RACP Written Examination February 2018
Adult Medicine
Clinical Applications questions 1−100
2018 February RACP Written Examination – Clinical Applications Adult Medicine 1
,1. Febuxostat is a newer urate-lowering therapy than allopurinol. Based on randomised controlled
trial data in chronic gout, what is the main benefit of febuxostat 80 mg daily over allopurinol
300 mg daily?
A. Faster resolution of tophi.
B. Fewer cardiovascular events.
C. Fewer flares of acute gout.
D. Less radiologic articular changes.
E. Lower serum uric acid.
2. A 71-year-old male with hypertension, chronic obstructive pulmonary disease from cigarette
smoking and previous coronary artery bypass grafting presents with a 3-day history of anuria
and dyspnoea. He is taking ramipril, atorvastatin, amlodipine, clopidogrel and aspirin,
amoxycillin, pantoprazole and inhaled corticosteroids. Blood pressure is 200/105 mmHg and an
ECG shows previous anterior myocardial infarction. A renal ultrasound shows a 6 cm right
kidney and an 11 cm left kidney. No urine is noted in the bladder. The creatinine is 900 μmol/L
and the patient requires urgent haemodialysis for acute pulmonary oedema.
What is the most likely diagnosis?
A. Acute interstitial nephritis.
B. Aortic dissection.
C. Pyelonephritis.
D. Renal thromboembolism.
E. Urinary obstruction.
2018 February RACP Written Examination – Clinical Applications Adult Medicine 2
,3. A 25-year-old man "A" underwent a general anaesthetic for an open reduction and fixation of a
fractured femur. Following induction of anaesthesia with propofol and suxamethonium he
developed tachycardia, tachypnoea, muscle rigidity and fever to 41 °C. He was treated with
dantrolene for this episode of malignant hyperthermia and recovered.
This is an autosomal dominant disease. What is the chance that this man's relative "B" is at risk
of an episode of malignant hyperthermia?
A. 6.25%
B. 12.5%
C. 25%
D. 50%
E. 100%
2018 February RACP Written Examination – Clinical Applications Adult Medicine 3
, 4. A 40-year-old female with a history of gastro-oesophageal reflux managed with high-dose
pantoprazole is admitted with severe hypertension and acute kidney injury (creatinine
315 μmol/L [49–90]). She has a history of Raynaud's and you note peripheral telangiectasia and
grade III fundal hypertensive changes. Urinalysis is bland and the full blood count shows
normochromic normocytic anaemia with a platelet count of 115 × 109/L [150–400]. The renal
ultrasound is normal.
What is the most likely cause of her hypertension and AKI?
A. Acute interstitial nephritis.
B. Conn syndrome.
C. Phaeochromocytoma.
D. Systemic lupus erythematosus.
E. Systemic sclerosis.
5. A 75-year-old man presents to his local doctor with abrupt onset of painless visual blurring
affecting the left eye only, and lasting 20 minutes. On reflection, he recalls a similar
episode 1 week earlier while driving, but he was able to complete his journey because vision in
the right eye was unaffected. Currently, the neurological examination is normal.
Which artery stenosis would be expected to cause this presentation?
A. Basilar.
B. Left carotid.
C. Left vertebral.
D. Right carotid.
E. Right vertebral.
6. At initial diagnosis, which factor is most predictive of reduced survival in patients with metastatic
renal cell cancer?
A. Age < 60.
B. Chromophobe histology.
C. Eastern Cooperative Oncology Group (ECOG) performance status of 3.
D. Lung metastases.
E. Smoking history.
2018 February RACP Written Examination – Clinical Applications Adult Medicine 4
Adult Medicine
Clinical Applications questions 1−100
2018 February RACP Written Examination – Clinical Applications Adult Medicine 1
,1. Febuxostat is a newer urate-lowering therapy than allopurinol. Based on randomised controlled
trial data in chronic gout, what is the main benefit of febuxostat 80 mg daily over allopurinol
300 mg daily?
A. Faster resolution of tophi.
B. Fewer cardiovascular events.
C. Fewer flares of acute gout.
D. Less radiologic articular changes.
E. Lower serum uric acid.
2. A 71-year-old male with hypertension, chronic obstructive pulmonary disease from cigarette
smoking and previous coronary artery bypass grafting presents with a 3-day history of anuria
and dyspnoea. He is taking ramipril, atorvastatin, amlodipine, clopidogrel and aspirin,
amoxycillin, pantoprazole and inhaled corticosteroids. Blood pressure is 200/105 mmHg and an
ECG shows previous anterior myocardial infarction. A renal ultrasound shows a 6 cm right
kidney and an 11 cm left kidney. No urine is noted in the bladder. The creatinine is 900 μmol/L
and the patient requires urgent haemodialysis for acute pulmonary oedema.
What is the most likely diagnosis?
A. Acute interstitial nephritis.
B. Aortic dissection.
C. Pyelonephritis.
D. Renal thromboembolism.
E. Urinary obstruction.
2018 February RACP Written Examination – Clinical Applications Adult Medicine 2
,3. A 25-year-old man "A" underwent a general anaesthetic for an open reduction and fixation of a
fractured femur. Following induction of anaesthesia with propofol and suxamethonium he
developed tachycardia, tachypnoea, muscle rigidity and fever to 41 °C. He was treated with
dantrolene for this episode of malignant hyperthermia and recovered.
This is an autosomal dominant disease. What is the chance that this man's relative "B" is at risk
of an episode of malignant hyperthermia?
A. 6.25%
B. 12.5%
C. 25%
D. 50%
E. 100%
2018 February RACP Written Examination – Clinical Applications Adult Medicine 3
, 4. A 40-year-old female with a history of gastro-oesophageal reflux managed with high-dose
pantoprazole is admitted with severe hypertension and acute kidney injury (creatinine
315 μmol/L [49–90]). She has a history of Raynaud's and you note peripheral telangiectasia and
grade III fundal hypertensive changes. Urinalysis is bland and the full blood count shows
normochromic normocytic anaemia with a platelet count of 115 × 109/L [150–400]. The renal
ultrasound is normal.
What is the most likely cause of her hypertension and AKI?
A. Acute interstitial nephritis.
B. Conn syndrome.
C. Phaeochromocytoma.
D. Systemic lupus erythematosus.
E. Systemic sclerosis.
5. A 75-year-old man presents to his local doctor with abrupt onset of painless visual blurring
affecting the left eye only, and lasting 20 minutes. On reflection, he recalls a similar
episode 1 week earlier while driving, but he was able to complete his journey because vision in
the right eye was unaffected. Currently, the neurological examination is normal.
Which artery stenosis would be expected to cause this presentation?
A. Basilar.
B. Left carotid.
C. Left vertebral.
D. Right carotid.
E. Right vertebral.
6. At initial diagnosis, which factor is most predictive of reduced survival in patients with metastatic
renal cell cancer?
A. Age < 60.
B. Chromophobe histology.
C. Eastern Cooperative Oncology Group (ECOG) performance status of 3.
D. Lung metastases.
E. Smoking history.
2018 February RACP Written Examination – Clinical Applications Adult Medicine 4
