FRACP recall paper 2002

This paper has been compiled by candidates who sat the 2002 exam, from the Austin &
Repatriation Medical Centre, Concorde, Fremantle, and Canberra Hospitals. It has been
supplied to DeltaMed by the authors and it is their request that it be distributed to all
candidates for the 2003 exam.

The paper was dominated by a disproportionate number of questions in the following

areas:
psychiatry epidemiol – especially phases of trials
geriatrics
genetics CT brains
applied pharmacology Pituitary endocrinology

There were no questions in the following areas:

cerebrovascular disease obesity
GN malaria
MS immunodfeciency
CRC / screening

Part A - 70 questions, 2 hours

Question 1
24 year old male with past history of transposition of the great vessels as a child
his ECG is show. Pick the most appropriate option

the ECG was a RBBB and appeared to have very large voltages and signs of strain in the
RV leads (more than would be expected from just RBBB). The axis was very hard to
work out because of the quality of the ECG and multiple leads had to be employed (aVR,
I, II, III, aVF) to calculate it

RBBB RVH Axis

A Y Y +140
B Y Y +240
C N N -140
D N Y -240
E Y N +140

Question 2
Repeat question – which of the following is most likely to lead to abnormal protein
synthesis?
A. missense
B. nonsense
C. translocations
D. splicing defect
E. single nucleotide substitution

FRACP 2002 Recall Exam 1

Question 3
Which of the following is the most common acute complication of PEG insertion?
A. acute bleeding at the insertion site
B. infection at the insertion site
C. peritonitis
D. gastric perforation
E. colonic perforation

Question 4
What is the purpose of a phase I trial for a chemotherapeutic agent?
A. so that the patient does not lose hope
B. to establish the maximum tolerated dose
C. to measure tumour response
D. to establish tumour free survivial
E. to determine the optimal dosage schedule

Question 5
What is the mechanism of resistance of Vancomycin in enterococcus?
A. alteration in the cell wall structure of the bacteria leading to  binding
B. alteration of PBPs
C. production of  lactamase
D. alteration of ribosomal proteins
E. active efflux

Question 6
Which of the following has the slowest clearance?
Drug Volume of Distribution (L) Half life (min)
(a) Amiloride 4000 300
(b) Amiodarone 600 40
(c) Tolbutamide 7 6
(d) Digoxin 300 15

Question 7
Hysteresis curve showing plot of drug concentration vs response?

the graph demonstrates

A. delayed oral absorption

B. down regulation of receptors
C. redistribution of drug to target
site
D. irreversible binding of drug to
receptor
E. reduced bioavailability

Question 8
FRACP 2002 Recall Exam 2
Warfarin is metabolized via the cytochrome P450 system. It characteristically has a low
1st pass hepatic clearance and slow clearance when given orally. Which of the following
options best describes the effect that a cytochrome P450 inhibitor such as erythromycin
would have?

bioavailability clearance
A ↔ ↑
B ↔ ↓
C ↑ ↓
D ↑ ↔
E ↓ ↓

Legend: ↔ no significant change

↓ significant decrease
↑ significant increase

Question 9
The plasma levels of lignocaine following an IV bolus seems to fall faster than
would be expected by its plasma clearance. The main reason for this is because

A. it is rapidly protein bound

B. it is rapidly distributed into fat
C. it induces its own metabolism
D. it undergoes rapid 1st pass metabolism
E. ???

Question 10
Which of the following best describes the reasons for obtaining informed consent
in patients entering clinical trials?

A. beneficence
B. non malfeasance
C. Justice
D. Risk management
E. Autonomy

Question 11
Which of the following provides the best assessment of the long term risk of
morbidity/mortality and institutionalization of an elderly patient?

A. max gait speed of habitual walk

B. 6 min walk test
C. recurrent chair rise times
D. heel-toe tandem gait
E. average speed of habitual gait

Question 12
An indigenous man in a remote area of Australia is being screen for renal disease in a
community with a 30% incidence of renal disease. His blood pressure is 140/90 and he

FRACP 2002 Recall Exam 3

has +1 protein in his urine (sens 85%, spec 80%). Which of the following is the next best
investigation?
A. repeat early morning urine for dipstix
B. renal biopsy
C. MSU
D. 24 hour urine
E. urinary Cr/Alb ratio

Question 13
A middle aged man has chronic stable angina and is on metoprol and isosorbide
mononitrate 60 mg daily. He has had only 2 episodes of chest pain in the last 6 months
and has not required to use his GTN tablets. He present to ED with a history of 30
minutes of chest pain which has occurred following an unusual amount of heavy exertion.
The pain is unrelieved by 3 of his GTN tablets. On arrival at the hospital the pain
resolves with oxygen. Which of the following is the most likely diagnosis /cause of pain?
A. unstable angina
B. nitrate tolerance
C. reduced efficiency of medications
D. ?? AMI
E. non cardiac pain

Question 14
A patient present for assessment one week following the resection of a pituitary
macroadenoma with post op XRT. She is on budesonide 400 mcg per day.
The following results are obtained
Early morning cortisol 120 (200- ?)
30 min following synacthen 550 (>500)
which of the following provides the best explanation for these results?
A. intact hypo-pituitary-adrenal axis
B. normal baseline function but inadequate stress response
C. prior budesonide exposure
D. primary hypoadrenalism
E. secondary hypoadrenalism

Question 15
A patient is presenting to a neurosurgical unit for the resection of an acoustic
neuroma. He has a family history involving a mutation in the NF2 gene. The gel
electrophoresis with NF2 probe for his tumour, peripheral blood, and a normal
control are shown below. Which of the following offers the best explanation for
the electrophoresis results?
** 1 = control
** 2 = patients blood
A. loss of normal NF2 gene from ** 3 = patients tumour
patients blood
B. loss of normal NF2 gene from
patients tumour
C. splitting of NF2 gene in blood
D. loss of abnormal NF2 in tumour
E. gain of extra abnormal NF2 in
blood

FRACP 2002 Recall Exam 4

Question 16
Which of the following conditions is most strongly associated with H.pylori infection?
A. gastric carcinoma
B. MALTOMA
C. Barrets esophagitis
D. Pernicious anemia
E. Non ulcerative dyspepsia
Question 17
A 26 year old female presents with lethargy, pallor and dark urine. She is on no
medications other than the OCP. o/e she is mildly icteric. Blood tests reveal

a. Hb 8.2, WCC and plt normal

b. mild  MCV (102)
c. increased reticulocytes
d.  LDH

which of the following is the next best

investigation?
A. G6PD isoenzyme testing
B. Heinz body preparation
C. Unconjugated BR
D. Urinary haemosiderin
E. Coombs testing (DAT)

Question 18
What is the most likely explanation for the improvement in lung function which follows
lung volume reduction surgery?
A. increased CO
B. increased VR
C. improved matching of V/Q
D. increased pulmonary recoil
E. reduced central ventilatory drive

