DIRECTIONS TO CANDIDATES

Paper 1 – Medical Sciences

h Time allowed: 2 HOURS

h Before you commence the Examination check that you have

been provided with two pencils, an eraser, a ruler and an answer
sheet entitled ‘Paper 1 – Medical Sciences’. If these items are
not on your desk please notify an invigilator. Use ONLY the
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h Your name and candidate number must appear BOTH on the

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h On completion of each examination paper, the question booklet

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2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 1
 h The following questions are A-type (single-best answer).

h To answer these questions fill in ONE box on the answer sheet

provided, corresponding to the alternative which you consider to
be the best answer.

h Do NOT mark any other box.

h Each correct answer scores one mark and each incorrect

answer zero.

h In the questions, values appearing within [ ] refer to normal

ranges.

h When visual material has been turned on its side, an arrow on

the page indicates the orientation of the visual material.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 2
QUESTION 1

Cerebral palsy is defined as a disorder of posture and movement due to an insult to the developing
brain. What is the most common period for the responsible brain insult to occur?

A. Antenatal.

B. Intrapartum.

C. Neonatal.

D. 1 to 12 months.

E. After 12 months.

QUESTION 2

A three-year-old boy is being resuscitated in the community following an immersion injury. What is the
currently recommended ratio of external cardiac compressions to exhaled air resuscitations for a two
rescuer resuscitation in this patient?

A. 3:1

B. 5:1

C. 15:2

D. 30:2

E. 30:1

QUESTION 3

In an otherwise well toddler with significant nutritional iron deficiency anaemia, what is the expected
time interval between commencing iron therapy and a reticulocytosis becoming evident on a blood
film?

A. 3 days.

B. 7 days.

C. 14 days.

D. 30 days.

E. 60 days.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 3
QUESTION 4

A six-month-old child with cardiac failure secondary to severe dilated cardiomyopathy is initially treated
with Frusemide and Spironolactone. The addition of which of the following drugs to the child’s medical
therapy is most likely to result in hyperkalaemia if no changes are made to the existing therapy?

A. Amiodarone.

B. Captopril.

C. Digoxin.

D. Metoprolol.

E. Warfarin.

QUESTION 5

Which of the following vaccines is least likely to induce long term immunologic memory?

A. Bacille Calmette-Guérin (BCG).

B. Diphtheria-tetanus-pertussis.

C. Haemophilus influenzae type B conjugate.

D. Hepatitis B.

E. Pneumococcal polysaccharide.

QUESTION 6

The results of a study undertaken to determine the utility of urinary leukocyte dipstick testing in the
diagnosis of urinary tract infections (UTI) in febrile children is shown below.

Number with UTI Number without UTI

Leukocyte test positive 70 10
Leukocyte test negative 30 90

In this study, the negative predictive value of the leukocyte dipstick test is:

A. 35%

B. 70%

C. 75%

D. 90%

E. 95%

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 4
QUESTION 7

An 11-year-old boy is seen in clinic for review of congenital cardiac disease, for which he underwent
surgery as a neonate. You notice asymmetry of his face, as demonstrated in the photograph below.

These findings are consistent with:

A. Duane syndrome.

B. Horner syndrome.

C. Mobius syndrome.

D. Waardenburg syndrome.

E. Williams syndrome.

QUESTION 8

Conventional antipsychotic medications (such as haloperidol, chlorpromazine, pericyazine) are used

for the treatment of psychosis, anxiety and aggression in children and adolescents. One of the side
effects of these medications is an increase in prolactin levels resulting in galactorrhea and amenorrhea
in females and gynaecomastia in males.

Which of the following best describes the mechanism for this increase in prolactin?

A. Dopamine receptor agonist.

B. Dopamine receptor antagonist.

C. Increased gonadotropin-releasing hormone levels.

D. Serotonin receptor agonist.

E. Serotonin receptor antagonist.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 5
QUESTION 9

Cystic fibrosis is an autosomal recessive disorder caused by mutations in a single gene on the long
arm of chromosome 7. These mutations lead to abnormal functioning of the cystic fibrosis
transmembrane conductance regulator (CFTR) protein, a chloride channel in the cell membrane. The
most common mutation in the Australasian population is ∆F508.

