PACKRAT 5|Questions With Correct Answers|Verified
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-
14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal
150,000-450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx
option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate - ✅(u) A. Desmopressin acetate is indicated in von Willebrand's
disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin K
supplement is not indicated in this patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and
function. Hemophilia A is treated with factor VIII concentrate or cryoprecipitate.
HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain MRI
reveals 6 lesions throughout the brain that show ring enhancement & surrounding
edema. Which is the tx of choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
D. Ventricular shunt placement - ✅(c) A. Toxoplasmosis is commonly noted in HIV
positive patients and presents with multiple ring-enhancing lesions. Treatment of choice
for possible toxoplasmosis is sulfadiazine and pyrimethamine.
(u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of toxoplasmosis, but not
for treatment of acute infection.
(u) C. Radiation therapy is indicated in CNS lymphoma, which typically presents with a
single lesion.
(u) D. Shunt placement is not indicated in patients with toxoplasmosis.
On examination of a pregnant patient the physician assistant notes a bluish or purplish
discoloration of the vagina and cervix. This is called
A. Hegar's sign.
B. McDonald's sign.
C. Cullen's sign
D. Chadwick's sign - ✅(u) A. Hegar's sign is the softening of the cervix that often occurs
with pregnancy.
(u) B. McDonald's sign is when the uterus becomes flexible at the uterocervical junction
at 7-8 weeks.
(u) C. Cullen's sign is a purplish discoloration periumbilical and noted in pancreatitis.
(c) D. Chadwick's sign is a bluish or purplish discoloration of the vagina and cervix.
,A 52 year-old female comes to the office because of black stools for the past 3 days.
She is afebrile and she has no pertinent physical examination abnormalities. Which of
the following is the most appropriate initial diagnostic study?
A. Stool for occult blood
B. Stool cultures
C. Sigmoidoscopy
D. Abdominal CT scan - ✅(c) A. Occult bleeding, as evidenced by the patient's history
of black stools, is initially verified by a positive fecal occult
blood test.
(u) B. Stool cultures are indicated in the evaluation of acute diarrhea and not for the
evaluation of acute GI bleeding.
(u) C. Melena suggests a source of bleeding that is proximal to the ligament of Treitz,
not a lower GI bleed. Sigmoidoscopy is used to evaluate only lower GI bleeding
sources.
(u) D. Abdominal CT scan is indicated for evaluation of obscure bleeding in order to
exclude a pancreatic or hepatic source of bleeding if endoscopy fails to identify the
source.
Which of the following is considered a risk factor for the development of malignant
melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals - ✅(u) A. Incidence of malignant melanoma is equal in
males and females.
(c) B. Inability to tan and propensity to burn are risk factors for developing malignant
melanoma.
(u) C. Malignant melanomas are most common in Caucasians and are rarely seen in
the Japanese population.
(u) D. Red hair and freckling is one of the major risk factors for malignant melanoma,
not brown hair.
A 43 year-old data entry clerk presents with a one-month history of pain and tingling in
the right thumb, index finger,
and middle finger. Tinel's sign and Phalen's maneuver are positive. The most
appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery. - ✅(u) A. A Medrol dose pack will have no affect on carpal tunnel syndrome.
(c) B. Splinting in neutral position relieves impingement of the median nerve, thus
improving symptoms of carpal tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to conservative therapy.
7. Which of the following is a cause of prerenal azotemia?
,A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction - ✅(u) A. Infection is associated with interstitial nephritis,
which is considered a cause of intrinsic renal azotemia.
(u) B. This is one of the causes of intrinsic renal azotemia.
(c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be rapidly
reversible when renal blood flow and glomerular ultrafiltration pressure are restored.
(u) D. Urinary tract obstruction is the cause of postrenal azotemia.
Which of the following is the most common cause of secondary hypertension?
A. Renal parenchymal disease
B. Primary aldosteronism
C. Oral contraceptive use
D. Cushing's syndrome - ✅(c) A. Renal parenchymal disease is the most common
cause of secondary hypertension.
(u) B. Primary aldosteronism can cause secondary hypertension, but it is not the most
common cause.
(u) C. Oral contraceptives can cause small increases in blood pressure but considerable
increases are much less common.
(u) D. Cushing's disease is a less common cause of secondary hypertension.
A newborn weighs 8 pounds at birth. On average, what should the infant weigh at 1
year of age?
A. 16 pounds
B. 20 pounds
C. 24 pounds
D. 28 pounds - ✅(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn that weighs 8
pounds at birth will weigh approximately 24 pounds at 1 year of age.
(u) D. See C for explanation.
The most reliable sign of acute otitis media (AOM) is
A. bulging of the tympanic membrane.
B. loss of tympanic membrane mobility.
C. reddening of the tympanic membrane.
D. air bubbles behind the tympanic membrane. - ✅(u) A. Bulging and air bubbles
behind the TM represent OM with effusion.