Question 19
A young asthmatic presents with severe SOB. ABGs show
pH 7.30

FRACP 2002 Recall Exam 5

 PO2 = 65
PCO2 = 33
Following the administration of IV salbutamol the PO2 worsens but the PCO2 remains
the same. Which of the following provides the best explanation?
A. bronchodilation to areas of low V/Q
B. pulmonary vasodilation to areas of low V/Q
C. peripheral vasodilation
D. increased muscle usage of O2
E. decreased CO

Question 20
Maximal O2 consumption is a measure of general cardiovascular fitness. What is the
most likely explanation for the reduction in maximal O2 which occurs with normal
ageing?
A. reduction in maximal HR
B. reduction in SV
C. reduction in FEV1
D. reduction in total lung capacity
E. ?? generalized respiratory muscle fatigue

Question 21
A middle aged present following surgery and XRT for a pituitary adenoma. She is on the
following drugs
Hydrocortisone (20 mg per day in divided doses = the equivalent of 25 mg cortisone per
day)
Thyroxine 150 g
Fluoxetine 20 mg daily

She now present with obesity and abdo striae and lethargy
Which of the following is the most likely cause?
A. inadequate T4 replacement
B. XS cortisol replacement
C. Growth hormone deficiency
D. Fluoxetine therapy
E. ??

Question 22
The following survival curves are shown for a particular malignancy with treatments A
and B. Which of the following is most true with respect to therapy A?

FRACP 2002 Recall Exam 6

 A. reduced median survival but better long term survival
B. better median survival and long term survival
C. reduced median survival and long term survival
D. identical median but improved long term survival
E. improved median and long term survival
Question 23
Repeat question – where is the highest concentration of Cox 2?
A. gastric mucosa
B. platelets
C. OA synovium
D. RA synovium
E. Scar tissue

Question 24
A middle aged man has moderate-severe OSA. What is the main mechanism underlying
his daytime sleepiness?
A. increased PCO2
B. reduced quantity of  wave sleep
C. increased sleep fragmentation
D. respiratory muscle fatigue
E. hypoxic induced brain injury

Question 25
A patient with mitral stenosis is being offered for surgery because of SOB. Assuming
that her LV function is normal and that her MVA is < 1 cm2, which of the following
portends to the worst long term prognosis?

CO varied from 2.0 – 4.0

I cant recall all of the permutations

CO RA pressure RV pressure PCWP PVR (woods

units)
3 4
2.5 66/ 2

FRACP 2002 Recall Exam 7

 2.5 55/ 15 10
2.5 2
2.5 70/10 4

Question 26
In patients with oliguria which is due to sepsis, which of the following therapies other
than antibiotics, is most likely to preserve renal function?

A. Lasix – IV continuous infusion

B. Lasix – IV intermittent boluses
C. Prostacyclin
D. Renal dose DA
E. Adr

Question 27
A diabetic lady undergoes cath for CAD. She is found to have 2VD which will need
plasties. She is on enalopril, celebrex, and a blocker. Post 1st angiogram her Cr
increases from 0.10 to 0.18. which of the following intervention is least likely to
preserve her renal function?
A. Delaying the procedure for at least 48 hours
B. withholding the celebrex
C. withholding the enalopril
D. giving IV fluid
E. giving IV lasix

Question 28
Which of the following investigation is the most sensitive for the diagnosis of gall
stones?
A. ultrasound
B. MRI
C. Plain XR
D. HIDA scan
E. CT

Question 29
A new anti-HT agent is being trialed. It is being tested in 1000 patients in 50 centers for
a 3 month period and is being compared to the standard anti-HT agent. Which of the
following best describes the nature of the trial?
A. it is a pre-marketing assessment
B. it is a phase IV trial
C. it is a phase III trial
D. it is a phase II trial
E. it is a phase I trial

Question 30
Which of the following cells of the immune system relies most heavily on the release of
substances into the extra-cellular fluid for killing of organisms?
A. neutrophils

FRACP 2002 Recall Exam 8

 B. eosinophils
C. NK cells
D. Cytotoxic T cells
E. Macrophages

Question 31
Which of the following cell surface markers is the least important for the function of the
NK cell?

A. IgG Fc receptor
B. MHC I
C. MHC II
D. NK cell activating receptor
E. NK cell inhibitory receptor

Question 32

Repeat question on -lactam antibiotics. Which of the following is the most

important pharmokinetic parameter in prescribing ?
A. area below curve
B. plasma conc/MIC
C. Time spent above MIC
D. Ratio AUC/MIC
E. Both D and B

Question 33
Poorly worded genetics question. A young man presents with a history of an X-linked
condition with mutation at position 27. The responsible gene has ? exons and ? introns.
The following genetic sequence was taken out of ?? exon 1. which of the following is
the most appropriate genetic interpretation of the mutation.
(I am unsure of the exact sequence – I think that this was in exon one and the sequence
may be impt as it could be a start codon which has been converted into a stop codon ? can
anybody recall) there was a single nucleotide inserted in the abnormal gene such that
there was a frame shift

gtcacttgaca
gtcaacttgac

the options were worded as follows

A. “the patient has a pathological mutation”

B. “the interpretation is in the flanking sequence of DNA”
C. “the interpretation is in the reading frame”
D. “the interpretation is due to polymorphisms”

Question 34
A trial was performed to determine benefits of smoking cessation, within a group of
patients with COAD who attend a particular hospital outpatient clinic. ‘Intention to treat’
analysis is most likely to result in

FRACP 2002 Recall Exam 9

 (a) Overestimation of efficacy of the trial
(b) Underestimation of efficacy of the trial
(c) Selection Bias
(d) Inaccuracy of the measures of outcome

Question 35
Patient with hyponatremia –?? (presented with confusion, headache and increased thirst)

Na 117
K 3.5
Cl 85
HCO3 = 30
BSL 10

Urinary Na 100
Urinary K 20
Urinary osmolarity 580

Which of the following is the most likely cause?

A. SIADH
B. Diuretics
C. Hypothyroidism
D. DM induced glycosuria
E. RTA

Question 36
A 17 year old Philipino girl presents with BSL of 28. She is obese and has acanthosis
nigricans and skin folds in her axillae. Her BSL is 28 and there is +1 ketones in her
urine. She has a family history of DM in her grandfather, mother and sister. What is the
most likely cause of her DM?
A. IDDM – idiopathic
B. IDDM – autoimmune
C. NIDDM – idiopathic
D. NIDDM – glucokinase deficiency
E. NIDDM – HNF – 1
Question 37
In patients with OA of the knee which of the following is the strongest RF?
A. increasing age
B. obesity
C. osteoporosis
D. “LL injury in youth” – i.e. no mention of intra-articular #
E. steroid use
F. Paget’s

Question 38
A young man is having a transfusion for H and M. He has never been transfused before.
During his 3rd unit he has a reaction with hypotension and sweating. In the absence of
ABO, Rh, and minor blood Ag incompatibility what is the most likely cause of this
reaction?
FRACP 2002 Recall Exam 10
 A. bacterial contamination of the blood
B. XS citrate
C. change in U and E
D. allergic reaction to plastics
E. GVHD

Question 39
Which of the following is most likely to be prevented with leuko-depletion of blood for
transfusion?
A. HCV
B. CMV
C. XS citrate
D. malaria
E. anaphylaxis
F. HIV

Question 40
Repeat question – which of the following is most likely to result in the
transmission of HCV?

