PACKRAT BOARD EVALUATION SCRIPT
2026 SOLVED QUESTIONS GRADED A+
⩥ Which of the following strategies promotes improved carbohydrate
metabolism and is recommended for all Type 2 diabetic patients?
A. Low-carbohydrate, high protein diet
B. Routine aerobic exercise
C. Metformin (Glucophage)
D. Acupuncture. Answer: (u) A. There is no evidence that a low-
carbohydrate, high protein diet is effective in improving carbohydrate
metabolism.
(c) B. Routine exercise improves carbohydrate metabolism and insulin
sensitivity.
(u) C. Metformin is a biguanide that primarily works to decrease
gluconeogenesis rather than affecting carbohydrate metabolism.
(u) D. There is no evidence that acupuncture improves carbohydrate
metabolism.
⩥ Acute rebound hypertensive episodes have been reported to occur
with the sudden withdrawal of
A. verapamil (Calan).
B. lisinopril (Prinivil).
C. clonidine (Catapres).
,D. hydrochlorothiazide (HCTZ). Answer: (u) A. Verapamil is a calcium
channel blocker and there is no associated rebound hypertension after
withdrawal.
(u) B. Lisinopril is an ACE inhibitor, which is not associated with
rebound hypertension.
(c) C. Clonidine (Catapres) is a central alpha agonist and abrupt
withdrawal may produce a rebound hypertensive crisis.
(u) D. Hydrochlorothiazide is a thiazide diuretic, which is not associated
with rebound hypertension.
⩥ A 72 year-old female presents with vulvular pruritus for the last nine
months, which has progressively worsened over the last two months.
She states that she went through menopause at age 54 and has been on
estrogen and progesterone therapy since that time. Physical examination
reveals red lesions with white plaques on the vulva. What should the
next course of management include?
A. Refer to a gynecologist for biopsy.
B. Refer to a dermatologist for antifungal therapy.
C. Treat with a topical steroid.
D. Treat with estrogen cream.. Answer: (c) A. Vulvular squamous cell
hyperplasia causes thickening and hyperkeratosis of the vulva. The
lesions are red and moist and cause intense pruritus over time the area
becomes thickened and a white plaque may develop. Biopsy must be
done to evaluate for intraepithelial neoplasm or invasive tumor.
(u) B. See A for explanation.
(u) C. See A for explanation.
,(u) D. See A for explanation.
⩥ A 30 year-old female presents to the emergency department with a
syncopal episode. She has a history of irregular menstrual cycles and
infertility. She has scanty, persistent vaginal bleeding and sharp pelvic
pain. A left adnexal mass is palpated. The most likely diagnosis is
A. placenta abruptio.
B. ectopic pregnancy.
C. pelvic inflammatory disease.
D. ruptured ovarian cyst.. Answer: (u) A. This is primarily a third
trimester cause of vaginal bleeding.
(c) B. Infertility increases the risk of developing ectopic pregnancy. The
onset of vaginal bleeding, pelvic pain, and formation of an adnexal mass
makes this the most likely diagnosis.
(u) C. Pelvic inflammatory disease typically presents with fever,
abdominal pain, purulent vaginal discharge, and cervical motion
tenderness.
(u) D. Acute pelvic pain may occur secondary to bleeding from the
rupture of a hemorrhagic ovarian cyst, but no adnexal mass would be
palpable on pelvic examination
⩥ A patient presents complaining of periumbilical pain. Which of the
following anatomical sites is this finding associated with?
A. Bladder
B. Stomach
, C. Pancreas
D. Small bowel. Answer: (u) A. Pain from the bladder, uterus, or colon
causes hypogastric pain.
(u) B. Pain from the stomach, duodenum, or pancreas causes epigastric
pain.
(u) C. See B for explanation.
(c) D. Pain from the small intestine, appendix, or proximal colon causes
periumbilical pain.
⩥ A 53 year-old patient presents with severe pain at the base of the
thumb and no other finger involvement. The pain is worse with activity
and lasts a short period of time following rest. There is no specific
history of trauma to the thumb but the patient admits working with her
hands as a typist. Which of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Hemochromatosis
D. Pseudogout. Answer: (u) A. Rheumatoid arthritis typically involves
the MCP and PIP joints of the digits for the second through fifth fingers.
The thumb is classically spared.
(c) B. The base of the thumb is typically involved with osteoarthritis as
are the DIP joints of the other fingers.
(u) C. Hemochromatosis classically involves the MCP joints of the
second through fifth fingers.
