PACKRAT 2 Question and answers
already passed 2025/2026
A 23 year-old male with recent upper respiratory symptoms presents complaining of chest pain. His pain
is worse lying down and better sitting up and leaning forward. Electrocardiogram shows widespread ST
segment elevation. Which of the following is the most likely physical examination finding in this patient?
A. Elevated blood pressure
B. Subungual hematoma
C. Diastolic murmur
D. Pericardial friction rub - correct answer ✔D
A 75 year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable
cord in the temporal region. Which of the following is the most helpful initial test to order on this
patient?
A. Carotid ultrasound
B. Chest x-ray
C. Complete blood count
D. Erythrocyte sedimentation rate - correct answer ✔D
What is the recommended target LDL to reduce the risk of coronary artery disease in a diabetic patient?
A. 200 mg/dL
B. 160 mg/dL
C. 130 mg/dL
D. 100 mg/dL - correct answer ✔D
Which of the following best describes the purpose of intravenous magnesium sulfate in patients with
preeclampsia?
,A. Prevention of convulsions
B. Prevention of HELLP syndrome
C. Lowering of blood pressure
D. Reversal of proteinuria - correct answer ✔A
A 53 year-old male with history of hypertension presents complaining of recent 4/10 left-sided chest
pain with exertion that is relieved with rest. He states the pain usually lasts approximately 4 minutes and
is relieved with rest. Heart examination reveals regular rate and rhythm with no S3, S4, or murmur.
Lungs are clear to auscultation bilaterally. Electrocardiogram reveals no acute changes. Which of the
following is the most appropriate initial step in the evaluation of this patient?
A. Cardiac catheterization
B. CT Angiogram of the chest
C. Echocardiogram
D. Nuclear stress test - correct answer ✔D
A 36 year-old African American female comes to the clinic for an insurance physical which requires a
chest x-ray. She denies any respiratory symptoms. Examination of her chest is negative. X-ray results
show marked lymphadenopathy in the right paratracheal region. Angiotensin-converting enzyme (ACE)
levels are elevated. Which of the following is the most likely diagnosis?
A. Sarcoidosis
B. Tuberculosis
C. Pulmonary fibrosis
D. Lymphoma - correct answer ✔A
A 33 year-old male presents to your office with a complaint of right knee injury associated with pain and
swelling. He states he was running after his loose dog and suddenly stopped, hyperextended his knee,
heard a pop and noticed immediate swelling. On physical examination, the Lachman test and anterior
drawer test demonstrates joint laxity. Which of the following ligaments is most likely injured?
A. Medial collateral
,B. Lateral collateral
C. Posterior cruciate
D. Anterior cruciate - correct answer ✔D
A 22 year-old woman comes to the office because her urine is cola-colored and she has not urinated
since yesterday morning. Her past medical history is significant for pharyngitis two weeks ago. Her
mother and grandmother have type 2 diabetes. Her blood pressure is 146/92mmHG. On physical
examination, she has edema of her face and hands. Which of the following is the most likely diagnosis?
A. Glomerulonephritis
B. Acute tubular necrosis
C. Nephrolithiasis
D. Diabetic nephropathy - correct answer ✔A
A 15 year-old girl is hit in the right eye by a golf ball. There is swelling and ecchymosis of the orbit. She
complains of double vision. The right eye does not move with downward gaze or right lateral gaze.
Which of the following diagnostic tests will provide the most accurate information regarding this injury?
A. Facial x-ray
B. Schiotz tonometry
C. Fluorescein angiography
D. Slit lamp biomicroscopy - correct answer ✔A
A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin) presents to the
emergency department after vomiting large amounts of bright red blood. INR is 3. Which of the
following is most appropriate to rapidly lower the patient's INR?
A. Discontinue warfarin
B. Administer fresh frozen plasma
C. Administer protamine sulfate
D. Administer heparin sulphate - correct answer ✔B
, A 48 year-old male with diabetes mellitus presents for routine physical examination. Of note his blood
pressure each of his last two follow-up visits was 150/90 mmHg. Today the patient's BP is 148/88
mmHg. The patient denies complaints of chest pain, change in vision, or headache. Which of the
following is the most appropriate management for this patient?
A. Atenolol (Tenormin)
B. Nifedipine (Procardia)
C. Hydralazine (Apresoline)
D. Lisinopril (Zestril) - correct answer ✔D
A 72 year-old farmer comes to the office for evaluation of a pearly ulcerated papule on his right nostril.
The papule has been bleeding off and on for the past couple weeks. Which of the following findings
would be most concerning on the physical examination of this patient?
A. Cherry angioma
B. Telangiectasia
C. Spider angioma
D. Pyogenic granuloma - correct answer ✔B
A 24 year-old female presents with complaints of abdominal pain, bloating, and chronic diarrhea. She
says she felt worse last month while on vacation in Italy. Despite eating well she lost weight. What
would be the most appropriate treatment for this patient?
A. Gluten-free diet
B. Small bowel resection
C. Ciprofloxacin (Cipro) therapy
D. Pancreatic enzymes - correct answer ✔A
Hypoglycemia in an elderly patient with diabetes is most likely to manifest as which of the following
symptoms?
