Вы находитесь на странице: 1из 12

CANDIDATE NUMBER:………………

MRCPCH EXAMINATION Scientific Knowledge & Theory of Practice Specimen Paper

MRCPCH EXAMINATION

Scientific Knowledge & Theory of Practice

Specimen Paper

1. Complete the following:

Your full name (BLOCK LETTERS)

…………………………………………………………………………………

RCPCH Number……………………………………………………………………….……

Signature…………………………………………………………………………

2. Check your surname (family name) and initials appear in the top left hand corner of the Answer Sheet. Check your candidate number is in the top right hand corner.

Using the pencil provided, complete your response to each item on the Answer Sheet.

3. It is strictly forbidden to talk to, read the work of, or attempt in any way to communicate with, other candidates whilst the examination is in progress. Please exercise vigilance to ensure that no other candidate can attempt to copy your work. The College has tools, which can identify copying of answers or collusion between candidates to share answers. If such a situation arises the suspicion of guilt falls upon both parties until it can be proved otherwise. Breaches of these instructions, or misbehaviour in any other way, including continuing to write after the allotted time, may lead to suspension from the examination. Any attempt at cheating or colluding to gain advantage, may incur permanent suspension from College examinations and will result in notification to the GMC.

4. Question papers and individual questions must not be copied or removed from the examination room.

5. Copyright law protects examination questions and the intellectual property of their authors. The unauthorised use of questions is a breach of copyright law.

Q1

This is a list of studies:

A Case controlled study

B Case series

C Cohort study

D Cross over study

E Double blind randomised controlled trial

F Meta-analysis

G Open label study

H Qualitative study

I Quasi-randomised control study

J Systematic review

Choose the most appropriate study design for the following clinical questions:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

 

1

A paediatric dermatology unit is one of several approached by a pharmaceutical company who are developing a new 4 times daily antibiotic for treating acne. They wish to compare their product with erythromycin. The clinic population is large enough to recruit 300 children. Efficacy would be tested by independent examination of the skin.

2

A research doctor wishes to do a short-term project to compare the efficacy and acceptability of 2 spacer devices when treating children with asthma. He can recruit 30 children aged 4 to 11 years.

3

A District General Hospital children’s diabetic service proposes to introduce a transition service in conjunction with the adult diabetic service. Prior to this they wish to identify important issues faced by the 15 teenagers leaving the paediatric service in the next two years.

Q2

This is a list of analgesic regimens

A Intravenous diamorphine

B Oral carbamazepine

C Oral carbamazepine and morphine slow release BD

D Oral diazepam

E Oral ibuprofen

F Oral morphine PRN

G Oral morphine slow release (MST) BD

H Oral morphine slow release tablets (MST) BD and oral morphine PRN

I Oral rofecoxib (Cox-2 selective non-steroidal anti-inflammatory)

J Rectal sodium diclofenac

Choose the most appropriate analgesic or combination for each of the following:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

1 A 14 year old boy in chronic severe pain from metastatic osteosarcoma

2 An 11 year old boy with chronic severe neuropathic pain secondary to chemotherapy

3 A 6 year old girl with 20% second degree burns presenting to the Emergency Department

Q3

This is a list of management options:

A Defibrillation

B Ice pack on the face

C Intravenous adenosine

D Intravenous amiodarone

E Intravenous lignocaine

F Intravenous magnesium sulphate

G Oral digoxin

H Oral sotalol

I Radiofrequency ablation

J Valsalva manoeuvre

Choose the best treatment for the following:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

1 A 7 year old boy presents to the Accident and Emergency department with palpitations and is found to have ventricular tachycardia. He has had similar self-limiting symptoms in the past. He looks well. His pulse rate is 200/min and blood pressure is 100/65

2 A 14 year old girl presents to the Accident and Emergency department with upper abdominal pain and is found to have supraventricular tachycardia. She looks well. Her pulse rate is 250/min and blood pressure is 120/65. She refuses to have an intravenous line inserted.

3 A 4 year old boy has had a nocturnal cough for a week. His mother has tried to control this with increasing doses of cough syrup. She finds him looking unwell this morning. In the Accident and Emergency Department he is pale, with GCS score of 12/15, with supraventricular tachycardia of 270 min and blood pressure of 90/55.

Q4

This is a list of diagnoses:

A Abetalipoproteinaemia

B Autoimmune enteropathy

C Coeliac disease

D Cow’s milk protein intolerance

E Crohn’s disease

F Giardiasis

G Lymphangiectasia

H Microvillous inclusion disease (microvillous atrophy)

I Primary hyperlipidaemia

J Whipple’s disease

Choose the most likely diagnosis for each of the following histology reports on endoscopic biopsies from the distal duodenum:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

1 There is a patchy enteropathy with relatively mild disturbance of crypt-villous architecture. Mucosal lymphocyte and eosinophil populations are increased, while intraepithelial lymphocyte numbers are within the normal range.

2 The villous height is within normal limits but the villi are distorted by ectatic villous core lacteals. There is no significant inflammatory infiltrate.

3 There is a diffuse enteropathy characterised by crypt hyperplasia and villous atrophy. The intraepithelial lymphocyte count is increased.

