PACKRAT EXAM STUDY GUIDE 2024 LATEST UPDATE WITH 100% CORRECT ANSWERS(graded A+)

1. Health Maintenance/Obstetrics/Gynecology Which of the following portends the greatest risk for the development of breast cancer? A. Nulliparity B. Early menarche C. BRCA 1 positivity D. Maternal family history of breast cancer (u) A. See C for explanation. (u) B. See C for explanation. (c) C. BRCA1 positivity is associated with half of the early onset breast cancers and 90% of the hereditary ovarian cancers. (u) D. See C for explanation. 2. Clinical Therapeutics/Urology/Renal In order to help delay the progression to kidney disease in a diabetic patient with proteinuria, which of the following would you consider using to treat the patient's concomitant hypertension? A. Atenolol (Tenormin) B. Amlodipine (Norvasc) C. Accupril (Quinapril) D. Amiloride (Midamor) (u) A. Atenolol is a beta blocker. Beta blockers are not first line therapy for hypertensive diabetics. (u) B. Amlodipine is a calcium channel blocker. Calcium channel blockers are not first line therapy for hypertensive diabetics. (c) C. Accupril is an ACE inhibitor. Because of their beneficial effects in diabetic neuropathy, ACE inhibitors (and ARBs) should be part of the initial treatment regimen for hypertension in diabetics. (u) D. Amiloride is a potassium-sparing diuretic. An ACE inhibitor is the standard first line therapy for hypertensive diabetics. Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:00 / 0:15 Full screen : 3. Diagnosis/Pulmonology A 58 year-old with a 20 pack-year history of tobacco use presents to the emergency department with sudden onset of severe, progressive right-sided chest pain and shortness of breath. She denies fever, nausea and productive cough but reports returning from a mission trip to South Africa yesterday. Her exam reveals tachycardia, tachypnea, clear lung fields and 3+ edema and erythema of the left leg. Her chest radiograph is normal. Which of the following is the most likely diagnosis? A. Pulmonary embolism B. Pneumothorax C. Pneumonia D. Pleurisy (c) A. The patient's risk factors, acutely progressive presentation and normal chest radiograph make a pulmonary embolism the most likely and most worrisome diagnosis. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. : (8) 4. History & Physical/Dermatology A 46 year-old male is brought to the emergency department after sustaining burns to his entire right arm and leg in a house fire. Which of the following percentages best classifies the extent of his burns? A. 12 B. 18 C. 27 D. 36 (u) A. See C for explanation. (u) B. See C for explanation. (c) C. According to the "rule of nines" the percentages can be calculated as follows: entire arm = 9% of body surface area (BSA). Anterior surface of each leg = 9% BSA, posterior surface of each leg = 9% BSA. The patient has a total of 27% BSA with burns. (u) D. See C for explanation. : (8) 5. Diagnostic Studies/ENT/Ophthalmology Which of the following imaging modalities is most appropriate in the evaluation of chronic sinusitis? A. Coronal CT B. Sinus MRI C. Panorex D. Sinus radiographs (c) A. Coronal CT is the most effective imaging to determine the anatomy of the sinuses as well as the presence and extent of sinusitis. (u) B. MRI is of limited value due to less than optimal visualization of bony structures. (u) C. Panorex imaging provides limited viusalization of the sinus structures. (u) D. Sinus radiographs are rarely used due to limited visualization of soft tissues. : (8) 6. Clinical Therapeutics/Orthopedics/Rheumatology Which of the following is indicated as the first-line treatment of an initial case of acute gouty arthritis? A. Indomethacin (Indocin) B. Colchicine (Probenicid) C. Methylprednisolone (Medrol) D. Allopurinol (Zyloprim) (c) A. A nonsteroidal antiinflammatory agent is indicated as the first-line treatment for an initial case of acute gout. (u) B. Colchicine is a useful adjunct to NSAIDs, corticosteroids, or synthetic ACTH for the treatment of severe gout, refractory acute gouty attacks, or as prevention. (u) C. An intra-articular injection of glucocorticoid or a tapered regimen of oral prednisone can be used as an alternative treatment to the first-line treatment of an NSAID. (u) D. Allopurinol is a xanthine oxidase inhibitor used for patients with more than three occurrences per year, gout that is difficult to manage safely (polyarticular gout in a transplant patient or one with renal insufficiency), tophaceous gout, and hyperuricemia. Allopurinol can trigger an episode of gout, especially in the first few months of treatment. : (8) 7. Diagnostic Studies/Infectious Diseases Which of the following is the most sensitive laboratory test to diagnose herpes simplex virus? A. Polymerase chain reaction (PCR) B. Enzyme-linked immunosorbent assay (ELISA) C. Tzanck smear D. HSV antibody titer (c) A. Diagnosis is usually made clinically however, PCR is more sensitive than culture. