

E

42.

C

66.

D

19.

D

43.

D

67.

D

20.

B

44.

B

68.

B

21.

C

45.

E

69.

E

22.

C

46.

C

70.

A

23.

A

47.

B

24.

A

48.

D


2006 FRACP Written Examination Paediatrics & Child

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