NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
When performing a pre-participation sports physical in the adolescent population, a murmur with which
of the following qualities indicates a risk for sudden death during exercise?
A. Increases with the Valsalva maneuver
B. Increases with squatting maneuver
C. Associated with a mid-systolic click
D. Mid-systolic without radiation to the carotids - (answer)(c) A. Hypertrophic cardiomyopathy (HCM) is a
known cause of sudden death during or just after physical exertion and competitive sports. The murmur
associated with HCM is worsened by conditions that cause reduced ventricular volume such as the
Valsalva maneuver, sudden standing, and tachycardia.
(u) B. Typical systolic flow murmurs will become accentuated with maneuvers which increase venous
blood flow to the heart and these murmurs do not place athletes at risk for sudden cardiac death.
(u) C. Mitral valve prolapse is the most common type of heart murmur that is associated with a mid-
systolic click. Mitral valve prolapse does not place the patient at risk for sudden cardiac death.
(u) D. A mid-systolic heart murmur that fails to radiate into the carotids is most commonly associated
with a benign systolic flow murmur and does not place the athlete at risk for sudden cardiac death.
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of which
of the
following?
A. Luteinizing hormone
B. Prostaglandin
C. Progesterone
D. Prolactin - (answer)(c) A. Luteinizing hormone is responsible for ovulation and, therefore, peaks at
that time.
(u) B. Prostaglandin is likely associated with the production of vasospasm, vascular necrosis, and
menstrual flow, not ovulation.
(u) C. The majority of progesterone is secreted by the corpus luteum and, therefore, peaks after
ovulation has occurred.
(u) D. Prolactin is an anterior pituitary hormone, and although important in reproduction and pregnancy,
it is not present in high levels at the time of ovulation.
,NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
A positive direct Coombs' test may be seen in which of the following conditions?
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia - (answer)(u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. A positive direct Coombs' test indicates that antibody has attached to an antigen on the RBC which
causes agglutination. Autoimmune hemolytic anemia results when the patient has antibodies against
their own RBCs. G6PD deficiency does result from an antibody antigen reaction. Sickle cell anemia is
caused by a defective hemoglobin which detected by hemoglobin electrophoresis. Hereditary
spherocytosis is detected utilizing the
osmotic fragility test.
In order to prevent the progression of diabetic nephropathy which of the following medications should
be instituted?
A. Lisinopril (Prinipril)
B. Propanolol (Inderal)
C. Verapamil (Calan)
D. Hydrochlorothiazide (Diuril) - (answer)(c) A. All patients should be started on an ACE inhibitor to
prevent the progression of proteinuria. ACE inhibitors appear to improve glomerular hemodynamics by
decreasing glomerular pressure.
(u) B. Beta blockers are not indicated for the treatment of microalbuminuria.
(u) C. Calcium channel blockers are not indicated for the treatment of microalubuminuria.
(u) D. Thiazide diuretics are not indicated for the treatment of microalbuminuria.
A 5 year-old male presents with a history of recurrent episodes of acute bronchitis, characterized by
fever and productive cough. He has no known significant past medical history. His pulmonary
examination reveals crackles in the bilateral lower lobes. The remainder of his physical examination is
,NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
normal. Chest x-ray demonstrates platelike atelectasis and dilated, thickened airways in the middle and
lower lungs. Which of the following is the most likely diagnosis?
A. Acute bronchitis
B. Bronchiectasis
C. Pneumonia
D. Tuberculosis - (answer)(u) A. Barring underlying pulmonary pathology, the chest x-ray in acute
bronchitis should be normal.
(c) B. Bronchiectasis typically presents as recurrent episodes of acute bronchitis. Platelike atelectasis and
dilated and thickened airways, sometimes described as tram lines, are common radiographic findings.
(u) C. While the history may suggest pneumonia, the radiographic findings do not support this diagnosis.
(u) D. Tuberculosis would present with cavitating granuloma formation more commonly at the apices.
Which of the following clinical characteristics is associated with bicipital tendonitis?
A. Aggravated by resisted supination of the forearm
B. Bulging appearance to the proximal arm
C. Weakness of the arm with internal rotation and adduction
D. Pain that awakens the patient at night - (answer)(c) A. Supraspinatus tendonitis will be aggravated by
resisted supination of the forearm.
