PACKRAT 2 COMPREHENSIVE TEST PAPER 2026
SOLUTIONS VERIFIED
◉ A 3 month-old female presents with her mom for physical
examination. The patient's mom denies any complaints. On
examination you note a well-developed, well-nourished infant in no
apparent distress. There is no cyanosis noted. Heart examination
reveals a normal S1 with a physiologically split S2. There is a grade
III/VI high-pitched, harsh, pansystolic murmur heard best at the 3rd
and 4th left intercostal spaces with radiation across the precordium.
Which of the following is the initial diagnostic study of choice in this
patient?
A. CT angiogram
B. Electrocardiogram
C. Echocardiogram
D. Cardiac catheterization. Answer: (u) A. This patient has signs and
symptoms consistent with a ventricular septal defect (VSD). CT
angiogram and electrocardiogram are not indicated in establishing
the diagnosis of a VSD.
(u) B. See A for explanation.
(c) C. Echocardiogram is the initial diagnostic study of choice in the
diagnosis of a VSD.
(u) D. Cardiac catheterization may be necessary to accurately
measure pulmonary pressures or if a VSD can not be well localized
on echocardiogram, but it is not the initial diagnostic study of choice.
,◉ A 62 year-old male smoker presents to the clinic with the
complaint of a chronic cough, hemoptysis, and weight loss. Chest CT
shows a mass obstructing the bronchus with hilar and mediastinal
lymph node abnormalities. Bronchoscopy with biopsy is performed.
On reviewing pathology results you explain to the patient that his
type of lung cancer is prone to early hematogenous spread, is rarely
amenable to surgical resection and has a very aggressive course.
What type of lung cancer is most likely in this patient?
A. Squamous cell
B. Small cell
C. Large cell
D. Adenocarcinoma. Answer: (u) A. Squamous cell carcinoma, large
cell carcinoma, and adenocarcinoma spread more slowly and have
the possibility of cure in early stages following resection and
chemotherapy.
(c) B. Small cell lung cancer is very aggressive with a median
survival (untreated) of 6-18 weeks.
(u) C. See A for explanation.
(u) D. See A for explanation.
◉ Otitis externa can be differentiated from uncomplicated otitis
media by which of the following physical examination findings?
A. Erythematous tympanic membrane
B. Mastoid tenderness
,C. Normal pneumatic otoscopy
D. Posterior auricular adenopathy. Answer: (u) A. In otitis externa,
the erythema is because the lateral surface of the tympanic
membrane is ear canal skin, and therefore is often erythematous.
(u) B. Mastoid tenderness is not directly associated with otitis media
or otitis externa.
(c) C. In contrast to acute otitis media, the tympanic membrane
moves normally with pneumatic otoscopy in a patient with otitis
externa.
(u) D. Both otitis media and otitis externa may have posterior
auricular adenopathy on examination.
◉ A 20 year-old male presents with complaint of brief episodes of
rapid heart beat with a sudden onset and offset that have increased
in frequency. He admits to associated shortness of breath and
lightheadedness. He denies syncope. Electrocardiogram reveals a
delta wave prominent in lead II. Which of the following is the most
appropriate long-term management in this patient?
A. Implantable cardio defibrillator
B. Radiofrequency ablation
C. Verapamil (Calan)
D. Metoprolol (Lopressor). Answer: (u) A. Implantable cardio
defibrillators are indicated in the treatment of ventricular
arrhythmias, not Wolf-Parkinson-White (WPW) syndrome.
, (c) B. Radiofrequency ablation is the procedure of choice for long-
term management in patients with accessory pathways (WPW) and
recurrent symptoms.
(u) C. Calcium channel blockers and beta-blockers are not the best
options for the long-term management of WPW. They may decrease
the refractoriness of the accessory pathway or increase the
refractoriness of the AV node in patients with atrial fibrillation or
atrial flutter who have an antegrade conducting bypass tract. This
may lead to faster ventricular rates.
(u) D. See C for explanation.
◉ A 26 year-old woman requests screening after her boyfriend was
treated for a sexually transmitted infection recently. On examination
you find a painless vulvar ulcer. Which of the following is the most
likely diagnosis?
A. Herpes
B. Syphilis
C. Chancroid
D. Granuloma inguinale. Answer: (u) A. The classic presentation of
herpes is a painful vesicle.
(c) B. The primary lesion of syphilis presents as a painless ulcer or
chancre. Secondary syphilis presents with a skin rash
lymphadenopathy and mucocutaneous lesions.
(u) C. Chancroid presents with a painful genital ulcer and tender
suppurative inguinal adenopathy.
