2001 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 Training and Assessment 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 © 2003 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.
 2 P101
Question 1

Which one of the following disorders is due to mutations in one of the fibroblast growth factor receptor (FGFR)
genes?

A. Achondroplasia.

B. Hunter syndrome.

C. Marfan syndrome.

D. Osteogenesis imperfecta.

E. Stickler syndrome.

Question 2

A two-year-old boy with severe haemophilia A has recently started treatment with recombinant factor VIII. He
has had a recent viral infection and presents with a large haematoma in the buttock. Factor levels are taken
before and one hour after an intravenous dose of factor VIII of 25 U/kg. Pre-treatment factor VIII level is <1%
[50-200] and post-treatment factor VIII level is 3%.

Which one of the following is the best explanation for the post-treatment factor VIII level?

A. Consumption of factor VIII in the area of bleeding.

B. Insufficient dose of factor VIII.

C. Presence of high titre factor VIII inhibitor.

D. Presence of lupus anticoagulant.

E. Presence of transient low titre factor VIII inhibitor.

Question 3

In which one of the following circumstances is hepatitis C transmission most likely to occur?

A. Blood transfusion.

B. Breast feeding where the mother is seropositive and polymerase chain reaction (PCR)-positive.

C. Intravenous drug use.

D. Unprotected sexual activity with multiple partners.

E. Vaginal delivery from a seropositive, PCR-positive mother.

Question 4

The cough associated with the use of angiotensin-converting enzyme (ACE) inhibitors is mediated through
which one of the following?

A. Aldosterone.

B. Angiotensin I.

C. Angiotensin II.

D. Bradykinin.

E. Gamma aminobutyric acid.

Copyright © 2003 by The Royal Australasian College of Physicians

 3 P101
Question 5

Which one of the following is the antibiotic of choice to treat pneumonia caused by Streptococcus
pneumoniae of intermediate susceptibility (minimum inhibitory concentration (MIC) 1 mg/L) to penicillin?

A. Amoxycillin-clavulanic acid.

B. Benzylpenicillin.

C. Cefotaxime.

D. Roxithromycin.

E. Vancomycin.

Question 6

A mother brings her daughter to a paediatrician because of concerns about her daughter’s eyes (shown
above). The only significant past history is of a difficult delivery due to large gestational size.

Which one of the following is the most likely diagnosis?

A. Left Horner syndrome.

B. Left oculomotor nerve palsy.

C. Left proptosis.

D. Right congenital ptosis.

E. Right Horner syndrome.

Question 7

Four subtypes of long QT (LQT) syndrome have been fully characterised: LQT1, LQT2, LQT3 and LQT5.

What is the abnormality in the cardiac action potential which results in QT prolongation in LQT1, LQT2 and
LQT5?

A. Prolonged calcium efflux.

B. Prolonged calcium influx.

C. Prolonged potassium efflux.

D. Prolonged sodium efflux.

E. Prolonged sodium influx.

Copyright © 2003 by The Royal Australasian College of Physicians

 4 P101
Question 8

Significant intercurrent illness is commonly associated with disturbances of thyroid function (sick euthyroid
syndrome).

Which one of the following is least likely to be present in a euthyroid patient with a severe illness?

A. Low free thyroxine (free T4).

B. Low free triiodothyronine (free T3).

C. Low thyroid-stimulating hormone (TSH).

D. Raised free T3.

E. Raised TSH.

Question 9

A new test may be useful as a screening test for Disease A. It is trialed with 100 patients attending a clinic,
10% of whom actually have Disease A, with the following results:

Disease A
Yes No

Test + 9 23 32
Results
– 1 67 68

10 90 100

Based on these results, it is next trialed in a community population in which the prevalence of Disease A is
1%.

Which one of the following is most likely to fall?

A. The sensitivity.

B. The specificity.

C. The positive predictive value.

D. The negative predictive value.

E. The number needed to treat (NNT).

Question 10

Which one of the following major immunoglobulin classes in the human fixes the alternate complement
pathway?

