Packrat exam QUESTIONS WELL
ANSWERED GRADED A+ 2025/2026
23 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 - ANS
✔✔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 - ANS ✔✔ESR
Recommended LDL tor educe risk of CAD in a diabetic pt - ANS ✔✔100mg/dL
What is the reason for giving IV mag sulfate to a pt with pre-eclampsia - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔Sarcoidosis
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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔Telangiectasia
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 - ANS ✔✔Gluten-Free diet
Hypoglycemia in an elderly pt with diabetes is most likely to manifest as what sx - ANS
✔✔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 - ANS ✔✔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 - ANS
✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔rotator cuff tear
Newborn weighs 8 pounds at birth. what would you expect her to weigh at 1 year of age - ANS
✔✔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 - ANS ✔✔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 - ANS ✔✔small cell lung
cancer
Otitis externa can be differentiated from uncomplicated otitis media by which of the following
PE findings - ANS ✔✔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 - ANS ✔✔Radiofrequency
ablation
26 yo woman requests screening after her boyfriend was treated for an STD. On exam you find a
painless vulvar ulcer. Most likely dx - ANS ✔✔syphilis
57 yo male recently on a high protein diet presents with an exquisitely tender, erythematous,
warm right great toe. Treatment of choice - ANS ✔✔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 - ANS ✔✔primary hypothyroidism
ANSWERED GRADED A+ 2025/2026
23 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 - ANS
✔✔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 - ANS ✔✔ESR
Recommended LDL tor educe risk of CAD in a diabetic pt - ANS ✔✔100mg/dL
What is the reason for giving IV mag sulfate to a pt with pre-eclampsia - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔Sarcoidosis
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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔Telangiectasia
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 - ANS ✔✔Gluten-Free diet
Hypoglycemia in an elderly pt with diabetes is most likely to manifest as what sx - ANS
✔✔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 - ANS ✔✔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 - ANS
✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔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 - ANS ✔✔rotator cuff tear
Newborn weighs 8 pounds at birth. what would you expect her to weigh at 1 year of age - ANS
✔✔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 - ANS ✔✔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 - ANS ✔✔small cell lung
cancer
Otitis externa can be differentiated from uncomplicated otitis media by which of the following
PE findings - ANS ✔✔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 - ANS ✔✔Radiofrequency
ablation
26 yo woman requests screening after her boyfriend was treated for an STD. On exam you find a
painless vulvar ulcer. Most likely dx - ANS ✔✔syphilis
57 yo male recently on a high protein diet presents with an exquisitely tender, erythematous,
warm right great toe. Treatment of choice - ANS ✔✔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 - ANS ✔✔primary hypothyroidism
