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 pencils provided to
mark the front cover and the answer sheet.

h Your name and candidate number must appear BOTH

on the front cover of this question booklet and on the
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COMPLETELY.

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h On completion of each examination paper, the

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surrendered. They are confidential and must NOT be
removed from the examination room.

2007 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.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 2
QUESTION 1

The growth promoting effects of Growth Hormone (GH) are mostly mediated by which of the following?

A. Growth hormone releasing hormone.

B. IGF1 (Insulin-like Growth Factor One).

C. IGF2 (Insulin-like Growth Factor Two).

D. IGFBP3 (Insulin-like Growth Factor Binding Protein Three).

E. Insulin.

QUESTION 2

Malrotation with midgut volvulus is a potentially life threatening condition in otherwise healthy infants.
Which of the following best describes the normal rotation of the bowel that occurs during
embryogenesis?

A. Clockwise 180 degrees.

B. Clockwise 270 degrees.

C. Counterclockwise 90 degrees.

D. Counterclockwise 180 degrees.

E. Counterclockwise 270 degrees.

QUESTION 3

A three-year-old child undergoes cardiac catheterization. The saturations obtained in room air during
the procedure are as follows:

Superior vena cava 75%

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

The most likely cardiac abnormality that this child has is:

A. atrial septal defect.

B. atrial septal defect with partial anomalous pulmonary venous drainage.

C. patent ductus arteriosus.

D. ventricular septal defect.

E. ventricular septal defect with Eisenmenger’s complex.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 3
QUESTION 4

In an X-linked disorder which has no effect on reproductive fitness or life expectancy, the expected
ratio of affected (hemizygous) males to carrier (heterozygous) females is closest to:

A. 1:3.

B. 1:2.

C. 1:1.

D. 2:1.

E. 3:1.

QUESTION 5

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 6

At what age does physical aggression peak across populations?

A. 1-2 years.

B. 2-3 years.

C. 5-6 years.

D. 8-10 years.

E. 14-18 years.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 4
QUESTION 7

A nine-year-old girl is referred from the surgical clinic, where evaluation of recurrent abdominal pain
included the following blood film. Her mother required cholecystectomy for gallstones at 19 years of
age, and her maternal grandfather is thought to have had a splenectomy as a young adult.

Which of the following tests is likely to be abnormal?

A. Acid serum lysis (Ham’s) test.

B. Bone marrow flow cytometry.

C. Direct antiglobulin (Coombs’) test.

D. Glucose-6-phosphate dehydrogenase level.

E. Osmotic fragility test.

QUESTION 8

A seven-year-old girl with Morquios syndrome is referred for respiratory assessment prior to a surgical
procedure. Her lung function demonstrated the following:

Total lung capacity (TLC) 60% of predicted

Residual volume (RV) 135% of predicted
Functional residual capacity (FRC) 80% of predicted.

The most likely explanation for this pattern is:

A. decreased chest wall compliance.

B. decreased small airway conductance.

C. increased upper airway resistance.

D. increased chest wall compliance.

E. narrowing of the trachea.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 5
QUESTION 9

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 10

The addition of starch to oral rehydration solution increases water absorption by which mechanism?

A. Aquaporin transport.

B. Colonic fermentation.

C. Enterohepatic reabsorption.

D. Sodium-glucose co-transport.

E. Sodium-Potasium ATPase.

QUESTION 11

In the fetus with a structurally normal heart. The percentage of pulmonary arterial blood flow that is
directed through the ductus arteriosus is:

A. 10.

B. 30.

C. 50.

D. 70.

E. 90.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 6
QUESTION 12

During acute hypovolaemia, which of the following mediators produces dilation of the renal afferent
arteriole?

A. Aldosterone.

B. Angiotensin II.

C. Anti diuretic hormone.

D. Prostaglandin I2.

E. Thromboxane.

QUESTION 13

A two-year-old boy presents with an incidentally noted abdominal mass. He is found to have sparse
pubic hair. Investigation confirms he has a hepatoblastoma.