SOLUTIONS VERIFIED
◉ A 3 month-old female presents with her mom for physical
examination. The patient's mom denies any complaints. On
examination you note a well-developed, well-nourished infant in no
apparent distress. There is no cyanosis noted. Heart examination
reveals a normal S1 with a physiologically split S2. There is a grade
III/VI high-pitched, harsh, pansystolic murmur heard best at the 3rd
and 4th left intercostal spaces with radiation across the precordium.
Which of the following is the initial diagnostic study of choice in this
patient?
A. CT angiogram
B. Electrocardiogram
C. Echocardiogram
D. Cardiac catheterization. Answer: (u) A. This patient has signs and
symptoms consistent with a ventricular septal defect (VSD). CT
angiogram and electrocardiogram are not indicated in establishing
the diagnosis of a VSD.
(u) B. See A for explanation.
(c) C. Echocardiogram is the initial diagnostic study of choice in the
diagnosis of a VSD.
(u) D. Cardiac catheterization may be necessary to accurately
measure pulmonary pressures or if a VSD can not be well localized
on echocardiogram, but it is not the initial diagnostic study of choice.
,◉ A 62 year-old male smoker presents to the clinic with the
complaint of a chronic cough, hemoptysis, and weight loss. Chest CT
shows a mass obstructing the bronchus with hilar and mediastinal
lymph node abnormalities. Bronchoscopy with biopsy is performed.
On reviewing pathology results you explain to the patient that his
type of lung cancer is prone to early hematogenous spread, is rarely
amenable to surgical resection and has a very aggressive course.
What type of lung cancer is most likely in this patient?
A. Squamous cell
B. Small cell
C. Large cell
D. Adenocarcinoma. Answer: (u) A. Squamous cell carcinoma, large
cell carcinoma, and adenocarcinoma spread more slowly and have
the possibility of cure in early stages following resection and
chemotherapy.
(c) B. Small cell lung cancer is very aggressive with a median
survival (untreated) of 6-18 weeks.
(u) C. See A for explanation.
(u) D. See A for explanation.
◉ Otitis externa can be differentiated from uncomplicated otitis
media by which of the following physical examination findings?
A. Erythematous tympanic membrane
B. Mastoid tenderness
,C. Normal pneumatic otoscopy
D. Posterior auricular adenopathy. Answer: (u) A. In otitis externa,
the erythema is because the lateral surface of the tympanic
membrane is ear canal skin, and therefore is often erythematous.
(u) B. Mastoid tenderness is not directly associated with otitis media
or otitis externa.
(c) C. In contrast to acute otitis media, the tympanic membrane
moves normally with pneumatic otoscopy in a patient with otitis
externa.
(u) D. Both otitis media and otitis externa may have posterior
auricular adenopathy on examination.
◉ A 20 year-old male presents with complaint of brief episodes of
rapid heart beat with a sudden onset and offset that have increased
in frequency. He admits to associated shortness of breath and
lightheadedness. He denies syncope. Electrocardiogram reveals a
delta wave prominent in lead II. Which of the following is the most
appropriate long-term management in this patient?
A. Implantable cardio defibrillator
B. Radiofrequency ablation
C. Verapamil (Calan)
D. Metoprolol (Lopressor). Answer: (u) A. Implantable cardio
defibrillators are indicated in the treatment of ventricular
arrhythmias, not Wolf-Parkinson-White (WPW) syndrome.
, (c) B. Radiofrequency ablation is the procedure of choice for long-
term management in patients with accessory pathways (WPW) and
recurrent symptoms.
(u) C. Calcium channel blockers and beta-blockers are not the best
options for the long-term management of WPW. They may decrease
the refractoriness of the accessory pathway or increase the
refractoriness of the AV node in patients with atrial fibrillation or
atrial flutter who have an antegrade conducting bypass tract. This
may lead to faster ventricular rates.
(u) D. See C for explanation.
◉ A 26 year-old woman requests screening after her boyfriend was
treated for a sexually transmitted infection recently. On examination
you find a painless vulvar ulcer. Which of the following is the most
likely diagnosis?
A. Herpes
B. Syphilis
C. Chancroid
D. Granuloma inguinale. Answer: (u) A. The classic presentation of
herpes is a painful vesicle.
(c) B. The primary lesion of syphilis presents as a painless ulcer or
chancre. Secondary syphilis presents with a skin rash
lymphadenopathy and mucocutaneous lesions.
(u) C. Chancroid presents with a painful genital ulcer and tender
suppurative inguinal adenopathy.