A. IgA.

B. IgD.

C. IgE.

D. IgG.

E. IgM.

Copyright © 2003 by The Royal Australasian College of Physicians

 5 P101
Question 11

Which one of the following is the most common risk factor for neonatal group B streptococcal (GBS) infection?

A. Maternal intrapartum fever.

B. Maternal urine culture grows GBS.

C. Offensive liquor.

D. Prolonged rupture of membranes.

E. Spontaneous pre-term onset of labour.

Question 12

A four-year-old girl discloses to her mother that a male contact has 'put his willy (penis) into me'. A clinical
examination is carried out.

Which one of the following is most indicative of child sexual abuse?

A. A blue-black colouration of the skin surrounding the anus.

B. A 2 mm prominence of the hymenal margin at two o'clock (hymenal 'bump').

C. A 'v' shaped indentation of the hymenal margin at five o'clock to the vaginal wall.

D. An absence of anal rugae at six and 12 o'clock.

E. Lateral synechiae at the level of the urethra.

Question 13

The pedigree below is consistent with several different modes of inheritance. All affected individuals
(represented by a filled-in symbol) have developmental delay and dysmorphism. Miscarriages are
represented by a small filled-in circle (this symbol does not indicate the sex or whether the foetus was
affected).

Which one of the following genetic mechanisms is the most likely explanation for this pedigree?

A. Autosomal recessive.

B. Chromosomal translocation.

C. Imprinting effect.

D. Mitochondrial.

E. X-linked.

Copyright © 2003 by The Royal Australasian College of Physicians

 6 P101
Question 14

A nine-year-old boy is diagnosed with acute lymphoblastic leukaemia. Full blood count shows:

haemoglobin 109 g/L [115-155]

9
white cell count 40 x 10 /L [4-11]
9
platelet count 110 x 10 /L [150-450]

Immunophenotype is positive for CD2, 5, 7, 10 and 34. Cytogenetic analysis was performed on his bone
marrow specimen.

Which one of the following prognostic factors confers the highest risk?

A. Age.

B. Hyperdiploidy.

C. t(4;11).

D. t(9;22).

E. White cell count.

Question 15

After a careful evaluation of the academic and social difficulties faced by a seven-year-old boy you
recommend a trial of dexamphetamine in conjunction with parental guidance and classroom support. His
mother is concerned about possible side-effects of the drug.

Which one of the following is the least common adverse effect of dexamphetamine?

A. Abdominal pain.

B. Headaches.

C. Motor incoordination.

D. Tearfulness.

E. Tics.

Question 16

Which one of the following target autoantigens is least likely to be associated with type 1 (insulin-dependent)
diabetes mellitus?

A. Double-stranded DNA.

B. Endomysial antigen.

C. Glutamic acid decarboxylase.

D. Thyroid peroxidase.

E. 21-hydroxylase.

Copyright © 2003 by The Royal Australasian College of Physicians

 7 P101
Question 17

A person who develops chickenpox three weeks after exposure to a case is infectious for which one of the
following five periods (A to E)?
All spots
crusted
All crusts
Exposure to Cropping separated
chickenpox
Rash

7 days 7 days 7 days

A.

B.

C.

D.

E.

Question 18

Following tetralogy of Fallot repair a child is noted to have a widely split second heart sound.

The most likely aetiology for this is:

A. anomalous pulmonary venous return.

B. aortic stenosis.

C. left superior vena cava draining to the coronary sinus.

D. residual patent foramen ovale.

E. right bundle branch block.

Question 19

An eight and a half-year-old girl is referred for assessment of obesity. Her weight is 45 kg, her height is 123
2
cm and her surface area is 1.1 m .

Her body mass index (BMI) is closest to:

A. 30.

B. 32.

C. 34.

D. 36.

E. 38.

Copyright © 2003 by The Royal Australasian College of Physicians

 8 P101
Question 20

Which one of the following mechanisms is responsible for most episodes of gastro-oesophageal reflux (GOR)
in children?