What is the principal effect of this mutation on the function of CFTR?

A. Abnormal adenosine triphosphate (ATP) gating of the chloride channel.

B. Abnormal protein folding and thus poor transportation to the cell membrane.

C. Abnormal splicing resulting in reduced amounts of functional protein.

D. Decreased conductance of the chloride channel.

E. Premature transcription termination signals resulting in a truncated or absent protein.

QUESTION 10

A 16-year-old girl is brought to the Emergency Department after attending a dance party. On
presentation, she is extremely confused and agitated, she looks flushed and sweaty, and has dilated
pupils. Her heart rate is 120 beats/minute and her blood pressure is 140/90 mmHg. She is
complaining of some central chest pain.

Her presentation is most likely due to the ingestion of which of the following drugs?

A. Cannabis (Marijuana).

B. Diamorphine (Heroin).

C. Gamma Hydroxybutyrate (Grievous Bodily Harm, GHB).

D. Ketamine (Special K).

E. 3,4–Methylenedioxymethamphetamine (Ecstasy).

QUESTION 11

Which of the following conditions is most likely to respond to selective serotonin reuptake inhibitors
(SSRIs)?

A. Aggression.

B. Anxiety.

C. Autism.

D. Depression.

E. Tics.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 6
QUESTION 12

A 13-year-old boy presents with right upper quadrant pain and vomiting. He lives on a sheep station.
On examination he is afebrile and has hepatomegaly.

An ultrasound scan confirms the presence of a 12 x 12 cm cyst, with several internal membranes, in
the right lobe of the liver. His chest X-ray was normal.

Which of the following medical treatments is indicated?

A. Albendazole.

B. Doxycycline.

C. Metronidazole.

D. Pentamidine.

E. Praziquantel.

QUESTION 13

Thyroid dysfunction due to which of the following is most likely to be missed on newborn screening?

A. Dyshormonogenesis.

B. Ectopic thyroid gland.

C. Panhypopituitarism.

D. Thyroid agenesis.

E. Transient hyperthyrotropinemia.

QUESTION 14

The most significant change in auscultatory findings during a cyanotic spell in an infant with tetralogy
of Fallot is that the:

A. ejection systolic murmur becomes louder.

B. ejection systolic murmur becomes softer.

C. pansystolic murmur becomes louder.

D. pansystolic murmur becomes softer.

E. second heart sound becomes more widely split.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 7
QUESTION 15

This family presents due to an apparent familial predisposition to a disorder.

I:1 I:2

II:1 II:2 II:3 II:4 II:5

III:1 III:2 III:3 III:4 III:5

IV:1 IV:2

What is the most likely explanation for the apparent normal health of III:3?

A. Anticipation.

B. Imprinting.

C. Non-paternity.

D. Non-penetrance.

E. X-linked inheritance.

QUESTION 16

At 24-months of age, what percentage of children will spontaneously feed a doll with a pretend bottle?

A. 10%

B. 25%

C. 50%

D. 75%

E. 90%

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 8
QUESTION 17

An 11-year-old child undergoes muscle biopsy under general anaesthetic for a suspected myopathy.
During the procedure she develops a high temperature and generalised stiffness. Biochemical testing
shows acidosis, hypercapnia and a markedly elevated serum creatine kinase (CK).

The most likely diagnosis is:

A. halothane allergy.

B. malignant hyperthermia.

C. mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes (MELAS).

D. neuroleptic malignant syndrome.

E. sepsis.

QUESTION 18

The initial luminal digestion of dietary starch by salivary and pancreatic amylase leads to the formation
of which disaccharide?

