PACKRAT Exam Questions | 100% Correct Answers | Verified | Latest 2024 Version

A 16 year old has just moved schools. He is quiet, moody and not like himself at all. Within six months he seems to have completely changed back to his previous personality. What is the most likely diagnosis? - Adjustment disorder What is the prophylactic antibiotic most commonly given before a dental procedure if one is necessary? - Amoxicillin 2 grams po 1 hour before procedure Wilson's disease is associated with a build up of what mineral? - There is a deficiency of the copper binding protein and therefore a buildup of copper. Name one oral medication that can be used for MRSA. - Linezolid (Zyvox) and Bactrim Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications? - Digoxin What medication used in hepatitis B infection helps prevent the need for liver transplant? - Lamivudine How is celiac disease most commonly diagnosed? - Endoscopic biopsy Mononucleosis A 14 year old field hockey player presents with prominent adenopathy, white purple exudates in the throat and a palpable spleen. What is the most likely diagnosis? - Wernicke's aphasia A patient presents with what appears to be an inability to understand speech. Which aphasia should be at the top of your differential? - It is blood in the joint indicating a fracture even if the fracture line cannot be seen. A fat pad sign on a lateral x-ray of the elbow has what significance? - It is blood in the joint indicating a fracture even if the fracture line cannot be seen.A corkscrew appearance on barium study should make you think of what diagnosis? - Esophageal spasms What is the treatment for Turner's syndrome? - Cyclical estrogen and progesterone What is the gold standard for diagnosing myocarditis? - Myocardial biopsy By what age should a child be able to hold up her head? - 3 months On physical exam, you notice ulnar deviations and swan neck deformities. What is the most likely diagnosis? - Rheumatoid arthritis What is the most accurate way to diagnose urethritis? - Urine PCR You hear a loud harsh holosystolic murmur in a child. It is heard best at the LLSB. What is the most likely diagnosis? - Ventricular septal defect The accessory pathway known as the James bundle should make you think of what syndrome? - Lown-Ganong-Levine syndrome A Blalock procedure is used to correct what congenital heart condition? - Tetralogy of Fallot What medication can be used to control bleeding due to uterine atony? - Oxytocin (Pitocin) What is the most common cause of a folate deficiency? - Alcoholism List three risk factors for placental abruption. - HTN, smoking, AMA, cocaine use, PROM What ejection fraction is typical for a patient with CHF? - 35-40%What is the major concern with using lithium? - It has a very narrow therapeutic window. Blood tests are needed every four weeks. List the four most common places lung cancer will metastasize to. - Bone, brain, adrenals and liver What is the main risk factor for esophagitis? - Immunocompromised patient An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis? - Junctional rhythm List two diagnoses which require antibiotic prophylaxis for "dirty procedures?" - Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work? - No, a recent change moves mitral valve prolapse from high risk to moderate risk. A pregnant woman and cat litter should make you think of what diagnosis? - Toxoplasmosis What two valvular issues do patients with Marfan's syndrome often have? - Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard). What is the most common cause of sudden cardiac death? - Ventricular fibrillation A positive straight leg test indicates what diagnosis? - Herniated disc What two psychiatric issues are more common in males than females? - Autism and ADD, the rest are all either equal or more common in females. How long must symptoms last before diagnosing ADD? - 6 months What are the two most common organisms responsible for cellulitis? - Strep and StaphDoes total lung capacity go up or down in COPD? What organism causes Lyme disease? - It goes up. What organism is most commonly responsible for community acquired pneumonia? - Borrelia burgdorferi An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis? - Strep pneumoniae What is the normal range for MCV? - Simple partial seizure A patient's lab work shows positive Smith antibody and positive double-stranded DNA antibodies. What is the most likely diagnosis? - 80-100 Lupus You hear a continuous machine-like murmur. What is the most likely diagnosis? - Patent ductus arteriosus (PDA) How do you administer the Weber hearing test? - Tuning fork placed in the middle of the forehead By what age should a child be able to kick a ball? - 24 months A 6 year old boy seems to have all of the symptoms of ADD while at school, but at home he has no problems. Does he have ADD? - No, symptoms must occur in both settings for diagnosis. Duchenne's and Becker's muscular dystrophy have what genetic characteristic? - X-linked recessive Why is folic acid given as a prenatal vitamin? - Low folic acid can lead to neural tube defects. Color blindness is transmitted through what genetic pattern? - Dominant X-linked A patient presents with facial paresis, arm drift and abnormal speech. What are the first three tests to order? - Thinking of a stroke you order a non-contrast brain CT or MRI, serum glucose and oxygen saturation.List 4 risk factors for endometrial cancer. - Chronic unopposed estrogen, nulliparity, early menarche, late