FRACGP Core Knowledge and Fundamentals 2 — Questions and Answers
Question 1: A 58-year-old man presents with a 3-month history of fatigue, weight loss, and night sweats. Examination reveals splenomegaly and a WBC of 120 × 10⁹/L with predominantly mature lymphocytes. The MOST likely diagnosis is:
- Chronic lymphocytic leukaemia (Correct answer)
- Acute lymphoblastic leukaemia
- Multiple myeloma
- Reactive lymphocytosis
Correct answer: Chronic lymphocytic leukaemia
CLL is the most common adult leukaemia, characterised by mature small lymphocytes, splenomegaly, and an indolent course in older adults.
Question 2: Which of the following antihypertensives is CONTRAINDICATED in bilateral renal artery stenosis?
- ACE inhibitors (Correct answer)
- Calcium channel blockers
- Beta-blockers
- Thiazide diuretics
Correct answer: ACE inhibitors
ACE inhibitors block angiotensin II–mediated efferent arteriolar constriction, which is the compensatory mechanism maintaining GFR in bilateral renal artery stenosis, risking acute renal failure.
Question 3: A 34-year-old woman in her second trimester presents with pruritus and jaundice. LFTs show elevated ALT and elevated bile acids at 42 µmol/L. The MOST appropriate management is:
- Ursodeoxycholic acid and monitoring of fetal wellbeing (Correct answer)
- Cholestyramine alone
- Immediate caesarean section
- Reassurance and antihistamines only
Correct answer: Ursodeoxycholic acid and monitoring of fetal wellbeing
Intrahepatic cholestasis of pregnancy is treated with ursodeoxycholic acid to reduce bile acids and fetal risk, alongside close fetal surveillance.
Question 4: According to Australian immunisation guidelines, at what age should the meningococcal ACWY vaccine be routinely given as a booster for adolescents?
- 14–16 years (Correct answer)
- 10–12 years
- 18–20 years
- 6–8 years
Correct answer: 14–16 years
The Australian immunisation schedule recommends meningococcal ACWY vaccine at 14–16 years (Year 10) as an adolescent booster.
Question 5: A 72-year-old man on warfarin for AF has an INR of 8.2 with no active bleeding. The MOST appropriate immediate management is:
- Withhold warfarin and administer oral vitamin K 1–2 mg (Correct answer)
- Give fresh frozen plasma immediately
- Continue warfarin at the same dose
- Administer protamine sulphate
Correct answer: Withhold warfarin and administer oral vitamin K 1–2 mg
For a supratherapeutic INR >8 without bleeding, guidelines recommend withholding warfarin and giving low-dose oral vitamin K to reduce the INR safely.
Question 6: Which of the following is the MOST sensitive screening test for primary hypothyroidism?
- TSH (Correct answer)
- Free T4
- Free T3
- Anti-TPO antibodies
Correct answer: TSH
TSH is the most sensitive test for primary hypothyroidism because the pituitary responds to falling thyroid hormone levels before serum T4 becomes abnormal.
Question 7: A 45-year-old woman presents with a 6-week history of diffuse scalp hair loss occurring 3 months after a febrile illness. Hair pull test shows telogen hairs. The MOST likely diagnosis is:
- Telogen effluvium (Correct answer)
- Alopecia areata
- Androgenetic alopecia
- Tinea capitis
Correct answer: Telogen effluvium
Telogen effluvium classically presents 2–3 months after a physiological stressor such as illness, causing diffuse shedding of telogen-phase hairs.
FRACGP Core Knowledge and Fundamentals 2
A 58-year-old man presents with a 3-month history of fatigue, weight loss, and night sweats.
Examination reveals splenomegaly and a WBC of 120 × 10⁹/L with predominantly mature lymphocytes.
The MOST likely diagnosis is: