PACKRAT PRACTICE EXAM STUDY GUIDE 2024 LATEST UPDATE WITH 100% CORRECT ANSWERS

History & Physical/Hematology A 55-year-old non-smoking male presents with a hemoglobin of 18.5 g/dl and a hematocrit of 56%. Which of the following physical examination findings is the most likely to be noted with this patient? A. Splenomegaly B. Cheilosis C. Purpura D. Decreased vibratory sense Explanations (c) A. Patients with polycythemia vera present with elevated hemoglobin and hematocrit. On physical examination plethora, engorged retinal veins, and splenomegaly are common. (u) B. Cheilosis is noted in iron deficiency anemia. (u) C. Purpura is typically noted in bleeding disorders. (u) D. Decreased vibratory sense is noted in vitamin B12 deficiency. History & Physical/Obstetrics/Gynecology On examination of a pregnant patient the physician assistant notes a bluish or purplish discoloration of the vagina and cervix. This is called Answers A. Hegar's sign. B. McDonald's sign. C. Cullen's sign D. Chadwick's sign Explanations (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. Brainpower Read More History & Physical/Orthopedics/Rheumatology Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle? Answers A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis Explanations (c) A. Abduction against resistance tests the supraspinatus. (u) B. Lateral rotation against resistance tests the infraspinatus and teres minor. (u) C. See B for explanation. (u) D. Medial rotation against resistance tests the subscapularis. History & Physical/Pulmonology A 45 year-old male presents with sudden onset of pleuritic chest pain, productive cough and fever for 1 day. He relates having symptoms of a "cold" for the past week that suddenly became worse yesterday. Which of the following findings will most likely be seen on physical examination of this patient? Answers A. spoken "ee" heard as "ay" B. hyperresonant percussion note C. wheezes over the involved area D. vesicular breath sounds over involved area Explanations (c) A. This patient most likely has a bacterial pneumonia with consolidation, which would produce egophony, where a spoken "ee" is heard as "ay." (u) B. Consolidation from bacterial pneumonia causes findings of dullness to percussion, late inspiratory crackles and bronchial breath sounds over the involved area. (u) C. See explanation B. (u) D. See explanation B. History & Physical/ENT/Ophthalmology A 4 year-old child presents with a rapid onset of high fever and extremely sore throat. Which of the following findings are suggestive of the diagnosis of epiglottitis? Answers A. Croupy cough and drooling B. Thick gray, adherent exudate C. Beefy red uvula, palatal petechiae, white exudate D. Inflammation and medial protrusion of one tonsil Explanations (c) A. A croupy cough with drooling in a patient who appears very ill is consistent with epiglottitis. Examining the throat is contraindicated, unless the airway can be maintained. (u) B. Thick gray adherent exudate is suggestive of diphtheria. (u) C. Beefy red uvula, palatal petechiae, and white exudate are findings suggestive of streptococcal pharyngitis. (u) D. Inflammation with medial protrusion of the tonsil is suggestive of a peritonsillar abscess. Which of the following is a common physical examination finding in early intestinal obstruction? A. high fever. B. profuse flatulence. C. rebound tenderness D. hyperactive, high-pitched bowel sounds (u) A. Fever and rebound tenderness occur only if a perforation has occurred. (u) B. Profuse flatulence is not noted in early intestinal obstruction. (u) C. See A for explanation. (c) D. Abdominal distention and high-pitched, hyperactive bowel sounds are common in early intestinal obstruction. History & Physical/Endocrinology A 26-year-old obese female complains of a 3-4 month history of discrete erythematous plaques on the pretibial areas of her legs. The lesions have increased in size, become darker, and are painful. She is concerned because the centers of the lesions have become ulcerated. This patient should be screened for which of the following? Answers A. Hypothyroidism B. Diabetes mellitus C. Melanoma D. Scleroderma Explanations (u) A. In hypothyroidism the skin of the pretibial area may thicken leading to edema. This is a diffuse finding, involving the face and eyelids, without discrete lesions. (c) B. The description of the skin lesions is characteristic of necrobiosis lipoidica diabeticorum, one of the dermatologic manifestations of diabetes mellitus. (u) C. The