PACKRAT 2 CERTIFICATION EVALUATION
SCRIPT 2026 FULL SOLUTION
◉ A 25 year-old female, G2 P1001, presents to your office at 11-
weeks gestation with vaginal bleeding, mild lower abdominal
cramping, and bilateral lower pelvic discomfort. On examination,
blood is noted at the dilated cervical os. No tissue is protruding from
the cervical os. The uterus by palpation is 8-9 weeks gestation. No
other abnormalities are found. Which of the following is the most
likely diagnosis?
A. Threatened abortion
B. Inevitable abortion
C. Incomplete abortion
D. Complete abortion. Answer: (u) A. Threatened abortion is
characterized by bleeding in the first trimester without loss of fluid
or tissue.
(c) B. Inevitable abortion is the gross rupture of membranes in the
presence of cervical dilation.
(u) C. Incomplete abortion is when the cervical os is open and allows
passage of blood. The products of conception may remain in utero or
may partially extrude through the open os.
(u) D. Complete abortion refers to a documented pregnancy that
spontaneously passes all of the products of conception.
,◉ What laboratory test should be closely monitored in patients on
long-term lithium treatment for bipolar disorder?
A. ALT
B. Calcium
C. Lipase
D. TSH. Answer: (u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. Patients with bipolar disorder and those on long term lithium
therapy are prone to hypothyroidism severe enough to require
treatment. Liver and pancreatic complications are not a common
concern. Electrolyte/renal issues can arise with poor fluid intake
and severe vomiting and diarrhea, calcium does not require routine
monitoring.
◉ A 16 year-old female comes to the office because her acne has
become more severe and she would like to discuss treatment. She
was originally prescribed topical clindamycin gel 1 year ago to treat
open and closed comedones on her face. Despite regular use of the
medication, she now has several comedones and papulopustules
across her nose, cheeks, chin and forehead. Which of the following
would be an appropriate additional treatment for moderate acne?
A. Intralesional steroids
B. Oral doxycycline
C. Benzoyl peroxide gel
,D. Metronidazole cream. Answer: (u) A. Intralesional steroids can be
used as an adjunct treatment for large cystic lesions.
(c) B. For moderate acne, oral antibiotics are added to the topical
medications treatment regimen.
(u) C. For mild acne, benzoyl peroxide gel can be used alone or in
combination with topical antibiotics and/or topical retinoids.
(u) D. Metronidazole cream is a treatment for rosacea.
◉ A 50 year-old male with history of alcohol abuse presents with
complaint of worsening dyspnea. Physical examination reveals
bibasilar rales, elevated jugular venous pressure, an S3 and lower
extremity edema. Chest x-ray reveals pulmonary congestion and
cardiomegaly. Electrocardiogram shows frequent ventricular ectopy.
Echocardiogram shows left ventricular dilatation and an ejection
fraction of 30%. Which of the following is the most likely diagnosis
in this patient?
A. Hypertrophic cardiomyopathy
B. Dilated cardiomyopathy
C. Restrictive cardiomyopathy
D. Tako-Tsubo cardiomyopathy. Answer: (u) A. Hypertrophic
cardiomyopathy is characterized by a hyperdynamic left ventricle
with asymmetric left ventricular hypertrophy.
(c) B. Dilated cardiomyopathy is often caused by chronic alcohol use.
It is characterized by signs and symptoms of left-sided heart failure,
a dilated left ventricle and decreased ejection fraction.
, (u) C. Restrictive cardiomyopathy is characterized more commonly
by right-sided heart failure than by left-sided heart failure. There is
rapid early filling with diastolic dysfunction. Patients with restrictive
cardiomyopathy will have a small thickened left ventricle and a
normal or near normal ejection fraction on echocardiogram.
(u) D. Tako-Tsubo cardiomyopathy (broken heart syndrome) is
characterized by signs and symptoms of acute coronary syndrome,
ST segment elevation on ECG and left ventricular apical dyskinesia.
◉ A 25 year-old female with a history of diarrhea presents to the
emergency department with Guillian-Barre syndrome. What is the
most likely causative pathogen in this patient?
A. Shigella dysenteriae
B. Yersinia enterocolitica
C. Entamoeba histolytica
D. Campylobacter jejuni. Answer: (u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. Campylobacter jejuni is a Gram-negative bacteria that has
been linked to the subsequent development of Guillain-Barre
syndrome (GBS). GBS usually develops two to three weeks after the
initial illness.
