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Introduction
Format
All questions are in the A-type multiple-choice format, that is, the single best answer of the five options given.
When visual material has been turned on its side, an arrow on the page indicates the orientation of the visual
material.
Questions do not necessarily appear in the order in which they were first printed.
Answers
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.
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 P103
QUESTION 1
Resection of 50% of the small bowel, including terminal ileum, following neonatal necrotising enterocolitis
may result in deficiency of a number of vitamins.
A. Vitamin A.
B. Vitamin B12.
C. Vitamin C.
D. Vitamin E.
E. Vitamin K.
QUESTION 2
Which of the following techniques is most appropriate for testing visual acuity in a four-year-old child?
A. Cover test.
B. E test.
D. Snellen chart.
QUESTION 3
Which combination of plasma glucose, insulin, beta hydroxybutyrate (β-OH-butyrate), lactate and cortisol can
best be described as a normal metabolic response after 18 hours of fasting in a five-year-old?
QUESTION 4
The pedigree shown above is most consistent with which one of the following modes of inheritance?
A. Autosomal dominant.
B. Autosomal recessive.
C. Mitochondrial.
D. X-linked dominant.
E. X-linked recessive.
QUESTION 5
Which one of the following best describes the renal function of a 34-week pre-term infant compared with a
full-term infant?
QUESTION 6
In obstructive airways disease the most useful long-term measure of disease progression is:
QUESTION 7
An acutely septic child’s blood gas result, in room air, demonstrates the following:
pH 7.35 [7.35-7.45]
plasma bicarbonate 11 mmol/L [22-26]
PCO2 21 mmHg [35-45]
PO2 90 mmHg [>80]
This blood gas result is most consistent with which of the following?
QUESTION 8
Which of the following classes of immunoglobulins has the longest mean half-life?
A. IgA.
B. IgD.
C. IgE.
D. IgG.
E. IgM.
QUESTION 9
Allopurinol is most likely to precipitate methotrexate toxicity by which one of the following mechanisms?
D. Inhibition of metabolism.
QUESTION 10
AUDIOGRAM TYMPANOMETRY
Ear Type
Right A
Left A
KEY
Right Left
Air { X
Bone < >
A child’s audiogram is shown. Which of the following is the most likely cause of these findings?
A. Cholesteatoma.
B. Goldenhar syndrome.
E. Otosclerosis.
QUESTION 11
An infant has sustained a large cerebral infarct involving most of the left occipital lobe. The remainder of the
brain is unaffected. A later neurological examination would be most likely to reveal which one of the
following?
B. Bitemporal hemianopia.
C. Central scotoma.
D. Right amblyopia.
QUESTION 12
In pre-renal failure secondary to acute haemorrhage, which of the following kidney changes would be most
likely to occur?
QUESTION 13
Bone marrow trephine biopsy is most commonly needed in attempting to confirm the diagnosis of which one
of the following conditions?
C. Aplastic anaemia.
E. Megaloblastic anaemia.
QUESTION 14
A two-week-old baby, otherwise well, has a warm, erythematous and enlarged breast bud that is discharging
pus. The infant is most likely to be infected with:
A. Escherichia coli.
B. Group A Streptococcus.
C. Group B Streptococcus.
D. Staphylococcus aureus.
E. Staphylococcus epidermidis.
QUESTION 15
The electrocardiogram (ECG) shown above was obtained from a three-year-old girl with a systolic murmur.
E. Subaortic stenosis.
QUESTION 16
Which of the following tests is most likely to detect early respiratory failure in neuromuscular disease?
E. Polysomnography.
QUESTION 17
Which of the following best describes the mechanism of resistance of Haemophilus influenzae to ampicillin?
C. Efflux pump.
E. Pus formation.
QUESTION 18
The diagram below shows the relationship between the plasma concentration of a drug and the effect of that
drug over time, in a single individual given one dose of the drug. The direction of change over time is shown
by the arrows. The relationship is described by an anti-clockwise hysteresis loop. The numbers on the loop
indicate the number of hours after the dose was given.
C. there is a delay in the absorption of the drug from the gastrointestinal tract.
D. there is a delay in the distribution of the drug from plasma to its site of action.
QUESTION 19
Which of the following correlates most strongly with language abilities at age six years?
B. Intelligence quotient.
C. Number of siblings.
D. Socio-economic status.
QUESTION 20
A three and a half-year-old boy presents after falling off a coffee table at home. He has sustained an injury
to his right elbow and is complaining of a ‘funny feeling’ in his right thumb and forefinger.
On examination he has obvious deformity of his right elbow with a strong radial pulse and normal capillary
refill of his nail beds. An X-ray of his elbow is shown below.