A. Defective basal lower oesophageal sphincter pressure.

B. Raised intra-abdominal pressure (strain-induced GOR).

C. Retrograde peristalsis.

D. Swallow-induced lower oesophageal sphincter relaxation.

E. Transient lower oesophageal sphincter relaxation.

Question 21

Which one of the following structures is embryologically derived from the ureteric bud?

A. Collecting duct.

B. Distal convoluted tubule.

C. Glomerulus.

D. Loop of Henle.

E. Proximal tubule.

Question 22

A four-year-old boy presents with a history of chronic mucopurulent nasal discharge, chronic discharging ears
and recurrent chest infections. He has dextrocardia.

Which one of the following abnormalities is most likely to be shown in the patient’s cilia?

A. Abnormal fibrous sheath.

B. Absent dynein arms.

C. Absent spokes.

D. Central sheath lacking ATP bond.

E. 9 + 1 structure of microtubules.

Question 23

A frameshift mutation is best described as a:

A. missing base or set of bases which results in a premature stop codon.

B. mutation which alters the codons downstream of its location.

C. mutation which alters the normal splicing of an intron.

D. sequence alteration which occurs at or near regulatory sequences in the 5' untranslated region of the
gene.

E. single base change which alters that codon to one which now reads stop.

Copyright © 2003 by The Royal Australasian College of Physicians

 9 P101
Question 24

A child is born with the defect shown above.

Which one of the following has been shown to reduce the incidence of this disorder?

A. Folic acid.

B. Pyridoxine.

C. Thiamine.

D. Vitamin B12.

E. Vitamin E.

Question 25

A five-year-old girl on weekly oral methotrexate for juvenile chronic arthritis inadvertently receives a course of
oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. She becomes ill with mucositis, fever
and bruising and is found to have moderately severe pancytopenia.

Folinic acid (in the form of calcium folinate) is administered intravenously for presumed methotrexate toxicity.

The principal mode of action of folinic acid in this context is:

A. activation of the enzyme dihydrofolate reductase.

B. conversion of methotrexate to an inactive metabolite.

C. enhanced renal excretion of methotrexate.

D. provision of reduced folates for nucleic acid synthesis.

E. reduced intracellular accumulation of methotrexate.

Copyright © 2003 by The Royal Australasian College of Physicians

 10 P101
Question 26

Which one of the following is not an essential feature for a diagnosis of autism?

A. Communication difficulties.

B. Impairment of social interaction.

C. Intellectual deficit.

D. Onset prior to age three years.

E. Repetitive and stereotyped behaviours.

Question 27

Which one of the following is the most important in clearing an acute infection with an intracellular organism?
+
A. CD4 type 1 helper T lymphocytes (Th1 cells).
+
B. CD4 type 2 helper T lymphocytes (Th2 cells).
+
C. CD8 cytotoxic T lymphocytes (CTL).

D. IgG antibody.

E. IgM antibody.

Question 28

In the salt-loaded human, the main mechanism whereby salt is excreted in the urine involves:

A. decreased proximal tubule reabsorption of salt.

B. increased glomerular filtration rate.

C. increased aldosterone activity.

D. increased atrial natriuretic factor.

E. increased prostaglandin F activity.

Question 29

Which one of the following is least toxic to bone marrow?

A. Carboplatin.

B. Cyclophosphamide.

C. Doxorubicin.

D. Etoposide (VP-16).

E. Vincristine.

Copyright © 2003 by The Royal Australasian College of Physicians

 11 P101
Question 30

A child is known to have pulmonary atresia. The oxygen saturations obtained at cardiac catheterisation are
displayed on the diagram shown below.

90%

96%

66%

What is the ratio of pulmonary to systemic blood flow (Qp:Qs ratio) based upon the data supplied?