◉ A 32 year-old female presents with an 8-week history of a burning
sensation deep in the chest, which starts about 30 minutes after she
SCRIPT 2026 FULL SOLUTION
◉ A 25 year-old female, G2 P1001, presents to your office at 11-
weeks gestation with vaginal bleeding, mild lower abdominal
cramping, and bilateral lower pelvic discomfort. On examination,
blood is noted at the dilated cervical os. No tissue is protruding from
the cervical os. The uterus by palpation is 8-9 weeks gestation. No
other abnormalities are found. Which of the following is the most
likely diagnosis?
A. Threatened abortion
B. Inevitable abortion
C. Incomplete abortion
D. Complete abortion. Answer: (u) A. Threatened abortion is
characterized by bleeding in the first trimester without loss of fluid
or tissue.
(c) B. Inevitable abortion is the gross rupture of membranes in the
presence of cervical dilation.
(u) C. Incomplete abortion is when the cervical os is open and allows
passage of blood. The products of conception may remain in utero or
may partially extrude through the open os.
(u) D. Complete abortion refers to a documented pregnancy that
spontaneously passes all of the products of conception.
,◉ What laboratory test should be closely monitored in patients on
long-term lithium treatment for bipolar disorder?
A. ALT
B. Calcium
C. Lipase
D. TSH. Answer: (u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. Patients with bipolar disorder and those on long term lithium
therapy are prone to hypothyroidism severe enough to require
treatment. Liver and pancreatic complications are not a common
concern. Electrolyte/renal issues can arise with poor fluid intake
and severe vomiting and diarrhea, calcium does not require routine
monitoring.
◉ A 16 year-old female comes to the office because her acne has
become more severe and she would like to discuss treatment. She
was originally prescribed topical clindamycin gel 1 year ago to treat
open and closed comedones on her face. Despite regular use of the
medication, she now has several comedones and papulopustules
across her nose, cheeks, chin and forehead. Which of the following
would be an appropriate additional treatment for moderate acne?
A. Intralesional steroids
B. Oral doxycycline
C. Benzoyl peroxide gel
,D. Metronidazole cream. Answer: (u) A. Intralesional steroids can be
used as an adjunct treatment for large cystic lesions.
(c) B. For moderate acne, oral antibiotics are added to the topical
medications treatment regimen.
(u) C. For mild acne, benzoyl peroxide gel can be used alone or in
combination with topical antibiotics and/or topical retinoids.
(u) D. Metronidazole cream is a treatment for rosacea.
◉ A 50 year-old male with history of alcohol abuse presents with
complaint of worsening dyspnea. Physical examination reveals
bibasilar rales, elevated jugular venous pressure, an S3 and lower
extremity edema. Chest x-ray reveals pulmonary congestion and
cardiomegaly. Electrocardiogram shows frequent ventricular ectopy.
Echocardiogram shows left ventricular dilatation and an ejection
fraction of 30%. Which of the following is the most likely diagnosis
in this patient?
A. Hypertrophic cardiomyopathy
B. Dilated cardiomyopathy
C. Restrictive cardiomyopathy
D. Tako-Tsubo cardiomyopathy. Answer: (u) A. Hypertrophic
cardiomyopathy is characterized by a hyperdynamic left ventricle
with asymmetric left ventricular hypertrophy.
(c) B. Dilated cardiomyopathy is often caused by chronic alcohol use.
It is characterized by signs and symptoms of left-sided heart failure,
a dilated left ventricle and decreased ejection fraction.
, (u) C. Restrictive cardiomyopathy is characterized more commonly
by right-sided heart failure than by left-sided heart failure. There is
rapid early filling with diastolic dysfunction. Patients with restrictive
cardiomyopathy will have a small thickened left ventricle and a
normal or near normal ejection fraction on echocardiogram.
(u) D. Tako-Tsubo cardiomyopathy (broken heart syndrome) is
characterized by signs and symptoms of acute coronary syndrome,
ST segment elevation on ECG and left ventricular apical dyskinesia.
◉ A 25 year-old female with a history of diarrhea presents to the
emergency department with Guillian-Barre syndrome. What is the
most likely causative pathogen in this patient?
A. Shigella dysenteriae
B. Yersinia enterocolitica
C. Entamoeba histolytica
D. Campylobacter jejuni. Answer: (u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. Campylobacter jejuni is a Gram-negative bacteria that has
been linked to the subsequent development of Guillain-Barre
syndrome (GBS). GBS usually develops two to three weeks after the
initial illness.
◉ A 32 year-old female presents with an 8-week history of a burning
sensation deep in the chest, which starts about 30 minutes after she