A. Fructose.

B. Galactose.

C. Glucose.

D. Maltose.

E. Sucrose.

QUESTION 19

A ten-year-old girl is brought into the Emergency Department after being bitten by an unidentified
snake. The snake venom detection kit is positive for brown snake venom from a bite site swab.
Which of the following is the most common clinical effect in this envenomation?

A. Cardiotoxicity.

B. Coagulopathy.

C. Nephrotoxicity.

D. Neurotoxicity.

E. Rhabdomyolysis.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 9
QUESTION 20

A three-year-old girl presents following a hypoglycaemic seizure and has some investigations. Urinary
metabolic screen confirms the diagnosis of Medium-Chain Acyl-CoA dehydrogenase
deficiency (MCAD). The defect in this condition is most likely to cause hypoglycaemia by which of the
following mechanisms?

A. Hyperinsulinism.

B. Impaired gluconeogenesis.

C. Impaired glycogenolysis.

D. Increased glycogen synthesis.

E. Increased ketone production.

QUESTION 21

Which one of the following is the major determinant of risk of perinatal transmission of hepatitis C
virus?

A. Breastfeeding.

B. Concomitant hepatitis B infection.

C. Concomitant human immunodeficiency virus (HIV) infection.

D. Maternal viral load.

E. Mode of delivery.

QUESTION 22

Which of the following is the main site of potassium reabsorption in the nephron?

A. Proximal convoluted tubule.

B. Descending limb of the Loop of Henle.

C. Ascending limb of the Loop of Henle.

D. Distal convoluted tubule.

E. Collecting duct.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 10
QUESTION 23

The mechanism of action of inhaled nitric oxide is:

A. degradation of phosphodiesterase PDE5.

B. improved binding of oxygen to haemoglobin (Hb).

C. stimulation of β2 receptors.

D. stimulation of nitric oxide synthase.

E. upregulation of cyclic guanosine monophosphate (cGMP).

QUESTION 24

Centre for Disease Control (CDC) body mass index (BMI) charts have been recommended as a
screening tool to identify individuals who are overweight.

Which of the following BMI’s define a child likely to be obese?

2
A. >25 kg/m .

2
B. >30 kg/m .
th
C. >85 percentile for age.
th th
D. >85 <95 percentile for age.
th
E. ≥95 percentile for age.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 11
QUESTION 25

A term infant with a history of neonatal sepsis was noted to have developed an area of subcutaneous
fat necrosis over the left spiral groove of the humerus. She has a left-sided wrist drop as shown in the
photograph below. Her deep tendon reflexes are normal.

What nerve is most likely affected?

A. Axillary.

B. Median.

C. Musculocutaneous.

D. Radial.

E. Ulnar.

QUESTION 26

What is the key developmental task of early infancy?

A. Autonomy.

B. Motor control.

C. Secure attachment.

D. Self-regulation.

E. Separation.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 12
QUESTION 27

Which of the following coagulation factors is most likely to be relatively decreased in the healthy
newborn compared to older infants?

A. factor V.

B. factor VII.

C. factor VIII.

D. Fibrinogen.

E. von Willebrand factor.

QUESTION 28

A three-year-old boy is evaluated because of delayed motor milestones. On examination he has

muscle weakness with calf hypertrophy. He has a markedly elevated creatine kinase level of
15,400 I/U [<240 I/U]. A diagnosis of Duchenne muscular dystrophy (DMD) is suspected and blood is
taken for dystrophin gene testing.

Which of the following is most likely to be found on testing of the dystrophin gene?

