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: exams@racp.edu.au.

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 Street, Sydney,
Australia.

Copyright © 2007 by The Royal Australasian College of Physicians

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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 located in the collecting duct is regulated by which of the following?

A. Adrenocorticotrophic hormone (ACTH).

B. Aldosterone.

C. Amiloride.

D. Cyclic AMP.

E. Renin.

QUESTION 3

Telomeres are best defined as:

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

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

C. specialised structures which "cap" the ends of 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 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 O Rhesus-negative

B. A Rhesus-negative O Rhesus-positive

C. AB Rhesus-negative A Rhesus-positive

D. O Rhesus-negative B Rhesus-positive

E. O Rhesus-negative A Rhesus-positive

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.

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 has had
six afebrile seizures. He is on anticonvulsant therapy. There is no family history of febrile 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 deficit.

D. Symptomatic epilepsy.

E. Young age.

QUESTION 10

Which of the following best describes the mode of action of aminoglycoside antibiotics?

A. Disruption of cytoplasmic membrane function.

B. Inhibition of bacterial DNA gyrase.

C. Inhibition of cell wall synthesis.

D. Inhibition of protein synthesis.

E. 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 likely to be falsely elevated?

A. Carbon dioxide retention.

B. Methaemoglobinaemia.

C. Persistent fetal 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.

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 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 (IV). The drug has linear kinetics
within the range of concentrations studied. The mean results are as follows:

100 mg tablet 50 mg IV
Maximum concentration (C max) (mg/L) 5 12
Time to peak concentration (Tmax) (hours) 2 0.25
Area under the Curve (AUC) (mg/L.h) 45 25
Elimination half life (t1/2) (hours) 4 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.

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 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. Which of the following is its most frequent side-effect?

A. Gastrointestinal disturbance.

B. Hypoglycaemia.

C. Rash.

D. Taste 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) 88 g/L [110-140]

Mean corpuscular volume (MCV) 55 fL [75-90]
Mean corpuscular haemoglobin (MCH) 19 pg [24-30]
White cell count (WCC) 18 x 109/L [5-15]
Platelet count 475 x 109L [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 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 minor.

B. Beta thalassaemia major.

C. Beta 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.

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.

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 reticulum.

B. rapid entry of sodium through fast ion specific channels.

C. release of stored calcium from 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 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 of

associated histones.

QUESTION 24

What is the major determinant of vocabulary size at age three years?

A. Amount of language stimulation.

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?

A. Adolescent anxiety disorder.

B. Conduct disorder in childhood.

C. Infantile 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-year-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 on admission include:

Haemoglobin 136 g/L [100-140]

Platelets 434 x 109/L [150-400]
White Cell Count 15.9 x 109/L [6.0-13.0]
Neutrophils 10.8 x 109/L [2.0-6.0]
Serum creatinine 30 µmol/L [27-62]
C-Reactive Protein < 3mg/L [<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 lymphocytic and neutrophilic infiltrate.

B. granular layer with no inflammatory cell infiltrate.

C. subepidermal layer with eosinophilic infiltration of the dermis.

D. subepidermal layer with full-thickness epidermal necrosis.

E. subepidermal layer with intense perivascular and interstitial 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) vaccine is most likely to reduce the risk of:

A. cutaneous tuberculosis.

B. latent tuberculous infection.

C. pulmonary tuberculosis.

D. tuberculous adenitis.

E. 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 valve stenosis.

E. structurally 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 with schizophrenia. What is the likelihood that their youngest son 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. In addition an umbilical arterial line is running at 1ml/hr with 0.45% (half-normal) saline.
His urine output is 0.5ml/kg/hour. Analysis of an arterial blood sample reveals the following:

Sodium 146 mmol/L [135 - 145]

Potassium 7.0 mmol/L [3.5 - 5.1]
Chloride 115 mmol/L [98 - 110]
Creatinine 0.11 mmol/L [0.01 - 0.03]
pH 7.25 [7.34- 7.43]
pCO2 45 mmHg [31- 42]
pO2 65 mmHg [50-90]
Bicarbonate 18 mmol/L [20-26]
Base deficit -8 [-5 - +5]

The most appropriate management would be:

A. furosemide.

B. glucose and insulin.

C. increased 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.

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.

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.

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 end-diastolic volume.

B. increased heart rate.

C. increased left ventricular afterload.

D. increased left ventricular preload.

E. increased 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.
B

E. Vitamin E.

QUESTION 42

Which of the following does not shift the oxyhaemoglobin dissociation curve to the left?

A. Decrease in 2,3 diphosphoglycerate in the red cell.

B. Decrease in carbon dioxide tension.

C. Decrease in pH.

D. Decrease in temperature.

E. Presence of carboxyhaemoglobin.

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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 the primary hepatic metabolic pathway for
alcohol?

A. Conjugation with glucuronic acid.

B. Oxidation by alcohol dehydrogenase.

C. Oxidation by peroxisomal catalase.

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

E. Reduction using nicotinamide-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. When using this technique, the most appropriate method of 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: negative
Red blood cells: negative
White blood cells: negative
Chymotrypsin: 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. The ventilation settings are as follows:

Mode: synchronised intermittent mandatory ventilation (SIMV)

Fractional inspired oxygen concentration 1.0
Peak inspiratory pressure (PIP) 28 cm H2O
Positive end-expiratory pressure (PEEP) 4 cm H2O
Rate 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 36 mmHg [45-60]
bicarbonate 27mmol/L [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 calcium is primarily stimulated by which of the following hormones?

A. 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 B C D E

A. A.

B. B.

C. C.

D. D.

E. 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.

C. deficiency of myeloperoxidase within the phagocyte granules.

D. failure to produce reactive oxygen 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 (CMV).

B. Epstein-Barr virus (EBV).

C. Human herpes virus-8 (HHV-8).

D. Human 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 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 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 is most consistently found in infants subjected to severe 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 [2.15-2.65]

Phosphate 3.0 mmol/L [1.3-2.3]
Lactate Dehydrogenase (LDH) 9800 U/L [500-920]
Uric Acid 0.4 mmol/L [0.1-0.3]
Urinary pH 7.8
Urinary specific gravity 1018
Urinary nitrates +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 disturbance.

B. Impaired renal function.

C. Invasive cytomegalovirus infections.

D. Leucopenia.

E. Post-transplant lymphoproliferative 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 risk?

A. Body mass index.

B. Height/weight ratio.

C. Skin fold thickness.

D. Waist 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.

E. Red Cell transfusion.

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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 in a tertiary referral hospital after Intensive Care Unit admission.

Treatment Micoffstop n=200 Placebo n=200

Number with ICU admission or
20 40
death in the next five years

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 the same?

A. Absolute risk reduction.

B. 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 girl to the Intensive Care Unit with septic shock. A randomised 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

Copyright © 2007 by The Royal Australasian College of Physicians

 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
white blood cell count is 29.4 x 109/L [5.50 - 11.0] with a neutrophil count of 26.46 x 109/L [1.8 - 7.0].

Which of the following is the most likely causative agent?

A. 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 side chains of glycoproteins.

C. dysfunction of membrane ion channels.

D. dysfunction of the mitochondrial respiratory chain.

E. failure of assembly of peroxisomes.

Copyright © 2007 by The Royal Australasian College of Physicians

 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

Copyright © 2007 by The Royal Australasian College of Physicians