A. IVDU
B. Unprotected sex with infected person
C. Sharing utensils with infected person
D. Normal vaginal delivery of baby
E. ?? blood transfusion

Question 41
Which of the following is least likely to occur following successful immunotherapy with
bee sting venom?

A. reduction of TH2 cytokines (?? Which ones)

B. increase in TH1 cytokines (?? Which ones)
C. production of blocking IgG
D. loss of specific B cell clone
E. increase in IL10

Question 42
Question regarding anemia
75 year man on PDN for PMR presents with shoulder and hip stiffness,  ESR and
anemia and some recent dyspepsia. He is on low dose PDN

Hb 10 ish
mildly microcytic
transferrin  (lower end normal)
Fe ()
Ferretin 200
Transferring receptor approx midrange
Plt 500, ESR 45

? aetiology of anemia

FRACP 2002 Recall Exam 11

 A. anemia of chronic disease
B. iron deficient anemia
C. sideroblastic anemia
D. thalassemia

Question 43
What is the commonest cause of impotence in elderly men?
A. vascular
B. psychogenic
C. neurogenic
D. Diabetes
E. Medications

Question 44
A patient with Ca is on a morphine infusion at 4mg per hour. You wish to change them
to slow release morphine. Which of the following is the most appropriate dose?
A. 50 mg bd
B. 100mg bd
C. 200 mg bd
D. 250 mg bd
E. 75 mg bd

Question 45
A women with metastatic Ca and lower back mets. Previously well controlled on
morphine and now presents with increasing hip pain. Which is most appropriate while
awaiting investigations?
A. change to tramadol
B. change to fentanyl
C. change to oxycodone
D. increase morphine
E. give morphine more frequently

Question 46 (concorde 65)

Which of the following events is the least important with respect to Langerhans cells
This was quite similar to the NK cell question - ?? details correct
A. activation following binding to bacterial carbohydrate
B. interaction with MHC II
C. interaction with MHC I
D. migration to LN after Ag encountered
E. up-regulation of co-stimulatory molecules following Ag encounter
Question 47
a 26 year old female with schizophrenia is on olanzepine. She now presents with weight
gain and amenorrhoea. Which of the following is likely to be the cause of her
amenorrhoea?
A. olanzepine
B. eating disorder
C. premature ovarian failure
D. weight gain
E. amphetamine abuse

Question 48
FRACP 2002 Recall Exam 12
Which of the following is least likely in CJD?
A. areflexia
B. myotonia
C. visual field defect
D. cerebellar signs / abnormal gait
E. dementia

Question 49
Which of the following best describes the best indicator of success of a phase III trial
with a novel melanoma vaccine?
A. serological response to the vaccine
B. melanoma associated mortality and QOL
C. disease free remission from tumour
D. response rate of tumour

Question 50
Repeat question – in which of the following tissues are you likely to find T cells with
both CD4 and CD8 in an adult?
A. BM
B. Thymus
C. Liver
D. Spleen
E. Blood

Question 51
Patient with recent onset of lower back pain. Has now developed weakness in foot dorsi-
flexion and loss of sensation over the medial aspect of dorsum of the foot. Ankle and
knee reflexes are normal? what is the most likely mechanism?
A. lumbar disc prolapse L4/L5
B. lateral nerve root entrapment L5/S1
C. spondylolysthesis L4/L5
D. L4/L5 zygo-appophyseal joint hypertrophy
E. S1/S2 spinal canal stenosis

Question 52
A 25 yo man presents 2 days after laying tiles on the floor (has been squatting), with
a unilateral foot drop. What is the most likely cause?
A. L5 radiculopathy
B. acute inflammatory demyelinating polyneuropathy
C. peroneal neuropathy
D. sciatic neuropathy
E. tile layer’s knee

Question 53
A 50 year old man is treated for his 1st episode of major depression. What is the
likelihood of recurrence?
A. < 1%
B 10%
C. 25%
D. 50%
E. 90%
FRACP 2002 Recall Exam 13
Question 54
Which of the following is least likely to protect a patient from hip # with falls in 82 year
old female in nursing home?
A. Ca supplements (no mention of Vit D)
B. Estrogen
C. Aledronate
D. Proximal muscle strengthening
E. Hip protectors

Question 55
Which of the following most likely represents maternal uniparental disomy?

Mother Father Child

1 1 2
2 1 3
2 0 2
1 1 3
2 1 2
Question 56
Which of the following is the most potent inhibitor of aldosterone release?

A. increased ang II
B. increased K
C. increased ANP
D. dietary Na restriction
E. ACTH

Question 57
A drug has a half life of 30 hours. An IV loading dose is given and then a daily oral dose
How long before the drug levels reach steady-state.?
A. 6 days
B. 4 days
C. 30 days
D. 2 days
E. 10 days

Question 58
52 yo male presenting with headache, lethargy for Ix. Smoker 20 cigs per day.
Examination SOB and plethoric
Ix: Normal CU and E ; Hb 216, WCC  with neutrophilia, plt 450
What would be the most useful investigation to determine if he has PCRV?

(a) Increased red cell mass

(b) Increased uric acid level
(c) Low EPO levels
(d) Serum B12 levels
(e) ?

Question 59

FRACP 2002 Recall Exam 14

Which of the following immune mechanisms is responsible for the response seen in
tuberculoid leprosy?
A. Complement
B. Specific cell mediated immunity
C. Immune complexes
D. Humeral response
E. hypersenstivity

Question 60
Repeat question: What is the mechanism of toxicity of gentamicin?
A. proximal tubular dysfunction
B. precipitation of casts in tubules
C. afferent arteriolar vasospasm
D. increased SVR
E. ischemic medulla

Question 61
Which of the following is least likely to be a feature of Cyclosporin A renal toxicity?
(a) Interstitial fibrosis
(b) Hyperkalaemia
(c) Hyperuricaemia/ Decreased uric acid excretion
(d) Glomerulopathy
(e) Vascular damage/Spasm

Question 62
which of the following is the most likely mechanism underlying the pathogenesis of
preeclampsia?
A. uterine and placental ischemia
B. hypovolemia
C. ??hypo Mg or pre-existing HT
D. renal impairment / reduced renal blood flow
E. complement activation

Question 63
a young female presents with dizziness which is relieved by eating. She is on no
medications. Which of the following combinations is most likely to represent an
insulinoma ?