A. Deletion of one base pair causing a frameshift.

B. Deletion of several exons.

C. Duplication of several exons.

D. Missense mutation.

E. Splice-site mutation.

QUESTION 29

Infliximab is effective in the treatment of Crohn’s disease. Its mode of action involves:

A. binding to tumour necrosis factor.

B. blockade of tumour necrosis factor receptors.

C. blockade of tumour necrosis factor secretion from inflammatory cells.

D. enhancement of hepatic metabolism of tumour necrosis factor.

E. inhibition of tumour necrosis factor production.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 13
QUESTION 30

A patient in the Emergency Department has the laboratory results shown below:

Serum Sodium 130 mmol/L [136 – 146 mmol/L]

Serum Potassium 6.5 mmol/L [3.5 – 5.0 mmol/L]
Serum HCO3 14 mmol/L [22 – 28 mmol/L]
Serum Chloride 115 mmol/L [95 – 107 mmol/L]
Venous pH 7.19 [7.34 – 7.44]
PCO2 42 mmHg [35 – 45 mmHg]
Base excess –10 mmol/L [-3 – + 3 mmol/L]

Which of the following is the most likely cause of the acidosis?

A. Acute renal failure.

B. Diabetic ketoacidosis.

C. Lactic acidosis.

D. Renal tubular acidosis.

E. Salicylate poisoning.

QUESTION 31

Phototherapy is commonly used in the management of unconjugated hyperbilirubinaemia. The

predominant mechanism of action of phototherapy is:

A. decreased binding of bilirubin to albumin.

B. destabilisation of photoisomers by bile acids.

C. geometric photo-isomerisation of unconjugated bilirubin to more soluble isomers.

D. intramolecular cyclisation to form lumirubin.

E. oxidation of bilirubin to form biliverdin and dypyrroles allowing excretion.

QUESTION 32

Which medication has the best evidence for the treatment of adolescent depression?

A. Citalopram.

B. Fluoxetine.

C. Imipramine.

D. Paroxetine.

E. Venlafaxine.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 14
QUESTION 33

A six-month-old child undergoes cardiac catheterisation. The oxygen saturations obtained in room air
during the procedure are as follows:

Superior vena cava 75%

Right atrium 75%
Inferior vena cava 75%
Right ventricle 87%
Main pulmonary artery 87%
Left ventricle 99%
Aorta 99%

These findings are most consistent with a diagnosis of:

A. atrial septal defect.

B. atrioventricular septal defect.

C. patent ductus arteriosus.

D. tetralogy of Fallot.

E. ventricular septal defect.

QUESTION 34

Which serological finding in patients with hepatitis B indicates active viral replication?

A. Anti-HBc positive.

B. Anti-HBe positive.

C. Anti-HBs positive

D. HBeAg positive.

E. HBsAg positive.

QUESTION 35

The incidence of autosomal recessive kidney disease in the population is 1:20,000. The population
carrier frequency for the PKHD1 gene that leads to this disorder is closest to:

A. 1:50

B. 1:70

C. 1:100

D. 1:140

E. 1:400

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 15
QUESTION 36

A ten-year-old boy with severe bronchiolitis obliterans presents to the Emergency Department with
increasing exercise intolerance over the previous week.

A capillary blood gas shows the following picture:

pH 7.29 [7.35 - 7.45]

pCO2 97 mmHg [36 – 44 mmHg]
-
Bicarbonate (HCO3 ) 45 mmol/L [21 – 30 mmol/L]
Base excess +18 mmol/L [-3 – +3 mmol/L]

This result is most consistent with which of the following?

A. Acute on chronic respiratory acidosis.

B. Acute respiratory acidosis.

C. Chronic respiratory acidosis.

D. Mixed metabolic and respiratory acidosis.

E. Uncompensated metabolic acidosis.

QUESTION 37

In acute paracetamol overdose, which of the following mechanisms may result in hepatotoxicity?

A. Conversion by cytochrome P450.

B. Conversion to glutathione conjugate.

C. Conversion to sulphate conjugate.

D. Direct toxic effect of unchanged drug.

E. Metabolism to phosphate form.

QUESTION 38

Which of the following provides the strongest stimulus for postnatal closure of the ductus arteriosus in
a term infant?

