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All questions are in the A-type multiple-choice format, that is, the single best answer of the five options
given.
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.
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.
QUESTION 1
Steroids used in the treatment of childhood acute lymphoblastic leukaemia are least frequently
associated with which one of the following side effects?
B. Behavioural disturbances.
C. Bone demineralisation.
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?
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.
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.
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?
QUESTION 9
Which of the following is the strongest predictor for attempted suicide in adolescence?
B. Depressive symptoms.
C. Feelings of hopelessness.
E. Rejection by peers.
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?
C. Random allocation.
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.
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.
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
B. Glucose-galactose malabsorption.
E. Sucrase-isomaltase deficiency.
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:
QUESTION 18
A disease has an annual incidence of 15 cases per 100,000. The mean survival after diagnosis is five
years.
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:
C. extending the primers once they are affixed to the single strands.
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.
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.
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:
A. asthma.
D. poor effort.
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.
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.
Which one of the following is the most likely aetiology for these findings?
B. Androgen insensitivity.
D. 5α-reductase deficiency.
E. Gonadal dysgenesis.
QUESTION 25
A child admitted to a surgical ward has coagulation tests performed with the following results:
B. haemophilia A.
C. heparin effect.
D. lupus anticoagulant.
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.
A. Adrenaline infusion.
B. Frusemide infusion.
C. Intermittent frusemide.
E. Prostacyclin infusion.
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?
B. 1 in 8.
C. 1 in 4.
D. 1 in 2.
E. 2 in 3.
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.
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.
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.
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.
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.
D. Hypoglycaemia.
E. Sleep.
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.
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?
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:
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.
E. Transcobalamin II deficiency.
QUESTION 42
The word ‘complex’ in complex partial seizures refers to:
QUESTION 43
In a patient presenting with a severe acute exacerbation of asthma, arterial blood gases on breathing
room air show:
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?
E. Pulmonary vasoconstriction.
QUESTION 44
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?
B. Cortisol.
E. Testosterone.
QUESTION 47
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.
A. Dilated cardiomyopathy.
B. Ebstein anomaly.
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.
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.
QUESTION 49
The most effective way of preventing mother-to-child transmission of human immunodeficiency virus
(HIV) is:
D. bottle-feeding.
E. Caesarean section.
QUESTION 50
Which one of the following is most important in controlling parathyroid hormone (parathormone)
secretion?
B. Ionised calcium.
C. Megalin.
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.
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?
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:
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%.
QUESTION 55
Activated protein C resistance is most likely to be associated with which one of the following states?
D. Lupus anticoagulant.
QUESTION 56
Which of the following is the chief determinant of intrathoracic airway resistance in normal children?
A. Airway length.
B. Alveolar pressure.
D. Lung volume.
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
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.
C. Premature stop codon at the site of the deletion resulting in a prematurely truncated protein
(nonsense mutation).
QUESTION 60
Diazoxide is used in the management of neonatal hyperinsulinaemic hypoglycaemia. Which of the
following is the main mechanism of action?
QUESTION 61
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.
E. Sinus arrhythmia.
QUESTION 62
AUDIOGRAM
TYMPANOMETRY KEY
A child’s audiogram is shown above. Which of the following is the most likely cause of these findings?
A. Cholesteatoma.
B. Goldenhar syndrome.
E. Otosclerosis.
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.
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?
E. Parental divorce.
QUESTION 66
In pre-renal failure secondary to acute haemorrhage, which of the following kidney changes would be
most likely to occur?
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).
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.
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