(u) B. Biceps rupture may present with a bulging appearance of the proximal arm.
(u) C. Weakness of the arm with internal rotation and adduction is characteristic of pectoralis major
rupture or tear.
(u) D. Night pain is characteristic of rotator cuff tear or tendonitis.
Which of the following antiarrhythmic drugs can be associated with hyper- or hypothyroidism following
long-term use?
A. Quinidine
B. Amiodarone
C. Digoxin
D. Verapamil - (answer)(u) A. See B for explanation.
, NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
(c) B. Amiodarone is structurally related to thyroxine and contains iodine, which can induce a hyper- or
hypothyroid state.
(u) C. See B for explanation.
(u) D. See B for explanation.
An 18 year-old male is involved in a motor vehicle accident with a question of cervical spine fracture.
What is the imaging test of choice to initially evaluate this patient and clear his cervical c-spine?
A. Positron emission tomography
B. Magnetic resonance imaging
C. Computed tomography
D. Lateral radiograph - (answer)(u) A. There is no role for positron emission tomography in suspected
cervical spine injury.
(u) B. MRI and CT of the spine may be performed in the setting of acute cervical spine injury when a
major fracture or dislocation is identified.
(u) C. See B for explanation.
(c) D. Cervical spine x-rays are most commonly used as the initial screen for cervical spine injury. A
cervical spine series consists of a lateral view, anteroposterior (AP) view, and an odontoid view. The
lateral view detects up to 80% of traumatic spine injuries.
A 4 year-old boy presents with pain and irritation of his left ear. Otoscopic examination reveals an insect
in the left auditory canal. The tympanic membrane is not completely visualized. Which of the following is
the most appropriate management of this patient?
A. Debrox insertion with suction removal
B. Irrigation with room temperature saline
C. Insertion of 2% lidocaine solution with suction or forceps removal
D. Polymyxin drop insertion via wick - (answer)(u) A. Debrox is used for cerumen impaction not foreign
body removal.
(u) B. Irrigation with room temperature saline is useful for small particle removal only if the tympanic
membrane is well-visualized and without perforation. It is not indicated in the removal of an insect.
VERIFIED!!!! ALREADY GRADED A+
When performing a pre-participation sports physical in the adolescent population, a murmur with which
of the following qualities indicates a risk for sudden death during exercise?
A. Increases with the Valsalva maneuver
B. Increases with squatting maneuver
C. Associated with a mid-systolic click
D. Mid-systolic without radiation to the carotids - (answer)(c) A. Hypertrophic cardiomyopathy (HCM) is a
known cause of sudden death during or just after physical exertion and competitive sports. The murmur
associated with HCM is worsened by conditions that cause reduced ventricular volume such as the
Valsalva maneuver, sudden standing, and tachycardia.
(u) B. Typical systolic flow murmurs will become accentuated with maneuvers which increase venous
blood flow to the heart and these murmurs do not place athletes at risk for sudden cardiac death.
(u) C. Mitral valve prolapse is the most common type of heart murmur that is associated with a mid-
systolic click. Mitral valve prolapse does not place the patient at risk for sudden cardiac death.
(u) D. A mid-systolic heart murmur that fails to radiate into the carotids is most commonly associated
with a benign systolic flow murmur and does not place the athlete at risk for sudden cardiac death.
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration of which
of the
following?
A. Luteinizing hormone
B. Prostaglandin
C. Progesterone
D. Prolactin - (answer)(c) A. Luteinizing hormone is responsible for ovulation and, therefore, peaks at
that time.
(u) B. Prostaglandin is likely associated with the production of vasospasm, vascular necrosis, and
menstrual flow, not ovulation.
(u) C. The majority of progesterone is secreted by the corpus luteum and, therefore, peaks after
ovulation has occurred.
(u) D. Prolactin is an anterior pituitary hormone, and although important in reproduction and pregnancy,
it is not present in high levels at the time of ovulation.
,NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
A positive direct Coombs' test may be seen in which of the following conditions?
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia - (answer)(u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. A positive direct Coombs' test indicates that antibody has attached to an antigen on the RBC which
causes agglutination. Autoimmune hemolytic anemia results when the patient has antibodies against
their own RBCs. G6PD deficiency does result from an antibody antigen reaction. Sickle cell anemia is
caused by a defective hemoglobin which detected by hemoglobin electrophoresis. Hereditary
spherocytosis is detected utilizing the
osmotic fragility test.
