Jonathan Gleadle - How to Pass the FRACP Written Examination

We would like to thank many of our colleagues who have made major contributions to this book. We would particularly like to acknowledge Dr Katherine Punshon, Dr Sonia Huang, Dr Naukhez Asif, and Dr Telena Kerkham for contributing questions and review.

We would like to thank Oliver Mountain, Justine Li, our student reviewers, and Jasmin Shuen who all provided meticulous review, editing of the manuscript, references and QR codes. Your contributions were essential in the generation of this book.

Finally, a special thanks to Anne Hunt, Anupama Sreekanth, James Watson, and Mary Malin at Wiley for your support in making this book possible.

We would like to acknowledge the following specialists and advanced trainees for their expertise, comments and reviews of the relevant chapters.

CardiologyProfessor Bill Heddle Consultant Cardiologist Department of Cardiology Flinders Medical Centre and College of Medicine and Public Health, Flinders University

Critical Care MedicineDr Hanmo Li Senior Registrar, Advanced Trainee in Critical Care Medicine Intensive and Critical Care Unit Flinders Medical Centre

DermatologyDr Alain Tran Senior Registrar, Advanced Trainee in Dermatology, Associate Lecturer Department of Dermatology Flinders Medical Centre and College of Medicine and Public Health, Flinders University

EndocrinologyDr Angela Chen Consultant Endocrinologist Department Endocrinology Flinders Medical Centre

Epidemiology, Statistics and ResearchPaul Hakendorf Manager, Clinical Epidemiology Unit Flinders Medical Centre

Chris Horwood

Senior Epidemiologist and Data Analyst

Clinical Epidemiology Unit

Flinders Medical Centre

GastroenterologyDr Alex Barnes Consultant Gastroenterologist, Associate Lecturer Department of Gastroenterology Flinders Medical Centre and College of Medicine and Public Health, Flinders University

General and Geriatric MedicineDr Pravin Shetty Consultant General Physician and Senior Lecturer Department of General Medicine Flinders Medical Centre and College of Medicine and Public Health, Flinders University

Genetic MedicineAssociate Professor Karen Lower Department of Molecular Medicine and Genetics College of Medicine and Public Health, Flinders University

HaematologyDr Angelina Yong Consultant Haematologist Department of Haematology Lyell McEwin Hospital

ImmunologyDr Claire Reynolds Senior Registrar, Advanced Trainee in Immunology Department of Immunology Flinders Medical Centre

Infectious DiseaseDr Nicholas Anagnostou Consultant Infectious Disease Physician Department of Infectious Disease Flinders Medical Centre

Medical ObstetricsDr Jessica Gehlert Consultant Endocrinologist, Clinical Pharmacologist and Obstetric Medicine Department of Clinical Pharmacology Flinders Medical Centre

Medical OncologyDr Anna Mislang Consultant Medical Oncologist Department of Medical Oncology Flinders Medical Centre

Mental HealthProfessor Michael Baigent Consultant Psychiatrist Centre for Anxiety and Related Disorders Flinders Medical Centre and College of Medicine and Public Health, Flinders University

NephrologyDr Sarah Tan Senior Registrar, Advanced Trainee in Nephrology, Associate Lecturer Department of Renal Medicine Flinders Medical Centre and College of Medicine and Public Health, Flinders University

NeurologyAssociate Professor Tim Kleinig Consultant Neurologist and Stroke Physician The Central Adelaide Neurology Service Royal Adelaide Hospital

Pharmacology, Toxicology and Addiction MedicineDr Jessica Gehlert Consultant Endocrinologist, Clinical Pharmacologist and Obstetric Medicine Department of Clinical Pharmacology Flinders Medical Centre

RadiologyDr Ramon Pathi Consultant Radiologist Medical Imaging Services Flinders Medical Centre

Respiratory and Sleep MedicineDr Brendan Dougherty Consultant Respiratory Physician Department of Respiratory & Sleep Medicine Flinders Medical Centre

Dr Teng Yuan Kang

Senior Registrar, Advanced Trainee in Respiratory & Sleep Medicine, Associate Lecturer

Department of Respiratory & Sleep Medicine

Flinders Medical Centre and College of Medicine and Public Health, Flinders University

RheumatologyAssociate Professor Mihir Wechalekar Consultant Rheumatologist Department of Rheumatology Flinders Medical Centre and College of Medicine and Public Health, Flinders University

Dr Anthea Gist

Senior Registrar, Advanced Trainee in Rheumatology

Canberra Hospital, ACT

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?Abdominal CT with contrast immediately and suspension of driver's license.Endovascular aneurysm repair immediately.Follow up ultrasound in 6 months and continue driving.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?Fixed splitting of second heart sound.Fourth heart sound.Loud first heart sound.Third heart sound.

3 3. Which of the following patient characteristics is LEAST LIKELY to increase an individual's susceptibility to anthracycline cardiomyopathy?Age of 70 years.Male sex.Mediastinal radiotherapy.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:Confirming the suitability for valve replacement.Deciding the need for cardiac resynchronisation therapy.Predicting prognosis post valve replacement.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?Aortic valve balloon valvuloplasty.Implantable cardioverter–defibrillator (ICD).Surgical aortic valve replacement (SAVR).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?Coronary angiogram to guide further therapy.Rivaroxaban and clopidogrel.Rivaroxaban and aspirin.Rivaroxaban monotherapy.