C. Thumb abduction.
D. Thumb adduction.
E. Wrist extension.
QUESTION 21
The incidence of type 2 (non-insulin-dependent) diabetes mellitus is increasing and presenting at a younger
age.
Which combination of the indicated group of markers would be most characteristic of this form of diabetes
mellitus?
B. + - + -
C. - + + +
D. - + - +
E. - - + -
QUESTION 22
On day 3 of life, a breastfed infant developed profuse watery diarrhoea, dehydration and acidosis. The
diarrhoea ceased within 24 hours when given intravenous fluids only. When nasogastric rehydration was
attempted with oral rehydration solution the diarrhoea and acidosis recurred.
B. Fructose malabsorption.
C. Glucose-galactose malabsorption.
D. Rotavirus gastroenteritis.
E. Sucrase-isomaltase deficiency.
QUESTION 23
Dendritic cells are distinguished by an exceptional ability to carry out which one of the following immune
functions?
A. Antigen presentation.
B. Chemokine secretion.
C. Cytokine secretion.
D. Immunoglobulin secretion.
E. Phagocytosis.
QUESTION 24
Female carriers of an X-linked recessive mutation may manifest features of the disorder. Which of the
following is the most common cause?
E. Turner syndrome.
QUESTION 25
A key feature of anorexia nervosa is a body mass index (BMI) of less than 17.5. This index is also valuable
for diagnosing and monitoring those with obesity.
The index is calculated with which one of the following formulae (in kilograms and metres)?
A. weight/height.
B. 2 x weight/height.
C. weight/2 x height.
D. weight/height2.
E. weight2/height.
QUESTION 26
A one-month-old infant presents with stridor, which is worse when crying. A barium swallow demonstrates
an anterior indentation of the oesophagus, while bronchoscopy demonstrates a pulsation of the posterior
wall of the lower trachea and also tracheomalacia.
QUESTION 27
D. iron deficiency.
QUESTION 28
In the diagrammatic representation of the cardiac cycle shown above, the aortic trace is represented by ‘Ao’
and the left ventricular trace by ‘V’. Which one of the periods represented at the bottom of the diagram best
corresponds to the period of isovolumetric contraction?
A. Period A.
B. Period B.
C. Period C.
D. Period D.
E. Period E.
QUESTION 29
A randomised controlled clinical trial of a new antibiotic for otitis media shows that children treated with the
new antibiotic have a 50% reduction in ear pain within 24 hours. Approximately 10% of children in the
control group had pain at 24 hours compared to only 5% of children treated with the new antibiotic.
The number of children who need to be treated with the new antibiotic in order to prevent one child from
having ear pain at 24 hours is:
A. 2.
B. 5.
C. 10.
D. 20.
E. 50.
QUESTION 30
Which of the following infectious agents is most commonly associated with erythema multiforme?
B. Group A Streptococcus.
D. Mycoplasma pneumoniae.
E. Parvovirus B19.
QUESTION 31
Growth hormone is secreted from the anterior pituitary gland. Which of the following is least likely to
stimulate growth hormone release?
A. Exercise.
D. Hypoglycaemia.
E. Sleep.
QUESTION 32
A mother brings her nine-month-old daughter to see you with concerns about her child’s hearing. Which of
the following would be the most appropriate to determine the child’s hearing acuity?
D. Tympanometry.
QUESTION 33
A 14-year-old girl is hiking on a school camp. She has been carrying a heavy backpack for about four hours
during the day. She wakes the next morning with pain across her right shoulder and upper arm. The pain
persists for about a day and she then develops arm weakness.
Examination shows weakness of abduction at the shoulder and of flexion at the elbow. She has a depressed
biceps deep tendon reflex and sensory loss on the lateral aspect of her arm at the insertion of the deltoid
muscle.
A. accessory nerve.
B. axillary nerve.
C. brachial plexus.
E. radial nerve.
QUESTION 34
The parents of a 13-year-old boy, an only child, are concerned about his recent behaviour. His mother
reports that he will not take books home from the library for fear of catching germs and frequently washes his
hands. The boy shakes his head while his mother is speaking, but doesn’t respond when you ask him about
this. The father reports that the boy’s problems often follow arguments with his mother. His mother
disagrees vigorously and emphasizes how she has needed to look after him, especially over the past week
as he has been home from school with a severe sore throat. The boy denies any problems at school but
agrees that there have been arguments about him washing his hands at home.
A. Family therapy.
C. Parental counselling.
D. Penicillin.
E. Sertraline.
QUESTION 35
During intermittent positive pressure ventilation, increasing which of the following (in isolation) would be least
likely to improve carbon dioxide removal?