BSL Insulin c-peptide Sulphon screen

2   -
2   -
2   +
3.5   -
3.5   +
Question 64
PCR is increasingly being applied to various aspects of medicine. This most crucial
element of the test involves the use of a DNA polymerase. Which of the following best
describes the actions of DNA pol in the PCR reaction
A. denatures the DNA
B. helps form bond between primer and target strand of DNA
FRACP 2002 Recall Exam 15
 C. extends primer once it is in place
D. synthesis of cDNA from mRNA
E.
Question 65
The following outlines the steps involved in a southern blot (or southern hybridization) in
random order. Which of the following options below describes the correct order
1. transfer of DNA to semisynthetic memebrane
2. digestion of DNA using endonucleases (they used another name)
3. separation of DNA using electrophoresis (I don’t think the words
“digested DNA” appeared in this part)
4. probing of DNA with labeled DNA (again I don’t think the words
“separated DNA” appeared in this part)

A. 1 2 3 4
B. 4 3 2 1
C. 2 3 1 4
D 1 3 2 4
E. 4 2 1 3
Question 66
In cirrhosis, which is the stongest predictor of variceal bleeding?

(a) PT
(b) Platelets
(c) Portal venous pressure
(d) Systemic pressure
(e) Child-Pugh score

Question 67
The greatest risk of aspiration after stroke would occur with:
a) facial droop
b) absent bilateral gag reflex
c) dysarthria
d) moist cough and weak vocal chords
e) lip smacking

Question 68
Husband and wife both with thalassaemia. Seek genetic counselling prior to having a
child. Which of the following combinations would be the least to worry about?

Mother Father
(a)  
(b)  
(c) HbE 
(d) + 
(e)  +

Question 69
Digoxin has a T1/2 of 33 hours. How long before it reaches steady state?

Question 70

FRACP 2002 Recall Exam 16

45 man with DM (no comment on whether recently diagnosed ) present with hand
arthritis. A left hand XR with shows a number of sclerotic erosions on the radial side of
the bases of the prox. Phalanges and ? chondrocalcinois (highly suggestive of HCT)
what is the most likely cause?
A. RA
B. HCT
C. Gout
D. OA

FRACP 2002 Recall Exam 17

 Part B - 100 questions, 3 hours
Question 1
To assess the efficacy of an intervention the analysis of number needed to treat is
increasingly being applied. An intervention for optimal control of asthma results in a
50% reduction in hospital admissions such that the rates of admissions are 10% and 5%
for the control and intervention groups respectively. On the basis of this the number
needed to treat is
A. 1
B. 50
C. 2
D. 20
E. 10

Question 2
which of the following arteries is the commonest to be involved in Takayasus vasculitis?
A. abdominal aorta
B. subclavian
C. coronaries
D. renals
E. Coeliac plexus

Question 3
Patient presents with head injury. In ICU on ventilator, suffers Seizure. Given
IV bolus of phenytoin (1000mg) and then daily dose down NGT(300mg). On
NGT feeds. At day 8 he has a very subtherapeutic phenytoin dose. What is the
most likely cause?

A. omeprazole
B. feeds
C. hyperventilation
D. metronidazole
E. erythromycin

Question 4
what is the commonest cause of death at more than 6 months post cardiac transplant?
A. rejection
B. opportunistic infection
C. coronary artery disease
D. malignancy
E. GVHD

Question 5
patient with PMR which has relapsed on reduction of steroids. Now presents with
worsening of symptoms. She has known osteoporosis with previous thoracic crush #, and
has had a hysterectomy. BMD in hips and back is reduced (t –scores = -2.5 and -3,
respectively). ??Biopsy confirms arteritis. Which of the following combinations is most
appropriate?
FRACP 2002 Recall Exam 18
 A. PDN (10mg) and azothiprine (100mg)
B. PDN (40mg) and aledronate 10mg
C. PDN (40mg) and calcitriol (0.25mcg bd)
D. PDN and MTX
E. PDN (40mg) and HRT

Question 6
Repeat question. Mildle aged man with renal impairment (?? CR 0.16 – might be impt
for allopurinol dose) on warfarin (??for AF). Has had gout arthritis in past. Now
presents with gout while gently trying to increase allopurinol which is now at 200 mg.
what is best course of management?
A. increase allopurinol to 300 mg and start colchicine
B. start PDN (??20 mg) and continue allopurinol at 200mg
C. keep allopurinol the same and start NSAID
D. start pred and increase allopurinol
E. ???

Question 7
a 22 y.o. female has had epilepsy for 3 years. She complains of reduced visual acuity at
night. Formal visual field testing reveals a scotoma. Which of the following drugs is the
most likely cause?
A. carbemazepine
B. valproate
C. vigabatrin
D. pheytoin
E. ethosuximide

Question 8
a young prima-gravida presents at 32 weeks with RUQ pain and BP 150/90. she has +1
protein in her urine and no swelling of ankles.
LFTS AST 670
ALT 590
BR 76
 GT 40
ALP 56
What is the most likely cause of her presentation?
A. fatty liver of pregnancy
B. preeclampsia
C. gallstones
D. hepatitis
E.

Question 9
Repeat question regarding diabetic with 3rd nerve palsy which shows that papillary reflex
is relatively intact. What is the most likely cause?
A. DM
B. PICA aneurysm
C. Vasculitis

Question 10

FRACP 2002 Recall Exam 19

Which of the following best describes the utility of CEA in the management of colorectal
cancer?
A. selecting patients which require adjunctive chemotherapy
B. monitoring the response to adjunctive therapy
C. staging
D. screening relatives
E. monitoring for the development of recurrent respectable disease post Rx

Question 11
a hospital staff member is exposed the measles. There is no prior history of
immunization or infection. Which of the following is the most appropriate course of
management?
A. measles Ig
B. Vaccinate with live attenuated measles vaccine
C. observation
D. urgent serology

Question 12
A 36/40 pregnant female is exposed to chicken pox in the prior 24 hours. She has no
history of infection or immunisation in past. Which of the following is the most
appropriate management?
A. acyclovir
B. ZIG
C. vaccination
D. urgent serology
E. observation

Question 12
Which of the following best describes the mechanism of action of naltrexone?
A. reduces symptoms of withdrawal
B. reduced euphoria associated with opiods
C. unpleasant sensation when taking with opiods
D. increased tolerance to effects of opiods
E. reduced cravings for opiods

Question 13
A patient is at day 50 post op renal transplant. The serum Cr has risen from 0.10 to 0.18.
the BP is 150/90 with no postural drop. JVP is 2cm. the last 24 hours UO = 800 ml.
which of the following is the most appropriate next investigation
A. ultrasound
B. biopsy
C. nuclear med renal perfusion scan
D. CT abdo
E.