menopause, tamoxifen, DM, obesity, HTN, breast CA, ovarian CA Tall peaked P waves should make you think of what diagnosis? - Right atrial enlargement What is the best test to check for H. pylori? - Urea breath test What it is the recommended treatment for hepatitis C infection? - Pegylated interferon alpha-2 Is a nulliparous or mulitparous woman more likely to get preeclampsia? - Nulliparity is a risk factor for preeclampsia. Name the condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. (Hint: It is often associated with hypospadias.) - Chordee Acute sinusitis is most commonly caused by which two pathogens? - Strep pneumoniae and haemophilus influenzae A physical exam finding of egophony should make you think of what diagonsis? - Lobar pneumonia A patient presents with erectile dysfunction and complains of some numbness in his feet. On second thought he has noticed significant polyuria and polydipsia. What diagnosis should you be thinking of? - Diabetic neuropathy What percentage of diabetes in the US is type 2? - 80-90% What is the treatment for pneumocystis jiroveci pneumonia? - Bactrim What will the bowel sounds be early on in a small bowel obstruction? What will they be later on? - Early they are hyperactive. Late they are absent.A feathery border in an eye exam should make you think of what diagnosis? - Fungal infection List six medications that can be used for migraine prophylaxis? - Beta blockers, tricyclics, calcium channel blockers, NSAIDs and valproic acid What is the #1 cause of retinal artery occlusion? - Carotid atherosclerotic disease. What is the formula for calculating estimated date of confinement or due date? - First day of last menstrual period + 7 days - 3 months The pap smear results on a 23 year old patient come back as atypical squamous cell uncertain significance (ASCUS). What is your next step? - Repeat pap smear in 12 months although HPV test is acceptable. What causes Mallory-Weiss tears? - Forced vomiting or retching (often involving alcohol) Ghon or Ranke complexes on CXR should make you think of what diagnosis? - TB During pregnancy which is the prefered treatment of hyperthyroidism PTU or methimazole? - PTU What are three causes for a postpartum hemorrhage? - Uterine atony, genital laceration, retained placenta What is the name of the test for dry eyes? - Schirmer's test Will serum potassium be decreased or elevated in renal failure? - Elevated Which lab should be tightly monitored in a patient taking an aldosterone antagonist? - Potassium, they may have hyperkalemia. What is the definitive treatment for atrial flutter? - Radiofrequency catheter ablationWhat medication is often used to treat postpartum depression in a woman who is breast feeding? - Sertraline (Zoloft) A doughnut shaped burn should make you think of what issue? - Abuse either child or elder A strawberry cervix with copious yellow/green discharge should make you think of what diagnosis? - Trichomonas vaginitis During a physical exam of a child, you feel a tubular or sausage-shaped mass. What is the most likely diagnosis? - Intussusception What is the first line treatment for carpal tunnel? - Night splint What is the most common cause of a hip dislocation? Is it usually anterior or posterior? - MVA, posterior Maltese crosses in the urine should make you think of what diagnosis? - Nephrotic syndrome Cystoscopy and biopsy Spermatocele You place a patient on rifampin. What side effect should you warn her about? - Orange-red discoloration of body fluids A patient believes that her 15 year old daughter is sleeping with the mailman. She has no evidence of this. She has confronted her daughter who denies it. It is not interfering with her daily activities, but she does spend time thinking about it. What is the most likely diagnosis? - Delusional disorder What two leads do you use to determine the axis of the heart? - Lead I and AVF What is the other term for Mobitz type I? - Wenckebach List three possible treatments for stress incontinence in women. - Kegels, estrogen therapy, surgical placement of a urethral slingA patient presents with unproductive retching, acute localized epigastric distention and inability to pass a nasogastric tube. What is the most likely diagnosis? - Gastric volvulus How do you treat amebiasis? - Metronidazole (Flagyl) Alcohol may be a major factor in which encephalopathy? - Wernicke's List the three diagnosis you should be thinking of if a question includes Heinz bodies. - G6PD deficiency anemia, chronic liver disease, alpha thalassemia A patient presents complaining of the worst headache of his life. What might you expect their blood pressure to be? - Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated. What is the best patient position to hear aortic regurge and aortic stenosis? - Sitting up and leaning forward List the six P's of an ischemic limb. - Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis Fasting gastrin will be above what level with gastrinoma? - 150 pg/ml How do you treat a Trichomonas infection? - Metronidazole A Gram-positive organism in clusters should make you think of what diagnosis? - Staph What is the most common cause of postpartum hemorrhage? - Uterine atony An HIV patient with ground glass appearance on CXR should make you think of what diagnosis? - Pneumocystis jiroveci pneumonia (PJP used to be know as PCP) Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis? - CHFPale and boggy nasal mucosa should make you think of what diagnosis? - Allergic rhinitis Shortness of breath What is