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. : (8) 8. Health Maintenance/Psychiatry/Behavioral Medicine Which of the following is the drug of choice for the prevention of Wernicke's encephalopathy? A. Folic acid B. Calcium gluconate C. Vitamin B 12 D. Thiamine (u) A. See D for explanation. (u) B. See D for explanation. (u) C. See D for explanation. (c) D. Wernicke's encephalopathy, also called alcoholic encephalopathy, is an acute neurological disorder of thiamine deficiency. Patients are given 100mg po BID to TID for 1 to 2 weeks or parenterally 100mg in each liter of glucose. : (8) 9. History & Physical/Cardiology S3 and S4 gallops are both signs of which type of cardiac abnormality? A. Atrial non-compliance B. Ventricular septal defect C. Valvular insufficiency D. Ventricular dysfunction (u) A. S3 and S4 are not indicative of atrial abnormalities. (u) B. Ventricular septal defect is not associated with an S3 and S4 gallop. (u) C. S3 and S4 are not directly correlated to valvular insufficiency. (c) D. S3 may be louder if filling pressure is increased or if ventricular compliance is reduced. S4 is most commonly heard when there is increased resistance to filling because of loss of compliance of the ventricular walls or the increased stroke volume of high-output states. : (11) 10. Diagnosis/Neurology A 48 year-old male presents with a mild tremor that seems to increase with stressful situations and subsides when he has a glass of wine with dinner. The patient does not demonstrate the tremor at rest but it reappears when he reaches for a pen. Which of the following is most likely the cause of this patient's symptoms? A. Parkinson disease B. Essential tremor C. Huntington disease D. Focal torsion dystonia (u) A. Parkinsonism is characterized by combination of tremor, rigidity, bradykinesia, and postural instability. (c) B. Essential tremor can be familial and cause action related hand tremor, head tremor, or voice tremor. The lower extremities are spared and generally no further neurologic findings are present. (u) C. Huntington disease is characterized by gradual onset of chorea and restlessness, progressing to choreiform movements. (u) D. Focal torsion dystonia causes involuntary spasmodic movements including torsion of neck, oromandibular dystonia, or uncontrolled eye blinking. : (11) 11. Health Maintenance/Pulmonology Which of the following is most likely to cause a false negative PPD? A. Aspirin allergy B. Diagnosis of AIDS C. BCG immunization D. Pregnancy (u) A. See B for explanation. (c) B. Any process that results in reduced immune response can cause a false negative PPD. Past immunization with BCG would typically result in a false positive while aspirin allergy and pregnancy generally have no effect in and of themselves on PPD results. (u) C. See B for explanation. (u) D. See B for explanation. : (8) 11 12. Diagnostic Studies/Orthopedics/Rheumatology An afebrile 50 year-old male presents with an acute onset of an exquisitely painful first metatarsophalangeal joint. Examination reveals a red and swollen joint with tenderness on palpation. Which of the following test results will most likely be found in this patient? A. Hyperuricemia B. Negative birefringent crystals C. Evidence of a septic joint with needle aspiration D. Calcium pyrophosphate dehydrate crystals (u) A. Although 75% of patients with gout have hyperuricemia, few patients with hyperuricemia develop gout. (c) B. Negative birefringence of the needle-shaped crystals associated with gout are seen by a yellow colorization on polarized light microscopy. (u) C. A coexisting septic joint is possible, but not typical of gout. (u) D. Calcium pyrophosphate dehydrate crystal deposition is a gout-like syndrome that typically affects the knee and is also known as pseudogout. : (8) 13. History & Physical/Gastrointestinal/Nutritional An elderly man who recently emigrated from a war-torn area of Africa is brought to the clinic by his daughter. She explains that her father's diet was very limited in calories and protein and that he mostly ate corn and very little fresh foods. He has chronic diarrhea and examination reveals pigmented regions on hands, arms, and face and mild dementia. His tongue is smooth and shiny. This patient most likely has a deficiency of which of following vitamins? A. Folate B. Niacin C. Thiamine D. Vitamin K (u) A. See B for explanation. (c) B. This patient's syndrome known as pellagra is due to niacin (vitamin B3) deficiency. It is often seen in people where corn is the major source of energy and is still endemic in parts of Africa. The syndrome includes glossitis, pigmented dermatitis, dementia, and diarrhea. (u) C. See B for explanation. (u) D. See B for explanation.