Question 14
A large Samoan man with 4 year history of NIDDM on oral hypo-glycemics present with
haematemesis. He is scope and found to have an ulcer in the pyloric channel. He is
found to be H.pylori positive and has successful eradication. 4 weeks later he presents
with vomiting. o/e he is relatively well
AXR shown
FRACP 2002 Recall Exam 20
what is he most likely aetiology of presentation?
A. gastric outlet obstruction
B. gastro-paresis secondary to DM
C. SBO
D. Gastric perforation
E. Gastric volvulus

Question 15
A middle aged man presents with 6 hours of palpitations and had chest pain
The ECG shows broad complex irregularly irregular rhythm with rate 250 – 300. BP
90/50. what is the best management
A. digoxin
B. DCR
C. Amioderone
D. Sotolol
E. Adenosine
F. lignocaine

Question 16
A 15 year old girl presents with a 2 years history of dizzy spells 1st thing in the morning.
They have occurred on an irregular basis (i.e. not frequent). A poor quality rhythm strip
with a wandering baseline is shown which contains a small run (< 30 beats) of self
terminating broad complex tachycardia. This is regular – most likely VT. The strip
before the VT shows 2 VEs – there was no obvious R on T or capture wave. You are told
that this strip was taken when the patient was presyncopal. The 12 lead ECG when the
patient is not symptomatic shows a sinus bradycardia (35 – 40 bpm). The PR interval is
normal and there is no  wave ???? what was the QTc

You’re asked “what’s the most likely intervention to prevent recurrence of the event”?
A. atrial pacing
B. implantable defibrillation
C. amioderone
D. metoprolol
E. sotolol
FRACP 2002 Recall Exam 21
Question 17
question on CF genetics – 75% of cases of cystic fibrosis is due to a the F508 mutation
in the CFTR gene. A young girl is the index case of CF in a particular family. Genetic
analysis reveals that she has a single copy of the F508 mutation. Analysis of her
brothers DNA does not reveal the F508 mutation. What is the risk that he is a carrier
for CF??
A. ½
B. ¼
C. 1/3
D. 1/6
E. 2/3

Question 18
a middle aged female presents with one hour history of chest pain and STAMI inferiorly.
She is thrombolysed with SK. 2 hours later there is still ST elevation and she still has
pain. ?? BP is low and she is oliguric. What is the most likely intervention to prolong
life expectancy?
A. PTCA RCA
B. giving further thrombolysis with tPA
C. inotropes
D. IABP
E. IV crystalloid

This would appear to be a cleaned up version of last years question involving RV

infarct and bradycardia

Question 19
Which of the following agents has its effect via a direct toxic effect rather than via one its
metabolites?
A. Metathione
B. Methanol
C. Ethylene glycol
D. Amitriptyline
E. Li
F. TCA

Question 20
A middle aged man on amioderone presents with low grade fevers and SOB. He has a
drug cough. o/e bibasal creps, JVP +2. CXR shows bibasal infiltrate extending up to
midzones, no evidence of cardiomegaly, no hilar LN, no effusions. (??Restrictive RFTs
with reduced DLCO). ESR 53 and “mild leucocytosis” of FBE. He is on amioderone for
AF. What is the most likely cause?

A. CCF
B. sarcoid
C. IPF
D. Amioderone lung

FRACP 2002 Recall Exam 22

 E. atypical pneumonia

Question 21
A young female is 2 hours post urgent Caesarian under GA. She is now SOB with SaO2
on room air of 86% and bibasal creps. There is no pHx of lung disease.
O/E RR 35, HR 110, BP 125/75,
What is the best form of management to improve outcome?
A. heparin
B. antibiotics
C. positive pressure ventilation
D. steroids
E. bronchodilators

Question 22
An elderly woman is in hospital and has problems with confusion. She is commence on
haloperidol 2mg nocte with good result. 2 weeks later she present with restlessness
claiming that she cant stand still. What is the most likely cause of the problem?
A. akathesia
B. dystonic reaction
C. extrapyramidal side effects
D. restless leg syndrome

Question 23
in patients with advanced stage cancer which of the following is he biggest risk factor for
expressed suicidal ideation?
A. current major depressive episode
B. severe pain
C. past psychiatric history
D. poor family supports
E.

Question 24

FRACP 2002 Recall Exam 23

a patient with HIV is admitted to hospital with PCP. He is initially well but 2 days into
the admission he is becoming increasingly agitated and aggressive. O/E he is confused
and disorientated. Which of the following is the most likely cause?
A. Delirium
B. AIDS related dementia
C. acute schizophrenia
D. major depression
E. mania

Question 25
A patient with advance HIV. Has a low CD4 count (approx 40) and high viral load
(about 18,000). He now present with flank pain. Meds include acyclovir, indinavir,
dapsone and sulfadiazine. He has not had an episode like this before
What is the most likely cause of his presentation.?
A. opportunistic infection
B. adverse drug reaction
C. malignancy
D. HIV per se
E. Not related to HIV

Question 26
Family tree is shown for patient with myotonic dystrophy. 2 of the boys have the
condition but “there is no evidence of myopathy in any of the other family member”

What is the most likely reason for this?

A. incomplete penetrance
B. imprinting
C. non paternity
D. mitochondrial inheritance
E. consanguinity

Question 27
Which of the following is the best way to distinguish polymyositis from inclusion body
myositis clinically?
A. involvement of finger flexors
B. involvement of eyelids
C. involvement of quads
D. truncal weakness
E. shoulder girdle weakness

Question 28
Which of the following is a relative contraindication for the use of raloxifene (a SERM)?
A. severe hot flushes
FRACP 2002 Recall Exam 24
 B. HT
C. Family history of breast CA
D. ?? endometrial hyperplasia
E. osteoporosis

Question 29
Which of the following is most likely to cause failure of the OCP?
A. doxycycline
B. rifampicin
C. erythromycin

Question 30
Which of the following is the most important factor dictating response to  IFN and
ribavirin in patients with HCV?
A. genotype
B. patients age
C. histology of liver Bx
D. LFTs
E. Viral RNA load

Question 31
A man with Parkinsons is on selegiline and qid madopar for Parkinsosns disease. Which
of the following is least likely to be effective in reducing the on/off effects he is
experiencing?
A. increasing the frequency of dosage
B. taking oral slow release medication
C. adding COMPT
D. adding DA agonist
E. increasing the dose but keeping qid

Question 32
Which of the following is the biggest risk factor for variceal bleeding in patients with
CLD and varices?
A. INR
B. Plt count
C. Portal HT
D. Systemic BP
E. Childs – Pugh stage

Question 33
Patient with AML now day 28 post induction therapy for AML. She is on GCSF and is
no longer neutropenic. She has been persistently febrile but is otherwise reasonably well.
She has been on ampho. 1mg/kg/day since day 20. Has had Candida albicans grown
from blood cultures draw from both Hickmans and peripheral stab. What is the next best
management?
A. remove Hickmans
B. increase AmB
C. do CT abdo to look for liver and spleen candida
D. change to fluconazole

Question 34
FRACP 2002 Recall Exam 25
78 year old man presents with visual impairment and epistaxis. On examination of fundi
he has engorged veins and venous infarts. He also has echymoses. Bloods show IgM
paraproteinemia of 60 mg/mL with depression of other Ig’s.
What is the next best management?
A. plasmaphoresis
B. melphalan and PDN
C. cyclophosphamide
D. platelet transfusion
E. IVIG

Question 35
An elderly lady is presenting for hernia repair. She is found to have an increased WCC
Hb and plt normal. Borderline cervical LN, no organomegaly
Hb 125, WCC 16.7
Her peripheral film shows some lymphocytes with 2 very clear smudge cells. What is the
next best investigation?