A. Decreased circulating prostaglandin levels.

B. Decreased pulmonary vascular resistance.

C. Increased pulmonary blood flow.

D. Increased systemic oxygen saturation.

E. Sympathetic stimulation.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 16
QUESTION 39

A 15-month-old boy recently completed chemotherapy for rhabdomyosarcoma. On routine testing the
following results were obtained:

Serum
Sodium 134 mmol/L [135–145 mmol/L] Creatinine 39 µmol/L [18–58 µmol/L]
Potassium 3.4 mmol/L [3.5-5.0 mmol/L] Calcium 2.46 mmol/L [2.20-2.70 mmol/L]
Chloride 114 mmol/L [97 – 109 mmol/L] Phosphate 0.44 mmol/L [1.07 - 2.03 mmol/L]
Bicarbonate 13.9 mmol/L [20.0 - 28.0 mmol/L] Magnesium 0.93 mmol/L [0.65 - 1.05 mmol/L]
Urea 4.9 mmol/L [2.1 – 8.4 mmol/L] Albumin 42 g/L [33 – 49 g/L]

Urinalysis
protein ++
glucose +++

The drug most likely to have caused these abnormalities is:

A. cyclophosphamide.

B. dactinomycin.

C. etoposide.

D. ifosfamide.

E. vincristine.

QUESTION 40

In the treatment of chronic hepatitis C infection, which of the following is the most common side effect
of ribavirin treatment?

A. Drug induced lupus.

B. Haemolytic anaemia.

C. Haemorrhagic cystitis.

D. Myocarditis.

E. Pancytopenia.

QUESTION 41

Which type of intervention is most likely to help children with delayed acquisition of reading skills?

A. Cerebellar exercises.

B. Combined phonics and whole word teaching.

C. Occupational therapy.

D. Stimulant medication.

E. Visual tracking exercises.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 17
QUESTION 42

A six-year-old girl presents after a fall from monkey bars. Her X-ray is shown below. On examination
she has paraesthesia of her thumb, index and middle fingers, as well as an impalpable radial pulse.

Compression of which of the following neurovascular structures best explains the physical findings?

A. Brachial artery and median nerve.

B. Brachial artery and radial nerve.

C. Brachial artery and ulnar nerve.

D. Radial artery and median nerve.

E. Ulnar artery and radial nerve.

QUESTION 43

Which of the following is not a mechanism used in the body for the production of endogenous
glucose?

A. Activation of lipolysis.

B. Gluconeogenesis from lactate and alanine.

C. Glycogenolysis in the kidney.

D. Glycogenolysis in the liver.

E. Glycolysis in the muscle.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 18
QUESTION 44

Which of the following clotting factors is found in cryoprecipitate?

A. factor II.

B. factor V.

C. factor VII.

D. factor VIII.

E. factor X.

QUESTION 45

The following results were obtained from a randomised controlled trial of a new artificial surfactant
called "S".

Chronic lung disease

Yes No
Yes 70 30
S given
No 80 20

The number of babies that you would need to treat with “S” to prevent one case of chronic lung
disease is:

A. 5

B. 10

C. 15

D. 20

E. 30

QUESTION 46

A two-year-old boy presents with a six week history of diarrhoea and lethargy. Clinical examination
reveals lower limb and periorbital oedema. Investigations show:

Normal liver function tests apart from albumin 22 g/L [35 - 50 g/L].
Urine analysis was normal.
Coagulation profile was normal.

What faecal test would confirm that the low albumin was related to gastrointestinal losses?

A. Alpha-1 antitrypsin.

B. Chymotrypsin.

C. Elastase.

D. Proalbumin.

E. Trypsin.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 19
QUESTION 47

Boys with X-linked lymphoproliferative disorder are at highest risk of the development of severe illness
or lymphoma following infection with which of the following pathogens?

A. Cytomegalovirus.

B. Epstein Barr virus.

C. Human herpesvirus 6.

D. Human herpesvirus 8.

E. Varicella zoster virus.

QUESTION 48

Which of the following substances can induce expression of CYP3A4 and lead to a decrease in the
blood level of cyclosporin?

