Passing the FRACP Written Examination

Questions and Answers

Jonathan Gleadle, Tuck Yong, Surjit Tarafdar, Danielle Wu, Jordan Li

• Publisher: Wiley-Blackwell
• Year: 2013
• Print ISBN: 9781118454954
• eBook ISBN: 9781118455043
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

Passing the FRACP Written Examination is the ideal study aid for candidates of the Fellow of the Royal Australasian College of Physicians (FRACP) examination. Written by a team of physicians based at Flinders Medical Centre, and covering the key components of the FRACP basic training syllabus, this guide presents over 500 multiple-choice questions on all major topics covered in the examination. It provides coverage of rapidly evolving topics such as healthcare in an ageing population, disparity in indigenous health outcomes, advances in molecular science and genetics, and the complexity of care arising from multiple chronic illnesses. Questions echo the written examination, including those on both 'Basic Sciences' and 'Clinical Practice'.

Many of the questions are similar to those in the actual examination; others are designed to 'teach' particularly important issues or to draw attention to contemporary topics. Each question has an answer that fully explains the correct and incorrect responses.

This study aid also includes:
• Questions and answers linked to a reference that is usually the best and most contemporary review for further reading and as additional guide to study
• QR code links to all the references
• Hints and tips from previous candidates on examination strategies
• A large number of the new style extended matching questions (EMQs).

This brand new study aid gives all FRACP candidates a unique opportunity to practise for the examination and improve their medical knowledge of the syllabus as a whole.

1

Cardiology

Questions

Basic Science

Answers can be found in the Cardiology Answers section at the end of this chapter.

1. Beta-blockers are recommended as first-line therapy for stable angina by both the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology. Their mechanism of action in this condition is explained by:

A. Plaque stabilisation

B. Increased coronary blood flow

C. Reduction in blood pressure

D. Reduction in myocardial oxygen demand

E. Reduction in systemic vasodilatation

2. Which one of the following compensatory mechanisms occurs in heart failure?

A. Decreased ventricular preload

B. Peripheral vasodilatation

C. Increased renal sodium and water excretion

D. Activation of the adrenergic nervous system

E. Myocardial atrophy

3. Which is the most common origin of idiopathic ventricular tachycardia in the absence of structural heart disease?

A. Aortic annulus

B. Aortic sinuses

C. Great cardiac vein

D. Epicardium

E. Right ventricular outflow tract

4. Which one of the following viral infections is the commonest cause of myocarditis in developed countries?

A. Enterovirus

B. Cytomegalovirus

C. Hepatitis C virus

D. Human immunodeficiency virus (HIV)

E. Influenza virus

5. Which one of the following statements is correct regarding the electrical conduction and contraction of the heart?

A. Electrical conduction is transmitted from the sino-atrial node to the bundle of His to the atrioventricular node to the Purkinje fibres to the myocardium

B. Muscle contraction is associated with release of calcium by the sarcoplasmic reticulum

C. Repolarisation of cardiac muscle is due to flow of potassium into the myocytes

D. On an electrocardiogram the QRS complex corresponds to ventricular repolarisation

E. The perfusion of the coronary arteries increases during systole

6. Perhexiline has been used in patients with chronic heart failure and refractory angina. Which one of the following statements about perhexiline is correct?

A. It is metabolised by cytochrome P450 3A4

B. About 7–10% of Caucasians are slow metabolisers

C. The recommended dose for slow metabolisers is 100 mg on alternate days

D. It can cause hyperglycaemia in diabetic patients

E. It improves 5-year survival

Theme: Beta-blockers (for Questions 7 and 8)

A. Propranolol

B. Metoprolol

C. Nebivolol

D. Atenolol

E. Pindolol

F. Sotalol

G. Bisoprolol

H. Carvedilol

Select the drug that best fits the description in each of the following statements.

7. A non-selective beta-blocker with α₁-adrenoreceptor blocking activity.

8. A selective β1-adrenoreceptor blocker with nitric-oxide potentiating vasodilatory effect.

Clinical

9. A 47-year-old man presents with chest pain. He reports moderately severe central chest pain of 24 h duration. The pain is worse with inspiration and is alleviated by maintaining an upright position. He also reports having had a fever recently. His medical history and physical examination are unremarkable. His ECG is shown below. What is the most likely diagnosis and the most appropriate treatment approach for this patient?

A. Acute pericarditis; perform an echocardiogram in 1 week to confirm diagnosis

B. Acute pericarditis; start a non-steroidal anti-inflammatory drug (NSAID)

C. Acute pericarditis; start prednisolone

D. ST elevation myocardial infarction; start thrombolytics

E. Pericardial tamponade; requires pericardiocentesis

10. A 21-year-old Aboriginal woman presents with a sore throat for 2 days. She has fever (38° C) and coryza. On physical examination, the patient appears well but has a markedly infected posterior pharynx and exudates over her tonsils. Streptococcal pharyngitis is suspected. Which one of the following approaches to management is most appropriate?

