PACKRAT 1 & 2 QUESTIONS AND ANSWERS
A patient with hypovolemic shock would most likely exhibit which of the following signs?
A. increased CVP; decreased BP; increased pulse rate
B. decreased CVP; decreased BP; increased pulse rate
C. increased CVP; increased BP; decreased pulse rate
D. decreased CVP; increased BP; decreased pulse rate - Answers - B. Hypovolemic
shock is a condition with a decrease in the amount of circulating blood volume in the
intravascular system. A decrease in the amount of circulating volume will result in a
decrease in the CVP pressure which is an indirect measurement of the amount of blood
in the right ventricle. Less blood in the
vascular system means decreased blood pressure. Since there is less blood in the
circulation, the body
will attempt to compensate for this by increasing the number of contractions (pulse rate)
and the force of those contractions due to increased sympathetic stimulation.
Examination of the heart in chronic heart failure frequently reveals
A. S3.
B. splitting of S2.
C. paradoxical splitting of S2.
D. holosystolic murmur. - Answers - A. S3 occurs as a result of the left ventricle
becoming stiff and interfering with blood entering the left ventricle during filling. As the
left ventricle loses its compliance, there is impaired filling which results in less blood
entering the left ventricle, increased left ventricle filling pressures, and left ventricular
failure. Contraction of the left ventricle is not initially affected, but becomes affected with
time.
Which of the following conditions is most suggestive of an asymptomatic abdominal
aortic aneurysm?
A. abdominal mass
B. hypertension
C. chest pain
D. syncope - Answers - A. Symptomatic abdominal aortic aneurysm presents with
pulsating upper abdominal mass.
Post-infarction syndrome (Dressler's syndrome) occurs after acute myocardial infarction
presenting as
A. ventricular aneurysm.
B. pericarditis and pleuritis.
C. cardiac tamponade.
D. pleural effusion and rash. - Answers - B. Dressler's syndrome is the occurrence of
pericarditis and pleuritis several days to weeks following an MI.
The typical physical examination finding of scarlet fever is which of the following?
A. slapped cheek appearance
B. strawberry tongue
,C. Koplik's spots
D. honey-crusted lesions - Answers - B. Scarlet fever presents with fever, chills, sore
throat, and a generalized fine papular rash with a sandpaper texture which begins on
the chest. "Strawberry tongue" is also noted.
In myxedema, the patient commonly complains of which of the following?
A. tremors
B. palpitation
C. cold intolerance
D. eructation - Answers - C. Myxedema is the result of hypothyroidism. Cold
intolerance is associated with hyopthyroidism
along with constipation and fatigue.
Which of the following signs or symptoms differentiates acute sinusitis from viral
rhinitis?
A. fever
B. rhinorrhea
C. facial pain
D. swollen nasal mucous membranes - Answers - C. Frontal headache, swollen nasal
mucous membranes, rhinorrhea and fever may all be signs of viral rhinitis, along with
sneezing and a scratchy throat. Sinusitis usually follows a viral rhinitis, but in addition to
the above symptoms, it will include pain and tenderness over the involved sinus.
Which of the following is most commonly seen in viral croup?
A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor - Answers - D. Viral croup typically presents with barking cough
and stridor.
A patient has double vision when he turns his eyes to the right. Examination shows that
he cannot move his right eye laterally. Which of the following cranial nerves is involved?
A. optic
B. oculomotor
C. trochlear
D. abducens - Answers - D. The abducens nerve affects lateral eye movement, and if
paralyzed will cause double vision with lateral gaze.
When palpating a patient's abdomen at the level of the left costal margin, the physician
assistant feels the edge of the spleen. To confirm findings, which of the following is
appropriate?
A. Roll the patient onto the right side and palpate for the spleen edge.
B. Roll the patient onto the left side and palpate for the spleen edge.
C. Have the patient get into the knee-chest position.
,D. Have the patient sit upright and palpate in the left costal vertebral angle. - Answers -
A. By rolling the patient onto the right side, gravity may bring the spleen forward and
medial so that it is in a palpable location.
Which of the following is a finding in vitamin A deficiency?
A. decreased proprioception
B. night blindness
C. hair loss
D. bleeding - Answers - B. Night blindness is the earliest symptom of vitamin A
deficiency.
The physician assistant would suspect food poisoning from Staphylococcus aureus in a
patient who
presents with
A. ingestion of mayonnaise-based salads 48 hours earlier.
B. bloody diarrhea with mucus for one week.
C. abdominal cramps and vomiting.
D. high fever. - Answers - C. Abdominal cramps, nausea, vomiting, and watery
diarrhea typically last 1-2 days with
Staphylococcal food poisoning.
The most common location of bleeding seen in patients with von Willebrand's disease is
the
A. mucosal surfaces.
B. spleen.
C. joint spaces.
D. muscle groups. - Answers - A. Von Willenbrand's disease most commonly presents
with mucosal bleeding such as epistaxis, gingival bleeding, and menorrhagia.
Which of the following physical findings suggest pernicious anemia?