A. Diltiazem.

B. Erythromycin.

C. Grapefruit juice.

D. Ketoconazole.

E. St John’s Wort.

QUESTION 49

Current extended newborn screening is most likely to miss disorders from which of the following
groups?

A. Aminoacidopathies.

B. Disorders of vitamin B12 metabolism.

C. Fatty acid oxidation disorders.

D. Lysosomal storage disorders.

E. Organic acidaemias.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 20
QUESTION 50

You are reviewing a 15-year-old boy with Duchenne muscular dystrophy (DMD) in your outpatient
clinic. He has been in an electric wheelchair for three years. He has not required admission to
hospital for more than five years.

You receive the following results of his lung function testing:

Forced vital capacity (FVC) 1.12 L [57% predicted]

Forced expiratory volume in 1 second (FEV1) 0.95 L [51% predicted]
Maximum mid-expiratory flow (MMEF) 0.7 L/min [25% predicted]
FEV1/FVC ratio 93%

Flow (L/sec)
Expected curve
Patient results

Volume (L)

Which of the following best describes these lung function results?

A. Mixed obstructive and restrictive pattern.

B. Moderate obstructive lung disease.

C. Moderate restrictive lung disease.

D. Poor technique.

E. Upper airway obstruction.

QUESTION 51

Absorption of iron in the ferrous form (Fe 2+) occurs mainly in the:

A. stomach.

B. duodenum.

C. jejunum.

D. ileum.

E. colon.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 21
QUESTION 52

A four-year-old boy presents with facial oedema and dark urine two weeks after a bout of tonsillitis.
He has been anuric for 18 hours. Initial investigations confirm acute renal failure with markedly
elevated serum urea and creatinine. His serum potassium is elevated at 6.8 mmol/L.

Which of the following reduces total body potassium?

A. Calcium infusion.

B. Glucose and insulin infusion.

C. Nebulised salbutamol.

D. Sodium bicarbonate infusion.

E. Sodium polystyrene sulphonate (Resonium) enema.

QUESTION 53

The arterial blood pressure trace of an unwell one-year-old child is shown below.

The child has a one week history of low grade fever with viral symptoms. At presentation the child is
tachycardic and tachypnoeic with poor peripheral perfusion. The most likely diagnosis is:

A. cardiac tamponade.

B. coarctation of aorta.

C. dilated cardiomyopathy.

D. septic shock.

E. viral myocarditis.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 22
QUESTION 54

Which of the following is the most common adverse effect of carbamazepine (Tegretol)?

A. Alopecia.

B. Pancreatitis.

C. Rash.

D. Visual field restriction.

E. Weight gain.

QUESTION 55

Which of the following is the most useful test for assessment of disease activity in systemic lupus
erythematosus?

A. Anti-nuclear antibody (ANA).

B. Complement factor 3 (C3).

C. C-reactive protein (CRP).

D. Extractable nuclear antigen antibodies (ENA).

E. Haemoglobin (Hb).

QUESTION 56

Ultraviolet (UV) radiation (sunlight) acts on the skin to catalyse which of the following reactions?

A. 7-dehydrocholesterol to vitamin D3 (cholecalciferol).

B. 25-hydroxyvitamin-D to 1,25-dihydroxyvitamin D.

C. Cholesterol to 7-dehydrocholesterol.

D. Vitamin D2 (ergocalciferol) to vitamin D3 (cholecalciferol).

E. Vitamin D3 (cholecalciferol) to 25-hydroxyvitamin D.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 23
QUESTION 57

What is the approximate half-life of serum immunoglobulin M (IgM)?

A. 1 day.

B. 7 days.

C. 21 days.

D. 3 months.

E. 6 months.

QUESTION 58

In infants with glucose-galactose malabsorption, ingestion of foods containing which of the following
carbohydrates is likely to cause severe diarrhoea and dehydration?

A. Fructose.

B. Mannitol.

C. Mannose.

D. Sorbitol.

E. Sucrose.

QUESTION 59

Which of the following observations regarding a rare disorder would provide the best evidence of
autosomal dominant inheritance?