A. 0.2:1

B. 1:1

C. 4:1

D. 5:1

E. Incalculable based upon the data supplied.

Question 31

There is still a risk of infection with human immunodeficiency virus (HIV) from a screened blood transfusion
due to the infectious window period of HIV.

This risk is closest to:

A. 1 in 25,000.

B. 1 in 100,000.

C. 1 in 250,000.

D. 1 in 500,000.

E. 1 in 1,000,000.

Copyright © 2003 by The Royal Australasian College of Physicians

 12 P101
Question 32

The following flow volume loop is from a 13-year-old boy with a five-year history of cough and stridor.

Normal Control

Expiration

Flow
Volume
Inspiration

Patient

The most likely diagnosis is:

A. bronchial stenosis.

B. bronchiolitis obliterans.

C. dynamic tracheomalacia.

D. laryngomalacia.

E. subglottic stenosis.

Question 33

The laboratory telephones you with the following test results of blood taken from a 16-year-old male student
who had requested hepatitis B screening.

HBsAg (surface antigen) negative

Anti-HBs (surface antibody) positive
Anti-HBc (core antibody) positive

The most likely explanation for these results is:

A. acute hepatitis B infection.

B. chronic hepatitis B infection.

C. hepatitis D superinfection.

D. past hepatitis B vaccination.

E. previous hepatitis B infection.

Copyright © 2003 by The Royal Australasian College of Physicians

 13 P101
Question 34

After commencement of once daily maintenance dosing of a drug with an elimination half-life of 48 hours, the
concentration of the drug in plasma will continue to accumulate:

A. for 2 days.

B. for 4 days.

C. for 10 days.

D. for 16 days.

E. indefinitely.

Question 35

During her first pregnancy, a woman develops chickenpox at 16 weeks gestation.

Which one of the following represents the closest approximation to the risk that the baby will develop
congenital varicella syndrome?

A. 0.01%.

B. 2%.

C. 15%.

D. 50%.

E. 80%.

Question 36

Regulation of water reabsorption in the collecting duct of the nephron is least dependent upon which one of
the following molecules?

A. Adenyl cyclase.

B. Antidiuretic hormone receptor.

C. Aquaporin 2.

D. G proteins.

E. Mineralocorticoid receptor.

Copyright © 2003 by The Royal Australasian College of Physicians

 14 P101
Question 37

A child with language delay was referred for full developmental assessment. The child performed close to the
50th percentile for cognitive, fine motor and visuo-spatial skills. The child drew the picture shown below
during the assessment.

The expected age of the child would be closest to:

A. 2½ years.

B. 3½ years.

C. 4½ years.

D. 5½ years.

E. 6½ years.

Question 38

You are asked to consult on the aerial transfer of a sick infant with bronchiolitis. By what amount will you
expect the alveolar oxygen to drop when the plane is pressurised at an altitude of 5000 feet?

(The atmospheric pressure at 5000 feet is 647 mmHg. The carbon dioxide level is 45 mmHg, the respiratory
quotient is 0.8 and the water vapour pressure is 47 mmHg. These values remain constant. The flight will
begin at sea level where the atmospheric pressure is 760 mmHg.)

A. 5-10 mmHg.

B. 11-15 mmHg.

C. 16-20 mmHg.

D. 21-25 mmHg.

E. 26-30 mmHg.

Copyright © 2003 by The Royal Australasian College of Physicians

 15 P101
Question 39

Which one of the following alterations in DNA sequence within a gene is most likely to result in an absent or
non-functional protein?

A. A base pair change that does not alter the amino acid encoded by that codon.

B. A single base pair substitution.

C. A three base pair deletion within an exon.

D. A three base pair deletion within an intron.

E. A two base pair deletion within an exon.

Question 40

Which one of the following is the most common cause of familial thrombophilia (deep vein thrombosis and
pulmonary emboli)?

