PACKRAT 1 QUESTIONS AND ANSWERS
A patient presents with eye pain and blurred vision. Snellen testing reveals vision of
20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals
the presence of a dendritic ulcer. Which of the following is the most likely diagnosis?
A. Viral keratitis
B. Fungal corneal ulcer
C. Acanthamoeba keratitis
D. Bacterial corneal ulcer - Answers - (c) A. Herpes Simplex virus is a common cause
of dendritic ulceration noted on fluorescein staining.
(u) B. Fungal corneal ulcers have an indolent course with intraocular infection being
common but fluorescein staining
is negative for a dendritic pattern.
(u) C. Acanthamoeba keratitis has a waxing and waning course over several months
and has no fluorescein staining
in a dendritic pattern.
(u) D. Bacterial corneal ulcers can progress aggressively resulting in corneal
perforation. Fluorescein staining does
not occur in a dendritic pattern.
A 6 year-old male presents with hemarthrosis of the left knee. Coagulation studies
reveal the following results: PT 12.5 seconds (normal range 12-14 seconds), INR 1.0,
aPTT 58 seconds (normal range 18-28 seconds), platelet count 430,000/microliter
(normal range 150,000-450,000/microliter), and bleeding time 4 minutes (normal range
2-12 minutes). Which of the following is the best treatment option for this patient?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate - Answers - (u) A. Desmopressin acetate is indicated in von
Willebrand's disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin K
supplement is not indicated in this
patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and
function. Hemophilia A is treated
with factor VIII concentrate or cryoprecipitate.
An HIV positive patient presents with worsening dementia, fever, headache, and right
hemiparesis. MRI of the brain reveals six lesions throughout the brain that show ring
enhancement and surrounding edema. Which of the following is the treatment of
choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
,D. Ventricular shunt placement - Answers - (c) A. Toxoplasmosis is commonly noted in
HIV positive patients and presents with multiple ring-enhancing lesions. Treatment of
choice for possible toxoplasmosis is sulfadiazine and pyrimethamine.
(u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of toxoplasmosis, but not
for treatment of acute infection.
(u) C. Radiation therapy is indicated in CNS lymphoma, which typically presents with a
single lesion.
(u) D. Shunt placement is not indicated in patients with toxoplasmosis.
On examination of a pregnant patient the physician assistant notes a bluish or purplish
discoloration of the vagina and cervix. This is called
A. Hegar's sign.
B. McDonald's sign.
C. Cullen's sign
D. Chadwick's sign - Answers - (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.
A 52 year-old female comes to the office because of black stools for the past 3 days.
She is afebrile and she has no pertinent physical examination abnormalities. Which of
the following is the most appropriate initial diagnostic study?
A. Stool for occult blood
B. Stool cultures
C. Sigmoidoscopy
D. Abdominal CT scan - Answers - (c) A. Occult bleeding, as evidenced by the
patient's history of black stools, is initially verified by a positive fecal occult blood test.
(u) B. Stool cultures are indicated in the evaluation of acute diarrhea and not for the
evaluation of acute GI bleeding.
(u) C. Melena suggests a source of bleeding that is proximal to the ligament of Treitz,
not a lower GI bleed.
Sigmoidoscopy is used to evaluate only lower GI bleeding sources.
(u) D. Abdominal CT scan is indicated for evaluation of obscure bleeding in order to
exclude a pancreatic or hepatic
source of bleeding if endoscopy fails to identify the source.
Which of the following is considered a risk factor for the development of malignant
melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals - Answers - (u) A. Incidence of malignant melanoma is
equal in males and females.
,(c) B. Inability to tan and propensity to burn are risk factors for developing malignant
melanoma.
(u) C. Malignant melanomas are most common in Caucasians and are rarely seen in
the Japanese population. (u) D. Red hair and freckling is one of the major risk factors
for malignant melanoma, not brown hair.
A 43 year-old data entry clerk presents with a one-month history of pain and tingling in
the right thumb, index finger, and middle finger. Tinel's sign and Phalen's maneuver are
positive. The most appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery. - Answers - (u) A. A Medrol dose pack will have no affect on carpal tunnel
syndrome.
(c) B. Splinting in neutral position relieves impingement of the median nerve, thus
improving symptoms of carpal
tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to conservative therapy.
Which of the following is a cause of prerenal azotemia?
A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction - Answers - (u) A. Infection is associated with interstitial
nephritis, which is considered a cause of intrinsic renal azotemia.
(u) B. This is one of the causes of intrinsic renal azotemia.
(c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be rapidly
reversible when renal blood flow
and glomerular ultrafiltration pressure are restored.
(u) D. Urinary tract obstruction is the cause of postrenal azotemia.
Which of the following is the most common cause of secondary hypertension?