2026 SOLVED QUESTIONS GRADED A+
⩥ Which of the following strategies promotes improved carbohydrate
metabolism and is recommended for all Type 2 diabetic patients?
A. Low-carbohydrate, high protein diet
B. Routine aerobic exercise
C. Metformin (Glucophage)
D. Acupuncture. Answer: (u) A. There is no evidence that a low-
carbohydrate, high protein diet is effective in improving carbohydrate
metabolism.
(c) B. Routine exercise improves carbohydrate metabolism and insulin
sensitivity.
(u) C. Metformin is a biguanide that primarily works to decrease
gluconeogenesis rather than affecting carbohydrate metabolism.
(u) D. There is no evidence that acupuncture improves carbohydrate
metabolism.
⩥ Acute rebound hypertensive episodes have been reported to occur
with the sudden withdrawal of
A. verapamil (Calan).
B. lisinopril (Prinivil).
C. clonidine (Catapres).
,D. hydrochlorothiazide (HCTZ). Answer: (u) A. Verapamil is a calcium
channel blocker and there is no associated rebound hypertension after
withdrawal.
(u) B. Lisinopril is an ACE inhibitor, which is not associated with
rebound hypertension.
(c) C. Clonidine (Catapres) is a central alpha agonist and abrupt
withdrawal may produce a rebound hypertensive crisis.
(u) D. Hydrochlorothiazide is a thiazide diuretic, which is not associated
with rebound hypertension.
⩥ A 72 year-old female presents with vulvular pruritus for the last nine
months, which has progressively worsened over the last two months.
She states that she went through menopause at age 54 and has been on
estrogen and progesterone therapy since that time. Physical examination
reveals red lesions with white plaques on the vulva. What should the
next course of management include?
A. Refer to a gynecologist for biopsy.
B. Refer to a dermatologist for antifungal therapy.
C. Treat with a topical steroid.
D. Treat with estrogen cream.. Answer: (c) A. Vulvular squamous cell
hyperplasia causes thickening and hyperkeratosis of the vulva. The
lesions are red and moist and cause intense pruritus over time the area
becomes thickened and a white plaque may develop. Biopsy must be
done to evaluate for intraepithelial neoplasm or invasive tumor.
(u) B. See A for explanation.
(u) C. See A for explanation.
,(u) D. See A for explanation.
⩥ A 30 year-old female presents to the emergency department with a
syncopal episode. She has a history of irregular menstrual cycles and
infertility. She has scanty, persistent vaginal bleeding and sharp pelvic
pain. A left adnexal mass is palpated. The most likely diagnosis is
A. placenta abruptio.
B. ectopic pregnancy.
C. pelvic inflammatory disease.
D. ruptured ovarian cyst.. Answer: (u) A. This is primarily a third
trimester cause of vaginal bleeding.
(c) B. Infertility increases the risk of developing ectopic pregnancy. The
onset of vaginal bleeding, pelvic pain, and formation of an adnexal mass
makes this the most likely diagnosis.
(u) C. Pelvic inflammatory disease typically presents with fever,
abdominal pain, purulent vaginal discharge, and cervical motion
tenderness.
(u) D. Acute pelvic pain may occur secondary to bleeding from the
rupture of a hemorrhagic ovarian cyst, but no adnexal mass would be
palpable on pelvic examination
⩥ A patient presents complaining of periumbilical pain. Which of the
following anatomical sites is this finding associated with?
A. Bladder
B. Stomach
, C. Pancreas
D. Small bowel. Answer: (u) A. Pain from the bladder, uterus, or colon
causes hypogastric pain.
(u) B. Pain from the stomach, duodenum, or pancreas causes epigastric
pain.
(u) C. See B for explanation.
(c) D. Pain from the small intestine, appendix, or proximal colon causes
periumbilical pain.
⩥ A 53 year-old patient presents with severe pain at the base of the
thumb and no other finger involvement. The pain is worse with activity
and lasts a short period of time following rest. There is no specific
history of trauma to the thumb but the patient admits working with her
hands as a typist. Which of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Hemochromatosis
D. Pseudogout. Answer: (u) A. Rheumatoid arthritis typically involves
the MCP and PIP joints of the digits for the second through fifth fingers.
The thumb is classically spared.
(c) B. The base of the thumb is typically involved with osteoarthritis as
are the DIP joints of the other fingers.
(u) C. Hemochromatosis classically involves the MCP joints of the
second through fifth fingers.