lesions of melanoma are typically not painful and do not ulcerate. (u) D. Scleroderma is marked by thickening of the skin, with swelling of the fingers and hands. The swelling may involve the forearms and face; the lower extremities are relatively spared. History & Physical/Neurology A 73 year-old male presents to the clinic with his wife. His wife has noticed that he has developed a resting tremor in his right hand and a shuffling gait over the last year. What finding on physical examination would support your suspected diagnosis? Answers A. Chorea B. Dystonia C. Masked facies D. Hyperreflexia Explanations (u) A. See C for explanation. (u) B. See C for explanation. (c) C. The patient symptoms are consistent with Parkinsonism. Physical exam findings include masked facies, micrographia, decreased arm swing, and monotonous speech. (u) D. See C for explanation. History & Physical/Psychiatry/Behavioral Medicine Which of the following historical factors differentiates post-traumatic stress disorder from acute stress disorder? Answers A. The inability of the person to recall an important aspect of the event. B. Avoidance of stimuli that invokes recollections of the event. C. A belief that their future has been foreshortened because of the event. D. The presence of sleep disorder. Explanations (u) A. See C for explanation. (u) B. See C for explanation. (c) C. Post-traumatic stress disorder and acute stress disorder have many of the same characteristics. A sense of a foreshortened future, such as not expecting a normal life span or a career due to the trauma, distinguishes post-traumatic stress disorder from an acute stress disorder. The other answers are common to both disorders. (u) D. See C for explanation. History & Physical/Dermatology A patient presents with a rash, characterized by red macules and edematous papules with a clearing center. This best describes which of the following? Answers A. erythema marginatum B. erythema multiforme C. varicella D. impetigo Explanations (u) A. Erythema marginatum is associated with rheumatic fever and is characterized by macular to maculopapular lesions. A clearing center is not found in the rash. (c) B. Target lesions, also termed iris lesions, are characteristic of erythema multiforme. The rash may be recurrent but typically resolves over 3-6 weeks. (u) C. The rash of varicella typically has maculopapules, vesicles, and scabs in various stages of development. A clearing center is not found in the rash. (u) D. The lesions of impetigo are pustules that form a honey-colored crust after rupturing. History & Physical/Urology/Renal A patient with a 15-year history of type 2 diabetic mellitus presents for follow-up. Labs reveal a BUN 100 mg/dl, serum creatinine 9.2 mg/dl, and serum glucose 164 mg/dl. Which of the following would you expect to find on physical examination? Answers A. Pruritus B. Hypotension C. Macroglossia D. Suprapubic tenderness Explanations (c) A. Hypertension, pruritus and xerosis are common findings in the uremic patient. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. Suprapubic tenderness is associated with urinary tract infection or acute obstructive uropathy. History & Physical/Endocrinology A 40 year-old male presents to your clinic complaining of nontender, yellow patches on both eyelids. He states his brother and uncle have similar growths. He denies any visual changes or other complaints. Your primary suspicion is Answers A. gout. B. lipoma. C. hyperlipidemia. D. seborrheic dermatitis. Explanations (u) A. Tophaceous gout may appear as yellow skin lesions but they usually occur around the joints and helix of the ear. (u) B. Lipomas tend to be flesh-colored and are not usually bilateral. (c) C. Xanthelasmas, along with xanthomas, are common findings in familial hypercholesterolemia. (u) D. Eyelids are a common location for seborrheic dermatitis but the lesions are not yellow in color. History & Physical/Orthopedics/Rheumatology A 22 year-old male presents to the ED after sustaining a blow to the knee during football practice. The knee exam demonstrates significant forward translation of the tibia when the knee is in 15 degrees of flexion and external rotation at the hip. Which of the following knee maneuvers does this represent? Answers A. Abduction stress test B. Anterior drawer sign C. Lachman test D. McMurray test Explanations (u) A. The abduction stress test is performed to evaluate medial collateral ligament tears while applying valgus stress. (u) B. The anterior