A. Renal parenchymal disease
B. Primary aldosteronism
C. Oral contraceptive use
D. Cushing's syndrome - Answers - (c) A. Renal parenchymal disease is the most
common cause of secondary hypertension.
(u) B. Primary aldosteronism can cause secondary hypertension, but it is not the most
common cause.
(u) C. Oral contraceptives can cause small increases in blood pressure but considerable
increases are much less
common.
(u) D. Cushing's disease is a less common cause of secondary hypertension.
, A newborn weighs 8 pounds at birth. On average, what should the infant weigh at 1
year of age?
A. 16 pounds B. 20 pounds C. 24 pounds D. 28 pounds - Answers - (u) A. See C for
explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn that weighs 8
pounds at birth will weigh
approximately 24 pounds at 1 year of age.
(u) D. See C for explanation.
The most reliable sign of acute otitis media (AOM) is
A. bulging of the tympanic membrane.
B. loss of tympanic membrane mobility.
C. reddening of the tympanic membrane.
D. air bubbles behind the tympanic membrane. - Answers - (u) A. Bulging and air
bubbles behind the TM represent OM with effusion.
(c) B. Loss of tympanic membrane mobility during pneumoinsufflation is the most
reliable sign for diagnosing acute
otitis media.
(u) C. Reddening of the eardrum is not reliable as it may be due to crying or other
vascular changes.
(u) D. See A for explanation.
Which of the following is a staphylococcal infection characterized by a localized red
swollen and acutely tender abscess of the upper or lower eyelid?
A. Hordeolum
B. Uveitis
C. Chalazion
D. Dacryocystitis - Answers - (c) A. Hordeolum (stye) is a staphylococcal infection
characterized by a localized red swollen and acutely tender abscess of the upper or
lower eyelid.
(u) B. Uveitis is an intraocular inflammation involving the uveal tract.
(u) C. Chalazion is a granulomatous inflammation of the meibomian gland.
(u) D. Dacryocystitis is an infection of the lacrimal sac due to obstruction of the
nasolacrimal system.
Progesterone influence on the breast tissue prior to menstruation causes
A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper's ligaments.
D. increase in the number of glands of Montgomery. - Answers - (u) A. Proliferation of
the mammary ducts is under the influence of estrogen.
(c) B. Growth of the lobules and alveoli is under the influence of progesterone. Prior to
menses, the breast swelling
that women notice is a result of the progesterone which is secreted from the corpus
luteum. During menses,
A patient presents with eye pain and blurred vision. Snellen testing reveals vision of
20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals
the presence of a dendritic ulcer. Which of the following is the most likely diagnosis?
A. Viral keratitis
B. Fungal corneal ulcer
C. Acanthamoeba keratitis
D. Bacterial corneal ulcer - Answers - (c) A. Herpes Simplex virus is a common cause
of dendritic ulceration noted on fluorescein staining.
(u) B. Fungal corneal ulcers have an indolent course with intraocular infection being
common but fluorescein staining
is negative for a dendritic pattern.
(u) C. Acanthamoeba keratitis has a waxing and waning course over several months
and has no fluorescein staining
in a dendritic pattern.
(u) D. Bacterial corneal ulcers can progress aggressively resulting in corneal
perforation. Fluorescein staining does
not occur in a dendritic pattern.
A 6 year-old male presents with hemarthrosis of the left knee. Coagulation studies
reveal the following results: PT 12.5 seconds (normal range 12-14 seconds), INR 1.0,
aPTT 58 seconds (normal range 18-28 seconds), platelet count 430,000/microliter
(normal range 150,000-450,000/microliter), and bleeding time 4 minutes (normal range
2-12 minutes). Which of the following is the best treatment option for this patient?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate - Answers - (u) A. Desmopressin acetate is indicated in von
Willebrand's disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin K
supplement is not indicated in this
patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and
function. Hemophilia A is treated
with factor VIII concentrate or cryoprecipitate.
An HIV positive patient presents with worsening dementia, fever, headache, and right
hemiparesis. MRI of the brain reveals six lesions throughout the brain that show ring
enhancement and surrounding edema. Which of the following is the treatment of
choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
,D. Ventricular shunt placement - Answers - (c) A. Toxoplasmosis is commonly noted in
HIV positive patients and presents with multiple ring-enhancing lesions. Treatment of
choice for possible toxoplasmosis is sulfadiazine and pyrimethamine.
(u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of toxoplasmosis, but not
for treatment of acute infection.
(u) C. Radiation therapy is indicated in CNS lymphoma, which typically presents with a
single lesion.
(u) D. Shunt placement is not indicated in patients with toxoplasmosis.
On examination of a pregnant patient the physician assistant notes a bluish or purplish
discoloration of the vagina and cervix. This is called
A. Hegar's sign.
B. McDonald's sign.
C. Cullen's sign
D. Chadwick's sign - Answers - (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.
A 52 year-old female comes to the office because of black stools for the past 3 days.