A. Activated protein C resistance.

B. Antithrombin III deficiency.

C. Protein C deficiency.

D. Protein S deficiency.

E. Prothrombin gene mutation.

Question 41

The energy requirements of the newborn are proportionally higher per gram of body weight when compared
to older children and adults.

The most metabolically active system in the newborn is the:

A. cardiovascular system.

B. central nervous system.

C. genitourinary system.

D. pulmonary system.

E. skeletal system.

Question 42

Which one of the following is an endothelium-derived vasodilator?

A. Angiotensin II.

B. Endothelin 1.

C. Prostacyclin.

D. Prostaglandin H2.

E. Thromboxane A2.

Copyright © 2003 by The Royal Australasian College of Physicians

 16 P101
Question 43

A patient who shows an unexpectedly small analgesic response to codeine phosphate is most likely to have
which one of the following phenotypes of polymorphic drug metabolising enzymes?

A. Fast acetylator (increased activity of N-acetyl transferase).

B. Impaired hepatic glucuronidation.

C. Poor metaboliser (reduced activity of cytochrome P450 2D6).

D. Rapid metaboliser (increased activity of cytochrome P450 2D6).

E. Slow acetylator (reduced activity of N-acetyl transferase).

Question 44

Wilson and Jungner devised a classic set of criteria with which to evaluate screening programmes. One
criterion is ‘Treatment at the early, latent or pre-symptomatic phase should favourably influence prognosis’.

Screening for which one of the following best meets this criterion?

A. Amblyopia at school entry.

B. Conductive deafness at school entry.

C. Impaired colour vision at school entry.

D. Scoliosis in adolescent girls.

E. Short stature at school entry.

Question 45

A three-year-old boy is evaluated because of an unusual gait, delayed motor milestones and an elevated
serum creatine kinase (CK) level. A muscle biopsy is performed and is shown below (A), with a normal
muscle biopsy for comparison (B). The sections are stained with haematoxylin and eosin (H & E).

A B
Which one of the following is the most likely diagnosis?

A. Central core myopathy.

B. Duchenne muscular dystrophy.

C. Myotonia congenita.

D. Pompe disease.

E. Spinal muscular atrophy.

Copyright © 2003 by The Royal Australasian College of Physicians

 17 P101
Question 46

IgE-mediated hypersensitivity reactions may resolve over years, due to loss of IgE antibodies.

For which one of the following is this least likely to occur?

A. Bee venom.

B. Egg.

C. Peanut.

D. Penicillin.

E. Soya bean.

Question 47

The use of artificial surfactant has been shown to reduce the incidence of which one of the following
complications of prematurity?

A. Chronic lung disease.

B. Periventricular haemorrhage.

C. Pneumothorax.

D. Retinopathy of prematurity.

E. Symptomatic patent ductus arteriosus.

Question 48

Which one of the following strategies has been shown to most effectively reduce the incidence of infections
with multi-resistant Mycobacterium tuberculosis in a population?

A. Directly observed treatment with short-course therapy.

B. Empirical use of four or more anti-tuberculous drugs.

C. Extensive contact tracing.

D. Increasing the duration of therapy.

E. Use of polymerase chain reaction (PCR) to identify multi-resistant strains.

Question 49

An increase in leptin production is most likely to lead to a decrease in which one of the following?

A. Catecholamine secretion.

B. Energy expenditure.

C. Food intake.

D. Glucose production.

E. Thermogenesis.

Copyright © 2003 by The Royal Australasian College of Physicians

 18 P101
Question 50

A drug X has a half-life of four hours and a volume of distribution of 0.8 L/kg.

First order, one compartment pharmacokinetics can be assumed.

The drug is administered by continuous intravenous infusion in a dose of Y mg/hr, starting at time zero.

After 24 hours the continuous infusion rate is halved to Y/2 mg/hr. At time 44 hours the plasma concentration
of X is approaching the new steady state concentration, B (within 3%).

