2004 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 Education 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 © 2005 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.

Copyright © 2005 by The Royal Australasian College of Physicians

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QUESTION 1
Steroids used in the treatment of childhood acute lymphoblastic leukaemia are least frequently
associated with which one of the following side effects?

A. Avascular necrosis of bone.

B. Behavioural disturbances.

C. Bone demineralisation.

D. Renal tubular defects.

E. Weight gain.

QUESTION 2
The protein shared by the alternate and classical complement systems is:

A. C1.

B. C2.

C. C3.

D. C4b.

E. Properdin.

QUESTION 3
A two-year-old boy is brought into the emergency department unconscious following a house fire. His
carboxyhaemoglobin level is measured on presentation as 40%. Which of the following mechanisms
is most important in producing the toxic effects of this inhalation?

A. Direct toxic effect on myoglobin.

B. Irreversible binding of carbon monoxide to haemoglobin.

C. Irreversible binding of carbon monoxide to myelin.

D. Reversible binding of carbon monoxide to cytochrome A3.

E. Shifting of the oxygen dissociation curve to the right.

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QUESTION 4

In the pedigree shown above, family members marked with a solid symbol are affected by a rare
autosomal dominant disorder. Individual II:3 has no features of the disorder, even on detailed
examination.

The term for this phenomenon is:

A. anticipation.

B. non-penetrance.

C. phenocopy.

D. pseudodominance.

E. reduced expression.

QUESTION 5
The need for informed consent before enrolling a patient in a clinical trial investigating a novel
treatment is primarily based on the principle of:

A. autonomy.

B. beneficence.

C. justice.

D. nonmaleficence.

E. risk management.

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QUESTION 6
The most important known factor which influences the rate of development of microvascular
complications in patients with diabetes is:

A. duration of diabetes.

B. hyperglycaemia.

C. hyperlipidaemia.

D. hypertension.

E. smoking.

QUESTION 7
Which of the following anticonvulsants is most likely to increase the half-life of topiramate?

A. Carbamazepine.

B. Phenobarbitone.

C. Phenytoin.

D. Primidone.

E. Sodium valproate.

QUESTION 8
In a 10-year-old with cystic fibrosis, which of the following lung parameters is the most reproducible?

A. Forced expiratory flow 25-75% (FEF25-75%).

B. Forced expiratory volume in 1 second (FEV1).

C. Forced vital capacity (FVC).

D. Intrathoracic gas volume (ITGV).

E. Residual volume to total lung capacity (RV:TLC) ratio.

QUESTION 9
Which of the following is the strongest predictor for attempted suicide in adolescence?

A. Critical home stresses.

B. Depressive symptoms.

C. Feelings of hopelessness.

D. History of a previous attempt.

E. Rejection by peers.

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QUESTION 10
Which of the following antibiotics would be expected to be least active in treating a patient with
infection caused by Pseudomonas aeruginosa?

A. Cefotaxime.

B. Gentamicin.

C. Imipenem.

D. Piperacillin.

E. Ticarcillin.

QUESTION 11
Which one of the following steps in the design of a clinical trial of a new therapeutic agent most
reduces the chance of a type II error?

A. Blinded assessment of outcomes.

B. Intention to treat analysis.

C. Random allocation.

D. Sample size calculation.

E. Stratification of major risk factors.

QUESTION 12
A 24-day-old boy presents with a one-week history of projectile vomiting and weight loss. Which of
the following findings would be most likely on arterial blood gas measurement?

A. Metabolic acidosis.

B. Metabolic alkalosis.

C. Mixed metabolic acidosis and respiratory alkalosis.

D. Mixed metabolic alkalosis and respiratory acidosis.

E. Normal blood gas.

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QUESTION 13
In a child with a massive abdominal Burkitt lymphoma, the most useful treatment to prevent tumour
lysis syndrome is:

A. allopurinol.

B. frusemide.

C. mannitol.

D. prednisolone.

E. urate oxidase.

QUESTION 14

A resting human mast cell is shown above. Substances present in the mast cell granules include all of
the following except:

A. chondroitin sulphate.

B. heparin.

C. histamine.

D. interferon.

E. tryptase.

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QUESTION 15
Idiopathic ascending aortic dilatation would be most likely to accompany which of the following
syndromes/associations?