A. splenomegaly and hepatomegaly
B. petechiae and ecchymosis
C. loss of position and vibratory sensation
D. cheilosis and koilonychia - Answers - C. Loss of position and vibratory sensation
are common neurologic findings in pernicious anemia.
Which of the following is the most common early presenting sign in patients with
Alzheimer's disease?
A. change in personality
B. loss of memory
C. multiple physical complaints
D. depressed mood - Answers - B. The presence of memory impairment is the most
common sign of Alzheimer's disease. Changes occur first with short-term memory.
The most frequent finding in a person presenting with a brain abscess is
A. nuchal rigidity.
, B. headache.
C. seizures.
D. vomiting. - Answers - B. Headache occurs in over 70% of patients with a brain
abscess.
A 28-year-old female presents on examination with enlarged ovaries bilaterally. The
possible diagnosis of polycystic ovarian syndrome is enhanced by finding which of the
following?
A. hirsutism
B. gynecomastia
C. anorexia
D. dyspareunia - Answers - A. The most common findings in polycystic ovarian
syndrome are infertility, menstrual irregularities,
obesity, and hirsutism.
Which of the following signs and symptoms is common in candidal vulvovaginitis?
A. extreme vulvar irritation
B. firm, painless ulcer
C. tender lymphadenopathy
D. purulent discharge - Answers - A. Candida infection presents with pruritus,
vulvovaginal erythema, and white, cheese-like (curd) discharge that is malodorous.
Subacromial bursitis is associated with
A. positive Yergason's sign.
B. pain along the proximal humeral groove.
C. positive Kanavel's sign.
D. pain with abduction of the arm from 70-100 degrees. - Answers - D. Subacromial
bursitis is believed to be part of the continuum of inflammatory conditions affecting
the shoulder; initial overuse or trauma involves the rotator cuff, supraspinatus, and
bicipital tendons. The inflammation then leads to secondary involvement of the
subacromial bursae. Pain and tenderness are localized to the lateral aspect of the
shoulder, with signs of impingement on active motion noted on exam
between 70-100° abduction.
Which of the following physical examination findings is consistent with a herniated disk
at L5-S1?
A. hypesthesia of the medial thigh
B. upgoing Babinski reflex
C. absent Achilles' reflex
D. decreased sensation in the groin region - Answers - C. Depression of the Achilles'
reflex is common with L5-S1disk disease, and may also be present in a significant
number of L4-L5 disk diseases.
A 65-year-old patient has a long history of schizophrenia that is treated with
phenothiazines. On an unrelated clinic visit, the patient has difficulty sticking out her
A patient with hypovolemic shock would most likely exhibit which of the following signs?
A. increased CVP; decreased BP; increased pulse rate
B. decreased CVP; decreased BP; increased pulse rate
C. increased CVP; increased BP; decreased pulse rate
D. decreased CVP; increased BP; decreased pulse rate - Answers - B. Hypovolemic
shock is a condition with a decrease in the amount of circulating blood volume in the
intravascular system. A decrease in the amount of circulating volume will result in a
decrease in the CVP pressure which is an indirect measurement of the amount of blood
in the right ventricle. Less blood in the
vascular system means decreased blood pressure. Since there is less blood in the
circulation, the body
will attempt to compensate for this by increasing the number of contractions (pulse rate)
and the force of those contractions due to increased sympathetic stimulation.
Examination of the heart in chronic heart failure frequently reveals
A. S3.
B. splitting of S2.
C. paradoxical splitting of S2.
D. holosystolic murmur. - Answers - A. S3 occurs as a result of the left ventricle
becoming stiff and interfering with blood entering the left ventricle during filling. As the
left ventricle loses its compliance, there is impaired filling which results in less blood
entering the left ventricle, increased left ventricle filling pressures, and left ventricular
failure. Contraction of the left ventricle is not initially affected, but becomes affected with
time.
Which of the following conditions is most suggestive of an asymptomatic abdominal
aortic aneurysm?
A. abdominal mass
B. hypertension
C. chest pain
D. syncope - Answers - A. Symptomatic abdominal aortic aneurysm presents with
pulsating upper abdominal mass.
Post-infarction syndrome (Dressler's syndrome) occurs after acute myocardial infarction
presenting as
A. ventricular aneurysm.
B. pericarditis and pleuritis.
C. cardiac tamponade.
D. pleural effusion and rash. - Answers - B. Dressler's syndrome is the occurrence of
pericarditis and pleuritis several days to weeks following an MI.
The typical physical examination finding of scarlet fever is which of the following?
A. slapped cheek appearance
B. strawberry tongue
,C. Koplik's spots
D. honey-crusted lesions - Answers - B. Scarlet fever presents with fever, chills, sore
throat, and a generalized fine papular rash with a sandpaper texture which begins on
the chest. "Strawberry tongue" is also noted.
In myxedema, the patient commonly complains of which of the following?
A. tremors
B. palpitation
C. cold intolerance
D. eructation - Answers - C. Myxedema is the result of hypothyroidism. Cold
intolerance is associated with hyopthyroidism
along with constipation and fatigue.