If, at time 24 hours, the continuous infusion rate had been reduced to Y/4 mg/hr, instead of Y/2 mg/hr, the
time at which the plasma concentration of X falls to within 3% of the new steady state concentration, C, would
be closest to:

A. 40 hours.

B. 44 hours.

C. 48 hours.

D. 64 hours.

E. 88 hours.

Copyright © 2003 by The Royal Australasian College of Physicians

 19 P101
Question 51

The chromosomal abnormality shown above is best described as:

A. aneuploidy.

B. euploidy.

C. translocation.

D. triploidy.

E. trisomy.

Question 52

Which one of the following modes of transmission of hepatitis B virus (HBV) resulting in hepatitis B infection,
in the absence of active or passive immunisation, is most likely to result in chronic carrier status in the
recipient?

A. A bite to a two-year-old in day care by a chronic carrier.

B. Blood transfusion from a chronic carrier to a 10-year-old child.

C. ‘Horizontal’ transmission of HBV from a chronic carrier to their five-year-old sibling.

D. Needle-stick injury to a one-year-old from a contaminated needle.

E. ‘Vertical’ transmission of HBV from a pregnant carrier to her newborn baby.

Question 53

A type 2 helper T lymphocyte (Th2 cell) differs most from a type 1 helper T lymphocyte (Th1 cell) in which one
of the following?

A. Production of interleukin 3 (IL-3).

B. Production of interleukin 5 (IL-5).

C. Responsiveness to antigen presented by macrophages.

D. Surface expression of CD4.

E. Surface expression of major histocompatibility complex (MHC) class II molecules.

Copyright © 2003 by The Royal Australasian College of Physicians

 20 P101
Question 54

An eight-year-old boy wakes after an orthopaedic procedure on his right leg. He is noted to have a right foot
drop. Examination shows weakness of the dorsiflexors of the ankle. He has normal plantar flexion at the
ankle and normal knee flexion strength. His right ankle jerk is reduced. No sensory abnormality is detected.

The nerve involved is the:

A. common peroneal.

B. saphenous.

C. sciatic.

D. sural.

E. tibial.

Question 55

Which one of the following is the predominant cause of hypoxaemia without hypercapnoea in children who
snore and have obstructive sleep apnoea?

A. Alveolar hypoventilation.

B. Diffusion disorder.

C. Intra-cardiac shunt.

D. Intra-pulmonary shunt.

E. Ventilation-perfusion (V/Q) imbalance.

Question 56

Retinal haemorrhages are known to occur in all of the following except:

A. late-onset haemorrhagic disease of the newborn.

B. meningococcal meningitis.

C. moderate head injury in a child with von Willebrand disease.

D. pertussis.

E. sudden infant death syndrome.

Copyright © 2003 by The Royal Australasian College of Physicians

 21 P101
Question 57

The following data were obtained at cardiac catheterisation from a patient with a ventricular septal defect.

Site Oxygen Saturation

Superior vena cava 70%

Inferior vena cava 70%
Right atrium 70%
Left pulmonary artery 85%
Left atrium 95%
Aorta 95%

Oxygen consumption 150 mL/minute

Oxygen content 100 mL/L

The cardiac output is:

A. 4 L/minute.

B. 6 L/minute.

C. 8 L/minute.

D. 10 L/minute.

E. incalculable.

Question 58

A 14-year-old girl with acute lymphoblastic leukaemia is treated with a variety of chemotherapeutic agents.
During therapy she develops bilateral foot drop. Examination reveals weakness of the dorsiflexors at the
ankles and absent deep tendon reflexes.

Which one of the following chemotherapeutic agents is the most likely to have caused her neuropathy?

A. Cisplatin.

B. Etoposide (VP-16).

C. Methotrexate.

D. Procarbazine.

E. Vincristine.

Question 59

A child had neonatal jaundice with an unconjugated bilirubin level peaking at 450 µmol/L. She recovered
completely.

Which one of the following is most likely to lead to a diagnosis of jaundice-induced hearing loss when the
child is three months old?

