PACKRAT REVIEW QUESTIONS & ANSWERS
A 32 year-old carpenter complains of right eye irritation all day after driving a metal
stake into the ground with his hammer. He states that "something flew into my eye."
Visual acuity is 20/20. Pupils are equal, round, reactive to light and accommodation.
Extraocular movements are intact. There is minimal right corneal injection. No foreign
body is noted with lid eversion. Fluorescein stain reveals a tiny pinpoint uptake in the
area of the corneal injection. Which of the following is the most appropriate diagnostic
test at this stage? - Answers - X-ray orbits
A 45 year-old male complains of loss of hearing in his left ear. He also complains of
ringing in the ear, and has had occasional dizziness. On exam, there is unilateral
leftsided sensorineural hearing loss and a diminished corneal reflex. Neuro exam is
otherwise normal. TMs are normal, and canals are clear. Neck is supple, without
adenopathy. Oropharynx is normal. Of the following, the best diagnostic study to identify
the cause of this patient's complaints is... - Answers - Gadolinium-Enhanced MRI
looking for acoustic neuromas
A 64 year-old patient with known history of type 1 diabetes mellitus for 50 years has
developed pain radiating from the right buttock to the calf. Patient states that the pain is
made worse with walking and climbing stairs. Based upon this history which of the
following would be the most appropriate test to order? - Answers - Arterial Duplex
Scanning looking at arterial perfusion
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 -
Masked Facies (thinking Parkinson's)
Primary biliary cirrhosis will have which of the following laboratory results? - Answers -
Antimitochondiral antibodies
Which of the following historical factors differentiates post-traumatic stress disorder from
acute stress disorder? - Answers - A belief that their future has been foreshortened
because of the event
What test is the single most useful test in establishing the diagnosis of multiple
sclerosis? - Answers - MRI
On physical examination you note diminished breath sounds over the right lower lobe
with decreased tactile fremitus and dullness to percussion. Which of the following is the
most likely cause? - Answers - Pleural Effusion
A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and
is taken to the operating room for an open reduction internal fixation of the distal tibia.
Sixteen hours post-op, the patient develops sustained pain, which is not relieved with
, narcotics. On passive range of motion of the toes the patient "yells" in agony. The
patient also states that the top of his foot has decreased sensation. On physical
examination the physician assistant notes that the leg is swollen and the foot is cool to
touch. Based upon this information what diagnostic testing should be done? - Answers
- Compartment Pressure
The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - Answers
- Vomiting and Bloody diarrhea
A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The
next step in the evaluation is... - Answers - Fine-Needle Biopsy
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 - 20
weeks
Cardiac nuclear scanning is done to detect... - Answers - Ventricular Wall Dysfunction
A classic skin finding seen in patients with inflammatory bowel disease would be... -
Answers - Poorly healing, indolent ulcers on lower extremities
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 -
Pruritus
A 22 year-old male presents to the clinic complaining of excessive daytime somnolence
and strong desires to sleep at inappropriate times. He came in today because he had
an episode of "feeling paralyzed" as he was falling asleep yesterday. What is the most
appropriate diagnostic test to confirm this patient's diagnosis? - Answers - Multiple
sleep latency test (trying to Dx narcolepsy)
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of
pericardial tamponade is strongly supported by the presence of... - Answers -
Distended neck veins
Young athlete presents w/ high pitched mid-systolic murmur heard best @ LLSB
increasing w/ valsalva or standing and decreasing w/ squatting. Dx and Tx? - Answers
- Hypertrophic cardiomyopathy (HOCM). Refrain from vigorous physical activity. Beta
blockers or CCBs. Surgical or alcohol ablation of hypertrophied septum and defibrillator
insertion.
Other than the classic murmur, other Sx of HOCM: - Answers - Sustained PMI, bifid
pulse, S4 gallop
A 32 year-old carpenter complains of right eye irritation all day after driving a metal
stake into the ground with his hammer. He states that "something flew into my eye."
Visual acuity is 20/20. Pupils are equal, round, reactive to light and accommodation.
Extraocular movements are intact. There is minimal right corneal injection. No foreign
body is noted with lid eversion. Fluorescein stain reveals a tiny pinpoint uptake in the
area of the corneal injection. Which of the following is the most appropriate diagnostic
test at this stage? - Answers - X-ray orbits
A 45 year-old male complains of loss of hearing in his left ear. He also complains of
ringing in the ear, and has had occasional dizziness. On exam, there is unilateral
leftsided sensorineural hearing loss and a diminished corneal reflex. Neuro exam is
otherwise normal. TMs are normal, and canals are clear. Neck is supple, without
adenopathy. Oropharynx is normal. Of the following, the best diagnostic study to identify
the cause of this patient's complaints is... - Answers - Gadolinium-Enhanced MRI
looking for acoustic neuromas
A 64 year-old patient with known history of type 1 diabetes mellitus for 50 years has
developed pain radiating from the right buttock to the calf. Patient states that the pain is
made worse with walking and climbing stairs. Based upon this history which of the
following would be the most appropriate test to order? - Answers - Arterial Duplex
Scanning looking at arterial perfusion
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 -
Masked Facies (thinking Parkinson's)
Primary biliary cirrhosis will have which of the following laboratory results? - Answers -
Antimitochondiral antibodies
Which of the following historical factors differentiates post-traumatic stress disorder from
acute stress disorder? - Answers - A belief that their future has been foreshortened
because of the event
What test is the single most useful test in establishing the diagnosis of multiple
sclerosis? - Answers - MRI
On physical examination you note diminished breath sounds over the right lower lobe
with decreased tactile fremitus and dullness to percussion. Which of the following is the
most likely cause? - Answers - Pleural Effusion
A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and
is taken to the operating room for an open reduction internal fixation of the distal tibia.
Sixteen hours post-op, the patient develops sustained pain, which is not relieved with
, narcotics. On passive range of motion of the toes the patient "yells" in agony. The
patient also states that the top of his foot has decreased sensation. On physical
examination the physician assistant notes that the leg is swollen and the foot is cool to
touch. Based upon this information what diagnostic testing should be done? - Answers
- Compartment Pressure
The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - Answers
- Vomiting and Bloody diarrhea
A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The
next step in the evaluation is... - Answers - Fine-Needle Biopsy
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 - 20
weeks
Cardiac nuclear scanning is done to detect... - Answers - Ventricular Wall Dysfunction
A classic skin finding seen in patients with inflammatory bowel disease would be... -
Answers - Poorly healing, indolent ulcers on lower extremities
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 -
Pruritus
A 22 year-old male presents to the clinic complaining of excessive daytime somnolence
and strong desires to sleep at inappropriate times. He came in today because he had
an episode of "feeling paralyzed" as he was falling asleep yesterday. What is the most
appropriate diagnostic test to confirm this patient's diagnosis? - Answers - Multiple
sleep latency test (trying to Dx narcolepsy)
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of
pericardial tamponade is strongly supported by the presence of... - Answers -
Distended neck veins
Young athlete presents w/ high pitched mid-systolic murmur heard best @ LLSB
increasing w/ valsalva or standing and decreasing w/ squatting. Dx and Tx? - Answers
- Hypertrophic cardiomyopathy (HOCM). Refrain from vigorous physical activity. Beta
blockers or CCBs. Surgical or alcohol ablation of hypertrophied septum and defibrillator
insertion.
Other than the classic murmur, other Sx of HOCM: - Answers - Sustained PMI, bifid
pulse, S4 gallop