Virilization is most likely in children with ectopic production of:

A. alpha fetoprotein.

B. androstenedione.

C. human chorionic gonadotrophin

D. luteinizing hormone

E. testosterone.

QUESTION 14

A woman presents for genetic counselling early in her first pregnancy. Her husband has a disorder
caused by a mitochondrial DNA point mutation; several other members of his family are also affected.

The risk that this baby will be affected by the same condition is closest to:

A. 0%.

B. 5%.

C. 25%.

D. 50%.

E. 100%.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 7
QUESTION 15

A 12-year-old girl presents to the Emergency Department following a motor vehicle accident
complaining of neck pain. She was a front seat passenger wearing a seat belt in a stationary car which
was hit from behind by a vehicle travelling at approximately 30 kilometers per hour. On examination
she has no bony tenderness and full neck movements with no neurological deficit.

Which of the following best describes the lateral cervical spine radiograph shown above?

A. Fracture C2 pedicles.

B. Fracture odontoid peg.

C. Pseudosubluxation of C2 on C3.

D. Spondylolisthesis of C2 on C3.

E. Anterior wedge fracture C3.

QUESTION 16

Children who are born with extremely low birth weight are surviving at higher rates than ever before.
What is the prevalence of severe neurological disability in surviving children who are born with
extremely low birth weight?

A. Less than 10%.

B. 10 to 20%.

C. 30 to 40%.

D. 50 to 60%.

E. Over 80%.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 8
QUESTION 17

The anterior pituitary gland releases all of the following hormones except:

A. adrenocorticotropin.

B. growth Hormone.

C. leuteinising hormone.

D. thyroid stimulating hormone.

E. vasopressin.

QUESTION 18

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 19

Lymph nodes are the major site for interaction between antigen presenting cells and:

A. B cells.

B. macrophages .

C. neutrophils.

D. NK cells.

E. T cells.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 9
QUESTION 20

Adolescence represents a stage of development where a number of cognitive and psychosocial tasks
must be mastered.

Which one of the following is not a task of adolescence?

A. Concrete operational thinking.

B. Establishing stronger peer group relationships.

C. Forming sexual relationships.

D. Identity formation.

E. Separation from the family group.

QUESTION 21

Which measure on spirometry is the most sensitive in children with small airways disease?

A. Forced Vital Capacity (FVC).

B. Forced Expiratory Volume in 1 second (FEV1).

C. Forced Expiratory Flow 25%-75% (FEF 25%-75%).

D. Peak flow.

E. FEV1/FVC ratio.

QUESTION 22

An otherwise well ten-year-old boy has chronic kidney disease secondary to posterior urethral valves.
His mother has noted that he is often very thirsty and drinks up to 2500mls of fluids per day.

Blood and urine tests from the outpatient clinic show:

Sodium (mmol/l) 140mmol/l [135-146]
Potassium (mmol/l) 4.5mmol/l [3.5-5.0]
Creatinine (mmol/l) 0.2mmol/l [0.05-0.090]
Urine sodium 70mmol/l
Urine creatinine 2.0mmol/l

Urine protein to Creatinine ratio 160mg/mmol [0-20]

The fractional excretion of sodium is:

A. 5%.

B. 10%.

C. 20%.

D. 30%.

E. 40%.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 10
QUESTION 23

A 15-year-old with a history of complex partial seizures is currently on carbamazepine. He develops

acute sinusitis and is prescribed an antibiotic by his general practitioner. He presents to the
emergency room with depressed conscious state and status epilepticus. He is found to have markedly
elevated carbamazepine levels.

Which of the following antibiotics is he likely to have been prescribed?

A. Amoxicillin-clavulinic acid.

B. Cefaclor.

C. Ciprofloxacin.

D. Doxycycline.

E. Erythromycin.

QUESTION 24

A previously well 14-year-old boy presents to the emergency department with a history of increasing
wheeze and shortness of breath over several days. On examination, he has facial fullness and
erythema, and his neck veins are easily visible. His chest X-ray is shown below.

A radiologically guided biopsy yields tissue consistent with lymphoblastic lymphoma.