She is afebrile and she has no pertinent physical examination abnormalities. Which of
the following is the most appropriate initial diagnostic study?
A. Stool for occult blood
B. Stool cultures
C. Sigmoidoscopy
D. Abdominal CT scan - Answers - (c) A. Occult bleeding, as evidenced by the
patient's history of black stools, is initially verified by a positive fecal occult blood test.
(u) B. Stool cultures are indicated in the evaluation of acute diarrhea and not for the
evaluation of acute GI bleeding.
(u) C. Melena suggests a source of bleeding that is proximal to the ligament of Treitz,
not a lower GI bleed.
Sigmoidoscopy is used to evaluate only lower GI bleeding sources.
(u) D. Abdominal CT scan is indicated for evaluation of obscure bleeding in order to
exclude a pancreatic or hepatic
source of bleeding if endoscopy fails to identify the source.
Which of the following is considered a risk factor for the development of malignant
melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals - Answers - (u) A. Incidence of malignant melanoma is
equal in males and females.
,(c) B. Inability to tan and propensity to burn are risk factors for developing malignant
melanoma.
(u) C. Malignant melanomas are most common in Caucasians and are rarely seen in
the Japanese population. (u) D. Red hair and freckling is one of the major risk factors
for malignant melanoma, not brown hair.
A 43 year-old data entry clerk presents with a one-month history of pain and tingling in
the right thumb, index finger, and middle finger. Tinel's sign and Phalen's maneuver are
positive. The most appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery. - Answers - (u) A. A Medrol dose pack will have no affect on carpal tunnel
syndrome.
(c) B. Splinting in neutral position relieves impingement of the median nerve, thus
improving symptoms of carpal
tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to conservative therapy.
Which of the following is a cause of prerenal azotemia?
A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction - Answers - (u) A. Infection is associated with interstitial
nephritis, which is considered a cause of intrinsic renal azotemia.
(u) B. This is one of the causes of intrinsic renal azotemia.
(c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be rapidly
reversible when renal blood flow
and glomerular ultrafiltration pressure are restored.
(u) D. Urinary tract obstruction is the cause of postrenal azotemia.
Which of the following is the most common cause of secondary hypertension?
A. Renal parenchymal disease
B. Primary aldosteronism
C. Oral contraceptive use
D. Cushing's syndrome - Answers - (c) A. Renal parenchymal disease is the most
common cause of secondary hypertension.
(u) B. Primary aldosteronism can cause secondary hypertension, but it is not the most
common cause.
(u) C. Oral contraceptives can cause small increases in blood pressure but considerable
increases are much less
common.
(u) D. Cushing's disease is a less common cause of secondary hypertension.
, A newborn weighs 8 pounds at birth. On average, what should the infant weigh at 1
year of age?
A. 16 pounds B. 20 pounds C. 24 pounds D. 28 pounds - Answers - (u) A. See C for
explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn that weighs 8
pounds at birth will weigh
approximately 24 pounds at 1 year of age.
(u) D. See C for explanation.
The most reliable sign of acute otitis media (AOM) is
A. bulging of the tympanic membrane.
B. loss of tympanic membrane mobility.
C. reddening of the tympanic membrane.
D. air bubbles behind the tympanic membrane. - Answers - (u) A. Bulging and air
bubbles behind the TM represent OM with effusion.
(c) B. Loss of tympanic membrane mobility during pneumoinsufflation is the most
reliable sign for diagnosing acute
otitis media.
(u) C. Reddening of the eardrum is not reliable as it may be due to crying or other
vascular changes.
(u) D. See A for explanation.
Which of the following is a staphylococcal infection characterized by a localized red
swollen and acutely tender abscess of the upper or lower eyelid?
A. Hordeolum
B. Uveitis
C. Chalazion
D. Dacryocystitis - Answers - (c) A. Hordeolum (stye) is a staphylococcal infection
characterized by a localized red swollen and acutely tender abscess of the upper or
lower eyelid.
(u) B. Uveitis is an intraocular inflammation involving the uveal tract.
(u) C. Chalazion is a granulomatous inflammation of the meibomian gland.
(u) D. Dacryocystitis is an infection of the lacrimal sac due to obstruction of the
nasolacrimal system.
Progesterone influence on the breast tissue prior to menstruation causes
A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper's ligaments.
D. increase in the number of glands of Montgomery. - Answers - (u) A. Proliferation of
the mammary ducts is under the influence of estrogen.
(c) B. Growth of the lobules and alveoli is under the influence of progesterone. Prior to
menses, the breast swelling
that women notice is a result of the progesterone which is secreted from the corpus
luteum. During menses,