A. Down syndrome.

B. Noonan syndrome.

C. Turner syndrome.

D. VACTERL association.

E. Velocardiofacial syndrome.

QUESTION 16
A breastfed two-day-old girl presents with profuse diarrhoea and develops severe dehydration. The
diarrhoea ceased during resuscitation with intravenous (IV) fluids when feeds were paused. However,
when breastfeeds were gradually introduced in the recovery period, the diarrhoea returned and IV
fluids were recommenced. A trial of oral rehydration solution also resulted in severe diarrhoea.
Analysis of the faecal fluid revealed the following electrolyte profile:

sodium 20 mmol/L
potassium 15 mmol/L
chloride 25 mmol/L

Which one of the following is the most likely diagnosis?

A. Congenital chloride diarrhoea.

B. Glucose-galactose malabsorption.

C. Primary lactose intolerance.

D. Secondary lactose intolerance.

E. Sucrase-isomaltase deficiency.

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QUESTION 17
A 1200 g 31-week gestation male infant is in good condition following a normal vaginal delivery. He is
nursed in room air in a single-walled incubator. At 24 hours of age his temperature per axilla is
35.5°C. His rectal temperature is 36.3°C. The incubator temperature is 34.1°C. The relative humidity
inside the incubator is 70%. The temperature of the wall of the incubator is 32°C. The nursery room
temperature is 23°C.

The most appropriate way of achieving a neutral thermal environment for this infant is to:

A. increase the incubator temperature.

B. increase the nursery environmental temperature.

C. increase the relative humidity of the incubator.

D. place a heat shield over the infant.

E. remove all draughts from the nursery.

QUESTION 18
A disease has an annual incidence of 15 cases per 100,000. The mean survival after diagnosis is five
years.

What is the best estimate of the prevalence of this disorder?

A. 3 per 100,000.

B. 15 per 100,000.

C. 30 per 100,000.

D. 45 per 100,000.

E. 75 per 100,000.

QUESTION 19
The polymerase chain reaction (PCR) requires the use of a DNA polymerase. The action of the DNA
polymerase is best described as:

A. allowing primers to affix to the single strands.

B. causing double-stranded DNA to become singled-stranded.

C. extending the primers once they are affixed to the single strands.

D. inducing fluorescence of DNA.

E. splitting the single strand and the extended primer.

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QUESTION 20
A 15-year-old boy sustains a right shoulder dislocation during a football game. The dislocation is
reduced in the emergency room within hours. On review two weeks after his injury, he complains of
numbness over the radial aspect of the forearm.

On examination he has sensory impairment over the lateral (radial) aspect of the forearm from just
below the elbow to just above the wrist. He also has weakness of elbow flexion. The biceps deep
tendon reflex is depressed. The rest of his examination is normal.

The most likely site of injury is to the:

A. axillary nerve.

B. median nerve.

C. musculocutaneous nerve.

D. radial nerve.

E. ulnar nerve.

QUESTION 21
A 15-year-old boy develops symptoms of shortness of breath on exertion, orthopnoea and ankle
oedema. At eight years of age he was treated for osteogenic sarcoma.

Which one of the following agents is most likely to be responsible for his current condition?

A. Actinomycin-D.

B. Cisplatin.

C. Doxorubicin.

D. Ifosfamide.

E. Methotrexate.

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QUESTION 22
A seven-year-old girl with a history of worsening dyspnoea on exertion is referred for lung function
testing. The following results are obtained:

forced vital capacity (FVC) 70% predicted [80-100]

forced expiratory volume in 1 second (FEV1) 60% predicted [80-100]
forced inspiratory flow 50% / forced expiratory flow 50%
(FIF50%/FEF50%) ratio 0.5 predicted [0.9-1.1]

The most likely diagnosis is:

A. asthma.

B. extrathoracic airway obstruction.

C. interstitial lung disease.

D. poor effort.

E. respiratory muscle weakness.

QUESTION 23
Which one of the following is currently believed to be the most important contributor to the increase in
child body mass index (BMI) over the last 15 years?

A. Decreasing fitness.

B. Decreasing participation in sport.

C. Increasing calorie (energy) intake.

D. Increasing fat intake.

E. Increasing sedentary behaviour.

QUESTION 24
A four-month-old boy is admitted to hospital for surgical management of his inguinal hernia.
Phenotypically he is a normal male. At surgery the hernial sac is found to contain uterine tissue. Both
testes are identified and appear normal.

Investigation shows him to have an XY karyotype.

Which one of the following is the most likely aetiology for these findings?

