PACKRAT 5 Exam with Complete Solutions
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-14 sec),
INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-
450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate CORRECT ANSWER-(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.
HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain MRI reveals 6
lesions throughout the brain that show ring enhancement & surrounding edema. Which is the
tx of choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
D. Ventricular shunt placement CORRECT ANSWER-(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.
, PACKRAT 5 Exam with Complete Solutions
(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 CORRECT ANSWER-(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
, PACKRAT 5 Exam with Complete Solutions
C. Sigmoidoscopy
D. Abdominal CT scan CORRECT ANSWER-(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 CORRECT ANSWER-(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.
, PACKRAT 5 Exam with Complete Solutions
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. CORRECT ANSWER-(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.
7. Which of the following is a cause of prerenal azotemia?
A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction CORRECT ANSWER-(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.
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s (normal12-14 sec),
INR 1.0, aPTT 58s (normal 18-28 sec), platelet 430,000/microliter (normal 150,000-
450,000/microliter), & bleeding time 4m (normal 2-12m). Which is the best tx option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate CORRECT ANSWER-(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.
HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain MRI reveals 6
lesions throughout the brain that show ring enhancement & surrounding edema. Which is the
tx of choice?
A. Sulfadiazine and pyrimethamine
B. Trimethoprim-sulfamethoxazole
C. Radiation therapy
D. Ventricular shunt placement CORRECT ANSWER-(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.
, PACKRAT 5 Exam with Complete Solutions
(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 CORRECT ANSWER-(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
, PACKRAT 5 Exam with Complete Solutions
C. Sigmoidoscopy
D. Abdominal CT scan CORRECT ANSWER-(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 CORRECT ANSWER-(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.
, PACKRAT 5 Exam with Complete Solutions
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. CORRECT ANSWER-(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.
7. Which of the following is a cause of prerenal azotemia?
A. Infection
B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction CORRECT ANSWER-(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.
