CANDIDATE NUMBER:..

PART

MRCPCH EXAMINATION

Scientific Knowledge & Theory of Practice

Specimen Paper

1. Complete the following:

Your full name (BLOCK LETTERS)

RCPCH Number.
Signature
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the Answer Sheet. Check your candidate number is in the top right hand corner.
Using the pencil provided, complete your response to each item on the Answer
Sheet.
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The College has tools, which can identify copying of answers or collusion between
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4. Question papers and individual questions must not be copied or removed from the
examination room.
5. Copyright law protects examination questions and the intellectual property of their
authors. The unauthorised use of questions is a breach of copyright law.
6. Answer all the following questions.

Q1
This is a list of studies:
A

Case controlled study

Case series

Cohort study

Cross over study

Double blind randomised controlled trial

Meta-analysis

Open label study

Qualitative study

Quasi-randomised control study

Systematic review

Choose the most appropriate study design for the following clinical questions:
SELECT ONE ANSWER ONLY FOR EACH QUESTION
Note: Each answer may be used more than once
1

A paediatric dermatology unit is one of several approached by a pharmaceutical

company who are developing a new 4 times daily antibiotic for treating acne.
They wish to compare their product with erythromycin. The clinic population is
large enough to recruit 300 children. Efficacy would be tested by independent
examination of the skin.

A research doctor wishes to do a short-term project to compare the efficacy and

acceptability of 2 spacer devices when treating children with asthma. He can
recruit 30 children aged 4 to 11 years.

A District General Hospital childrens diabetic service proposes to introduce a

transition service in conjunction with the adult diabetic service. Prior to this they
wish to identify important issues faced by the 15 teenagers leaving the
paediatric service in the next two years.

Q2
This is a list of analgesic regimens
A

Intravenous diamorphine

Oral carbamazepine

Oral carbamazepine and morphine slow release BD

Oral diazepam

Oral ibuprofen

Oral morphine PRN

Oral morphine slow release (MST) BD

Oral morphine slow release tablets (MST) BD and oral morphine PRN

Oral rofecoxib (Cox-2 selective non-steroidal anti-inflammatory)

Rectal sodium diclofenac

Choose the most appropriate analgesic or combination for each of the following:
SELECT ONE ANSWER ONLY FOR EACH QUESTION
Note: Each answer may be used more than once
1

A 14 year old boy in chronic severe pain from metastatic osteosarcoma

An 11 year old boy with chronic severe neuropathic pain secondary to

chemotherapy

A 6 year old girl with 20% second degree burns presenting to the Emergency
Department

Q3
This is a list of management options:
A

Defibrillation

Ice pack on the face

Intravenous adenosine

Intravenous amiodarone

Intravenous lignocaine

Intravenous magnesium sulphate

Oral digoxin

Oral sotalol

Radiofrequency ablation

Valsalva manoeuvre

Choose the best treatment for the following:

SELECT ONE ANSWER ONLY FOR EACH QUESTION
Note: Each answer may be used more than once
1

A 7 year old boy presents to the Accident and Emergency department with
palpitations and is found to have ventricular tachycardia. He has had similar
self-limiting symptoms in the past. He looks well. His pulse rate is 200/min and
blood pressure is 100/65

A 14 year old girl presents to the Accident and Emergency department with
upper abdominal pain and is found to have supraventricular tachycardia. She
looks well. Her pulse rate is 250/min and blood pressure is 120/65. She
refuses to have an intravenous line inserted.

A 4 year old boy has had a nocturnal cough for a week. His mother has tried to
control this with increasing doses of cough syrup. She finds him looking unwell
this morning. In the Accident and Emergency Department he is pale, with GCS
score of 12/15, with supraventricular tachycardia of 270 min and blood pressure
of 90/55.

Q4
This is a list of diagnoses:
A

Abetalipoproteinaemia

Autoimmune enteropathy

Coeliac disease

Cows milk protein intolerance

Crohns disease

Giardiasis

Lymphangiectasia

Microvillous inclusion disease (microvillous atrophy)

Primary hyperlipidaemia

Whipples disease

Choose the most likely diagnosis for each of the following histology reports on endoscopic
biopsies from the distal duodenum:
SELECT ONE ANSWER ONLY FOR EACH QUESTION
Note: Each answer may be used more than once
1

There is a patchy enteropathy with relatively mild disturbance of crypt-villous

architecture. Mucosal lymphocyte and eosinophil populations are increased,
while intraepithelial lymphocyte numbers are within the normal range.

The villous height is within normal limits but the villi are distorted by ectatic
villous core lacteals. There is no significant inflammatory infiltrate.

There is a diffuse enteropathy characterised by crypt hyperplasia and villous

atrophy. The intraepithelial lymphocyte count is increased.