A. Tachycardia
already passed 2025/2026
A 23 year-old male with recent upper respiratory symptoms presents complaining of chest pain. His pain
is worse lying down and better sitting up and leaning forward. Electrocardiogram shows widespread ST
segment elevation. Which of the following is the most likely physical examination finding in this patient?
A. Elevated blood pressure
B. Subungual hematoma
C. Diastolic murmur
D. Pericardial friction rub - correct answer ✔D
A 75 year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable
cord in the temporal region. Which of the following is the most helpful initial test to order on this
patient?
A. Carotid ultrasound
B. Chest x-ray
C. Complete blood count
D. Erythrocyte sedimentation rate - correct answer ✔D
What is the recommended target LDL to reduce the risk of coronary artery disease in a diabetic patient?
A. 200 mg/dL
B. 160 mg/dL
C. 130 mg/dL
D. 100 mg/dL - correct answer ✔D
Which of the following best describes the purpose of intravenous magnesium sulfate in patients with
preeclampsia?
,A. Prevention of convulsions
B. Prevention of HELLP syndrome
C. Lowering of blood pressure
D. Reversal of proteinuria - correct answer ✔A
A 53 year-old male with history of hypertension presents complaining of recent 4/10 left-sided chest
pain with exertion that is relieved with rest. He states the pain usually lasts approximately 4 minutes and
is relieved with rest. Heart examination reveals regular rate and rhythm with no S3, S4, or murmur.
Lungs are clear to auscultation bilaterally. Electrocardiogram reveals no acute changes. Which of the
following is the most appropriate initial step in the evaluation of this patient?
A. Cardiac catheterization
B. CT Angiogram of the chest
C. Echocardiogram
D. Nuclear stress test - correct answer ✔D
A 36 year-old African American female comes to the clinic for an insurance physical which requires a
chest x-ray. She denies any respiratory symptoms. Examination of her chest is negative. X-ray results
show marked lymphadenopathy in the right paratracheal region. Angiotensin-converting enzyme (ACE)
levels are elevated. Which of the following is the most likely diagnosis?
A. Sarcoidosis
B. Tuberculosis
C. Pulmonary fibrosis
D. Lymphoma - correct answer ✔A
A 33 year-old male presents to your office with a complaint of right knee injury associated with pain and
swelling. He states he was running after his loose dog and suddenly stopped, hyperextended his knee,
heard a pop and noticed immediate swelling. On physical examination, the Lachman test and anterior
drawer test demonstrates joint laxity. Which of the following ligaments is most likely injured?
A. Medial collateral
,B. Lateral collateral
C. Posterior cruciate
D. Anterior cruciate - correct answer ✔D
A 22 year-old woman comes to the office because her urine is cola-colored and she has not urinated
since yesterday morning. Her past medical history is significant for pharyngitis two weeks ago. Her
mother and grandmother have type 2 diabetes. Her blood pressure is 146/92mmHG. On physical
examination, she has edema of her face and hands. Which of the following is the most likely diagnosis?
A. Glomerulonephritis
B. Acute tubular necrosis
C. Nephrolithiasis
D. Diabetic nephropathy - correct answer ✔A
A 15 year-old girl is hit in the right eye by a golf ball. There is swelling and ecchymosis of the orbit. She
complains of double vision. The right eye does not move with downward gaze or right lateral gaze.
Which of the following diagnostic tests will provide the most accurate information regarding this injury?
A. Facial x-ray
B. Schiotz tonometry
C. Fluorescein angiography
D. Slit lamp biomicroscopy - correct answer ✔A
A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin) presents to the
emergency department after vomiting large amounts of bright red blood. INR is 3. Which of the
following is most appropriate to rapidly lower the patient's INR?
A. Discontinue warfarin
B. Administer fresh frozen plasma
C. Administer protamine sulfate
D. Administer heparin sulphate - correct answer ✔B
, A 48 year-old male with diabetes mellitus presents for routine physical examination. Of note his blood
pressure each of his last two follow-up visits was 150/90 mmHg. Today the patient's BP is 148/88
mmHg. The patient denies complaints of chest pain, change in vision, or headache. Which of the
following is the most appropriate management for this patient?
A. Atenolol (Tenormin)
B. Nifedipine (Procardia)
C. Hydralazine (Apresoline)
D. Lisinopril (Zestril) - correct answer ✔D
A 72 year-old farmer comes to the office for evaluation of a pearly ulcerated papule on his right nostril.
The papule has been bleeding off and on for the past couple weeks. Which of the following findings
would be most concerning on the physical examination of this patient?
A. Cherry angioma
B. Telangiectasia
C. Spider angioma
D. Pyogenic granuloma - correct answer ✔B
A 24 year-old female presents with complaints of abdominal pain, bloating, and chronic diarrhea. She
says she felt worse last month while on vacation in Italy. Despite eating well she lost weight. What
would be the most appropriate treatment for this patient?
A. Gluten-free diet
B. Small bowel resection
C. Ciprofloxacin (Cipro) therapy
D. Pancreatic enzymes - correct answer ✔A
Hypoglycemia in an elderly patient with diabetes is most likely to manifest as which of the following
symptoms?
A. Tachycardia