drawer sign is performed to evaluate the anterior cruciate ligament; however the patient is supine, hips and knees flexed, and feet are flat on the table. (c) C. The Lachman test is performed to evaluate the anterior cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of the hip. (u) D. The McMurray test is performed to evaluate medial and lateral meniscal tears while rotating the lower leg internally and externally. History & Physical/Pulmonology Which of the following is a common symptom associated with laryngotracheobronchitis (viral croup)? Answers A. drooling B. high fever C. "hot potato" voice D. barking cough Explanations (u) A. Drooling and a "hot potato" voice are seen with epiglottitis, not viral croup. (u) B. Fever is usually absent or low grade in patients with viral croup. (u) C. See A for explanation. (c) D. Viral croup is characterized by history of an upper respiratory tract symptoms followed by onset of a barking cough and stridor. History & Physical/ENT/Ophthalmology Which of the following are normal findings in a Weber test? Answers A. The tympanic membrane is movable with pneumatic otoscopy. B. The tympanic membrane is pearly gray with a sharp cone of light with apex at the umbo. C. Sound is heard equally in both ears when a vibrating tuning fork is placed on the mid forehead. D. Air conduction is greater than bone conduction when a vibrating tuning fork is moved from the mastoid bone to close to the ear canal. Explanations (u) A. A movable tympanic membrane indicates there is no effusion, and is not the Weber test. (u) B. The tympanic membrane is evaluated by direct observation with an otoscope, and is not the Weber test. (c) C. A normal Weber test means there is no lateralization of sound perception when a vibrating tuning fork is placed on the mid forehead. (u) D. A normal Rinne test means that tuning fork vibration is heard longer through the air than the bone. History & Physical/Obstetrics/Gynecology On examination of a pregnant patient the physician assistant notes the fundal height is at the level of the umbilicus. This corresponds to what gestational age? Answers A. 16 weeks B. 20 weeks C. 24 weeks D. 28 weeks Explanations (u) A. See B for explanation. (c) B. At 20-22 weeks the fundal height is typically at the level of the umbilicus. (u) C. See B for explanation. (u) D. See B for explanation. History & Physical/Urology/Renal When performing a rectal examination, prostatic massage is contraindicated in Answers A. prostatodynia. B. non-bacterial prostatitis. C. chronic bacterial prostatitis. D. acute bacterial prostatitis. Explanations (u) A. Prostatodynia is an inflammatory disorder involving voiding dysfunction and pelvic floor musculature dysfunction. There is no bacterial involvement. (u) B. Non-bacterial prostatitis is similar to chronic bacterial prostatitis, but no bacteria are cultured, and the cause is unknown. (u) C. Prostate massage can be performed in the absence of fever. Expressed prostatic secretions are cultured to help identify the organism. (c) D. Vigorous manipulation of the prostate during rectal examination may result in septicemia. This is contraindicated in the presence of fever, irritative voiding symptoms, and perineal/sacral pain. History & Physical/Neurology A patient with an upper motor neuron lesion would exhibit which of the following findings? Answers A. Fasciculations B. Areflexia C. Muscular atrophy D. Spasticity Explanations (u) A. Fasciculations, areflexia and muscle atrophy are consistent with lower motor neuron lesions. (u) B. See A for explanations. (u) C. See A for explanation. (c) D. Spasticity is an upper motor neuron lesion finding. History & Physical/Psychiatry/Behavioral Medicine A patient with obsessive-compulsive disorder would most likely have which of the following findings? Answers A. Raw, red hands B. Priapism C. Memory impairment D. Abdominal pain Explanations (c) A. Common manifestations of obsessive-compulsive disorder include phobias of germ and contaminants, which results in frequent hand washing leading to chafe and reddened hands. The other answers are inconsistent with obsessive-compulsive disorder. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. History & Physical/Dermatology In a patient suspected of having seborrheic dermatitis, the most common site of involvement would be the A. upper extremities. B. thighs. C. scalp. D. feet. Explanations (u) A. See C for explanation. (u) B. See C for explanation. (c) C. The most common site of involvement o