(c) B. Loss of tympanic membrane mobility during pneumoinsufflation is the most
reliable sign for diagnosing acute
otitis media.
(u) C. Reddening of the eardrum is not reliable as it may be due to crying or other
vascular changes.
(u) D. See A for explanation.
, Which of the following is a staphylococcal infection characterized by a localized red
swollen and acutely tender abscess of the upper or lower eyelid?
A. Hordeolum
B. Uveitis
C. Chalazion
D. Dacryocystitis - ✅(c) A. Hordeolum (stye) is a staphylococcal infection characterized
by a localized red swollen and acutely tender abscess of the upper or lower eyelid.
(u) B. Uveitis is an intraocular inflammation involving the uveal tract.
(u) C. Chalazion is a granulomatous inflammation of the meibomian gland.
(u) D. Dacryocystitis is an infection of the lacrimal sac due to obstruction of the
nasolacrimal system.
Progesterone influence on the breast tissue prior to menstruation causes
A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper's ligaments.
D. increase in the number of glands of Montgomery. - ✅(u) A. Proliferation of the
mammary ducts is under the influence of estrogen.
(c) B. Growth of the lobules and alveoli is under the influence of progesterone. Prior to
menses, the breast swelling that women notice is a result of the progesterone which is
secreted from the corpus luteum. During menses, the swelling subsides.
(u) C. See B for explanation.
(u) D. See B for explanation.
A 36 year-old man has a 30 pack-year history of smoking cigarettes and wants to quit.
He is otherwise healthy at this time. Which of the following drugs would be appropriate
for him?
A. Amitriptyline (Elavil)
B. Bupropion (Wellbutrin)
C. Fluoxetine (Prozac)
D. Venlafaxine (Effexor) - ✅(u) A. See B for explanation.
(c) B. The only two approved drugs for aiding smoking cessation are nicotine and
bupropion.
(u) C. See B for explanation.
(u) D. See B for explanation.
A patient presents with chronic back pain. On physical examination testing, the patient
is found to have abnormalities of proprioception and vibration discrimination. Which of
the following portions of the spinal column are most likely affected?
A. Lateral spinothalamic tract
B. Ventral spinothalamic tract
C. Posterior column
D. Transection of the cord - ✅(u) A. The lateral spinothalamic tract affects pain and
temperature sensation.
(u) B. The ventral spinothalamic tract affects pressures and touch sensations.
(c) C. The posterior column affects proprioception (position sense) and vibration sense.
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-
14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal
150,000-450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx
option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate - ✅(u) A. Desmopressin acetate is indicated in von Willebrand's
disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin K
supplement is not indicated in this patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and
function. Hemophilia A is treated with factor VIII concentrate or cryoprecipitate.
HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain MRI
reveals 6 lesions throughout the brain that show ring enhancement & surrounding
edema. Which is the tx of choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
D. Ventricular shunt placement - ✅(c) A. Toxoplasmosis is commonly noted in HIV
positive patients and presents with multiple ring-enhancing lesions. Treatment of choice
for possible toxoplasmosis is sulfadiazine and pyrimethamine.
(u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of toxoplasmosis, but not
for treatment of acute infection.
(u) C. Radiation therapy is indicated in CNS lymphoma, which typically presents with a
single lesion.
(u) D. Shunt placement is not indicated in patients with toxoplasmosis.
On examination of a pregnant patient the physician assistant notes a bluish or purplish
discoloration of the vagina and cervix. This is called
A. Hegar's sign.
B. McDonald's sign.
C. Cullen's sign
D. Chadwick's sign - ✅(u) A. Hegar's sign is the softening of the cervix that often occurs
with pregnancy.
(u) B. McDonald's sign is when the uterus becomes flexible at the uterocervical junction
at 7-8 weeks.
(u) C. Cullen's sign is a purplish discoloration periumbilical and noted in pancreatitis.
(c) D. Chadwick's sign is a bluish or purplish discoloration of the vagina and cervix.
,A 52 year-old female comes to the office because of black stools for the past 3 days.
She is afebrile and she has no pertinent physical examination abnormalities. Which of
the following is the most appropriate initial diagnostic study?
A. Stool for occult blood
B. Stool cultures
C. Sigmoidoscopy
D. Abdominal CT scan - ✅(c) A. Occult bleeding, as evidenced by the patient's history
of black stools, is initially verified by a positive fecal occult
blood test.
(u) B. Stool cultures are indicated in the evaluation of acute diarrhea and not for the
evaluation of acute GI bleeding.
(u) C. Melena suggests a source of bleeding that is proximal to the ligament of Treitz,
not a lower GI bleed. Sigmoidoscopy is used to evaluate only lower GI bleeding
sources.
(u) D. Abdominal CT scan is indicated for evaluation of obscure bleeding in order to
exclude a pancreatic or hepatic source of bleeding if endoscopy fails to identify the
source.