Q5

The relation between oxygen partial pressure and oxygen saturation in blood (oxygen dissociation curve of haemoglobin) is shifted to the left by

A

a decreased pH

B

an increased pCO 2

C

chronic iron deficiency anaemia

D

deficiency of 2, 3-diphosphoglycerate in the red cells

E

hypothermia

Q6

The following are recognised adverse drug reactions (ADR) in the neonate:

A

Gentamicin and renal impairment

B

Grey baby syndrome and chloramphenicol

C

Indomethacin and necrotising enterocolitis

D

Methylxanthine and seizures

E

Sodium feredetate and constipation

Q7

Fetal

haemoglobin (HbF)

A

constitutes a greater percentage of total haemoglobin in full-term than in preterm babies

B

has a greater affinity for oxygen than adult haemoglobin

C

in high concentration reduces mortality in sickle cell disease

D

is absent in β-thalassaemia major

E

is increased in the newborn as a result of prolonged intrauterine hypoxia

Q8

The following statements on sexual differentiation are correct:

A

Bilateral inguinal herniae in a baby with female external genitalia suggests androgen insensitivity

B

Oestradiol is required for differentiation of the female internal genitalia

C

The absence of the SRY gene means that the gonads will differentiate into ovaries

D

The commonest cause of ambiguous genitalia in a 46XX baby is 21-hydroxylase deficiency

E

The karyotype is the most appropriate guide to gender assignment in a baby with ambiguous genitalia

Q9

Recognised causes of alkalosis include

A

pyloric stenosis

B

cardiogenic shock

C

acute anxiety

D

cystic fibrosis

E

therapy with a loop diuretic

Q10

Ketotic hypoglycaemia is a recognised feature of

A a newly diagnosed child with Type I diabetes mellitus

B starvation

C fatty acid oxidation defect

D persistent hyperinsulinaemic hypoglycaemia of infancy

E congenital hypopituitarism

Q11

A 3 year old girl is on maintenance chemotherapy for acute lymphatic leukaemia.

She is admitted with a limp, fever and local tenderness of the femur. Blood cultures and bone aspiration are performed.

What is the most likely pathogen?

SELECT ONE ANSWER ONLY

A

Haemophilus influenzae

B

Mycobacterium tuberculosis

C

Pseudomonas aeruginosa

D

Salmonella enteritidis

E

Staphylococcus aureus

Q12

A 14 year old boy with muscle weakness is undergoing respiratory assessment.

Lung function tests:

FVC

52% predicted

FEV1

53% predicted

Peak expiratory flow

before bronchodilator 80% predicted

after bronchodilator

84% predicted

What is the best interpretation of the findings?

SELECT ONE ANSWER ONLY

A Bronchial hyper-reactivity

B Hyperinflation

C Impaired gas exchange

D Restrictive lung disease

E Ventilation-perfusion mismatch

Q13

A 6-week-old girl presents with cough and dyspnoea. Chest X-ray shows hyperinflation with interstitial infiltrates. She was born at 37 weeks weighing 2.9kg. She had mild conjunctivitis, eye swabs grew Haemophilus influenzae and she was treated with topical chloramphenical. She a first born baby. Her mother has eczema and her father has asthma.

Which pathogen is most likely to have caused the respiratory illness?

SELECT ONE ANSWER ONLY

A Chlamydia trachomatis

B Haemophilus influenzae

C Mycoplasma pneumoniae

D Neisseria gonorrhoea

E Respiratory syncitial virus

Q14

A 3-day –old girl was born at 27-weeks gestation. She received 2 doses of surfactant and is remains ventilated on SIMV. Her oxygen saturations are 92%

Ventilator settings rate

50/min

inspiratory time PIP PEEP

0.36 secs 20 cm H 2 O 4 cm H 2 O

FiO 2

0.28

Arterial gas

pH

7.38

PaCO 2

3.9kPa

PaO 2

8.2 kPa

BE

– 3.0

What is the best next step?

SELECT ONE ANSWER ONLY

A Increase the FiO 2

B Increase the PEEP

C Increase the PIP

D Reduce the rate

E Repeat blood gases in 4 hours

Q15

A

14

year

old

girl

is

referred

by

further

investigation

and

management

of

menorrhagia.

Blood

 

APTT prothrombin time platelet count fibrinogen Factor IX Factor VIII

51 secs (22-45) 11secs (10-15) 325 x 10 9 /l (150-450 3.1g/dl (2-4) 81% (50-120) 38% (50-120)

What

is the most likely diagnosis?

SELECT ONE ANSWER ONLY

A

Glanzmann thrombasthenia

B

Haemophilia B

C

Protein C deficiency

D

Vitamin K deficiency

E

Von-Willebrand disease

Q16

A girl is born at term weighing 4.2 kg following a prolonged labour due to shoulder

dystocia.

was established at the age of 30 minutes.

She was transferred to the special care

Respiration

She was blue and floppy at birth and required resuscitation.

baby unit.

She is reassessed at the age of 14 days.

What is the most reliable clinical indicator of future neurodisability at this stage?

SELECT ONE ANSWER ONLY

A Absence of asymmetric tonic neck reflexes

B Brisk deep tendon reflexes

C Not taking bottle feeds

D Persistent irritablity

E Unilateral facial palsy involving forehead