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PACKRAT 5 – Questions With Detailed Correct Answers
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PACKRAT 5 – Questions With Detailed Correct Answers**(C) Denotes - Right Ans **
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s
(normal12-14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet
430,000/microliter (normal 150,000-450,000/microliter), & bleeding time
4m (normal 2-12m). Which is the best tx option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate (u) A. Desmopressin acetate is indicated in von
Willebrand's disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin
K supplement is not indicated in this patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count
and function. Hemophilia A is treated with factor VIII concentrate or
cryoprecipitate.
HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain
MRI reveals 6 lesions throughout the brain that show ring enhancement &
surrounding edema. Which is the tx of choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
D. Ventricular shunt placement (c) A. Toxoplasmosis is commonly noted in
HIV positive patients and presents with multiple ring-enhancing lesions.
Treatment of choice for possible toxoplasmosis is sulfadiazine and
pyrimethamine.
(u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of
toxoplasmosis, but not for treatment of acute infection.
(u) C. Radiation therapy is indicated in CNS lymphoma, which typically
presents with a single lesion.
(u) D. Shunt placement is not indicated in patients with toxoplasmosis.
,On examination of a pregnant patient the physician assistant notes a bluish or
purplish discoloration of the vagina and cervix. This is called
A. Hegar's sign.
B. McDonald's sign.
C. Cullen's sign
D. Chadwick's sign (u) A. Hegar's sign is the softening of the cervix that
often occurs with pregnancy.
(u) B. McDonald's sign is when the uterus becomes flexible at the
uterocervical junction at 7-8 weeks.
(u) C. Cullen's sign is a purplish discoloration periumbilical and noted in
pancreatitis.
(c) D. Chadwick's sign is a bluish or purplish discoloration of the vagina and
cervix.
A 52 year-old female comes to the office because of black stools for the past 3
days. She is afebrile and she has no pertinent physical examination
abnormalities. Which of the following is the most appropriate initial
diagnostic study?
A. Stool for occult blood
B. Stool cultures
C. Sigmoidoscopy
D. Abdominal CT scan (c) A. Occult bleeding, as evidenced by the patient's
history of black stools, is initially verified by a positive fecal occult
blood test.
(u) B. Stool cultures are indicated in the evaluation of acute diarrhea and not
for the evaluation of acute GI bleeding.
(u) C. Melena suggests a source of bleeding that is proximal to the ligament of
Treitz, not a lower GI bleed. Sigmoidoscopy is used to evaluate only lower GI
bleeding sources.
(u) D. Abdominal CT scan is indicated for evaluation of obscure bleeding in
order to exclude a pancreatic or hepatic source of bleeding if endoscopy fails
to identify the source.
Which of the following is considered a risk factor for the development of
malignant melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
,D. brown-haired individuals (u) A. Incidence of malignant melanoma is
equal in males and females.
(c) B. Inability to tan and propensity to burn are risk factors for developing
malignant melanoma.
(u) C. Malignant melanomas are most common in Caucasians and are rarely
seen in the Japanese population.
(u) D. Red hair and freckling is one of the major risk factors for malignant
melanoma, not brown hair.
A 43 year-old data entry clerk presents with a one-month history of pain and
tingling in the right thumb, index finger,
and middle finger. Tinel's sign and Phalen's maneuver are positive. The most
appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery. (u) A. A Medrol dose pack will have no affect on carpal tunnel
syndrome.
(c) B. Splinting in neutral position relieves impingement of the median nerve,
thus improving symptoms of carpal tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to conservative
therapy.
7. Which of the following is a cause of prerenal azotemia?
A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction (u) A. Infection is associated with interstitial
nephritis, which is considered a cause of intrinsic renal azotemia.
(u) B. This is one of the causes of intrinsic renal azotemia.
(c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be
rapidly reversible when renal blood flow and glomerular ultrafiltration
pressure are restored.
(u) D. Urinary tract obstruction is the cause of postrenal azotemia.
Which of the following is the most common cause of secondary hypertension?
A. Renal parenchymal disease
B. Primary aldosteronism
, C. Oral contraceptive use
D. Cushing's syndrome (c) A. Renal parenchymal disease is the most
common cause of secondary hypertension.
(u) B. Primary aldosteronism can cause secondary hypertension, but it is not
the most common cause.
(u) C. Oral contraceptives can cause small increases in blood pressure but
considerable increases are much less common.
(u) D. Cushing's disease is a less common cause of secondary hypertension.
A newborn weighs 8 pounds at birth. On average, what should the infant
weigh at 1 year of age?
A. 16 pounds
B. 20 pounds
C. 24 pounds
D. 28 pounds (u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn
that weighs 8 pounds at birth will weigh approximately 24 pounds at 1 year of
age.
(u) D. See C for explanation.
The most reliable sign of acute otitis media (AOM) is
A. bulging of the tympanic membrane.
B. loss of tympanic membrane mobility.
C. reddening of the tympanic membrane.
D. air bubbles behind the tympanic membrane. (u) A. Bulging and air
bubbles behind the TM represent OM with effusion.
(c) B. Loss of tympanic membrane mobility during pneumoinsufflation is the
most reliable sign for diagnosing acute
otitis media.
(u) C. Reddening of the eardrum is not reliable as it may be due to crying or
other vascular changes.
(u) D. See A for explanation.
Which of the following is a staphylococcal infection characterized by a
localized red swollen and acutely tender abscess of the upper or lower eyelid?
A. Hordeolum
B. Uveitis
C. Chalazion
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