A. Absent Leydig cells.

B. Androgen insensitivity.

C. Deficiency of anti-Müllerian hormone.

D. 5α-reductase deficiency.

E. Gonadal dysgenesis.

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QUESTION 25
A child admitted to a surgical ward has coagulation tests performed with the following results:

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

prothrombin time 12 seconds [11-13]
partial thromboplastin time 50 seconds [28-37]
mixing test 1 + 1 with normal plasma 48 seconds [28-37]
thrombin time 50 seconds [11-15]
reptilase time normal

The most likely explanation for this profile is:

A. disseminated intravascular coagulation (DIC).

B. haemophilia A.

C. heparin effect.

D. lupus anticoagulant.

E. von Willebrand disease.

QUESTION 26
Which one of the following is least likely to lead to a progression of chronic renal failure?

A. Hyperlipidaemia.

B. Hypocalcaemia.

C. Metabolic acidosis.

D. Phosphate retention.

E. Proteinuria.

QUESTION 27
Despite adequate fluid resuscitation, a child has ongoing hypotension and oliguria (<0.5 mL/kg urine
output per 24 hours) associated with sepsis.

Which of the following is most likely to be of benefit?

A. Adrenaline infusion.

B. Frusemide infusion.

C. Intermittent frusemide.

D. Low (renal)-dose dopamine.

E. Prostacyclin infusion.

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QUESTION 28

In the pedigree shown above, a diagnosis of Duchenne muscular dystrophy (DMD) is made in a three-
year-old boy (IV:1). The family history reveals that a maternal uncle (II:1) died of DMD aged 19, and
that the proband’s aunt (III:4) is currently at 30 weeks of gestation in her first pregnancy.

What is the risk that the baby (IV:2) will be affected by DMD?

A. Approximately 1 in 8000 (population risk).

B. 1 in 8.

C. 1 in 4.

D. 1 in 2.

E. 2 in 3.

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QUESTION 29

The diagram above shows the histology of a human tonsil. The arrow indicates a germinal centre.
What are the predominant cells in the germinal centres?

A. B cells.

B. Dendritic cells.

C. Macrophages.

D. Neutrophils.

E. T cells.

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QUESTION 30
A new diagnostic test for a certain disease has been evaluated. Compared with the definitive
diagnostic standard, this test has a sensitivity of 100% and a specificity of 95%. The prevalence of the
disorder in the population to be tested is 0.1%.

What is the best estimate of the positive predictive value of the new test?

A. <1%.

B. 2%.

C. 5%.

D. 10%.

E. 25%.

QUESTION 31
An otherwise normal two-year-old boy is brought to see you because of recurrent generalised febrile
convulsions. He had his first febrile convulsion at 14 months of age and has had one further febrile
seizure. The seizures both lasted less than one minute.

There is no family history of febrile convulsions or epilepsy.

Which of the following is the best estimate for the risk of later epilepsy?

A. 1%.

B. 2.5%.

C. 5%.

D. 10%.

E. 20%.

QUESTION 32
Long-term cyclosporin administration most frequently causes which one of the following?

A. Hirsutism.

B. Hyperglycaemia.

C. Hypomagnesaemia.

D. Nephrotoxicity.

E. Rash.

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QUESTION 33
Which one of the following cells of the immune system relies most on its release of mediators into the
extracellular fluid surrounding the organism in order to carry out its role in eradication of foreign
organisms?

A. Cytotoxic T lymphocytes.

B. Eosinophils.

C. Macrophages.

D. Natural killer cells.

E. Neutrophils.

QUESTION 34

A rhythm strip from an electrocardiogram (ECG) is shown above. Which of the following is the most
likely cause for the abnormality displayed?

A. Hyperkalaemia.

B. Hyperthermia.

C. Hyperthyroidism.

D. Hypocalcaemia.

E. Uraemia.

QUESTION 35
Growth hormone is secreted from the anterior pituitary gland. Which of the following is least likely to
stimulate growth hormone release?

A. Exercise.

B. High carbohydrate intake.

C. High protein intake.

D. Hypoglycaemia.

E. Sleep.

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QUESTION 36

Of the five sites (1-5) indicated in the diagram above, which is the primary site of ocular inflammation
in pauci-articular juvenile idiopathic arthritis?

A. 1.

B. 2.

C. 3.

D. 4.

E. 5.

QUESTION 37
Which research design can most conclusively demonstrate causality?

