How to Pass the FRACP Written Examination

Jonathan Gleadle, Jordan Li, Danielle Wu, Paul Kleinig

• Publisher: Wiley-Blackwell
• Year: 2021
• ISBN:
  9781119599548
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

How to Pass the FRACP Written Examination is an indispensable review and study guide for anyone preparing for the challenging Fellow of the Royal Australasian College of Physicians (FRACP) exam. This up-to-date resource fully aligns with the current FRACP core training curriculum, containing a wealth of traditional multiple-choice questions (MCQs) as well as extended-matching questions (EMQs). There are hundreds of questions for every major topic of the written examination, including critical care medicine, cardiology, infectious diseases, immunology and allergy, neurology, and pharmacology.

More than a simple practice exam, this guide provides clear and complete explanations of each answer, a mini-review of the subject, and links to the most recent or relevant articles on the topic. Complementing the main body of questions are a number of 'teaching' and two-step questions—designed to strengthen clinical reasoning skills, highlight important issues, and expand knowledge of contemporary 'hot' topics. Written by an experienced team of physicians and educators, this must-have book:

• Provides a thorough review of the latest FRACP basic training syllabus
• Features QR codes embedded in the text to enable quick access to all references
• Offers tips, hints, advice, and examination strategies from previous candidates
• Provides numerous questions grounded in clinically relevant cases
• Covers of areas of medicine that are new, contemporary, and evolving

Covering both the 'Basic Sciences' and 'Clinical Practice' of the latest exam, Passing the FRACP Written Examination?is an essential companion for FRACP candidates as well as those looking to refresh, improve, or update their knowledge of the FRACP syllabus.

1 Cardiology

Questions

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

1. 1. A 65‐year‐old accountant undergoes an abdominal ultrasound because of mildly abnormal liver function tests. The ultrasound reveals a few mobile gallstones and a 5 cm abdominal aortic aneurysm. He drinks three to four standard drinks of alcohol every day and is an ex‐smoker. He is known to have hypertension and is taking irbesartan 150 mg daily. Blood pressure control is satisfactory with mean systolic BP of 130 mmHg.
   What is your most appropriate course of action?
   1. Abdominal CT with contrast immediately and suspension of driver's license.
   2. Endovascular aneurysm repair immediately.
   3. Follow up ultrasound in 6 months and continue driving.
   4. Open surgical aneurysm repair immediately.
2. 2. A 39‐year‐old man with a known atrial septal defect presents to emergency department with a 6‐hour history of palpitations. His ECG is shown below:Which one of the following signs is UNLIKELY to be present?

   

   1. Fixed splitting of second heart sound.
   2. Fourth heart sound.
   3. Loud first heart sound.
   4. Third heart sound.
3. 3. Which of the following patient characteristics is LEAST LIKELY to increase an individual's susceptibility to anthracycline cardiomyopathy?
   1. Age of 70 years.
   2. Male sex.
   3. Mediastinal radiotherapy.
   4. Positive carrier status for C282Y HFE gene.
4. 4. A 65‐year‐old‐man presents with a three‐month history of exertional dyspnoea. He is found to have aortic stenosis with a valve area of 0.9 cm² and a mean transvalvular pressure gradient of 15 mmHg. His left ventricle ejection fraction (LVEF) is 35%. A Dobutamine Stress Echocardiography (DSE) has been arranged which will provide all of the following information, EXCEPT:
   1. Confirming the suitability for valve replacement.
   2. Deciding the need for cardiac resynchronisation therapy.
   3. Predicting prognosis post valve replacement.
   4. Diagnosing low‐flow, low‐gradient aortic stenosis.
5. 5. An 84‐year‐old man with severe aortic stenosis complains of shortness of breath after walking for 20 metres and a couple of episodes of unexplained collapse. He is independent with activities of daily living. His medical history includes hypertension, hyperlipidaemia, cholecystectomy, and hernia repair.
   What is the most appropriate management approach?
   1. Aortic valve balloon valvuloplasty.
   2. Implantable cardioverter–defibrillator (ICD).
   3. Surgical aortic valve replacement (SAVR).
   4. Transcatheter aortic valve implantation (TAVI).
6. 6. You see a 75‐year‐old woman with a new diagnosis of atrial fibrillation. Her CHA₂DS₂‐VASc score is 4. She has a history of myocardial infarction four years ago, treated with percutaneous coronary intervention and a bare‐metal stent inserted in the right coronary artery, and is currently on aspirin.
   Which of the following options is the most appropriate regarding ongoing anti‐thrombotic therapy?
   1. Coronary angiogram to guide further therapy.
   2. Rivaroxaban and clopidogrel.
   3. Rivaroxaban and aspirin.
   4. Rivaroxaban monotherapy.
7. 7. Beta‐blockers are recommended as first line therapy for stable angina. Their main mechanism of action is explained by:
   1. Increased coronary artery blood flow.
   2. Plaque stabilisation.
   3. Reduction in blood pressure.
   4. Reduction in myocardial oxygen demand.
8. 8. What is the management strategy for a patient with the following ECG?

   

   1. Amiodarone.
   2. Beta‐blocker.
   3. Implantable cardioverter–defibrillator (ICD).
   4. Pacemaker.
9. 9. A 54‐year‐old man is admitted to hospital because of syncope. This is his third presentation with syncope due to severe postural hypotension over the past six months. He has developed chronic diarrhoea and lost 6 kg of body weight in the past six months. He has no significant past medical history. On examination, BP is 90/50 mmHg. HR is 86 bpm. There are no murmurs. Urinary analysis shows ++++ protein but no RBCs nor RBC casts. His investigation results are shown below. ECG shows sinus rhythm and low voltage in all leads. Echocardiogram reports moderate left ventricular hypertrophy, biatrial dilatation and grade 2 diastolic dysfunction.

   Tests	Results	Normal values
   Haemoglobin	108 g/L	135–175
   White blood cell	5.48 x 10^9/L	4.0–11.0
   Platelet	206 x 10^9/L	150–450
   Sodium	133 mmol/L	135–145
   Potassium	4.3 mmol/L	3.5–5.2
   Creatinine	156 μmol/L	60–110
   Albumin	22 g/L	34–48
   Globulin	42 g/L	21–41
   Liver function tests	normal
   Troponin	<29 ng/L	0–29
   N‐terminal pro b‐type Natriuretic Peptide (NT‐proBNP)	1800 ng/L	0–124

   What would you consider the most appropriate next investigation?
   1. Cardiac MRI.
   2. Coronary artery angiogram.
   3. Holter monitor.
   4. Implantable loop recorder.
10. 10. Which one of the following increases cardiac output?
    1. Atropine.
    2. Acidosis.
    3. Beta‐blockers.
    4. Hypertension.
11. 11. A 72‐year‐old woman presents to emergency department after an episode of loss of consciousness. Which of the following clinical features, if present, DO NOT increase the likelihood that her loss of consciousness was due to cardiac syncope?
    1. Breathlessness prior to the episode.
    2. Cyanosis during the episode.
    3. History of atrial fibrillation.
    4. Significant injury as a result of loss of consciousness.
12. 12. An 80‐year‐old man presents to emergency department with sudden onset of left‐sided weakness two hours ago. His medical history includes hypertension, hypercholesterolaemia, and atrial fibrillation for which he is taking aspirin only. CT head shows acute right middle cerebral artery territory infarction. He is treated with thrombolysis followed by bridging low molecular weight heparin then a direct thrombin inhibitor. Two weeks later while in rehabilitation, he develops low grade fever, myalgia, painful feet (shown below), anaemia, and AKI.

    

    The most likely diagnosis...