the most common patient complaint with emphysema? - Conversion disorder A patient complains of acute paralysis in his left arm. This does not seem to bother him, but his wife made him come in. There was no traumatic event. A complete neurologic workup is negative. What is the most likely diagnosis? - Ceftriaxone and doxycycline How do you treat urethritis? - Catatonic depression Posturing should make you think of what diagnosis? - When you lift the patient's head the patient bends his hips. Describe Brudzinski's sign. - Systolic pressure of 140-159 and diastolic of 90-99 Define stage 1 hypertension according to JNC 7. - Trick question - NEVER do a physical exam on someone with presumed placenta previa. What is the hallmark physical exam finding for placenta previa? - 10-20 years old What age range is typically associated with testicular torsion? - How long should you wait for a swallowed marble to pass through the body before considering surgery? - 24 hours A fixed or consistent split S2 should make you think of what diagnosis? - Atrial septal defect When does quickening occur? - Nulliparous 18-20 weeks, multiparous 14-16 weeks Oval patches of hair loss should make you think of what diagnosis? - Alopecia areataUnder routine circumstances when should patients begin getting screening colonoscopies? - Age 50 The scotch tape test is used to diagnose what disease? - Pinworm A child with a fever lasting longer than five days should make you think of what diagnosis? - Kawasaki syndrome Which heart valve is most associated with rheumatic fever? - Mitral What is the most common precipitating event for posttraumatic stress disorder in women? - Rape Hampton's hump on CXR should make you think of what diagnosis? - Pulmonary embolism Forchheimer spots are associated with what disease? - Rubella A 15 year old boy presents complaining of night pain in the pelvis. Since you have no idea what to do, you order an x-ray. The report comes back with a description of a mass with an "onion skin appearance." What is the most likely diagnosis? - Ewing sarcoma What ligament is most commonly injured in an ankle sprain? - Anterior talofibular ligament (ATFL) What is the treatment for epiglottitis? - 2nd or 3rd generation cephalosporin (ceftriaxone), macrolides may also be used (clindamycin) In Cushing's disease is ACTH elevated or decreased? - Elevated What is the #1 cause of small bowel obstruction? - Postoperative adhesions What Rh combination for mom and dad might cause the mother to create antiboides against the baby's red blood cells? - Mom Rh-negative and dad Rh- positiveWhich are painful and found on the fingers and toes, Osler nodes or Janeway lesions? - Osler nodes What is the most common prophylactic antibiotic used preoperatively? - Cefazolin = Ancef, Keflex = Cefalexin, The answer is Cefazolin (Ancef) What will an x-ray show in acute osteomyelitis? - Nothing - it will show bone destruction in chronic osteomyelitis. You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis? - Transesophageal echo As it relates to diabetics, what is the dawn phenomenon? - Reduced insulin response between 5 and 8 am If you hear crackles in the lung fields list three pulmonary issues that should be in your differential. - Pneumonia, fibrosis, CHF, Bronchitis A pathology report comes back showing negatively birefringent crystals. What is the most likely diagnosis? - Gout Cottage cheese discharge should make you think of what diagnosis? - Vaginal candidiasis What is the most common organism causing pneumonia in COPD patients? - Haemophilus influenzae What type of hearing loss would be caused by cerumen impaction? - Conductive A christmas tree pattern should make you think of what diagnosis? - Pityriasis rosea What is the age range for Duchenne's muscular dystrophy? - 3-5 years oldA question about Prinzmetal's angina will often contain what key thing in the patient's history? - Cocaine use Will unconjugated bilirubin be high or low in a patient with sickle cell disease? - High The heart rate is irregular, so you can't count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG? - Count QRS waves in a six second strip and multiply by 10 to get beats per minute. If you have a patient with positive blood cultures for candida what is the first line drug? - Amphotericin B Would a B12 deficiency anemia most likely be microcytic, normocytic or macrocytic? - Macrocytic What is the most serious complication of Kawasaki syndrome? - Aortic Aneurysm Are one half of all adult hernias direct or indirect inguinal hernias? - Indirect inguinal hernias makeup 50% of all adult hernias. Which way does a Colles fracture angulate: dorsal or volar? What about a Smith fracture? - Colles = Dorsal, Smith = Volar A patient complains of seeing halos and rainbows around lights. She also complains of moderate photophobia? What is the most likely diagnosis? - Glaucoma What is the appropriate treatment for a patent ductus arteriosus. - Indomethacin What is the term for difficulty swallowing? - Dysphagia An RSR prime in leads V1 or V2 should make you think of what diagnosis? - Right bundle branch blockWhat is the age range for osteosarcoma? Where are they most typically found in the body? - "Osteosarcoma usually occur in 15-25 year old males and are most commonly found around the knee." What medication is used to increase surfactant levels and help with lung maturity if you are worried about preterm labor? - Betamethasone What is the most specific diagnostic test for peptic ulcer disease? - Endoscopy