A. Case-control study.

B. Multiple-baseline intervention study.

C. Prospective cohort study.

D. Randomised controlled trial.

E. Retrospective cohort study.

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QUESTION 38
The daily energy requirement of a parenterally fed three-week-old neonate is estimated to be 100 kcal
(420 kJ) per kilogram body weight. Which of the following intravenous glucose and lipid solutions will
provide adequate daily energy for an infant of 4 kg body weight?

A. 400 mL of glucose 10% plus 20 mL of intravenous lipid 20%.

B. 400 mL of glucose 15% plus 30 mL of intravenous lipid 20%.

C. 400 mL of glucose 15% plus 40 mL of intravenous lipid 20%.

D. 400 mL of glucose 15% plus 50 mL of intravenous lipid 20%.

E. 400 mL of glucose 20% plus 60 mL of intravenous lipid 20%.

QUESTION 39
Which of the following antipsychotic medications is most likely to cause the greatest weight increase
when prescribed to adolescents?

A. Haloperidol.

B. Olanzapine.

C. Pimozide.

D. Quetiapine.

E. Risperidone.

QUESTION 40
A haplotype is best defined as a group of alleles which:

A. are at a specific genomic locus for which an individual is heterozygous.

B. are closely linked together at a genomic locus.

C. are present on the same chromosome as a pathogenic mutation.

D. are specific to a particular ethnic group.

E. show reduced linkage disequilibrium.

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QUESTION 41
Low serum vitamin B12 levels are least likely to be seen in which one of the following?

A. Crohn disease.

B. Pernicious anaemia.

C. Severe folate deficiency.

D. Short bowel syndrome.

E. Transcobalamin II deficiency.

QUESTION 42
The word ‘complex’ in complex partial seizures refers to:

A. a seizure lasting >10 minutes.

B. automatisms occurring during the seizure.

C. focal motor seizures.

D. impaired consciousness during the seizure.

E. multiple seizures in a 24-hour period.

QUESTION 43
In a patient presenting with a severe acute exacerbation of asthma, arterial blood gases on breathing
room air show:

PaCO2 31 mmHg [36-44]

PaO2 59 mmHg [80-100]
pH 7.47 [7.36-7.44]

The hypoxaemia worsens with the administration of an intravenous beta-2 agonist bronchodilator.
The PaCO2 is unchanged.

Which one of the following mechanisms best explains the worsening of this patient’s hypoxaemia?

A. Increase in cardiac output.

B. Increase in oxygen consumption by skeletal muscle.

C. Peripheral systemic arterial dilatation.

D. Pulmonary arterial dilatation in low ventilation-perfusion ratio (V/Q) units.

E. Pulmonary vasoconstriction.

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QUESTION 44

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QUESTION 44 (continued)
The diagram shown opposite represents the normal cardiac cycle. At which of the points marked on
the diagram would the left ventricular volume be greatest?

A. A.

B. B.

C. C.

D. D.

E. E.

QUESTION 45
An eight-year-old boy is diagnosed as having a congenital antibody deficiency after being found to
have an IgG level of 0.50 g/L [4.95-16.56]. He weighs 25 kg. Six hours after infusion of 30 g of
intravenous immunoglobulin his IgG level is 9 g/L.

How many days later would you expect his IgG level to be at 4.5 g/L?

A. 3.

B. 7.

C. 14.

D. 28.

E. 56.

QUESTION 46
The activity of some hormones are affected by the levels of specific carrier proteins. Abnormal levels
of carrier proteins are most likely to have clinically significant effects on the activity of which one of the
following hormones?

A. Adrenocorticotrophic hormone (ACTH).

B. Cortisol.

C. Growth hormone (GH).

D. Parathyroid hormone (PTH).

E. Testosterone.

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QUESTION 47

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QUESTION 47 (continued)
A 10-year-old boy presents with a history of recurrent palpitations, precipitated by strenuous exercise,
over the last 12 months. On the day of presentation he had the sudden onset of a rapid heart rate
while playing cricket at school. On arrival at triage he has a pulse rate of 240/minute, a respiratory
rate of 29/minute and a blood pressure of 80/50 mmHg. He is pale but alert and after a large vomit at
triage his rapid heart rate spontaneously resolves. His 12-lead electrocardiogram (ECG) is shown
opposite.

An echocardiogram is most likely to show which of the following?

A. Dilated cardiomyopathy.

B. Ebstein anomaly.

C. l-Transposition of the great arteries (corrected transposition).

D. Mitral valve prolapse.

E. Normal cardiac anatomy.

QUESTION 48
Below are the tabulated results of five clinical trials for different drugs using death as the primary
outcome. Follow-up time is five years for all trials.

