Ace PACKRAT 1: The Complete Study Resource with Verified Q&A| Updated 2025
PACKRAT 1 (Physician Assistant Clinical Knowledge Rating and Assessment Tool) is a
formative exam designed to assess the clinical knowledge and readiness of Physician Assistant
(PA) students. It covers a wide range of medical topics, including anatomy, pathology,
pharmacology, clinical medicine, and diagnostic procedures. The exam helps students gauge
their strengths and areas for improvement, typically with a focus on key concepts they will need
to know for the Physician Assistant National Certifying Exam (PANCE). PACKRAT 1 is often
used early in PA programs to help guide study and ensure that students are on track with their
learning.
A patient with hypovolemic shock would most likely exhibit which of the following signs?
A. increased CVP; decreased BP; increased pulse rate
B. decreased CVP; decreased BP; increased pulse rate
C. increased CVP; increased BP; decreased pulse rate
D. decreased CVP; increased BP; decreased pulse rate
B. Hypovolemic shock is a condition with a decrease in the amount of circulating blood volume in the
intravascular system. A decrease in the amount of circulating volume will result in a decrease in the CVP
pressure which is an indirect measurement of the amount of blood in the right ventricle. Less blood in the
vascular system means decreased blood pressure. Since there is less blood in the circulation, the body
will attempt to compensate for this by increasing the number of contractions (pulse rate) and the force of
those contractions due to increased sympathetic stimulation.
Examination of the heart in chronic heart failure frequently reveals
A. S3.
B. splitting of S2.
C. paradoxical splitting of S2.
D. holosystolic murmur.
A. S3 occurs as a result of the left ventricle becoming stiff and interfering with blood entering the left
ventricle during filling. As the left ventricle loses its compliance, there is impaired filling which results in
less blood entering the left ventricle, increased left ventricle filling pressures, and left ventricular failure.
Contraction of the left ventricle is not initially affected, but becomes affected with time.
Which of the following conditions is most suggestive of an asymptomatic abdominal aortic aneurysm?
A. abdominal mass
B. hypertension
C. chest pain
D. syncope
A. Symptomatic abdominal aortic aneurysm presents with pulsating upper abdominal mass.
,Post-infarction syndrome (Dressler's syndrome) occurs after acute myocardial infarction presenting as
A. ventricular aneurysm.
B. pericarditis and pleuritis.
C. cardiac tamponade.
D. pleural effusion and rash.
B. Dressler's syndrome is the occurrence of pericarditis and pleuritis several days to weeks following an
MI.
The typical physical examination finding of scarlet fever is which of the following?
A. slapped cheek appearance
B. strawberry tongue
C. Koplik's spots
D. honey-crusted lesions
B. Scarlet fever presents with fever, chills, sore throat, and a generalized fine papular rash with a
sandpaper texture which begins on the chest. "Strawberry tongue" is also noted.
In myxedema, the patient commonly complains of which of the following?
A. tremors
B. palpitation
C. cold intolerance
D. eructation
C. Myxedema is the result of hypothyroidism. Cold intolerance is associated with hyopthyroidism
along with constipation and fatigue.
Which of the following signs or symptoms differentiates acute sinusitis from viral rhinitis?
A. fever
B. rhinorrhea
C. facial pain
D. swollen nasal mucous membranes
C. Frontal headache, swollen nasal mucous membranes, rhinorrhea and fever may all be signs of viral
rhinitis, along with sneezing and a scratchy throat. Sinusitis usually follows a viral rhinitis, but in addition
to the above symptoms, it will include pain and tenderness over the involved sinus.
Which of the following is most commonly seen in viral croup?
A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor
D. Viral croup typically presents with barking cough and stridor.
A patient has double vision when he turns his eyes to the right. Examination shows that he cannot move
his right eye laterally. Which of the following cranial nerves is involved?
A. optic
, B. oculomotor
C. trochlear
D. abducens
D. The abducens nerve affects lateral eye movement, and if paralyzed will cause double vision with
lateral gaze.
When palpating a patient's abdomen at the level of the left costal margin, the physician assistant feels the
edge of the spleen. To confirm findings, which of the following is appropriate?
A. Roll the patient onto the right side and palpate for the spleen edge.
B. Roll the patient onto the left side and palpate for the spleen edge.
C. Have the patient get into the knee-chest position.
D. Have the patient sit upright and palpate in the left costal vertebral angle.
A. By rolling the patient onto the right side, gravity may bring the spleen forward and medial so that it is
in a palpable location.
Which of the following is a finding in vitamin A deficiency?
A. decreased proprioception
B. night blindness
C. hair loss
D. bleeding
B. Night blindness is the earliest symptom of vitamin A deficiency.
The physician assistant would suspect food poisoning from Staphylococcus aureus in a patient who
presents with
A. ingestion of mayonnaise-based salads 48 hours earlier.
B. bloody diarrhea with mucus for one week.
C. abdominal cramps and vomiting.
D. high fever.
C. Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with
Staphylococcal food poisoning.
The most common location of bleeding seen in patients with von Willebrand's disease is the
A. mucosal surfaces.
B. spleen.
C. joint spaces.
D. muscle groups.
A. Von Willenbrand's disease most commonly presents with mucosal bleeding such as epistaxis, gingival
bleeding, and menorrhagia.
Which of the following physical findings suggest pernicious anemia?
