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PACKRAT EXAM QUESTIONS AND ANSWERS
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PACKRAT EXAM QUESTIONS AND ANSWERS
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PACKRAT EXAM QUESTIONS AND ANSWERS23 yo male with recent URI sxs presents c/o chest pain. His pain is worse when lying
down and better sitting up and leaning forward. ECG shows widespread ST segment
elevation. Dx - Answers-Pericardial friction rub
75 yo woman presents to the office with complain of vision loss. Exam reveals a
palpable cord in the temporal region. Most helpful initial test to order - Answers-ESR
Recommended LDL tor educe risk of CAD in a diabetic pt - Answers-100mg/dL
What is the reason for giving IV mag sulfate to a pt with pre-eclampsia - Answers-
prevention of seizure by increasing the seizure threshold
53 yo man with h/o HTN presents c/o recent 4/10 left sided chest pain with exertion that
is relieved with rest. Heart exam reveals regular rate and rhythm with no S3, S4 or
murmur. Lungs are CTA bilat. ECG reveals no acute changes. Most appropriate initial
test - Answers-Nuclear Stress Test
36 yo AA female comes to the clinic for an insurance physical which requires a CXR.
She denies any respiratory sxs. Exam of her chest is negative. Xray results show
marked LAD in the right paratracheal region. ACE levels are elevated. Most likely dx -
Answers-Sarcoidosis
24 yo female presents with c/o abd pain, bloating, and chronic diarrhea. She says she
felt worse last month while on vacation in Italy. Despite eating well she lost weight. What
would be the most appropriate traetment for this pt - Answers-Gluten-Free diet
Hypoglycemia in an elderly pt with diabetes is most likely to manifest as what sx -
Answers-Mental confusion
An 85 yo nursing home resident presents witha abrupt onset of cough, sore throat, HA,
myalgias, and malaise. On exam pt temp is 102F, the rest of the exam is unremarkable.
Nasal smear is positive for Influenza B. Tx of choice for this pt - Answers-Oseltamivir
(tamiflu)
36 yo female presents for routine PE. She has no current complaints and her only
medication is oral contraceptives. The pt is preparing for a trip in Australia and is
worried about the long flight as her Mom has a hx of DVT after a long trip several yaers
ago. PE reveals BP 110/60. HR 66, regular. Heart is regular rate and rhythm without
murmur, lungs are clear to auscultation bilaterally and extremities are without edema.
Most appropriate recommendation - Answers-recommend walking frequently during the
flight
43 yo woman presents with episodes of facial flushing with increased skin temp.
followed by the development of tiny papules and pustules primarily on her cheeks and
,chin. These sxs worsen when she eats spicy food. On exam, telangiectasias are noted
along the nasal folds and tiny pustules on both cheeks. Dx - Answers-rosacea
25 yo male presents to the ED for eval of a wound on his hand. He cut his hand while
tearing down a chicken coop. On exam of his right hand you note a dirty 3cm jagged
laceration. The pt is unaware of his tetanus immunization status. Besides cleaning and
debriding the wound, what is the recommended intervention - Answers-administer
tetanus-diptheria toxoid (Th) and tetanus immune globulin (TIG)
25 yo female presents for a routine gynecological exam. You palpate a 2cm breast
mass in her right breast. Her menstrual period was last week. She has no family hx of
breast cancer. What is the modality of choice to further evaluate her breast mass -
Answers-ultrasound
60 yo right hand dominant male presents to your office complaining of right shoulder
pain and progressively worsening arm weakness. His sxs are aggravated when working
above the shoulder level. On PE, there is no evidence of muscle atrophy. He has strong
(5/5) adduction of his right shoulder but considerable weakness (1/5) with abduction
when raising his arm above his head. Passive range of motion is intact. Dx - Answers-
rotator cuff tear
Newborn weighs 8 pounds at birth. what would you expect her to weigh at 1 year of age
- Answers-24 pounds
3 month old female presents with her Mom for PE. The pts Mom denies any complaints.
On exam you note a well developed, well nourished infant in no apparent distress.
There is no cyanosis noted. Heart exam reveals a normal S1 with a physiologically split
S2. There is a grade III/VI high pitched, harsh pansystolic murmur heard best at the 3rd
and 4th left intercostal spaces with radiation across the precordium. Initial study of
choice - Answers-echocardiogram
62 yo male smoker presents to the clinic with c/o chronic cough, hemoptysis, and
weight loss. Chest CT shows a mass obstructing the bronchus with hilar and
mediastinal lymph node abnormalities. Bronchoscopy with biopsy is performed. On
reviewing pathology results you explain to the pt that his type fo lung cancer is prone to
early hematogenous spread, is rarely amenable to surgical resection and has a very
aggressive course. Dx - Answers-small cell lung cancer
Otitis externa can be differentiated from uncomplicated otitis media by which of the
following PE findings - Answers-normal pneumatic otoscopy
20 yo male presents with complaint of brief episodes of rapid heart beat with a sudden
onset and offset that have increased in frequency. He admits to associated SOB and
lightheadedness. He denies syncope. Electrocardiogram reveals a delta wave
prominent in lead II. Which of the following is the most appropriate long term
management in this pt - Answers-Radiofrequency ablation
,33 year old presents to your office with a c/o right knee injury associated with pain and
swelling. He states he was running after his loose dog and suddently stopped,
hyperextended his knee, heard a pop, and noticed immediate swelling. On PE, the
Lachman test and anterior drawer test demonstates joint laxity. Most likely injury -
Answers-ACL
22 yo woman comes to the office because her urine is cola colored and she hasnot
urinated since yesturday morning. Her past medical hx is significant for pharyngitis two
weeks ago. Her mother and grandmother have type 2 diabetes. Her BP is 146/92
mmHg. On PE she has edema of her face and hands. Dx - Answers-glomerulonephritis
15 yo girl hit in the right eye by a golf ball. There is swelling and echymosis of the orbit.