In order to prevent the progression of diabetic nephropathy which of the following medications should
be instituted?
A. Lisinopril (Prinipril)
B. Propanolol (Inderal)
C. Verapamil (Calan)
D. Hydrochlorothiazide (Diuril) - (answer)(c) A. All patients should be started on an ACE inhibitor to
prevent the progression of proteinuria. ACE inhibitors appear to improve glomerular hemodynamics by
decreasing glomerular pressure.
(u) B. Beta blockers are not indicated for the treatment of microalbuminuria.
(u) C. Calcium channel blockers are not indicated for the treatment of microalubuminuria.
(u) D. Thiazide diuretics are not indicated for the treatment of microalbuminuria.
A 5 year-old male presents with a history of recurrent episodes of acute bronchitis, characterized by
fever and productive cough. He has no known significant past medical history. His pulmonary
examination reveals crackles in the bilateral lower lobes. The remainder of his physical examination is
,NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
normal. Chest x-ray demonstrates platelike atelectasis and dilated, thickened airways in the middle and
lower lungs. Which of the following is the most likely diagnosis?
A. Acute bronchitis
B. Bronchiectasis
C. Pneumonia
D. Tuberculosis - (answer)(u) A. Barring underlying pulmonary pathology, the chest x-ray in acute
bronchitis should be normal.
(c) B. Bronchiectasis typically presents as recurrent episodes of acute bronchitis. Platelike atelectasis and
dilated and thickened airways, sometimes described as tram lines, are common radiographic findings.
(u) C. While the history may suggest pneumonia, the radiographic findings do not support this diagnosis.
(u) D. Tuberculosis would present with cavitating granuloma formation more commonly at the apices.
Which of the following clinical characteristics is associated with bicipital tendonitis?
A. Aggravated by resisted supination of the forearm
B. Bulging appearance to the proximal arm
C. Weakness of the arm with internal rotation and adduction
D. Pain that awakens the patient at night - (answer)(c) A. Supraspinatus tendonitis will be aggravated by
resisted supination of the forearm.
(u) B. Biceps rupture may present with a bulging appearance of the proximal arm.
(u) C. Weakness of the arm with internal rotation and adduction is characteristic of pectoralis major
rupture or tear.
(u) D. Night pain is characteristic of rotator cuff tear or tendonitis.
Which of the following antiarrhythmic drugs can be associated with hyper- or hypothyroidism following
long-term use?
A. Quinidine
B. Amiodarone
C. Digoxin
D. Verapamil - (answer)(u) A. See B for explanation.
, NEW PACKRAT 3 NEW SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
(c) B. Amiodarone is structurally related to thyroxine and contains iodine, which can induce a hyper- or
hypothyroid state.
(u) C. See B for explanation.
(u) D. See B for explanation.
An 18 year-old male is involved in a motor vehicle accident with a question of cervical spine fracture.
What is the imaging test of choice to initially evaluate this patient and clear his cervical c-spine?
A. Positron emission tomography
B. Magnetic resonance imaging
C. Computed tomography
D. Lateral radiograph - (answer)(u) A. There is no role for positron emission tomography in suspected
cervical spine injury.
(u) B. MRI and CT of the spine may be performed in the setting of acute cervical spine injury when a
major fracture or dislocation is identified.
(u) C. See B for explanation.
(c) D. Cervical spine x-rays are most commonly used as the initial screen for cervical spine injury. A
cervical spine series consists of a lateral view, anteroposterior (AP) view, and an odontoid view. The
lateral view detects up to 80% of traumatic spine injuries.
A 4 year-old boy presents with pain and irritation of his left ear. Otoscopic examination reveals an insect
in the left auditory canal. The tympanic membrane is not completely visualized. Which of the following is
the most appropriate management of this patient?
A. Debrox insertion with suction removal
B. Irrigation with room temperature saline
C. Insertion of 2% lidocaine solution with suction or forceps removal
D. Polymyxin drop insertion via wick - (answer)(u) A. Debrox is used for cerumen impaction not foreign
body removal.
(u) B. Irrigation with room temperature saline is useful for small particle removal only if the tympanic
membrane is well-visualized and without perforation. It is not indicated in the removal of an insect.