A. peripheral immunophenotyping
B. cytogenetics of peripheral blood
C. BM
D. EBV serology

Question 36
Which of the following is the best indicator of the success of a cancer screening
program?
A. early detection of cases
B. increased case detection
C. cancer specific mortality
D. overall mortality

Question 37
In patients with Alzheimers disease treated with Aricept, which of the following is least
likely to improve?
A. increased visual-spatial ability
B. memory
C. performance in ADLs
D. social engagement/interaction
E. cognition beyond 3 months
F. incontinence
FRACP 2002 Recall Exam 26
Question 38
Which of the following is least likely to be effective in a delirium management program
in inpatients following surgery
A. early IV therapy
B.
C. use of benzodiazepines
Question 39
Which of the following is associated with the highest risk of a delirium?
A. CABGS
B. AMI
C. Post op THR
D. TURP under epidural
E. Post op-TURP done under GA

Question 40
A diabetic patient (???IDDM or NIDDM) presents for review and is found to have
background diabetic nephropathy. HbA1C = ?? 7.6 or 8.5%% (upper limit normal quoted
as 6%). ?? BP quoted
Which of the following is most likely to improve retinopathy / or which is most
appropriate Mx?
A. ACEi
B. Tighter sugar control
C. Laser therapy
D. BP control

Question 41
Which of the following is most likely to result in a chronic HBV carrier status?
A. being bitten by person with HBV
B. having unprotected sex with HBV positive patient
C. mother passing HBV onto child inutero

Question 42
Patient with metastatic Ca lung now post op from procedure on PCA pethidine. Has Cr
0.15. developing jerking movements over past day and new develops seizure. What is
the most likely cause?
A. brain mets
B. peth metabolites
C. hypercalcemia

Question 43
Which of the following is least likely to be consistent with a diagnosis of trigeminal
neuralgia?
A. onset of facial pain > 60 years old
B. “lack of absence corneal reflexes”
C. spontaneous resolution of pain
D. response of pain to carbemazepine
E. normal MRI

Question 43

FRACP 2002 Recall Exam 27

A previously well patient presents with febrile illness, headache and “focal neurological
signs”. A CT brain is shown

what is the most appropriate therapy?

A. penicillin, metronidazole, rifampicin

B. penicillin, metronidazole, gentamicin
C. vancomycin, metronidazole, penicillin
D. ceftriaxone, metronidazole, acyclovir

Question 44
An elderly woman is on warfarin for AF presents with a headache and confusion and is
found to have and intracranial bleed. She requires urgent neurosurgery and her INR is 6.
what is the most appropriate way to reverse her anticoagulation?
A. FFP
B. Cryoprecipitate
C. Vit K
D. Platelets
E. PRBC

Question 45
A 25 year old male with history of ETOH of 140 gm / weeks and heavy smoker presents
with nausea and then a single vomit stained with blood.

O/E stable, BP ok with no postural drop, soft brown faeces PR. Mild epigastric
tenderness. No signs CLD
What is the most likely cause?
A. DU
B. GU
C. Acute H.pylori gastritis
D. M-W tear
E. ???? varices or esophagitis

Question 46
An elderly man presents with fatigue and ? bruising
Found to be pancytopenic with macrocytosis
On examination is found to have palpable spleen 12cm below costal margin
Peripheral film shows pancytopenia with no blasts and ? erythroblastic picture
FRACP 2002 Recall Exam 28
Which of the following is most likely?
A. macrocytosis
B. essential myelofibrosis
C. CML
D. Cirrhosis
E. Tumour infiltration

Question 47
Question about AML
Young female presents with fatigue and bleeding of gums with bruising
Pale on examination
Pancytopenic
Prolonged INR and APTT, elevated d-dimer, low fibrinogen
Excellent peripheral film showing blast cells, one of which contains a faggot/bundle of
Aur rods

Which of the following is the most appropriate 1st line therapy?

A. cyclophosphamide
B. CHOP
C. ATRA

FRACP 2002 Recall Exam 29

 D. Prednisolone
E. chlorambucil

Question 48
A young man develops tonsillitis with temp 38 and is commenced on erythromycin.
The following day he is still febrile and mildly icteric.
Blood tests show increased WCC with neutrophilia of 18
Increased BR (70) with normal LFTs
Normal Hb
What is the most likely cause of the increased BR?
A. erythromycin
B. EBV
C. Gilberts syndrome
D. Haemolysis

Question 49
Patient with small cell ca lung
Isolated mass in right lung with negative studies for mets

Which of the following is most likely to provide longest survival?

A. chemo then surgery
B. chemo then XRT
C. XRT
D. Surgery
E. Chemo and XRT then surgery

Question 50
Patient with NSCLC staged at IIIa with mediastinal involvement
?? the primary lesion is 3 cm from the carina
what is the most appropriate management?
A. surgery
B. XRT
C. XRT and surgery
D. Neo-adjuvant chemo and surgery
E.

Question 51
Which of the following is the commonest manifestation of Bechets disease?
A. recurrent mouth ulcers
B. genital ulcers
C. lung disease
D. meningitis
E. arthritis

Question 52
HIV positive man presents with headaches
CD4 count 10
Viral load high (RNA 280,000)
?? Antivirals and prophylaxis
FRACP 2002 Recall Exam 30
Toxo serology IgG and IgM both negative
EBV and CMV IgG +, but IgM negative
Lumbar puncture - 20 lymphocytes, no RBC, protein normal-slightly 
- cyptococcal Ag negative
- EBV PCR positive
CT brain shows 2 ring enhancing structures, both in the parietal lobes

what is the most likely aetiol of presentation

A. cyptococcus
B. cerebral lymphoma
C. EBV
D. HIV perse
E. Toxoplasmosis

Question 53
40 year old man presents with generalized seizure
gives history of hallucinations over past 6 months
EEG is shown which is of poor quality but seems to show have discharges in both
temporal lobes (right > left) with minimal in the frontal lobes
What is the most likely cause?
A. TLE secondary to temporal cavernoma
B. delayed onset of primary GTCC
C. frontal lobe gliosis
D. TLE secondary to cerebral abscess
E. Non-epilepsy

Question 54
28y.o male previously diagnosed with syphilis and Treated with 10/7 course penicillin,
now presents with a macular rash on his trunk. Picture shown: faint macular rash in
pts trunk. RPR – 1/256; FTA- +ve.
What is the best Treatment?

(a) Benzyl Penicillin 1.8gm QID intramuscular for 10 days.

(b) Benzethine Penicillin 1.8gm intramuscular single dose.
(c) Procaine Penicillin 1.8gm daily for 10/7.
(d) Ceftriaxone 250mg imi for 5/7.

FRACP 2002 Recall Exam 31

 (e) Doxycycline 100mg bd for 14/7.