B. Inspiratory time.
E. Ventilator rate.
QUESTION 36
Captopril is an angiotensin converting enzyme inhibitor. Its clinical benefit in congestive cardiac failure
derives mostly from:
QUESTION 37
Which one of the following capsular polysaccharides of Neisseria meningitidis is least immunogenic?
A. A.
B. B.
C. C.
D. W-135.
E. Y.
QUESTION 38
Which one of the following is the most potent inhibitor of aldosterone secretion in a healthy individual?
QUESTION 39
A 10-year-old boy presents with a history of recurrent palpitations, precipitated by strenuous exercise, over
the last 12 months. On the day of presentation he had the sudden onset of a rapid heart rate while playing
cricket at school. On arrival at triage he has a pulse rate of 240/minute, a respiratory rate of 29/minute and a
blood pressure of 80/50 mmHg. He is pale but alert and after a large vomit at triage his rapid heart rate
spontaneously resolves. His 12-lead electrocardiogram (ECG) is shown above.
A. Dilated cardiomyopathy.
B. Ebstein anomaly.
QUESTION 40
E. randomising participants.
QUESTION 41
In which of the following disorders have the beneficial effects of human immune globulin not been
established in controlled clinical trials?
B. Dermatomyositis.
C. Guillain-Barré syndrome.
E. Kawasaki disease.
QUESTION 42
In a patient presenting with a severe acute exacerbation of asthma, arterial blood gases on breathing room
air show:
The hypoxaemia worsens with the administration of an intravenous beta-2 agonist bronchodilator. The
PaCO2 is unchanged.
Which one of the following mechanisms best explains the worsening of this patient’s hypoxaemia?
E. Pulmonary vasoconstriction.
QUESTION 43
Which of the following organisms is the most efficient at breaking down urea?
A. Campylobacter jejuni.
B. Cryptosporidium parvum.
C. Escherichia coli.
D. Helicobacter pylori.
E. Rotavirus.
QUESTION 44
A 38-week gestation male infant is delivered by caesarean section because of concerns regarding foetal growth.
The baby weighs 1850 g at birth but is otherwise normal.
A. hypertension.
D. short stature.
QUESTION 45
QUESTION 46
Which one of the following types of mutation is most likely to lead to the introduction of a premature stop
codon?
QUESTION 47
Which one of the following cells of the immune system is most reliant on its release of mediators into the
extracellular fluid surrounding the organism, in order to carry out its role in eradication of foreign organisms?
A. Cytotoxic T lymphocytes.
B. Eosinophils.
C. Macrophages.
E. Neutrophils.
QUESTION 48
The risk of externalising (antisocial or under-controlled behaviour) among school-aged girls is highest in
families with which one of the following demographic characteristics?
A. Divorced parents.
B. Low income.
D. Rural abode.
QUESTION 49
Warfarin is predominantly cleared by hepatic metabolism, with a low hepatic extraction ratio and therefore a
low hepatic first pass effect and high bioavailability after oral administration.
Which one of the following best describes the most likely effect on warfarin pharmacokinetics of concomitant
administration of an inhibitor of warfarin metabolism, such as erythromycin?
↑ = significant increase
↓ = significant decrease
A. ↔ ↓
B. ↔ ↔
C. ↑ ↓
D. ↑ ↔
E. ↓ ↔
QUESTION 50
If blood is taken 72 hours following a significant paracetamol overdose, which one of the following tests will
allow the best prediction of death or need for liver transplantation?
A. Blood ammonia.
D. Serum albumin.
E. Serum bilirubin.
QUESTION 51
B. 7 hours.
C. 9 hours.
D. 11 hours.
QUESTION 52
A five-year-old boy with a diagnosis of intractable epilepsy is prescribed a new anticonvulsant. About one
month later, he presents with a 24-hour history of abdominal pain, vomiting and low-grade fever. The pain
worsens over the subsequent 24 hours and he develops intractable vomiting.
On examination he is dehydrated, mildly jaundiced and febrile. He has tenderness in the epigastric area. A
serum amylase is elevated. He is diagnosed with pancreatitis.
Which of the following anticonvulsants is most likely to be associated with this clinical scenario?
A. Carbamazepine.
B. Lamotrigine.
C. Phenytoin.
D. Sodium valproate.
E. Topiramate.
QUESTION 53
QUESTION 54
Which of the following is the most appropriate antibiotic to treat a child with pneumococcal meningitis caused
by a strain of Streptococcus pneumoniae with intermediate resistance to penicillin (minimum inhibitory
concentration (MIC) 1 mg/L)?