Q5
The relation between oxygen partial pressure and oxygen saturation in blood (oxygen
dissociation curve of haemoglobin) is shifted to the left by
A

a decreased pH

an increased pCO2

chronic iron deficiency anaemia

deficiency of 2, 3-diphosphoglycerate in the red cells

hypothermia

Q6
The following are recognised adverse drug reactions (ADR) in the neonate:
A

Gentamicin and renal impairment

Grey baby syndrome and chloramphenicol

Indomethacin and necrotising enterocolitis

Methylxanthine and seizures

Sodium feredetate and constipation

Q7
Fetal haemoglobin (HbF)
A

constitutes a greater percentage of total haemoglobin in full-term than in

preterm babies

has a greater affinity for oxygen than adult haemoglobin

in high concentration reduces mortality in sickle cell disease

is absent in -thalassaemia major

is increased in the newborn as a result of prolonged intrauterine hypoxia

Q8
The following statements on sexual differentiation are correct:
A Bilateral inguinal herniae in a baby with female external genitalia suggests
androgen insensitivity
B Oestradiol is required for differentiation of the female internal genitalia
C The absence of the SRY gene means that the gonads will differentiate into
ovaries
D The commonest cause of ambiguous genitalia in a 46XX baby is 21-hydroxylase
deficiency
E The karyotype is the most appropriate guide to gender assignment in a baby with
ambiguous genitalia

Q9
Recognised causes of alkalosis include
A

pyloric stenosis

cardiogenic shock

acute anxiety

cystic fibrosis

therapy with a loop diuretic

Q10
Ketotic hypoglycaemia is a recognised feature of
A

a newly diagnosed child with Type I diabetes mellitus

starvation

fatty acid oxidation defect

persistent hyperinsulinaemic hypoglycaemia of infancy

congenital hypopituitarism

Q11
A 3 year old girl is on maintenance chemotherapy for acute lymphatic leukaemia.
She is admitted with a limp, fever and local tenderness of the femur. Blood cultures
and bone aspiration are performed.
What is the most likely pathogen?
SELECT ONE ANSWER ONLY
A

Haemophilus influenzae

Mycobacterium tuberculosis

Pseudomonas aeruginosa

Salmonella enteritidis

Staphylococcus aureus

Q12
A 14 year old boy with muscle weakness is undergoing respiratory assessment.
Lung function tests:
FVC
52% predicted
FEV1
53% predicted
Peak expiratory flow
before bronchodilator 80% predicted
after bronchodilator
84% predicted
What is the best interpretation of the findings?
SELECT ONE ANSWER ONLY
A Bronchial hyper-reactivity
B Hyperinflation
C Impaired gas exchange
D Restrictive lung disease
E Ventilation-perfusion mismatch

Q13
A 6-week-old girl presents with cough and dyspnoea.
Chest X-ray shows
hyperinflation with interstitial infiltrates.
She was born at 37 weeks weighing 2.9kg. She had mild conjunctivitis, eye swabs
grew Haemophilus influenzae and she was treated with topical chloramphenical.
She a first born baby. Her mother has eczema and her father has asthma.
Which pathogen is most likely to have caused the respiratory illness?
SELECT ONE ANSWER ONLY
A Chlamydia trachomatis
B Haemophilus influenzae
C Mycoplasma pneumoniae
D Neisseria gonorrhoea
E Respiratory syncitial virus

Q14
A 3-day old girl was born at 27-weeks gestation. She received 2 doses of
surfactant and is remains ventilated on SIMV. Her oxygen saturations are 92%
Ventilator settings
rate
inspiratory time
PIP
PEEP
FiO2

50/min
0.36 secs
20 cm H2O
4 cm H2O
0.28

Arterial gas
pH
PaCO2
PaO2
BE

7.38
3.9kPa
8.2 kPa
3.0

What is the best next step?

SELECT ONE ANSWER ONLY
A

Increase the FiO2

Increase the PEEP

Increase the PIP

Reduce the rate

Repeat blood gases in 4 hours

Q15
A 14 year old girl is referred by further investigation and management of
menorrhagia.
Blood
APTT
51 secs (22-45)
prothrombin time
11secs (10-15)
platelet count
325 x 109/l (150-450
fibrinogen
3.1g/dl (2-4)
Factor IX
81% (50-120)
Factor VIII
38% (50-120)
What is the most likely diagnosis?
SELECT ONE ANSWER ONLY
A

Glanzmann thrombasthenia

Haemophilia B

Protein C deficiency

Vitamin K deficiency

Von-Willebrand disease

Q16
A girl is born at term weighing 4.2 kg following a prolonged labour due to shoulder
dystocia. She was blue and floppy at birth and required resuscitation. Respiration
was established at the age of 30 minutes. She was transferred to the special care
baby unit.
She is reassessed at the age of 14 days.
What is the most reliable clinical indicator of future neurodisability at this stage?
SELECT ONE ANSWER ONLY
A

Absence of asymmetric tonic neck reflexes

Brisk deep tendon reflexes

Not taking bottle feeds

Persistent irritablity

Unilateral facial palsy involving forehead