2008 Paper A Flashcards
Cerebral palsy is defined as a disorder of posture and movement due to an insult to the developing brain. What is the most common period for the responsible brain insult to occur?
A. Antenatal.
B. Intrapartum.
C. Neonatal.
D. 1 to 12 months.
E. After 12 months.
Answer A. Antenatal
A three-year-old boy is being resuscitated in the community following an immersion injury. What is the currently recommended ratio of external cardiac compressions to exhaled air resuscitations for a two rescuer resuscitation in this patient?
A. 3:1
B. 5:1
C. 15:2
D. 30:2
E. 30:1
Answer C. 15:2
In an otherwise well toddler with significant nutritional iron deficiency anaemia, what is the expected time interval between commencing iron therapy and a reticulocytosis becoming evident on a blood film?
A. 3 days.
B. 7 days.
C. 14 days.
D. 30 days.
E. 60 days.
Answer A. 3 days
A six-month-old child with cardiac failure secondary to severe dilated cardiomyopathy is initially treated with Frusemide and Spironolactone. The addition of which of the following drugs to the child’s medical therapy is most likely to result in hyperkalaemia if no changes are made to the existing therapy?
A. Amiodarone.
B. Captopril.
C. Digoxin.
D. Metoprolol.
E. Warfarin.
B Captopril
Which of the following vaccines is least likely to induce long term immunologic memory?
A. Bacille Calmette-Guérin (BCG).
B. Diphtheria-tetanus-pertussis.
C. Haemophilus influenzae type B conjugate.
D. Hepatitis B.
E. Pneumococcal polysaccharide
E Pneumococcal polysaccharide
The results of a study undertaken to determine the utility of urinary leukocyte dipstick testing in the diagnosis of urinary tract infections (UTI) in febrile children is shown below.
In this study, the negative predictive value of the leukocyte dipstick test is:
A. 35%
B. 70%
C. 75%
D. 90%
E. 95%
C 75%
An 11-year-old boy is seen in clinic for review of congenital cardiac disease, for which he underwent surgery as a neonate. You notice asymmetry of his face, as demonstrated in the photograph below
These findings are consistent with:
A. Duane syndrome.
B. Horner syndrome.
C. Mobius syndrome.
D. Waardenburg syndrome.
E. Williams syndrome
B Horner Syndrome
Conventional antipsychotic medications (such as haloperidol, chlorpromazine, pericyazine) are used for the treatment of psychosis, anxiety and aggression in children and adolescents. One of the side effects of these medications is an increase in prolactin levels resulting in galactorrhea and amenorrhea in females and gynaecomastia in males.
Which of the following best describes the mechanism for this increase in prolactin?
A. Dopamine receptor agonist.
B. Dopamine receptor antagonist.
C. Increased gonadotropin-releasing hormone levels.
D. Serotonin receptor agonist.
E. Serotonin receptor antagonist
B Dopamine receptor antagonist
Cystic fibrosis is an autosomal recessive disorder caused by mutations in a single gene on the long arm of chromosome 7. These mutations lead to abnormal functioning of the cystic fibrosis transmembrane conductance regulator (CFTR) protein, a chloride channel in the cell membrane. The most common mutation in the Australasian population is ∆F508.
What is the principal effect of this mutation on the function of CFTR?
A: Abnormal adenosine triphosphate (ATP) gating of the chloride channel.
B: Abnormal protein folding and thus poor transportation to the cell membrane.
C: Abnormal splicing resulting in reduced amounts of functional protein.
D: Decreased conductance of the chloride channel.
E: Premature transcription termination signals resulting in a truncated or absent protein.
B Abnormal protein folding and thus poor transportation to the cell membrane
A 16-year-old girl is brought to the Emergency Department after attending a dance party. On presentation, she is extremely confused and agitated, she looks flushed and sweaty, and has dilated pupils. Her heart rate is 120 beats/minute and her blood pressure is 140/90 mmHg. She is complaining of some central chest pain.
Her presentation is most likely due to the ingestion of which of the following drugs?
A. Cannabis (Marijuana).
B. Diamorphine (Heroin).
C. Gamma Hydroxybutyrate (Grievous Bodily Harm, GHB).
D. Ketamine (Special K).
E. 3,4–Methylenedioxymethamphetamine (Ecstasy).
E 3,4–Methylenedioxymethamphetamine (Ecstasy)
Which of the following conditions is most likely to respond to selective serotonin reuptake inhibitors (SSRIs)?
A. Aggression.
B. Anxiety.
C. Autism.
D. Depression.
E. Tics.
B Anxiety
A 13-year-old boy presents with right upper quadrant pain and vomiting. He lives on a sheep station. On examination he is afebrile and has hepatomegaly.
An ultrasound scan confirms the presence of a 12 x 12 cm cyst, with several internal membranes, in the right lobe of the liver. His chest X-ray was normal.
Which of the following medical treatments is indicated?
A. Albendazole.
B. Doxycycline.
C. Metronidazole.
D. Pentamidine.
E. Praziquantel.
A Albendazole
Thyroid dysfunction due to which of the following is most likely to be missed on newborn screening?
A. Dyshormonogenesis.
B. Ectopic thyroid gland.
C. Panhypopituitarism.
D. Thyroid agenesis.
E. Transient hyperthyrotropinemia.
C Panhypopituitarism
The most significant change in auscultatory findings during a cyanotic spell in an infant with tetralogy of Fallot is that the:
A. ejection systolic murmur becomes louder.
B. ejection systolic murmur becomes softer.
C. pansystolic murmur becomes louder.
D. pansystolic murmur becomes softer.
E. second heart sound becomes more widely split.
B ejection systolic murmur becomes softer.
This family presents due to an apparent familial predisposition to a disorder
What is the most likely explanation for the apparent normal health of III:3?
A: Anticipation.
B: Imprinting.
C: Non-paternity.
D: Non-penetrance. X-linked inheritance
D Non-penetrance. X-linked inheritance
At 24-months of age, what percentage of children will spontaneously feed a doll with a pretend bottle?
A. 10%
B. 25%
C. 50%
D. 75%
E. 90%
E: 90%
An 11-year-old child undergoes muscle biopsy under general anaesthetic for a suspected myopathy. During the procedure she develops a high temperature and generalised stiffness. Biochemical testing shows acidosis, hypercapnia and a markedly elevated serum creatine kinase (CK).
The most likely diagnosis is:
A. halothane allergy.
B. malignant hyperthermia.
C. mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes (MELAS).
D. neuroleptic malignant syndrome.
E. sepsis.
B. Malignant Hyperthermia
The initial luminal digestion of dietary starch by salivary and pancreatic amylase leads to the formation of which disaccharide?
A. Fructose.
B. Galactose.
C. Glucose.
D. Maltose.
E. Sucrose.
D Maltose
A ten-year-old girl is brought into the Emergency Department after being bitten by an unidentified snake. The snake venom detection kit is positive for brown snake venom from a bite site swab. Which of the following is the most common clinical effect in this envenomation?
A. Cardiotoxicity.
B. Coagulopathy.
C. Nephrotoxicity.
D. Neurotoxicity.
E. Rhabdomyolysis.
B Coagulopathy
A three-year-old girl presents following a hypoglycaemic seizure and has some investigations. Urinary metabolic screen confirms the diagnosis of Medium-Chain Acyl-CoA dehydrogenase deficiency (MCAD). The defect in this condition is most likely to cause hypoglycaemia by which of the following mechanisms?
A. Hyperinsulinism.
B. Impaired gluconeogenesis.
C. Impaired glycogenolysis.
D. Increased glycogen synthesis.
E. Increased ketone production.
B Impaired gluconeogenesis
Which one of the following is the major determinant of risk of perinatal transmission of hepatitis C virus?
A. Breastfeeding.
B. Concomitant hepatitis B infection.
C. Concomitant human immunodeficiency virus (HIV) infection.
D. Maternal viral load.
E. Mode of delivery.
D Maternal viral load
Which of the following is the main site of potassium reabsorption in the nephron?
A. Proximal convoluted tubule.
B. Descending limb of the Loop of Henle.
C. Ascending limb of the Loop of Henle.
D. Distal convoluted tubule.
E. Collecting duct.
A Proximal convoluted tubule
The mechanism of action of inhaled nitric oxide is:
A. degradation of phosphodiesterase PDE5.
B. improved binding of oxygen to haemoglobin (Hb).
C. stimulation of β2 receptors.
D. stimulation of nitric oxide synthase.
E. upregulation of cyclic guanosine monophosphate (cGMP)
E: upregulation of cyclic guanosine monophosphate (cGMP)
Centre for Disease Control (CDC) body mass index (BMI) charts have been recommended as a screening tool to identify individuals who are overweight.
Which of the following BMI’s define a child likely to be obese?