Which of the following is considered a risk factor for the development of malignant
melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals - ✅(u) A. Incidence of malignant melanoma is equal in
males and females.
(c) B. Inability to tan and propensity to burn are risk factors for developing malignant
melanoma.
(u) C. Malignant melanomas are most common in Caucasians and are rarely seen in
the Japanese population.
(u) D. Red hair and freckling is one of the major risk factors for malignant melanoma,
not brown hair.
A 43 year-old data entry clerk presents with a one-month history of pain and tingling in
the right thumb, index finger,
and middle finger. Tinel's sign and Phalen's maneuver are positive. The most
appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery. - ✅(u) A. A Medrol dose pack will have no affect on carpal tunnel syndrome.
(c) B. Splinting in neutral position relieves impingement of the median nerve, thus
improving symptoms of carpal tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to conservative therapy.
7. Which of the following is a cause of prerenal azotemia?
,A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction - ✅(u) A. Infection is associated with interstitial nephritis,
which is considered a cause of intrinsic renal azotemia.
(u) B. This is one of the causes of intrinsic renal azotemia.
(c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be rapidly
reversible when renal blood flow and glomerular ultrafiltration pressure are restored.
(u) D. Urinary tract obstruction is the cause of postrenal azotemia.
Which of the following is the most common cause of secondary hypertension?
A. Renal parenchymal disease
B. Primary aldosteronism
C. Oral contraceptive use
D. Cushing's syndrome - ✅(c) A. Renal parenchymal disease is the most common
cause of secondary hypertension.
(u) B. Primary aldosteronism can cause secondary hypertension, but it is not the most
common cause.
(u) C. Oral contraceptives can cause small increases in blood pressure but considerable
increases are much less common.
(u) D. Cushing's disease is a less common cause of secondary hypertension.
A newborn weighs 8 pounds at birth. On average, what should the infant weigh at 1
year of age?
A. 16 pounds
B. 20 pounds
C. 24 pounds
D. 28 pounds - ✅(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn that weighs 8
pounds at birth will weigh approximately 24 pounds at 1 year of age.
(u) D. See C for explanation.
The most reliable sign of acute otitis media (AOM) is
A. bulging of the tympanic membrane.
B. loss of tympanic membrane mobility.
C. reddening of the tympanic membrane.
D. air bubbles behind the tympanic membrane. - ✅(u) A. Bulging and air bubbles
behind the TM represent OM with effusion.
(c) B. Loss of tympanic membrane mobility during pneumoinsufflation is the most
reliable sign for diagnosing acute
otitis media.
(u) C. Reddening of the eardrum is not reliable as it may be due to crying or other
vascular changes.
(u) D. See A for explanation.
, Which of the following is a staphylococcal infection characterized by a localized red
swollen and acutely tender abscess of the upper or lower eyelid?
A. Hordeolum
B. Uveitis
C. Chalazion
D. Dacryocystitis - ✅(c) A. Hordeolum (stye) is a staphylococcal infection characterized
by a localized red swollen and acutely tender abscess of the upper or lower eyelid.
(u) B. Uveitis is an intraocular inflammation involving the uveal tract.
(u) C. Chalazion is a granulomatous inflammation of the meibomian gland.
(u) D. Dacryocystitis is an infection of the lacrimal sac due to obstruction of the
nasolacrimal system.
Progesterone influence on the breast tissue prior to menstruation causes
A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper's ligaments.
D. increase in the number of glands of Montgomery. - ✅(u) A. Proliferation of the
mammary ducts is under the influence of estrogen.
(c) B. Growth of the lobules and alveoli is under the influence of progesterone. Prior to
menses, the breast swelling that women notice is a result of the progesterone which is
secreted from the corpus luteum. During menses, the swelling subsides.
(u) C. See B for explanation.
(u) D. See B for explanation.
A 36 year-old man has a 30 pack-year history of smoking cigarettes and wants to quit.
He is otherwise healthy at this time. Which of the following drugs would be appropriate
for him?
A. Amitriptyline (Elavil)
B. Bupropion (Wellbutrin)
C. Fluoxetine (Prozac)
D. Venlafaxine (Effexor) - ✅(u) A. See B for explanation.
(c) B. The only two approved drugs for aiding smoking cessation are nicotine and
bupropion.
(u) C. See B for explanation.
(u) D. See B for explanation.
A patient presents with chronic back pain. On physical examination testing, the patient
is found to have abnormalities of proprioception and vibration discrimination. Which of
the following portions of the spinal column are most likely affected?
A. Lateral spinothalamic tract
B. Ventral spinothalamic tract
C. Posterior column
D. Transection of the cord - ✅(u) A. The lateral spinothalamic tract affects pain and
temperature sensation.
(u) B. The ventral spinothalamic tract affects pressures and touch sensations.
(c) C. The posterior column affects proprioception (position sense) and vibration sense.