A. Father and daughter affected.

B. Father and son affected.

C. Male and female cousins affected.

D. Mother and daughter affected.

E. Mother and son affected.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 24
QUESTION 60

A six-year-old boy is receiving induction chemotherapy for newly diagnosed acute lymphoblastic
leukaemia. He is brought to the Emergency Department by his parents three days after receiving
chemotherapy. He complains of an aching jaw and abdominal pain, and his parents report that he has
not had a bowel action for three days.

The drug most likely to have caused these symptoms is:

A. asparaginase.

B. daunorubicin.

C. methotrexate.

D. prednisolone.

E. vincristine.

QUESTION 61

Ondansetron and granisetron are widely used as antiemetics post anaesthesia and in
chemotherapeutic regimens. What is the mode of action of these drugs?

A. Anticholinergic.

B. Antihistamine.

C. Dopamine agonist.

D. Dopamine antagonist.

E. Serotonin antagonist.

QUESTION 62

Phenobarbitone is commonly used as the first line anticonvulsant in the treatment of neonatal
seizures. In what percentage of cases would you expect to achieve clinical control of seizures after a
loading dose of 20 mg/kg phenobarbitone?

A. 20%

B. 40%

C. 60%

D. 80%

E. 95%

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 25
QUESTION 63

Which of the following lipid-lowering drugs works primarily by the upregulation of low density
lipoprotein (LDL) receptor activity?

A. Cholestyramine.

B. Clofibrate.

C. Colestipol.

D. Nicotinic acid.

E. Simvastatin.

QUESTION 64

A 3200 g term baby girl, born by ventouse extraction, is seen at five hours of age with recurrent
apnoeic episodes. On examination she is afebrile, pale but well perfused, heart rate is 150 beats/min
and mean arterial pressure is 42 mmHg. A computed tomography (CT) scan of her head is shown
below.

The scan is most suggestive of haemorrhage that is both intracerebral and:

A. extradural.

B. intraventricular.

C. subarachnoid.

D. subdural.

E. subgaleal.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 26
QUESTION 65

Which of the following psychoactive medications is most likely to cause excessive weight gain?

A. Fluoxetine.

B. Haloperidol.

C. Olanzapine.

D. Quetiapine.

E. Sodium valproate.

QUESTION 66

Human Metapneumovirus infection is associated with which of the following?

A. Bronchiolitis.

B. Croup.

C. Febrile convulsions.

D. Gastroenteritis.

E. Viral exanthem.

QUESTION 67

A three-year-old girl is diagnosed with adrenocortical carcinoma. Her maternal aunt died from
osteosarcoma at 12 years of age, and her maternal grandmother was treated for breast carcinoma in
her early forties. A familial tumour predisposition syndrome is suspected.

The most likely mechanism for this is a germline mutation in which of the following genes?

A. APC.

B. NF1.

C. p53.

D. RB1.

E. RET.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 27
QUESTION 68

Macrolide antibiotics have been increasingly used in the treatment of children with cystic fibrosis. The
beneficial effect is most likely:

A. killing of atypical mycobacteria.

B. killing of Staphylococcus aureus

C. modulation of airway inflammation.

D. reduced adherence of Pseudomonas aeruginosa to airway epithelium.

E. upregulation of CFTR.

QUESTION 69

Which immunoglobulin in human breast milk is the most immunoprotective?

A. IgA.

B. IgD.

C. IgE.

D. IgG.

E. IgM.

QUESTION 70

As glomerular filtration rate (GFR) declines, urinary creatinine clearance overestimates GFR because
creatinine is:

A. metabolised by the tubules.

B. poorly filtered at the glomerulus.

C. reabsorbed by the tubules.

D. secreted by the tubules.

E. synthesized by the tubules.

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 28
 Paediatrics & Child Health

Paper 1 – Medical Sciences

Answers

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

2008 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 29