PACKRAT 2 QUESTIONS & ANSWERS
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 - Answers - D
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 - Answers - D
A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin)
presents to the emergency department after vomiting large amounts of bright red blood.
INR is 3. Which of the following is most appropriate to rapidly lower the patient's INR?
A. Discontinue warfarin
B. Administer fresh frozen plasma
C. Administer protamine sulfate
D. Administer heparin sulphate - Answers - B
A 48 year-old male with diabetes mellitus presents for routine physical examination. Of
note his blood pressure each of his last two follow-up visits was 150/90 mmHg. Today
the patient's BP is 148/88 mmHg. The patient denies complaints of chest pain, change
in vision, or headache. Which of the following is the most appropriate management for
this patient?
A. Atenolol (Tenormin)
B. Nifedipine (Procardia)
C. Hydralazine (Apresoline)
D. Lisinopril (Zestril) - Answers - D
A 72 year-old farmer comes to the office for evaluation of a pearly ulcerated papule on
his right nostril. The papule has been bleeding off and on for the past couple weeks.
Which of the following findings would be most concerning on the physical examination
of this patient?
A. Cherry angioma
B. Telangiectasia
C. Spider angioma
D. Pyogenic granuloma - Answers - B
,A 24 year-old female presents with complaints of abdominal pain, bloating, and chronic
diarrhea. She says she felt worse last month while on vacation in Italy. Despite eating
well she lost weight. What would be the most appropriate treatment for this patient?
A. Gluten-free diet
B. Small bowel resection
C. Ciprofloxacin (Cipro) therapy
D. Pancreatic enzymes - Answers - A
Hypoglycemia in an elderly patient with diabetes is most likely to manifest as which of
the following symptoms?
A. Tachycardia
B. Diaphoresis
C. Intense hunger
D. Mental confusion - Answers - D
An 85 year-old nursing home resident presents with abrupt onset of cough, sore throat,
headache, myalgias, and malaise. On examination the patient's temperature is 102
degrees F; the rest of the exam is unremarkable. Nasal smear is positive for Influenza
B. Which of the following is the treatment of choice in this patient?
A. Amantadine (Symmetrel)
B. Oseltamivir (Tamiflu)
C. Acyclovir (Zovirax)
D. Nevirapine (Viramune) - Answers - B
A 36 year-old female presents for a routine physical. She has no current complaints and
her only medication is oral contraceptives. The patient is preparing for a trip to Australia
and is worried about the long flight as her mom has a history of deep vein thrombosis
after a long trip several years ago. Physical examination reveals BP 110/60 mmHg, HR
66 bpm, regular. Heart is regular rate and rhythm without murmur, lungs are clear to
auscultation bilaterally and extremities are without edema. Which of the following is the
most appropriate recommendation for your patient?
A. Discontinue oral contraceptives
B. Recommend walking frequently during the flight
C. Begin daily aspirin therapy
D. Increase fluid intake 2-3 days prior to the flight - Answers - B
A 43 year-old woman presents with episodes of facial flushing with increased skin
temperature followed by the development of tiny papules and pustules primarily on her
cheeks and chin. These symptoms worsen when she eats spicy foods. On examination,
telangiectasia are noted along the nasal folds and tiny pustules on both cheeks. Which
of the following is the most likely diagnosis?
A. Atopic dermatitis
B. Rosacea
C. Lupus
D. Acne vulgaris - Answers - B
,A 25 year-old male presents to the emergency department for evaluation of a wound on
his hand. He cut his hand while tearing down a chicken coop. On examination of his
right hand you note a dirty 3cm jagged laceration. The patient is unaware of his tetanus
immunization status. Besides cleaning and debriding the wound, what is the
recommended clinical intervention in this patient?
A. Administer tetanus-diptheria toxoid (Td) and tetanus immune globulin (TIG)
B. Administer diphtheria, tetanus, and pertussis vaccine (DTP)
C. Administer tetanus toxoid vaccine (TT) and tetanus immune globulin (TIG)
D. No tetanus immunization or tetanus immune globulin is necessary in this patient -
Answers - A
A 25 year-old female presents for a routine gynecological examination. You palpate a 2
cm breast mass in her right breast. Her menstrual period was last week. She has no
family history of breast cancer. What is the modality of choice to further evaluate her
breast mass?
A. Magnetic resonance imaging (MRI)
B. Excisional biopsy
C. Ultrasound
D. Mammography - Answers - C
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 - Answers - D
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
D. Reversal of proteinuria - Answers - A
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 - Answers - D
, 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 - Answers - A
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
B. Lateral collateral
C. Posterior cruciate
D. Anterior cruciate - Answers - D
A 22 year-old woman comes to the office because her urine is cola-colored and she has
not urinated since yesterday morning. Her past medical history is significant for
pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her
blood pressure is 146/92mmHG. On physical examination, she has edema of her face
and hands. Which of the following is the most likely diagnosis?
A. Glomerulonephritis
B. Acute tubular necrosis
C. Nephrolithiasis
D. Diabetic nephropathy - Answers - A
A 15 year-old girl is hit in the right eye by a golf ball. There is swelling and ecchymosis
of the orbit. She complains of double vision. The right eye does not move with
downward gaze or right lateral gaze. Which of the following diagnostic tests will provide
the most accurate information regarding this injury?
A. Facial x-ray
B. Schiotz tonometry
C. Fluorescein angiography
D. Slit lamp biomicroscopy - Answers - A
A 60 year-old right hand dominant male presents to your office complaining of right
shoulder pain and progressively worsening arm weakness. His symptoms are
aggravated when working above the shoulder level. On physical examination, there is
no evidence of muscle atrophy. He has strong (5/5) adduction of his right shoulder but
considerable weakness (1/5) with abduction when raising his arm above his head.