A. splenomegaly and hepatomegaly
B. petechiae and ecchymosis
C. loss of position and vibratory sensation
D. cheilosis and koilonychia
C. Loss of position and vibratory sensation are common neurologic findings in pernicious anemia.
PACKRAT 1 (Physician Assistant Clinical Knowledge Rating and Assessment Tool) is a
formative exam designed to assess the clinical knowledge and readiness of Physician Assistant
(PA) students. It covers a wide range of medical topics, including anatomy, pathology,
pharmacology, clinical medicine, and diagnostic procedures. The exam helps students gauge
their strengths and areas for improvement, typically with a focus on key concepts they will need
to know for the Physician Assistant National Certifying Exam (PANCE). PACKRAT 1 is often
used early in PA programs to help guide study and ensure that students are on track with their
learning.
A patient with hypovolemic shock would most likely exhibit which of the following signs?
A. increased CVP; decreased BP; increased pulse rate
B. decreased CVP; decreased BP; increased pulse rate
C. increased CVP; increased BP; decreased pulse rate
D. decreased CVP; increased BP; decreased pulse rate
B. Hypovolemic shock is a condition with a decrease in the amount of circulating blood volume in the
intravascular system. A decrease in the amount of circulating volume will result in a decrease in the CVP
pressure which is an indirect measurement of the amount of blood in the right ventricle. Less blood in the
vascular system means decreased blood pressure. Since there is less blood in the circulation, the body
will attempt to compensate for this by increasing the number of contractions (pulse rate) and the force of
those contractions due to increased sympathetic stimulation.
Examination of the heart in chronic heart failure frequently reveals
A. S3.
B. splitting of S2.
C. paradoxical splitting of S2.
D. holosystolic murmur.
A. S3 occurs as a result of the left ventricle becoming stiff and interfering with blood entering the left
ventricle during filling. As the left ventricle loses its compliance, there is impaired filling which results in
less blood entering the left ventricle, increased left ventricle filling pressures, and left ventricular failure.
Contraction of the left ventricle is not initially affected, but becomes affected with time.
Which of the following conditions is most suggestive of an asymptomatic abdominal aortic aneurysm?
A. abdominal mass
B. hypertension
C. chest pain
D. syncope
A. Symptomatic abdominal aortic aneurysm presents with pulsating upper abdominal mass.
,Post-infarction syndrome (Dressler's syndrome) occurs after acute myocardial infarction presenting as
A. ventricular aneurysm.
B. pericarditis and pleuritis.
C. cardiac tamponade.
D. pleural effusion and rash.
B. Dressler's syndrome is the occurrence of pericarditis and pleuritis several days to weeks following an
MI.
The typical physical examination finding of scarlet fever is which of the following?
A. slapped cheek appearance
B. strawberry tongue
C. Koplik's spots
D. honey-crusted lesions
B. Scarlet fever presents with fever, chills, sore throat, and a generalized fine papular rash with a
sandpaper texture which begins on the chest. "Strawberry tongue" is also noted.
In myxedema, the patient commonly complains of which of the following?
A. tremors
B. palpitation
C. cold intolerance
D. eructation
C. Myxedema is the result of hypothyroidism. Cold intolerance is associated with hyopthyroidism
along with constipation and fatigue.
Which of the following signs or symptoms differentiates acute sinusitis from viral rhinitis?
A. fever
B. rhinorrhea
C. facial pain
D. swollen nasal mucous membranes
C. Frontal headache, swollen nasal mucous membranes, rhinorrhea and fever may all be signs of viral
rhinitis, along with sneezing and a scratchy throat. Sinusitis usually follows a viral rhinitis, but in addition
to the above symptoms, it will include pain and tenderness over the involved sinus.
Which of the following is most commonly seen in viral croup?
A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor
D. Viral croup typically presents with barking cough and stridor.
A patient has double vision when he turns his eyes to the right. Examination shows that he cannot move
his right eye laterally. Which of the following cranial nerves is involved?
A. optic
, B. oculomotor
C. trochlear
D. abducens
D. The abducens nerve affects lateral eye movement, and if paralyzed will cause double vision with
lateral gaze.
When palpating a patient's abdomen at the level of the left costal margin, the physician assistant feels the
edge of the spleen. To confirm findings, which of the following is appropriate?
A. Roll the patient onto the right side and palpate for the spleen edge.
B. Roll the patient onto the left side and palpate for the spleen edge.
C. Have the patient get into the knee-chest position.
D. Have the patient sit upright and palpate in the left costal vertebral angle.
A. By rolling the patient onto the right side, gravity may bring the spleen forward and medial so that it is
in a palpable location.
Which of the following is a finding in vitamin A deficiency?
A. decreased proprioception
B. night blindness
C. hair loss
D. bleeding
B. Night blindness is the earliest symptom of vitamin A deficiency.
The physician assistant would suspect food poisoning from Staphylococcus aureus in a patient who
presents with
A. ingestion of mayonnaise-based salads 48 hours earlier.
B. bloody diarrhea with mucus for one week.
C. abdominal cramps and vomiting.
D. high fever.
C. Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with
Staphylococcal food poisoning.
The most common location of bleeding seen in patients with von Willebrand's disease is the
A. mucosal surfaces.
B. spleen.
C. joint spaces.
D. muscle groups.
A. Von Willenbrand's disease most commonly presents with mucosal bleeding such as epistaxis, gingival
bleeding, and menorrhagia.
Which of the following physical findings suggest pernicious anemia?
A. splenomegaly and hepatomegaly
B. petechiae and ecchymosis
C. loss of position and vibratory sensation
D. cheilosis and koilonychia
C. Loss of position and vibratory sensation are common neurologic findings in pernicious anemia.