Number (%) surviving on active Number (%) surviving on

Trial for:
treatment placebo

Drug A (n=200) 30 (15%) 20 (10%)

Drug B (n=600) 12 (2%) 3 (0.5%)

Drug C (n=400) 80 (20%) 64 (16%)

Drug D (n=500) 75 (15%) 55 (11%)

Drug E (n=300) 30 (10%) 18 (6%)

n = the total number of patients entered in each arm of the trial

The trial for which drug shows the lowest number needed to treat (NNT)?

A. Drug A.

B. Drug B.

C. Drug C.

D. Drug D.

E. Drug E.

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QUESTION 49
The most effective way of preventing mother-to-child transmission of human immunodeficiency virus
(HIV) is:

A. antiretroviral therapy to the mother during delivery.

B. antiretroviral therapy to the mother during pregnancy.

C. antiretroviral therapy to the newborn baby.

D. bottle-feeding.

E. Caesarean section.

QUESTION 50
Which one of the following is most important in controlling parathyroid hormone (parathormone)
secretion?

A. Calcium sensing receptor.

B. Ionised calcium.

C. Megalin.

D. 1,25 dihydroxycholecalciferol (calcitriol).

E. Total serum calcium.

QUESTION 51
In the process of cellular transcription, messenger RNA (mRNA) is derived from which one of the
following components of the gene?

A. Enhancer sequences.

B. Exon sequences.

C. Intron sequences.

D. Promoter sequences.

E. Termination sequences.

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QUESTION 52
Which of the following most accurately describes the known effects of supplementation of artificial milk
formulae with long chain polyunsaturated fatty acids (LCPUFA) in term infants?

A. A beneficial effect on bone maturation.

B. A beneficial effect on growth.

C. A beneficial effect on neurodevelopmental outcome.

D. A beneficial effect on visual maturation.

E. No additional benefit demonstrated.

QUESTION 53
The cytotoxic effect of chemotherapeutic agents in some tumours is defined by first order kinetics.
The best explanation for this is that these agents:

A. kill a constant fraction of cancer cells.

B. kill a constant number of cancer cells.

C. kill a higher number of cancer cells with prolonged exposure.

D. undergo first pass metabolism in the liver.

E. undergo intracellular metabolism.

QUESTION 54
If two or more first-degree relatives have atopic disorders, the risk of a subsequent infant developing
an atopic disorder is closest to:

A. <10%.

B. 20%.

C. 33%.

D. 75%.

E. 90%.

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QUESTION 55
Activated protein C resistance is most likely to be associated with which one of the following states?

A. Antithrombin III deficiency.

B. Factor V Leiden mutation.

C. Factor VIII deficiency.

D. Lupus anticoagulant.

E. Prothrombin gene mutation.

QUESTION 56
Which of the following is the chief determinant of intrathoracic airway resistance in normal children?

A. Airway length.

B. Alveolar pressure.

C. Lung elastic recoil.

D. Lung volume.

E. Number of conducting airways.

QUESTION 57
A six-year-old patient with coeliac disease undergoes dual sugar intestinal permeability testing. Two
sugars, rhamnose and lactulose, are administered orally and the subsequent urinary excretion is
measured over five hours. Rhamnose is actively absorbed by the small intestinal villus, whereas
lactulose is absorbed via passive paracellular transport.

Which of the following findings in urine indicate poor adherence to a gluten-free diet?

Rhamnose Lactulose

A. Decreased Decreased

B. Decreased Normal

C. Increased Decreased

D. Increased Normal

E. Normal Increased

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QUESTION 58
An ambulance attends a 13-year-old girl who collapses at school and is unconscious for a brief period.
Witnesses to the event said that she had some brief jerking of her limbs when on the ground. By the
time she is brought to the emergency room she is back to normal. On further questioning, there have
been three previous events.

An association with which of the following is most likely to raise concerns that the diagnosis is not
simple syncope?

A. Exercise.

B. Mild trauma.

C. Prolonged standing.

D. Venipuncture.

E. Vomiting.

QUESTION 59
What is the most likely effect at the protein level of a 1 base pair deletion within an exon of a gene?