A. Auditory brainstem responses (ABR).

B. Distraction test.

C. Oto-acoustic emissions (OAE).

D. Tympanometry.

E. Visual reinforcement audiometry.

Copyright © 2003 by The Royal Australasian College of Physicians

 22 P101
Question 60

Which one of the following psychiatric disorders has the highest heritability (rate of inheritance)?

A. Autism.

B. Bipolar disorder.

C. Major depressive disorder.

D. Obsessive-compulsive disorder.

E. Schizophrenia.

Question 61

Which one of the following is most commonly found in obesity?

A. Mutation of the β3 adrenergic receptor.

B. Mutation of the insulin receptor.

C. Raised blood glucose.

D. Raised serum C-peptide.

E. Reduced serum leptin.

Question 62

In a baby requiring resuscitation at birth, which one of the following most reliably indicates that a significant
intrapartum hypoxic-ischaemic insult has occurred?

A. A five-minute Apgar score of less than 4.

B. A one-minute Apgar score of 1.

C. Convulsions during the first 24 hours after birth.

D. Cranial ultrasound findings suggestive of cerebral oedema.

E. Umbilical artery pH of less than 7 at birth.

Question 63

The major strength of the study design used in randomised controlled trials is that it:

A. allows assessment of multiple end points.

B. allows assessment of multiple exposures.

C. draws representative samples.

D. is efficient in resource use.

E. minimises bias and confounding.

Copyright © 2003 by The Royal Australasian College of Physicians

 23 P101
Question 64

The 14-year-old boy, shown above, is attempting to close his eyes.

Which of the following cranial nerves is affected?

A. Abducens.

B. Facial.

C. Oculomotor.

D. Trigeminal.

E. Trochlear.

Question 65

The half-life of factor IX is closest to which one of the following?

A. 8 hours.

B. 12 hours.

C. 24 hours.

D. 48 hours.

E. 72 hours.

Copyright © 2003 by The Royal Australasian College of Physicians

 24 P101
Question 66

During a phase 1 clinical trial, a drug was administered as single doses to the same patient, on two different
occasions. On the first occasion it was given by rapid intravenous infusion, and on the second occasion the
same dose was given by the oral route. The two plasma concentration versus time curves are shown above.
Both graphs have the same scale. Area A (intravenous) is five times greater than area B (oral).

Which one of the following statements is not consistent with these findings?

A. The drug has a high hepatic extraction ratio.

B. The drug is a well-absorbed, controlled-release preparation.

C. The oral bioavailability of the drug is poor.

D. There is a significant first pass effect.

E. There is metabolic degradation of the drug by the gut mucosa.

Question 67

Group A streptococci cause disease in a number of ways.

Which one of the following mechanisms is least likely?

A. Autoimmune reaction.

B. Direct invasion of adjacent tissues.

C. Endotoxaemia.

D. Immune complex-mediated.

E. Superantigen-mediated.

Question 68

What is the most important risk factor for chronic lung disease?

A. Barotrauma.

B. Fluid overload.

C. Infection.

D. Oxygen toxicity.

E. Prematurity.

Copyright © 2003 by The Royal Australasian College of Physicians

 25 P101
Question 69

The most accurate measure of glomerular filtration rate is provided by:

51
A. Cr EDTA clearance.

B. creatinine clearance.

C. Schwartz formula.

D. urea clearance.
99
E. Tc MAG-3 clearance.

Question 70

Which one of the following best defines complementary DNA (cDNA)?

A. An intermediary for DNA viruses.

B. A non-functioning pseudogene.

C. A reverse copy of a gene without introns.

D. A single-stranded DNA molecule.

E. The template for a messenger RNA (mRNA) molecule.

Copyright © 2003 by The Royal Australasian College of Physicians

 26 P101
2001 FRACP Written Examination

Paediatrics & Child Health

Paper 1 – Medical Sciences

Answers

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

Copyright © 2003 by The Royal Australasian College of Physicians