A. A throat swab is adequate to establish diagnosis in Aboriginal patients

B. Intravenous benzylpenicillin 1.2 g four times a day for 10 days is the treatment of choice in eradicating Group A streptococci from the nasopharynx

C. Treatment should be started within 9 days of the onset of symptoms to prevent acute rheumatic fever

D. Aspirin can prevent rheumatic chorea

E. Asymptomatic family contacts of patients with streptococcal pharyngitis should have throat swabs for streptococcal infection

11. A 50-year-old man presents with a 2-h history of severe chest pain. The pain started suddenly while eating, was constant and radiated to the back and interscapular region. His past medical history includes hypertension and hyperlipidaemia. On examination, his heart rate is 120 beats/min and his blood pressure is 80/40 mmHg. Jugular venous pressure is not visualised. All peripheral pulses are present and equal. While stabilising the patient, which one of the following investigations should be undertaken?

A. Serum lipase

B. Computed tomography (CT) angiography of the chest

C. D-dimer

D. Lung ventilation–perfusion scan

E. Upper gastrointestinal endoscopy

12. Which one of the following best describes the use of plasma brain natriuretic peptide (BNP) in the assessment of congestive heart failure (CHF)?

A. BNP level is more useful in detecting diastolic heart failure than systolic heart failure

B. Measurement of BNP is recommended as routine in the diagnosis of CHF

C. BNP offers additional diagnostic information beyond that provided by echocardiogram

D. BNP levels have been shown to predict all-cause mortality, including sudden death

E. Plasma BNP or N-terminal pro-BNP measurement is not useful in patients presenting with new-onset breathlessness

13. A 46-year-old woman presents with a 2-week history of shortness of breath and ankle swelling. On examination her jugular venous pressure (JVP) is elevated and there are fine crackles at the bases of both lungs on auscultation. She was diagnosed with breast cancer a year ago and has been treated with surgery, doxorubicin, cyclophosphamide and radiotherapy. She has no cardiac risk factors or family history of cardiac disease. Computed tomography pulmonary angiography (CTPA) is normal and chest X-ray shows interstitial pulmonary oedema. What is the most likely cause for this presentation?

A. Anthracycline cardiotoxicity

B. Constrictive pericarditis

C. Pulmonary fibrosis

D. Radiation-induced cardiomyopathy

E. Pulmonary embolism

14. All of the following drugs can be utilised in patients with heart failure. Which one is the most effective in improving systolic function?

A. Spironolactone

B. Angiotensin converting enzyme (ACE) inhibitor

C. Digoxin

D. Frusemide

E. Hydralazine

15. A 72-year-old man describes substernal chest pressure while walking for more than 100 m and this is relieved by rest. His medical history is remarkable for hypertension and a myocardial infarction 3 years ago. His medications include aspirin 150 mg daily; metoprolol 50 mg twice daily; atorvastatin 40 mg daily; perindopril 5 mg daily; and isosorbide mononitrate 120 mg daily. He had a cardiac catheterisation 1 month ago that showed a left main coronary artery stenosis of 85%, a proximal left anterior descending artery stenosis of 70% and a 80% stenosis of the first obtuse marginal branch. His left ventricular ejection fraction (LVEF) was estimated at 45%. Which one of the following therapies would be most beneficial for this patient?

A. Addition of clopidogrel

B. Regular exercise programme

C. Percutaneous transluminal angioplasty (PCTA)

D. Coronary artery bypass grafting (CABG)

E. Transmyocardial revascularisation procedure (TMR)

16. The use of computed tomography coronary angiography (CTCA) is most appropriate in which one of the following patients?

A. An asymptomatic patient who has a strong family history of ischaemic heart disease

B. A patient with coronary stents presenting with chest pain in whom you suspect in-stent restenosis

C. A patient presenting with severe crushing chest pain and an ECG showing ST-elevation myocardial infarction (STEMI)

D. A patient presenting with chest pain and palpitations and an ECG showing rapid atrial fibrillation (heart rate: 125 beats/min)

E. A patient with chest pain with normal serial cardiac enzymes and ECGs who you think has a low-to-intermediate pre-test probability of coronary artery disease

17. An 86-year-old woman with a history of ischaemic heart disease, atrial fibrillation and type 2 diabetes presented to the emergency department with flank pain and symptomatic anaemia with haemoglobin of 69 g/L. After abdominal CT imaging, she was found to have a retroperitoneal haemorrhage. Three weeks prior to the presentation she had been changed from warfarin to dabigatran (taking a standard dose of 150 mg twice a day) for stroke prevention. Prior to this change, her INR has been within the target range for 6 years. What is the most likely explanation for the significant haemorrhagic complication in this patient after commencing dabigatran?

A. She is also taking phenytoin

B. She has impaired renal function

C. Her atrial fibrillation had reverted to sinus rhythm

D. Her INR has not been checked during the 3 weeks on the new medication

E. She is also taking digoxin

18. A 60-year-old man has had an inferior myocardial infarction 5 days ago. Today he is feeling lightheaded and his pulse rate is 40 beats/min...

Table of contents

• Cover
• Title page
• Copyright page
• Introduction
• Acknowledgements
• Features contained in your study aid
• 1: Cardiology
• 2: Respiratory and sleep medicine
• 3: Gastroenterology
• 4: Nephrology
• 5: Endocrinology
• 6: Neurology
• 7: Rheumatology
• 8: Dermatology
• 9: Oncology
• 10: Infectious diseases
• 11: Haematology
• 12: Clinical immunology
• 13: Clinical pharmacology
• 14: Clinical genetics
• 15: General medicine, geriatric medicine and other topics
• 16: Psychiatry
• 17: Statistics, epidemiology and research
• 18: Intensive care medicine
• Index