A. Frameshift resulting in abnormal protein sequence from the site of the deletion.

B. No effect (i.e. benign polymorphism).

C. Premature stop codon at the site of the deletion resulting in a prematurely truncated protein
(nonsense mutation).

D. Single amino acid (missense) change.

E. Splicing abnormality resulting in exon skipping.

QUESTION 60
Diazoxide is used in the management of neonatal hyperinsulinaemic hypoglycaemia. Which of the
following is the main mechanism of action?

A. Altering the beta cell membrane permeability to calcium.

B. Increasing glucokinase activity.

C. Increasing insulin resistance.

D. Stimulating glucagon release.

E. Stimulation of the potassium ATP channel.

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QUESTION 61

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QUESTION 61 (continued)
A seven-year-old girl presents with sudden onset at rest of sharp left-sided chest pain, with no
associated palpitations. There is a family history of sudden death from cardiac causes. A 12-lead
electrocardiogram (ECG) is shown opposite.

Which of the following best describes the ECG?

A. Normal sinus rhythm.

B. Normal sinus rhythm with atrial ectopics.

C. Second degree heart block - Mobitz type I.

D. Second degree heart block - Mobitz type II.

E. Sinus arrhythmia.

QUESTION 62
AUDIOGRAM

TYMPANOMETRY KEY

Ear Type Right Left

Right A Air { X
Left A Bone < >

A child’s audiogram is shown above. Which of the following is the most likely cause of these findings?

A. Cholesteatoma.

B. Goldenhar syndrome.

C. Homozygous Connexin 26 mutation.

D. Otitis media with effusion.

E. Otosclerosis.

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QUESTION 63
You wish to study the relative contributions of the home environment versus genetic influences in the
causation of literacy problems.

Which method used to study genetic influences would be most likely to answer this question?

A. Adoption studies.

B. Family aggregation studies.

C. Molecular genetic studies.

D. Pedigree analysis.

E. Twin studies.

QUESTION 64
The ratio of systemic to pulmonary vascular resistances changes postnatally. What changes would be
expected to systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) one day
after normal delivery of a term infant in comparison to antenatal values?

SVR PVR

A. Decrease Decrease

B. Decrease No change

C. Increase Decrease

D. Increase No change

E. No change Decrease

QUESTION 65
Among children and adolescents with significant behavioural disturbances, a poor prognosis is most
likely with which of the following?

A. Alcoholic or sociopathic father.

B. Greater severity of problem behaviour.

C. Lower age of presentation.

D. Maternal psychosocial problems.

E. Parental divorce.

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QUESTION 66
In pre-renal failure secondary to acute haemorrhage, which of the following kidney changes would be
most likely to occur?

A. Decreased afferent and efferent arteriolar vascular tone.

B. Decreased filtration fraction.

C. Increased potassium and hydrogen secretion.

D. Increased renal blood flow.

E. Increased sodium reabsorption.

QUESTION 67
A 12-year-old girl completed treatment for a Ewing sarcoma four years ago. The chemotherapy agent
most likely to increase her risk of second malignancy is:

A. actinomycin-D.

B. cyclophosphamide.

C. doxorubicin.

D. methotrexate.

E. vincristine.

QUESTION 68
Which of the following measures has been shown to be most effective in reducing the incidence of
early-onset neonatal Group B streptococcal (GBS) sepsis?

A. Antibiotic treatment of babies whose mothers have risk factors (fever, preterm labour,
prolonged membrane rupture).

B. Antibiotic treatment of GBS-colonised mothers in early pregnancy.

C. Chlorhexidine vaginal douches for GBS-colonised mothers during labour.

D. Intrapartum antibiotic treatment of GBS-colonised mothers.

E. Single dose of intramuscular penicillin to all babies at birth.

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QUESTION 69
Occult bacteraemia refers to bacteraemia in a febrile child with no focus of infection. Which of the
following is the most common cause of occult bacteraemia in Australasian children?

A. Group A Streptococcus.

B. Neisseria meningitidis.

C. Salmonella enteritidis.

D. Staphylococcus aureus.

E. Streptococcus pneumoniae.

QUESTION 70
Which of the following interleukins has most influence on haematopoietic lymphoid growth and
differentiation?

A. Interleukin 1.

B. Interleukin 2.

C. Interleukin 3.

D. Interleukin 4.

E. Interleukin 6.

Copyright © 2005 by The Royal Australasian College of Physicians

 32 P104

2004 FRACP Written Examination

Paediatrics & Child Health

Paper 1 – Medical Sciences

Answers

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

Copyright © 2005 by The Royal Australasian College of Physicians