Which of the following signs or symptoms differentiates acute sinusitis from viral
rhinitis?
A. fever
B. rhinorrhea
C. facial pain
D. swollen nasal mucous membranes - Answers - C. Frontal headache, swollen nasal
mucous membranes, rhinorrhea and fever may all be signs of viral rhinitis, along with
sneezing and a scratchy throat. Sinusitis usually follows a viral rhinitis, but in addition to
the above symptoms, it will include pain and tenderness over the involved sinus.
Which of the following is most commonly seen in viral croup?
A. drooling
B. wheezing
C. sputum production
D. inspiratory stridor - Answers - D. Viral croup typically presents with barking cough
and stridor.
A patient has double vision when he turns his eyes to the right. Examination shows that
he cannot move his right eye laterally. Which of the following cranial nerves is involved?
A. optic
B. oculomotor
C. trochlear
D. abducens - Answers - D. The abducens nerve affects lateral eye movement, and if
paralyzed will cause double vision with lateral gaze.
When palpating a patient's abdomen at the level of the left costal margin, the physician
assistant feels the edge of the spleen. To confirm findings, which of the following is
appropriate?
A. Roll the patient onto the right side and palpate for the spleen edge.
B. Roll the patient onto the left side and palpate for the spleen edge.
C. Have the patient get into the knee-chest position.
,D. Have the patient sit upright and palpate in the left costal vertebral angle. - Answers -
A. By rolling the patient onto the right side, gravity may bring the spleen forward and
medial so that it is in a palpable location.
Which of the following is a finding in vitamin A deficiency?
A. decreased proprioception
B. night blindness
C. hair loss
D. bleeding - Answers - B. Night blindness is the earliest symptom of vitamin A
deficiency.
The physician assistant would suspect food poisoning from Staphylococcus aureus in a
patient who
presents with
A. ingestion of mayonnaise-based salads 48 hours earlier.
B. bloody diarrhea with mucus for one week.
C. abdominal cramps and vomiting.
D. high fever. - Answers - C. Abdominal cramps, nausea, vomiting, and watery
diarrhea typically last 1-2 days with
Staphylococcal food poisoning.
The most common location of bleeding seen in patients with von Willebrand's disease is
the
A. mucosal surfaces.
B. spleen.
C. joint spaces.
D. muscle groups. - Answers - A. Von Willenbrand's disease most commonly presents
with mucosal bleeding such as epistaxis, gingival bleeding, and menorrhagia.
Which of the following physical findings suggest pernicious anemia?
A. splenomegaly and hepatomegaly
B. petechiae and ecchymosis
C. loss of position and vibratory sensation
D. cheilosis and koilonychia - Answers - C. Loss of position and vibratory sensation
are common neurologic findings in pernicious anemia.
Which of the following is the most common early presenting sign in patients with
Alzheimer's disease?
A. change in personality
B. loss of memory
C. multiple physical complaints
D. depressed mood - Answers - B. The presence of memory impairment is the most
common sign of Alzheimer's disease. Changes occur first with short-term memory.
The most frequent finding in a person presenting with a brain abscess is
A. nuchal rigidity.
, B. headache.
C. seizures.
D. vomiting. - Answers - B. Headache occurs in over 70% of patients with a brain
abscess.
A 28-year-old female presents on examination with enlarged ovaries bilaterally. The
possible diagnosis of polycystic ovarian syndrome is enhanced by finding which of the
following?
A. hirsutism
B. gynecomastia
C. anorexia
D. dyspareunia - Answers - A. The most common findings in polycystic ovarian
syndrome are infertility, menstrual irregularities,
obesity, and hirsutism.
Which of the following signs and symptoms is common in candidal vulvovaginitis?
A. extreme vulvar irritation
B. firm, painless ulcer
C. tender lymphadenopathy
D. purulent discharge - Answers - A. Candida infection presents with pruritus,
vulvovaginal erythema, and white, cheese-like (curd) discharge that is malodorous.
Subacromial bursitis is associated with
A. positive Yergason's sign.
B. pain along the proximal humeral groove.
C. positive Kanavel's sign.
D. pain with abduction of the arm from 70-100 degrees. - Answers - D. Subacromial
bursitis is believed to be part of the continuum of inflammatory conditions affecting
the shoulder; initial overuse or trauma involves the rotator cuff, supraspinatus, and
bicipital tendons. The inflammation then leads to secondary involvement of the
subacromial bursae. Pain and tenderness are localized to the lateral aspect of the
shoulder, with signs of impingement on active motion noted on exam
between 70-100° abduction.
Which of the following physical examination findings is consistent with a herniated disk
at L5-S1?
A. hypesthesia of the medial thigh
B. upgoing Babinski reflex
C. absent Achilles' reflex
D. decreased sensation in the groin region - Answers - C. Depression of the Achilles'
reflex is common with L5-S1disk disease, and may also be present in a significant
number of L4-L5 disk diseases.
A 65-year-old patient has a long history of schizophrenia that is treated with
phenothiazines. On an unrelated clinic visit, the patient has difficulty sticking out her