A. >25 kg/m2
B. >30 kg/m2
C. >85th percentile for age
D. >85 <95 percentile for age.
E. ≥95th percentile for age.
E ≥95th percentile for age
A term infant with a history of neonatal sepsis was noted to have developed an area of subcutaneous fat necrosis over the left spiral groove of the humerus. She has a left-sided wrist drop as shown in the photograph below. Her deep tendon reflexes are normal
What nerve is most likely affected?
A. Axillary.
B. Median.
C. Musculocutaneous.
D. Radial.
E. Ulnar.
D Radial
What is the key developmental task of early infancy?
A: Autonomy.
B: Motor control.
C: Secure attachment.
D: Self-regulation.
E: Separation.
C Secure attachment
Which of the following coagulation factors is most likely to be relatively decreased in the healthy newborn compared to older infants?
A. factor V.
B. factor VII.
C. factor VIII.
D. Fibrinogen.
E. von Willebrand factor
B factor VII
A three-year-old boy is evaluated because of delayed motor milestones. On examination he has muscle weakness with calf hypertrophy. He has a markedly elevated creatine kinase level of 15,400 I/U [<240 I/U]. A diagnosis of Duchenne muscular dystrophy (DMD) is suspected and blood is taken for dystrophin gene testing.
Which of the following is most likely to be found on testing of the dystrophin gene?
A. Deletion of one base pair causing a frameshift.
B. Deletion of several exons.
C. Duplication of several exons.
D. Missense mutation.
E. Splice-site mutation.
B Deletion of several exons
A patient in the Emergency Department has the laboratory results shown below:
Which of the following is the most likely cause of the acidosis?
A. Acute renal failure.
B. Diabetic ketoacidosis.
C. Lactic acidosis.
D. Renal tubular acidosis.
E. Salicylate poisoning
D. Renal tubular acidosis
A six-month-old child undergoes cardiac catheterisation. The oxygen saturations obtained in room air during the procedure are as follows:
These findings are most consistent with a diagnosis of:
A. atrial septal defect.
B. atrioventricular septal defect.
C. patent ductus arteriosus.
D. tetralogy of Fallot.
E. ventricular septal defect.
E. ventricular septal defect
A ten-year-old boy with severe bronchiolitis obliterans presents to the Emergency Department with increasing exercise intolerance over the previous week.
A capillary blood gas shows the following picture:
This result is most consistent with which of the following?
A. Acute on chronic respiratory acidosis.
B. Acute respiratory acidosis.
C. Chronic respiratory acidosis.
D. Mixed metabolic and respiratory acidosis.
E. Uncompensated metabolic acidosis.
A. Acute on chronic respiratory acidosis
A 15-month-old boy recently completed chemotherapy for rhabdomyosarcoma. On routine testing the following results were obtained:
The drug most likely to have caused these abnormalities is:
A. cyclophosphamide.
B. dactinomycin.
C. etoposide.
D. ifosfamide.
E. vincristine
D. ifosfamide
A six-year-old girl presents after a fall from monkey bars. Her X-ray is shown below. On examination she has paraesthesia of her thumb, index and middle fingers, as well as an impalpable radial pulse.
Compression of which of the following neurovascular structures best explains the physical findings?
A. c
B. Brachial artery and radial nerve.
C. Brachial artery and ulnar nerve.
D. Radial artery and median nerve.
E. Ulnar artery and radial nerve
A. Brachial artery and median nerve.
The following results were obtained from a randomised controlled trial of a new artificial surfactant called “S”.
The number of babies that you would need to treat with “S” to prevent one case of chronic lung disease is:
A. 5
B. 10
C. 15
D. 20
E. 30
B. 10
You are reviewing a 15-year-old boy with Duchenne muscular dystrophy (DMD) in your outpatient clinic. He has been in an electric wheelchair for three years. He has not required admission to hospital for more than five years
You receive the following results of his lung function testing:
Which of the following best describes these lung function results?
A. Mixed obstructive and restrictive pattern.
B. Moderate obstructive lung disease.
C. Moderate restrictive lung disease.
D. Poor technique.
E. Upper airway obstruction.
C. Moderate restrictive lung disease
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
A. cardiac tamponade
A 3200 g term baby girl, born by ventouse extraction, is seen at five hours of age with recurrent apnoeic episodes. On examination she is afebrile, pale but well perfused, heart rate is 150 beats/min and mean arterial pressure is 42 mmHg. A computed tomography (CT) scan of her head is shown below
The scan is most suggestive of haemorrhage that is both intracerebral and:
A. extradural.
B. intraventricular.
C. subarachnoid.
D. subdural.
E. subgaleal.
C. subarachnoid