Immunocytochemistry is likely to show the cells originate from which lymphocyte group?

A. Mature B cells.

B. Natural killer (NK) cells.

C. Precursor B cells.

D. Reed-Sternberg cells.

E. T cells.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 11
QUESTION 25

Patients with isolated hemihypertrophy are at increased risk of intra-abdominal tumours. Which of the
following tumors is the most likely to develop?

A. Adrenal carcinoma.

B. Hepatoblastoma.

C. Neuroblastoma.

D. Phaeochromocytoma.

E. Wilms tumour.

QUESTION 26

Which one of the following antibiotics is the most useful for treating community acquired infections
caused by resistant Staphylococcus aureus (MRSA)?

A. Amoxicillin-clavulanate acid.

B. Cephalexin.

C. Clindamycin.

D. Erythromycin.

E. Flucloxacillin.

QUESTION 27

In which segment of the gastrointestinal tract is most of dietary iron absorbed?

A. Distal ileum.

B. Duodenum.

C. Jejunum.

D. Proximal ileum.

E. Stomach.

QUESTION 28

Which of the following medications is least likely to cause significant sedation?

A. Atomoxotine.

B. Clonidine.

C. Fluoxetine.

D. Methylphenidate.

E. Risperidone.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 12
QUESTION 29

CDC (Centre for Disease Control) BMI (body mass index) 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. equal to or >95 percentile for age.

QUESTION 30

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

A. killing of staphylococcus aureus.

B. killing of atypical mycobacteria.

C. modulation of airway inflammation.

D. reduced adherence of Pseudomonas aeruginosa to airway epithelium.

E. upregulation of CFTR.

QUESTION 31

A 27-year-old pregnant Somali woman is referred from the antenatal clinic after a screening test
shows she is a carrier of Haemoglobin S (HbS). Her husband, also Somali, has not been tested.

Given that 1 in 10 Somalis are HbS carriers, the risk of her unborn baby having sickle cell disease is:

A. 1 in 2.

B. 1 in 4.

C. 1 in 10.

D. 1 in 20.

E. 1 in 40.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 13
QUESTION 32

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.

QUESTION 33

An infant is born at 26 weeks gestational with a birth weight of 750g. What are the expected insensible
water losses (mls/kg/hour) on day one of life?

A. 0.5 – 1.0.

B. 2.0 – 3.0.

C. 4.0 – 5.0.

D. 8.0 –10.0.

E. 12.0 – 15.0.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 14
QUESTION 34

Which one of the following drugs will most likely lead to an increase in tacrolimus drug levels and
nephrotoxicity?

A. Acyclovir.

B. Amoxycillin.

C. Fluconazole.

D. Prednisone.

E. Rifampicin.

QUESTION 35

Human Metapneumovirus infection is associated with which of the following?

A. Bronchiolitis.

B. Croup.

C. Febrile convulsions.

D. Gastroenteritis.

E. Viral exanthem.

QUESTION 36

Supplementation with which of the following micronutrients has been shown to be most effective in the
treatment of chronic diarrhoea in malnourished children?

A. Cyanocobalamin.

B. Folic acid.

C. Iron.

D. Magnesium.

E. Zinc.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 15
QUESTION 37

A five-year-old boy presents to the Emergency Department with a one week history of intermittent
vomiting and increasing lethargy with polyuria and thirst. Examination reveals deep sighing respiration
with severe dehydration. His initial blood chemistry is shown below:

Result Normal Range

Sodium (mmol/l) 133 [133-143]
Potassium (mmol/l) 4.8 [3.8-6.0]
Chloride (mmol/l) 101 [95-110]
Bicarbonate (mmol/l) 5.0 [18-24]
Anion Gap 31.8 [< 18]
Glucose (mmol/l) 29.5 [3.5-5.5]
pH 7.09 [7.36-7.44]
pCO2 (mmHg) 22 [35-45]
Base Excess (mmol/l) -23 [0-2]

Which of the following substances best accounts for the elevated anion gap?

