PACKRAT Review Questions and
complete solutions
What test is the single most useful test in establishing the diagnosis of multiple sclerosis? -
correct answer ✔✔MRI
On physical examination you note diminished breath sounds over the right lower lobe with
decreased tactile fremitus and dullness to percussion. Which of the following is the most likely
cause? - correct answer ✔✔Pleural Effusion
A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken
to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours
post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive
range of motion of the toes the patient "yells" in agony. The patient also states that the top of
his foot has decreased sensation. On physical examination the physician assistant notes that the
leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing
should be done? - correct answer ✔✔Compartment Pressure
The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - correct answer
✔✔Vomiting and Bloody diarrhea
A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next
step in the evaluation is... - correct answer ✔✔Fine-Needle Biopsy
On examination of a pregnant patient the physician assistant notes the fundal height is at the
level of the umbilicus. This corresponds to what gestational age? - correct answer ✔✔20 weeks
Cardiac nuclear scanning is done to detect... - correct answer ✔✔Ventricular Wall Dysfunction
, A classic skin finding seen in patients with inflammatory bowel disease would be... - correct
answer ✔✔Poorly healing, indolent ulcers on lower extremities
A patient with a 15-year history of type 2 diabetic mellitus presents for follow-up. Labs reveal a
BUN 100 mg/dl, serum creatinine 9.2 mg/dl, and serum glucose 164 mg/dl. Which of the
following would you expect to find on physical examination? - correct answer ✔✔Pruritus
A 32 year-old carpenter complains of right eye irritation all day after driving a metal stake into
the ground with his hammer. He states that "something flew into my eye." Visual acuity is
20/20. Pupils are equal, round, reactive to light and accommodation. Extraocular movements
are intact. There is minimal right corneal injection. No foreign body is noted with lid eversion.
Fluorescein stain reveals a tiny pinpoint uptake in the area of the corneal injection. Which of the
following is the most appropriate diagnostic test at this stage? - correct answer ✔✔X-ray orbits
A 45 year-old male complains of loss of hearing in his left ear. He also complains of ringing in the
ear, and has had occasional dizziness. On exam, there is unilateral leftsided sensorineural
hearing loss and a diminished corneal reflex. Neuro exam is otherwise normal. TMs are normal,
and canals are clear. Neck is supple, without adenopathy. Oropharynx is normal. Of the
following, the best diagnostic study to identify the cause of this patient's complaints is... -
correct answer ✔✔Gadolinium-Enhanced MRI looking for acoustic neuromas
A 64 year-old patient with known history of type 1 diabetes mellitus for 50 years has developed
pain radiating from the right buttock to the calf. Patient states that the pain is made worse with
walking and climbing stairs. Based upon this history which of the following would be the most
appropriate test to order? - correct answer ✔✔Arterial Duplex Scanning looking at arterial
perfusion
A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has
developed a resting tremor in his right hand and a shuffling gait over the last year. What finding
on physical examination would support your suspected diagnosis? - correct answer ✔✔Masked
Facies (thinking Parkinson's)
complete solutions
What test is the single most useful test in establishing the diagnosis of multiple sclerosis? -
correct answer ✔✔MRI
On physical examination you note diminished breath sounds over the right lower lobe with
decreased tactile fremitus and dullness to percussion. Which of the following is the most likely
cause? - correct answer ✔✔Pleural Effusion
A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken
to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours
post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive
range of motion of the toes the patient "yells" in agony. The patient also states that the top of
his foot has decreased sensation. On physical examination the physician assistant notes that the
leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing
should be done? - correct answer ✔✔Compartment Pressure
The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - correct answer
✔✔Vomiting and Bloody diarrhea
A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next
step in the evaluation is... - correct answer ✔✔Fine-Needle Biopsy
On examination of a pregnant patient the physician assistant notes the fundal height is at the
level of the umbilicus. This corresponds to what gestational age? - correct answer ✔✔20 weeks
Cardiac nuclear scanning is done to detect... - correct answer ✔✔Ventricular Wall Dysfunction
, A classic skin finding seen in patients with inflammatory bowel disease would be... - correct
answer ✔✔Poorly healing, indolent ulcers on lower extremities
A patient with a 15-year history of type 2 diabetic mellitus presents for follow-up. Labs reveal a
BUN 100 mg/dl, serum creatinine 9.2 mg/dl, and serum glucose 164 mg/dl. Which of the
following would you expect to find on physical examination? - correct answer ✔✔Pruritus
A 32 year-old carpenter complains of right eye irritation all day after driving a metal stake into
the ground with his hammer. He states that "something flew into my eye." Visual acuity is
20/20. Pupils are equal, round, reactive to light and accommodation. Extraocular movements
are intact. There is minimal right corneal injection. No foreign body is noted with lid eversion.
Fluorescein stain reveals a tiny pinpoint uptake in the area of the corneal injection. Which of the
following is the most appropriate diagnostic test at this stage? - correct answer ✔✔X-ray orbits
A 45 year-old male complains of loss of hearing in his left ear. He also complains of ringing in the
ear, and has had occasional dizziness. On exam, there is unilateral leftsided sensorineural
hearing loss and a diminished corneal reflex. Neuro exam is otherwise normal. TMs are normal,
and canals are clear. Neck is supple, without adenopathy. Oropharynx is normal. Of the
following, the best diagnostic study to identify the cause of this patient's complaints is... -
correct answer ✔✔Gadolinium-Enhanced MRI looking for acoustic neuromas
A 64 year-old patient with known history of type 1 diabetes mellitus for 50 years has developed
pain radiating from the right buttock to the calf. Patient states that the pain is made worse with
walking and climbing stairs. Based upon this history which of the following would be the most
appropriate test to order? - correct answer ✔✔Arterial Duplex Scanning looking at arterial
perfusion
A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has
developed a resting tremor in his right hand and a shuffling gait over the last year. What finding
on physical examination would support your suspected diagnosis? - correct answer ✔✔Masked
Facies (thinking Parkinson's)