A. Ceftriaxone.
B. Cotrimoxazole.
C. Erythromycin.
D. Penicillin G.
E. Vancomycin.
QUESTION 55
The use of high frequency oscillation compared with conventional mechanical ventilation has been
demonstrated to be of most benefit in reducing the incidence of:
B. intraventricular haemorrhage.
C. mortality.
D. pneumothorax.
E. retinopathy of prematurity.
QUESTION 56
In the process of cellular transcription, messenger RNA (mRNA) is derived from which one of the following
components of the gene?
A. Enhancer sequences.
B. Exon sequences.
C. Intron sequences.
D. Promoter sequences.
E. Termination sequences.
QUESTION 57
Which of the following factors is the most consistently identified in cases that result in litigation against a
doctor?
A. Dosing errors.
B. Incorrect medication.
C. Insufficient knowledge.
D. Negligence of duty.
E. Poor communication.
QUESTION 58
The chronic administration of a thiazide diuretic is associated with all of the following except:
A. hypercalciuria.
B. hyperglycaemia.
C. hyperuricaemia.
D. hypochloraemic alkalosis.
QUESTION 59
In a patient with a ventricular septal defect (VSD), which of the following clinical signs best correlates with a
pulmonary to systemic blood flow ratio (Qp/Qs) of greater than 2:1?
QUESTION 60
Which of the following is the most common long-term complication of cranial irradiation?
A. Delayed puberty.
B. Diabetes insipidus.
D. Hypothyroidism.
E. Thyroid malignancy.
QUESTION 61
Which immunological mechanism is the major cause of the destruction of the small intestinal villous
architecture in coeliac disease?
A. Activation of B lymphocytes.
B. Activation of T lymphocytes.
QUESTION 62
The polymerase chain reaction (PCR) requires the use of a DNA polymerase. The action of the DNA
polymerase is best described as:
C. extending the primers once they are affixed to the single strands.
QUESTION 63
Specific lung compliance is best standardised by measuring lung compliance at which of the following lung
volumes?
D. Residual volume.
QUESTION 64
A couple wants to start a family. There is a vague history of thalassaemia in both families. Which one of the
following combinations would be of least concern?
A. β-thalassaemia β-thalassaemia
B. αo-thalassaemia αo-thalassaemia
C. α+-thalassaemia αo-thalassaemia
D. haemoglobin E β-thalassaemia
E. αo-thalassaemia β-thalassaemia
Legend:
β = beta
αo = absent alpha chain production
α+ = decreased alpha chain production
QUESTION 65
A six-year-old child has a syncopal episode in association with an airway infection. An electrocardiogram
(ECG) shows a QTc of 500 milliseconds.
Which of the following medications is least likely to exacerbate the prolonged QT interval?
A. Cisapride.
B. Dexamphetamine.
C. Erythromycin.
D. Imipramine.
E. Ketoconazole.
QUESTION 66
The patient shown in the photograph below is pushing with arms extended against a fixed object.
A. Accessory.
B. Long thoracic.
C. Pectoral.
D. Subclavian.
E. Suprascapular.
QUESTION 67
During an acute infection with a virus, which of the following is the most important antigen-specific immune
response that eradicates viruses from the body?
A. Cytotoxic T lymphocytes.
B. IgG antibody.
C. IgM antibody.
D. Interferon.
E. Secretory antibody.
QUESTION 68
A 10-month-old boy has a longstanding history of failure to thrive, vomiting and recurrent dehydration.
Which one of the following is most consistent with a diagnosis of distal renal tubular acidosis?
QUESTION 69
The need for informed consent before enrolling a patient in a clinical trial investigating a novel treatment is
primarily based on the principle of:
A. autonomy.
B. beneficence.
C. justice.
D. nonmaleficence.
E. risk management.
QUESTION 70
Which of the following chromosomal abnormalities is most likely to not be detected on routine karyotyping?
B. Microdeletion.
C. Monosomy.
D. Robertsonian translocation.
E. Trisomy.
Answers
1. C 25. D 49. A
2. B 26. A 50. B
3. D 27. A 51. E
4. C 28. B 52. D
5. E 29. D 53. C
6. C 30. C 54. E
7. A 31. B 55. A
8. D 32. E 56. B
9. B 33. C 57. E
10. C 34. B 58. A
11. E 35. D 59. A
12. E 36. C 60. C
13. C 37. B 61. B
14. D 38. D 62. C
15. C 39. E 63. B
16. E 40. B 64. E
17. D 41. A 65. B
18. D 42. D 66. B
19. B 43. D 67. A
20. C 44. B 68. E
21. D 45. E 69. A
22. C 46. A 70. B
23. A 47. B
24. D 48. E