PACKRAT 2 Exam with Complete Solutions
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-(u) A. Acute pericarditis is usually not
associated with elevated blood pressure. One would expect to see hypertensive pressures in the
setting of an aortic dissection.
(u) B. Subungual hematomas are usually seen in endocarditis not pericarditis.
(u) C. A diastolic murmur in a patient with chest pain would likely be associated with acute
aortic regurgitation in the setting of an aortic dissection.
(c) D. This patient has symptoms consistent with acute pericarditis and would most likely have a
pericardial friction rub on examination.
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-(u) A. See D for explanation.
(u) B. See D for explanation.
, PACKRAT 2 Exam with Complete Solutions
(u) C. See D for explanation.
(c) D. The patient is suspected of having temporal arteritis. This disease is most commonly
noted in patients over age 50 and should be suspected in patients with sudden vision loss and a
palpable cord in the temporal region. Erythrocyte sedimentation rate is almost always increased
in this disease.
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-(u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. The National Cholesterol Education Program clinical practice guidelines have designated
diabetes as a coronary risk equivalent and have recommended that patients with diabetes
should have an LDL cholesterol goal of 100 mg/dL.
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
, PACKRAT 2 Exam with Complete Solutions
D. Reversal of proteinuria CORRECT ANSWER-(c) A. Magnesium sulfate is used to prevent
and treat eclamptic seizures. Magnesium sulfate is not sufficient to treat hypertension,
therefore antihypertensives must be added. Magnesium sulfate is excreted solely from the
kidneys and urine output must be preserved to prevent accumulation of the drug. Magnesium
sulfate does nothing to prevent HELLP syndrome.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
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-(u) A. This patient has signs and symptoms
consistent with stable angina. Noninvasive diagnostic testing is preferred in this patient.
(u) B. CT angiogram may be useful for the evaluation of chest pain, however its role in routine
practice has not been established.
(u) C. This patient has signs and symptoms of stable angina. There are no signs of valvular heart
disease on examination. While an echocardiogram may be performed at some point, it is not
the best initial diagnostic step to determine the etiology of the patient's angina.
, PACKRAT 2 Exam with Complete Solutions
(c) D. Nuclear stress testing is the most appropriate initial diagnostic study in the evaluation of a
patient with signs and symptoms consistent with stable angina.
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-(c) A. Sarcoidosis is characterized by paratracheal
lymphadenopathy and elevated ACE levels. It is more common in African American patients and
may be asymptomatic.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
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
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-(u) A. Acute pericarditis is usually not
associated with elevated blood pressure. One would expect to see hypertensive pressures in the
setting of an aortic dissection.
(u) B. Subungual hematomas are usually seen in endocarditis not pericarditis.
(u) C. A diastolic murmur in a patient with chest pain would likely be associated with acute
aortic regurgitation in the setting of an aortic dissection.
(c) D. This patient has symptoms consistent with acute pericarditis and would most likely have a
pericardial friction rub on examination.
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-(u) A. See D for explanation.
(u) B. See D for explanation.
, PACKRAT 2 Exam with Complete Solutions
(u) C. See D for explanation.
(c) D. The patient is suspected of having temporal arteritis. This disease is most commonly
noted in patients over age 50 and should be suspected in patients with sudden vision loss and a
palpable cord in the temporal region. Erythrocyte sedimentation rate is almost always increased
in this disease.
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-(u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. The National Cholesterol Education Program clinical practice guidelines have designated
diabetes as a coronary risk equivalent and have recommended that patients with diabetes
should have an LDL cholesterol goal of 100 mg/dL.
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
, PACKRAT 2 Exam with Complete Solutions
D. Reversal of proteinuria CORRECT ANSWER-(c) A. Magnesium sulfate is used to prevent
and treat eclamptic seizures. Magnesium sulfate is not sufficient to treat hypertension,
therefore antihypertensives must be added. Magnesium sulfate is excreted solely from the
kidneys and urine output must be preserved to prevent accumulation of the drug. Magnesium
sulfate does nothing to prevent HELLP syndrome.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
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-(u) A. This patient has signs and symptoms
consistent with stable angina. Noninvasive diagnostic testing is preferred in this patient.
(u) B. CT angiogram may be useful for the evaluation of chest pain, however its role in routine
practice has not been established.
(u) C. This patient has signs and symptoms of stable angina. There are no signs of valvular heart
disease on examination. While an echocardiogram may be performed at some point, it is not
the best initial diagnostic step to determine the etiology of the patient's angina.
, PACKRAT 2 Exam with Complete Solutions
(c) D. Nuclear stress testing is the most appropriate initial diagnostic study in the evaluation of a
patient with signs and symptoms consistent with stable angina.
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-(c) A. Sarcoidosis is characterized by paratracheal
lymphadenopathy and elevated ACE levels. It is more common in African American patients and
may be asymptomatic.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
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