A. Glucose.

B. Hydrogen.

C. Ketones.

D. Lactate.

E. Phosphate.

QUESTION 38
A four-year-old boy has an 11-year-old sister who has recently been diagnosed with Type 1 diabetes
mellitus. His parents seek advice about the risk of their son also developing Type 1 diabetes.

His lifetime risk of developing Type 1 diabetes mellitus is closest to:

A. 0.5%.

B. 5%.

C. 25%.

D. 50%.

E. 100%.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 16
QUESTION 39

The optimal method of rehydration in children with gastroenteritis is widely accepted to be through the
use of Oral Rehydration Solution because it optimises the absorption of both water and electrolytes in
appropriate quantities.

Which of the following best describes the mechanism by which water is absorbed from the
gastrointestinal lumen?

A. Activation of adenylate cyclase.

B. Active transport via sodium - glucose cotransporter.

C. Active transport via sodium - water cotransporter.

D. Passive diffusion across an osmotic gradient.

E. Utilisation of sodium - potassium ATPase pump.

QUESTION 40

A term infant was noted to have a grade 3/6 systolic murmur prior to discharge. Oxygen saturations
were measured at 90%. The child’s ECG is shown below.

The most likely diagnosis is:

A. atrioventricular septal defect.

B. pulmonary valve stenosis .

C. severe aortic stenosis.

D. tricuspid atresia.

E. truncus arteriosus.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 17
QUESTION 41

A 40-year-old woman has chorionic villus sampling because of the age-related risk of chromosomal
abnormalities in her pregnancy. The karyotype is shown below. There is no evidence of confined
placental mosaicism.

The most likely outcome for this pregnancy is:

A. a child with Angelman syndrome.

B. a child with multiple congenital malformations who dies in the first weeks of life.

C. a child with Prader-Willi syndrome.

D. a normal child.

E. spontaneous abortion.

QUESTION 42

Which vitamin B complex nutritional deficiency is most likely to cause angular cheilosis and glossitis?

A. Cobalamin.

B. Folate.

C. Niacin.

D. Riboflavin.

E. Thiamin.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 18
QUESTION 43

According to the diagram shown above, the most common type of oesophageal atresia is:

A. a.

B. b.

C. c.

D. d.

E. e.

QUESTION 44
A 14-year-old girl with Type 1 diabetes mellitus is seen for follow-up of her diabetes. She has had two
severe hypoglycaemic episodes in the last three months. Both of these have been associated with the
use of alcohol.

Which of the following mechanisms best explains alcohol related hypoglycaemia?

A. Increased insulin absorption.

B. Increased insulin sensitivity.

C. Interaction with other drug use.

D. Reduction counter-regulatory hormone responses.

E. Suppresses hepatic gluconeogenesis.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 19
QUESTION 45

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.

QUESTION 46

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.

E. Vitamin E.

QUESTION 47

An infant with cyanotic congenital heart disease has a blood gas performed in room air which shows a
PO2 of 40 mmHg and PCO2 of 40 mmHg. The infant has no associated lung disease. The PO2 and
PCO2 in 100% O2 would be closest to:

A. 40 mmHg.

B. 50 mmHg.

C. 80 mmHg.

D. 100 mmHg.

E. 320 mmHg.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 20
QUESTION 48

Desmopressin (DDAVP) can limit bleeding in type 1 von Willebrand disease by transiently increasing
plasma von Willebrand factor (vWF) and factor VIII (FVIII) levels.

The mechanism by which this occurs is:

A. decreased breakdown of Vwf.

B. increased synthesis of FVIII.

C. increased synthesis of vWF.

D. release of FVIII from platelets.

E. release of vWF from endothelial cells.

QUESTION 49

Which of the following immune responses best describes ABO incompatibility?

A. Antibody dependent cytotoxicity.

B. Delayed type hypersensitivity.

C. Immediate hypersensitivity.

D. Immune complex mediated.

E. T cell mediated cytotoxicity.

QUESTION 50

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.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 21
QUESTION 51

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 millimoles / litre.

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 52

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.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 22
QUESTION 53

Which of the following best describes the mechanism of action of the thiazolidinediones?

