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Model Paper One
Model Paper One
Model Paper One
Question 1.
3. 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.
11. 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.
12. Low serum vitamin B12 levels are least likely to be seen in which one of the
following?
A. Crohn disease.
B. Pernicious anaemia.
C. Severe folate deficiency.
D. Short bowel syndrome.
E. Transcobalamin II deficiency.
15. Which of the following most accurately describes the known effects of
supplementation of artificial milk formulae with long chain polyunsaturated fatty
acids (LCPUFA) in term infants?
A. A beneficial effect on bone maturation.
B. A beneficial effect on growth.
C. A beneficial effect on neurodevelopmental outcome.
D. A beneficial effect on visual maturation.
E. No additional benefit demonstrated.
16. 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%.
17. Activated protein C resistance is most likely to be associated with which one
of the following states?
A. Antithrombin III deficiency.
B. Factor V Leiden mutation.
C. Factor VIII deficiency.
D. Lupus anticoagulant.
E. Prothrombin gene mutation.
18. 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
21. 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.
22. Which one of the following interventions has most consistently been shown
to decrease the duration of hospital stay with acute asthma?
A. Inhaled ipratropium bromide.
B. Inhaled salbutamol.
C. Intravenous salbutamol.
D. Oral prednisolone.
E. Oral theophylline.
23. A 15-year-old boy has been on an anticonvulsant for three years. The dosage
has been stable. He recently noticed difficulties in seeing at night. A formal
ophthalmological assessment demonstrated visual field constriction.
Which one of the following anticonvulsants is most likely to be the cause of his
symptoms?
A. Carbamazepine.
B. Gabapentin.
C. Lamotrigine.
D. Sodium valproate.
E. Vigabatrin.
24. A term neonate presents with jitteriness at three hours of age. The following
recordings are made:
weight 3450 g (50th percentile)
length 50 cm (50th percentile)
head circumference 36 cm (50th percentile)
penile length 1.8 cm (<10th percentile)
plasma glucose 0.7 mmol/L
The remainder of the examination is normal.
The most likely cause is:
A. congenital adrenal hyperplasia.
B. 5 alpha-reductase deficiency.
C. hyperinsulinism.
D. hypopituitarism.
E. 45XO/46XY mosaicism.
25. The following results are obtained from a 14-year-old boy, prior to elective
hernia surgery, who gives a history of excessive bleeding after dental extraction.
Bleeding time 6 minutes [2-9]
Prothrombin time 12 seconds [12-14]
Prothrombin time-international normalised ratio (PT-INR) 1.0 [0.9-1.2]
Activated partial thromboplastin time (APTT) 56 seconds [26-35]
Fibrinogen 2.4 g/L [1.8-4.0]
Mixing the patient's plasma with an equal volume of normal plasma
normalises the APTT.
Which one of the following is the most likely diagnosis?
A. Antiphospholipid antibody syndrome.
B. Factor VII deficiency.
C. Haemophilia.
D. Recent aspirin ingestion.
E. Von Willebrand disease.
33. You are asked for a second opinion regarding a 10-year-old boy who has a
long history of hyperactive, impulsive, attention-seeking and destructive
behaviour, both at home and at school. A paediatrician and a child psychiatrist
have previously diagnosed him as having attention deficit hyperactivity disorder
(ADHD). He responded poorly to dexamphetamine but concentration and
attention have improved on methylphenidate. He is currently on 30 mg/day. His
weight is 35 kg.
Further assessment demonstrated average intelligence but with a significant
language-based learning disorder. He is at the 3rd percentile for receptive
language and the 14th percentile for expressive language. He is making progress
at school with the provision of remedial help and an integration aide.
He also receives on-going counselling and cognitive behavioural management
from his psychiatrist.
His parents are divorced and are unable to manage him consistently. His father is
strict, distant and loses his temper with his son. His mother is caring, finds it
hard to set limits and is overwhelmed by his demands. The boy dominates and
intrudes on all aspects of family life. His father denigrates his ex-wife in front of
the boy.
34. A 14-month-old infant has been dependent on parenteral nutrition since birth
due to surgical resection secondary to volvulus of the small bowel. He currently
receives 30% of his caloric requirement by the parenteral route and the
remainder as Pregestimil via a nasogastric tube. On examination he is icteric.
He has 3 cm of splenomegaly, the liver is not palpable and there is no ascites.
His blood tests reveal:
bilirubin (total) 120 mol/L [<10]
bilirubin conjugated 96 mol/L [<10]
alanine aminotransferase (ALT) 203 U/L [10-50]
gamma glutamyltransferase (GGT) 593 U/L [5-24]
albumin 23 g/L [34-52]
Abdominal ultrasound shows a small liver with normal intra and extra hepatic
ducts and an enlarged spleen. A Doppler study of his portal vessels shows blood
flowing from the liver to the spleen. The most effective intervention to arrest the
progression of his liver disease would be to:
A. administer chenodeoxycholic acid.
B. administer phenobarbitone.
C. administer rifampicin.
D. cease parenteral nutrition.
E. perform a portacaval shunt.
35. A four-year-old boy presents with the sole symptom of a generally dry cough
of four months duration, which has been affecting his sleep. He is well grown and
there are no localising or generalised signs. He has not responded to nebulised
salbutamol prescribed by his general practitioner. His blood count and chest X-
ray are normal.