She c/o double vision. The right eye doesn't move with downward gaze or right lateral
gaze. Dx test that will provide the most information - Answers-facial x-ray
A 48 yo male with DM presents for routine PE. Of note his BP each of his last two f/u
visits was 150/90. Today his BP is 148/88. The pt denies c/o chest pain, change in
vision, or headache. Most appropriate management - Answers-linsinopril (Zestril)
68 yo male with a h/o a-fib treated with warfarin (Coumadin) presents to the ED after
vomiting large amounds of bright red blood. INR is 3. Most appropriate treatment to
rapidly lower the patient's INR - Answers-administer FFP
72 yo farmer comes to the office for eval of a pearly ulcerated papule on his right nostril.
The papule has been bleeding off and on for hte past couple weeks. Which of the
following findings would be most concerning on the PE of this pt - Answers-
Telangiectasia
26 yo woman requests screening after her boyfriend was treated for an STD. On exam
you find a painless vulvar ulcer. Most likely dx - Answers-syphilis
57 yo male recently on a high protein diet presents with an exquisitely tender,
erythematous, warm right great toe. Treatment of choice - Answers-NSAID
55 yo female presents to the clinic with lethargy, fatigue, constipation, and menorrhagia.
PE reveals an enlarged thyroid, dry skin, and a haert rate of 50bpm. Lab results show a
decrease in free T4, and an elevation in TSH. Dx - Answers-primary hypothyroidism
Which of the following diagnostic studies is indicated in the eval of an upper GI bleed -
Answers-upper endoscopy
45 yo male presents to the clinic c/o morning slugishness, daytime fatigue, headaches.
he admits to drinking two cocktails each evening. His bed partner reports loud cyclical
snoring, breath cessation, and admits thrashing movements of his extremities during
sleep. BMI is 40. Heart exam reveals regular rate and rhythm without S3, S4, or murmur
, and lungs are clear to auscultation. Polysomnography shows apneic episodes lasting as
long as 60 seconds. Which of the following clinical interventions would most likely
provide for the acute cessation of apneic episodes - Answers-nasal continuous positive
airway pressure (CPAP)
45 yo female presents with her daughter who is concerned because her Mom will not
leave the house. The patient descrives feeling anxious in crowds and places where
there are no easy means of escape. Most likely dx - Answers-agoraphobia
18 yo female with DM presents to the ED with altered LOC, deep breathing, and fruity
odor to her breath. Which med is indicated for this pt - Answers-Regular Insulin
69 yo male with a hx of CLL presents to the clinic c/o cough, dyspnea, and production of
copious amounts of foul smelling sputum. PE reveals crackles at the lung bases. CXR
shows dilated and thickened bronchi that appear as ring-like markings. Most likely dx -
Answers-bronchiectasis
Bony and cartilaginous enlargement of distal interphalangeal joints is commonly seen in
which medical condition - Answers-OA
9 yo male is brought by his mother who reports the pt has exhibited an extremely
negative attitude for the past year. He seems angry much of the time and frequently
loses his temper. Arguing over even trivial details is common place and he seems to
take delight in annoying his family. His grades and conduct at school remain excellent.
He has few friends, though he has never been seen bullying or destroying others'
property. Dx - Answers-oppositional defiant disorder
Pt presents c/o gradual hearing loss over the past 3 months. He admits to use of Q-tips
and otherwise doesn't wear ear plugs or palce other foreign objects in his ear. On exam
external auditory canals are obstructed with cerumen. After remvoal of cerumen,
hearing is equal on both sides. Appropriate counseling of this pt includes what -
Answers-Advise him to discontinue use of cotton swabs
Dysmenorrhea would most likely occur in which of the following pts - Answers-35 year
old woman with regular cycles
49 yo female presents complaing of several episodes of chest pain recently. Initial ECG
i nthe Ed shows no acute changes. Two hours later, while the pt was having pain,
repeat electrocardiogram revealed ST segment elevation in leads II, II, and aVF.
Cardiac Cath shows no significant obstruction of the coronary arteries. Treatment of
choice - Answers-nifedipine (Procardia)
62 year old male presents with c/o dyspepsia, early satiety, and dysphagia. diagnostic
study for initial workup - Answers-upper endoscopy
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