A. Increased insulin sensitivity.

B. Increased insulin synthesis.

C. Stimulation of beta cell proliferation.

D. Stimulation of conversion of pro-insulin to C peptide.

E. Stimulation of insulin secretion.

QUESTION 54

A seven-year-old boy with a diagnosis of intractable epilepsy is prescribed an anticonvulsant. Six

months later, he presents with a four hour history of colicky abdominal pain and vomiting. Examination
reveals him to be distressed and pale. He is not jaundiced. During the examination he suffers a bout
of pain. A diagnosis of renal colic is made.

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 55

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. Mannose.

C. Mannitol.

D. Sorbitol.

E. Sucrose.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 23
QUESTION 56

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.

QUESTION 57

Which of the following is not a common side effect of therapy with cyclosporin?

A. hirsutism.

B. hypertension.

C. hypomagnesaemia.

D. renal impairment.

E. tinnitus.

QUESTION 58

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 .

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 24
QUESTION 59

Oral medications, Drugs A and B, have the following properties in healthy individuals.

Drug A Drug B
Absorption 100% 100%
Bioavailability 2% 90%
Volume of distribution 350 L 50 L
Renal Clearance 2 L/hr 1 L/hr
Hepatic clearance 10 L/hr 2 L/hr
Protein Binding 75% 25%

Compared to healthy individuals, patients with cirrhosis have a much higher concentration of drug A
than drug B. The best explanation for this is the difference in:

A. bioavailability.

B. volume of distribution.

C. renal clearance.

D. hepatic clearance.

E. protein binding.

QUESTION 60

Jaundice in the first 24 hours of life is most commonly due to:

A. biliary atresia.

B. breast milk jaundice.

C. haemolytic disorders.

D. hepatocellular damage secondary to birth asphyxia.

E. physiological jaundice.

QUESTION 61

The most common psychiatric cause of school refusal in older adolescents is:

A. conduct disorder.

B. oppositional defiant disorder.

C. obsessive compulsive disorder.

D. separation anxiety disorder.

E. social phobia.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 25
QUESTION 62

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.

QUESTION 63

If Rubella vaccine is inadvertently given to a woman in the first four weeks of pregnancy the risk of
vaccine related birth defects is closest to:

A. 1%.

B. 5%.

C. 10%.

D. 20%.

E. 50%.

QUESTION 64

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 65

Which subgroup of children with cerebral palsy is at most risk of hip displacement?

A. Ataxic.

B. Hypotonic.

C. Spastic diplegia.

D. Spastic hemiplegia.

E. Spastic quadriplegia.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 26
QUESTION 66

A one-day-old male infant of a diabetic mother has a seizure. At the time his blood glucose registers
as 'LO' on the bedside glucometer and a formal blood glucose is measured as 1.2 mmol/L [ 2.8 - 7.8
mmol/L].

Which of the following investigation profiles is most likely?

Serum Insulin Serum Ketones Urinary Reducing Substances

A ↑ ↑ Negative

B ↑ ↓ Negative

C ↑ ↓ Positive

D ↓ ↑ Negative

E ↓ ↓ Positive

QUESTION 67

Which of the following cells is most likely to cause bony erosions in patients with rheumatoid arthritis?

A. T-Lymphocyte.

B. B-Lymphocyte.

C. Osteoclast.

D. Osteoblast.

E. Plasma cells.

QUESTION 68

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.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 27
QUESTION 69

In the performance of spirometry in 6-12 year old children, the flow volume curves should appear
similar in configuration on repeat testing.

What is the maximum allowable variation on repeat testing?

A. 5%

B. 10%

C. 15%

D. 20%

E. 25%

QUESTION 70

The most likely cause of an IgE level of 2000 (Normal: 0-35kIU/L) in a two-year-old child is:

A. allergic rhinitis.

B. asthma.

C. atopic dermatitis.

D. food allergy.

E. hyperIgE syndrome.

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 28
 Paediatrics & Child Health

Paper 1 – Medical Sciences

Answers

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

2007 FRACP Written Examination Paper 1 - Medical Sciences Paediatrics & Child Health 29