Which one of the following is the most appropriate management?
A. Bedroom humidification.
B. Erythromycin.
C. Inhaled corticosteroids.
D. No therapy.
E. Oral steroids.
37. Which one of the following factors is most likely to be associated with the
occurrence of late-onset haemorrhagic disease (vitamin K deficiency bleeding)?
A. Breastfeeding.
B. Formula feeding.
C. Maternal anticonvulsants.
D. Post-natal antibiotic administration.
E. Prematurity.
38. A previously well two and a half-year-old girl, whose parents are divorced,
returns from weekend access with her father. On return home the child is a little
more demanding than usual but is otherwise behaviourally normal. At bed-time
the mother notices that her daughter has a significantly reddened vulva.
Which one of the following is the most likely diagnosis?
A. Candidiasis.
B. Child sexual abuse.
C. Lichen sclerosis.
D. Non-specific vulvovaginitis.
E. Straddle injury.
40. Which one of the following would not be consistent with a diagnosis of night
terrors?
A. Associated somnambulism.
B. Associated sweating and pupillary dilatation.
C. Inability to recall the event.
D. Multiple episodes per night.
E. Occurrence at age seven years.
E. Perform a gastroscopy.
42. A nine-month-old boy, who has been fully immunised, presents with a
pneumonia and has the following results:
IgG 1.1 g/L [2.1-12.2]
IgA <0.10 g/L [0.17-1.20]
IgM 0.15 g/L [0.32-1.40]
IgE <5 kU/L [0-35]
Lymphocyte markers:
CD3 (T cells) 93% [53-71]
CD4 (T helper) 68% [28-52]
CD8 (T suppressor) 24% [13-31]
CD19 (B cells) 0% [19-38]
natural killer (NK) cells 4% [3-12]
His pneumonia is most likely to be due to which one of the following organisms?
A. Escherichia coli.
B. Haemophilus influenzae type b.
C. Mycoplasma pneumoniae.
D. Pneumocystis carinii.
E. Staphylococcus aureus
45. A 30-year-old mother and her five-year-old son are both HIV (human
immunodeficiency virus)-positive. She is well and takes all her own medication
reliably. She is pregnant and would like to know what are the chances of her baby
developing HIV infection. She understands that both baby and she will be treated
with the best available current treatments.
The risk of the baby acquiring HIV is closest to:
A. 90%.
B. 70%.
C. 50%.
D. 30%.
E. 10%.
46. Stevens-Johnson syndrome is most likely to occur with which one of the
following anticonvulsant drugs?
A. Carbamazepine.
B. Lamotrigine.
C. Phenytoin.
D. Sodium valproate.
E. Vigabatrin.
48. You have been asked to review the biochemical profile of a 13-year-old girl
who is undergoing nasogastric feeding for severe anorexia nervosa, which was
initiated three days earlier. You calculate that she is receiving 100 calories per
hour. She had normal biochemistry on admission.
Her current biochemical profile is:
sodium 135 mmol/L [134-142]
potassium 2.7 mmol/L [3.5-4.5]
chloride 98 mmol/L [96-110]
urea 1.0 mmol/L [2.1-6.5]
creatinine 0.02 mmol/L [0.03-0.08]
glucose 2.4 mmol/L [3.5-5.4]
calcium 1.99 mmol/L [2.10-2.60]
phosphate 0.8 mmol/L [1.1-1.8]
albumin 30 g/L [35-50]
This picture is most likely to be due to which one of the following?
A. Addisonian crisis.
B. Diuretic abuse.
C. Laxative abuse.
D. Secondary renal tubular acidosis.
E. The enteral nutrition.
49. Which one of the following cardiac lesions would be an unexpected finding in
a baby with a 22q11 deletion?
A. Infradiaphragmatic totally anomalous pulmonary venous return.
B. Interrupted aortic arch.
C. Pulmonary atresia, ventricular septal defect and major aorto-pulmonary
collaterals.
D. Tetralogy of Fallot.
E. Truncus arteriosus.
50. Which one of the following measures is most effective in preventing neonatal
early onset group B streptococcal infection?
A. Antibiotics (single intramuscular dose) given after delivery to babies of
colonised mothers.
B. Antibiotics given during pregnancy to colonised mothers at 28 weeks
gestation.
C. Antibiotics given during pregnancy to colonised mothers with group B
streptococcal antigenuria.
D. Maternal intrapartum antibiotics to colonised mothers.
E. Vaginal antiseptic douches before and during delivery to intrapartum colonised
mothers.