Question 55
Elderly female presents with interscapular pain whilst lifting.
Lateral thoracic spine xray (shown) – crush #’s T3 and T9
Investigations:
Normal serum protein.
Serum EPG – no paraprotein; hypogammaglobulinaemic.
BMD: Lumbar spine T-3, Z-4; Femoral neck T-1.8, Z –2.1
UA +protein
Next best investigation?
A. Bone biopsy
B. FSH
C. Urinary EPG
D. Bone scan
E. Bone turnover markers

Question 56
Repeat question – middle aged man with recurrent urinary calculi requiring lithotripsies.
He has normal Ca/P/PTH and high urinary urate and Ca
Which is least likely to prevent recurrent stones?
A. high fluid intake
B. allopurinol
C. alkalinsation of urine
D. low Ca diet
E. thiazide

Question 57
Bone scan is shown – which of the following is most likely?
A. Ca breast
B. Ca prostate
C. Pagets
D. OA
E. Myeloma

scan shows hot spots symmetrically in the spine, sacrum, prox femurs, and scapulae

Question 58

FRACP 2002 Recall Exam 32

Patient presents with right sided neck swelling (no details if febrile or tender)
cold thyroid scan and normal TFTs
Aspirate shows “follicular cells”
What is next best step?
A. repeat aspirate
B. total thyroidectomy
C. right hemithyroidectomy
D. core Bx (drill Bx)
E. observe

Question 59
Which of the following is most likely to interact with St.Johns Wart (Hypericium
Perforatum)?
A. CyA
B. Digoxin
C. Cimetidine
D. Metformin
E. amitryptiline

Question 60
Young female with RA presents for review. She has had the condition for 5 years and
her original XR show a small erosion at the base of the 2nd metacarpal. She is on MTX
7.5 mg weekly and PDN 7.5 mg daily. She claims that she felt better than 2 years ago
ESR 45, CRP 60, mild anemia
Palpable thickening of MCPs and end of ulna
XR shows ?? 2-3 small erosions at the bases of metacarpals of left hand
what is the best management?

A. reduce PDN to 5 mg
B. increase PDN to 20 mg
C. add leflunamide
D. increase MTX
E. change MTX to CyA

Question 61
What Ab is most specific for SLE?
a. sm
b. dsDNA
c. ANA
d. Ro
e. U1-RNP

Question 62
Lady with advanced ovarian cancer presents with ataxia. CTB shows cerebellar atrophy.
What is the next best Ix. ??LP is negative for cytology ??biochem provided

A. meningeal Bx
B. PET scan of brain
C. Anti Hu Ab
D. Anti-perkinje cell Ab
FRACP 2002 Recall Exam 33
 E. MRI

Question 63
22 year old man with lethargy, SOBOE, easy bruising. WCC 3.9, Hb 6.9, plt 20
a cellular and fatty BMA. Which of the following is likely to give best long term
outcome?
A. BMT with HLA matches sib
B. Cyclophosphamide
C. ATG
D. GCSF and Epo
E. Autologous bmt
F. PDN
Question 65
Peri-menapausal female present with LN negative and ER+ breast Ca. She has a
lumpectomy. What are the effects of XRT to breast?
A. reduced local recurrence
B. prolonged survival
C. reduced mets

Question 66
Female with Ca breast now presents with back pain and subtle long tract signs. What is
the next best management?
A. surgical decompression
B. dexamethasone
C. chemo and XRT
D. palmidronate
E.

Question 67
Patient with metastatic Ca lung now presents with abdo discomfort and shortness of
breath. On examination JVP elevated
CT chest is shown – (?? massive pericardial
effusions)

what is the next best Mx

A. pericardial tap / drainage
B. pleural tap / drainage
C. XRT to chest wall
D. diuretics
E. ???

FRACP 2002 Recall Exam 34

Question 68
Middle aged builder drops a load (question actually said “hod”) of bricks onto foot 2
months ago. Initial XR shows no #
Subsequently develops increased pain and ?dysthaesia/hyperesthesia of foot

Foot is cold and sweaty and ankle is painful to move and has reduced ROM
Which of the following is the next best investigation?
A. XR foot
B. Bone scan
C. Aspiration of joint
D. Local anaesthetic injection in between tarsal heads
E. Doppler ultrasound of the lower limb
F. Nerve conduction studies
Question 69
Elderly female with CLL. She has had 2 chest infections over last year
Now has normal Hb and other cells numbers
?? no splenomegaly or sig lymphadenopthy

Ig show mild pan hypogamma glob in IgA,G and M

What is the best Mx?

A. prophylactic antibiotics
B. GCSF
C. Regular IVIG
D. ??melphalan and PDN

Question 70
A female present with history of sister who has had a child born with congenital heart
block. She is 12/40 pregnant and wants to know if next child is at risk. What is the most
appropriate investigation?
A. dsDNA
B. ANA
C. Anticardiolipin Abs
D. antiphospholipid Abs
E. option which said “extractable nuclear Ag” or Anti – Ro or Anti - La

Question 71
Middle aged man with long history of erosive RA. Now presents with peripheral sensory
neuropathy and foot drop. He is on MTX and PDN
What is the most likely cause of presentation?
A. vasculitis
B. MTX
C. AIDP
D. Multifocal motor neuropathy with conduction block
E. MND

Question 72
Man in 40s (?43) presents with 6 months history of headache and now has unilateral
weakness.
CT is show with massive tumour in right frontal lobe. This appears to have ring
enhancement/hyperdense periphery but it wasn’t a scan with contrast
FRACP 2002 Recall Exam 35
Diagnosis A. GBM
B. olgiodendroma
C. astrocytopma
D. meningioma
E. DNET tumour

Question 73
Youngish man on PD is having problems with SOB and ? fluid retention

What is the best way to asses the efficacy of PD?

A. serum glc
B. serum K
C. serum Cr
D. peritoneal exchange study
E. peritoneal fluid Na

Question 74
Which of the following requires FFP rather than Alb for plasma exchange?
A. MG
B. AIDP/GBS
C. TTP
D. CIDP
E. waldenstroms

Question 75
Young man presents with mediastinal mass. Which of the following serum tumour
markers would suggest to a good prognosis?

A.  HCG
B. Ca-125
C. Ca 15.3
D. CEA
E. Ca19.9

Question 76
FRACP 2002 Recall Exam 36
A middle aged man is 10 days post op from BMT (allogeneic / autologous) for AML
Now presents with abdo discomfort and SOA
LFTs elevated Bili 80, ALP 180, GGT 800, AST 1500, ALT 1500.

No comment on the presence of skin rash

No splenomegaly on CT abdo
What is the cause of the presentation?
A. venoocculsive disease
B. portal vein thrombosis
C. GVHD
D. opportunistic infection
E. liver candidiasis

Question 77
Young female presents with short history of SOBOE. CXR shows mild cardiomegaly at
most. TTE trace is shown which has transmitral flow study

what is the diagnosis?

A. MS
B. AS
C. MS and AS
D. MR and MR

Question 78
What is the complication of OSA which has the highest RR compared to the general
population?
A. stroke
B. AMI
C. MCA
D. HT
E. PHT

Question 79
Which of the following diets is most likely to result in a reduction in BP?
A. Na intake < 400 meq / day
B. K intake > 60 mg / day
C. Low fat and high fibre

FRACP 2002 Recall Exam 37

Question 80
A middle aged man with inoperable IHD is on metoprolol, GTN, amlodipine and digoxin
and warfarin. He is also on Li for manic depression. Which of the following would be
most appropriate to reduce the dose of when you start him on fluoxetine?
A. Warfarin
B. metoprolol
C. Li
D. Digoxin
E. amlodipine

Question 81
Female presents with increased weight and depression
↓ FSH / LH
prolactin 1900
 TSH and T4

what is the most likely cause?

A. nonfunctioning macroactinoma
B. primary hypo T4
C. prolactinoma

Question 82
A 35 year old woman presents concerned about her family history of Ca breast in mother
(onset 32) and aunt (48). She wants to know what the risk of her 15 year old daughter is
at with respect to Ca breast. The mothers serology is negative but the aunts BRCA 1
and 2 are positive. What can be said about the daughters risk from these studies?
A. unable to ascertain risk
B. she is at an increased risk
C. she is a reduced risk
D. need to test the fathers BRCA gene status
E. need full family pedigree to determine risk

Question 83
Elderly man with prior XRT for Ca prostate now presents with widespread bony mets.
What is the best course of management?

FRACP 2002 Recall Exam 38

 A. androgen deprivation
B. XRT
C. Systemic chemo
D. Best supportive care

Question 84
Middle aged man presents with chest symptoms following recent insertion of grommets
CXR is shown with multiple largish cavitating lesions
What is the test which will help most with
the diagnosis?
A. cANCA
B. CT chest
C. Sputum cytology
D. Aspergillus skin prick
E. FNA

Question 85
Woman in 30s presents with history of depression. She has a family history of HD and
her brother (??older or younger) has recently been diagnosed as having a tremor of his
hand. Her neurological examination is normal

What is the most appropriate thing to do with her with respect to HD screening?
A. should do it to differentiate from psych symptoms which are associated
with HD
B. should do it to determine the most appropriate Rx
C. should do it only if the brothers HD genotype is known
D. screening / genetic analysis is not indicated

Question 86
55 y.o female patient presents with sudden onset of SOB. She has history of MVR with
tilting disc St. Judes valve 2 years prior. Echo shows the one of the discs is stuck and
that there is moderate MR
The INR is 1.9

What is the most appropriate Mx?

A. ABic
B. Heparin IV
C. Add aspirin
D. Thrombolysis

FRACP 2002 Recall Exam 39

 E. Urgent MVR

Question 87
An elderly man presents with parietal lobe bleed. What is the most likely aetiol?
A. HT
B. Amyloid
C. AVM
D. Mycotic aneurysm
E. Lacunar stroke

Question 88
38 year old female presents with proximal muscle weakness, SOB over 6 weeks
Hands show hyperkeratotic changes on the “palmer surface and the lateral aspect of
fingers” ??also mentioned that it was cracking
↑ CK (890)
↑ ANA with speckled pattern
↑ Jo-1

what is the most likely cause?

A. dermatomyositis
B. Polymyositis (antisynthetase syndrome)
C. SLE
D. Sjogrens
E. Scleroderma
F. RA

Question 89
Where is the initial place of ankylosis in patient with ank spond?
A. Cx
B. Lx
C. Tx – Lx junction
D. Sx
E. Cx-Tx junction
Question 90
45 year old man presents with malaise
O/E he has gynaecomastia and spiders
Mild increase  GT with relatively normal other LFTs
Ferretin is 2000 – ?? other aspects of Fe studies not show
Transferrin sat was definitely not

What is the most best next Ix?

A. Autoimmune screen
B. HFE gene analysis
C. Hepatitis serology
D.

Question 91
Female presents with mild hypercalcemia. Her mother also had hypercalcemia and had
paratyroidectomy without improvement. She has mildly increased Ca, normal phosphate
with PTH at the upper limit of normal. What is the next best step?
FRACP 2002 Recall Exam 40
 A. neck exploration
B. 24 hour urinary Ca
C. Sestamibi scan

Question 92
Diabetic lady with multiple other coronary risk factors is now day 5 post op from
cholecystectomy. She presents with ? chest pain / ?? SOB and is tachycardic. ECG
shows widespread precordial ECG changes in ST-T segement highly suggestive of
ischemia but with no indication for thrombolysis and not > 1mm ST horizontal
depression. She is on aspirin and

i.e. the changes are biphasic T waves / down sloping ST depression in multiple
leads. It also shows sinus tachy
You are asked what is the most appropriate Mx prior to waiting for ??
investigation /blood tests to return

A. thrombolysis with SK
B.  blocker,
C. heparin alone
D. heparin and blocker
E. heparin and blocker and tirofiban

one of the options may have had aspirin in it but the stem definitely stated that she was on
aspirin

Question 93
Repeat question regarding young male just successfully treated with steroids for CD.
What is the most appropriate prophylaxis to reduce chance of remission?
A. Azothioprine
B. Salazopyrine
C. PDN
D. CyA

Question 94

45 yo male. BP 180/100. Na 144, K 2.6, U and Cr normal. Aldo 800 Renin

200(N>250). Next Ix?

(a) Adrenal vein aldo sampling

(b) Urinary aldo
(c) Dexamethasone for 5 days then repeat aldo
(d) Normal saline for 4 hours then repeat aldo
(e) Give ACTH then repeat aldo

Question 95
37 yo male presenting for investigation of thrombocytopaenia. Has been well previously.
FBC normal except for platelets 78
FRACP 2002 Recall Exam 41
 EUC/LFT normal
On further questioning, recalls being assaulted at age 17, requiring hospitalization and
NG tube for ‘pancreatic injury’
2 non consecutive slices of CT abdo (shown) – non contrast
? some pancreatic calcification ?dilated splenic vein
What is the most likely diagnosis?
(a) Portal vein thrombosis
(b) Splenic vein thrombosis
(c) Pancreatic pseudocyst
(d) Budd Chiari

Question 96
The severity of tricuspid regurgitation is used to estimate RV pressures using the
equation P=4V2. In a patient with TR with mean vel 3.5, peak vel 4, RA pressures
5 cm, what is the RV pressure (correct to +/- 2mmHg)
(a) 55
(b) 60
(c) 65
(d) 70

Question 97
A man with non small cell lung cancer- right sided lesion 3cm from the carina , R hilar
mass, mediastinum mentioned. Told stage IIIa
Best management to prolong survival?
a) chemotherapy alone
b) chemotherapy and surgery
c) chemotherapy and radiotherapy and surgery
d) radiotherapy alone
e) surgery alone

Question 98
In the following family, what is the chance of the person with the arrow having the disease?
(Carrier frequency 10%)

Question 99
Best predictor of suicide in a terminal cancer patient?
A. major depression
FRACP 2002 Recall Exam 42
 B. end stage disease
C. severe pain
D. poor family support
E. poor prognosis

Question 100
Middle aged man. Presents to multiple doctors with a number of physical complaints. No
cause is found after investigation. Admits to being stressed and having financial
difficulties. Most likely dx?
A. somatisation
B. panic attack
C. anxiety
D. hypochondria
E. malignering

FRACP 2002 Recall Exam 43