Passive range of motion is intact. Which of the following is the most likely diagnosis?
A. Rotator cuff tear
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 - Answers - D
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 - Answers - D
A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin)
presents to the emergency department after vomiting large amounts of bright red blood.
INR is 3. Which of the following is most appropriate to rapidly lower the patient's INR?
A. Discontinue warfarin
B. Administer fresh frozen plasma
C. Administer protamine sulfate
D. Administer heparin sulphate - Answers - B
A 48 year-old male with diabetes mellitus presents for routine physical examination. Of
note his blood pressure each of his last two follow-up visits was 150/90 mmHg. Today
the patient's BP is 148/88 mmHg. The patient denies complaints of chest pain, change
in vision, or headache. Which of the following is the most appropriate management for
this patient?
A. Atenolol (Tenormin)
B. Nifedipine (Procardia)
C. Hydralazine (Apresoline)
D. Lisinopril (Zestril) - Answers - D
A 72 year-old farmer comes to the office for evaluation of a pearly ulcerated papule on
his right nostril. The papule has been bleeding off and on for the past couple weeks.
Which of the following findings would be most concerning on the physical examination
of this patient?
A. Cherry angioma
B. Telangiectasia
C. Spider angioma
D. Pyogenic granuloma - Answers - B
,A 24 year-old female presents with complaints of abdominal pain, bloating, and chronic
diarrhea. She says she felt worse last month while on vacation in Italy. Despite eating
well she lost weight. What would be the most appropriate treatment for this patient?
A. Gluten-free diet
B. Small bowel resection
C. Ciprofloxacin (Cipro) therapy
D. Pancreatic enzymes - Answers - A
Hypoglycemia in an elderly patient with diabetes is most likely to manifest as which of
the following symptoms?
A. Tachycardia
B. Diaphoresis
C. Intense hunger
D. Mental confusion - Answers - D
An 85 year-old nursing home resident presents with abrupt onset of cough, sore throat,
headache, myalgias, and malaise. On examination the patient's temperature is 102
degrees F; the rest of the exam is unremarkable. Nasal smear is positive for Influenza
B. Which of the following is the treatment of choice in this patient?
A. Amantadine (Symmetrel)
B. Oseltamivir (Tamiflu)
C. Acyclovir (Zovirax)
D. Nevirapine (Viramune) - Answers - B
A 36 year-old female presents for a routine physical. She has no current complaints and
her only medication is oral contraceptives. The patient is preparing for a trip to Australia
and is worried about the long flight as her mom has a history of deep vein thrombosis
after a long trip several years ago. Physical examination reveals BP 110/60 mmHg, HR
66 bpm, regular. Heart is regular rate and rhythm without murmur, lungs are clear to
auscultation bilaterally and extremities are without edema. Which of the following is the
most appropriate recommendation for your patient?
A. Discontinue oral contraceptives
B. Recommend walking frequently during the flight
C. Begin daily aspirin therapy
D. Increase fluid intake 2-3 days prior to the flight - Answers - B
A 43 year-old woman presents with episodes of facial flushing with increased skin
temperature followed by the development of tiny papules and pustules primarily on her
cheeks and chin. These symptoms worsen when she eats spicy foods. On examination,
telangiectasia are noted along the nasal folds and tiny pustules on both cheeks. Which
of the following is the most likely diagnosis?
A. Atopic dermatitis
B. Rosacea
C. Lupus
D. Acne vulgaris - Answers - B
,A 25 year-old male presents to the emergency department for evaluation of a wound on
his hand. He cut his hand while tearing down a chicken coop. On examination of his
right hand you note a dirty 3cm jagged laceration. The patient is unaware of his tetanus
immunization status. Besides cleaning and debriding the wound, what is the
recommended clinical intervention in this patient?
A. Administer tetanus-diptheria toxoid (Td) and tetanus immune globulin (TIG)
B. Administer diphtheria, tetanus, and pertussis vaccine (DTP)
C. Administer tetanus toxoid vaccine (TT) and tetanus immune globulin (TIG)
D. No tetanus immunization or tetanus immune globulin is necessary in this patient -
Answers - A
A 25 year-old female presents for a routine gynecological examination. You palpate a 2
cm breast mass in her right breast. Her menstrual period was last week. She has no
family history of breast cancer. What is the modality of choice to further evaluate her
breast mass?
A. Magnetic resonance imaging (MRI)
B. Excisional biopsy
C. Ultrasound
D. Mammography - Answers - C
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 - Answers - D
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
D. Reversal of proteinuria - Answers - A
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 - Answers - D
, 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 - Answers - A
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
B. Lateral collateral
C. Posterior cruciate
D. Anterior cruciate - Answers - D
A 22 year-old woman comes to the office because her urine is cola-colored and she has
not urinated since yesterday morning. Her past medical history is significant for
pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her
blood pressure is 146/92mmHG. On physical examination, she has edema of her face
and hands. Which of the following is the most likely diagnosis?
A. Glomerulonephritis
B. Acute tubular necrosis
C. Nephrolithiasis
D. Diabetic nephropathy - Answers - A
A 15 year-old girl is hit in the right eye by a golf ball. There is swelling and ecchymosis
of the orbit. She complains of double vision. The right eye does not move with
downward gaze or right lateral gaze. Which of the following diagnostic tests will provide
the most accurate information regarding this injury?
A. Facial x-ray
B. Schiotz tonometry
C. Fluorescein angiography
D. Slit lamp biomicroscopy - Answers - A
A 60 year-old right hand dominant male presents to your office complaining of right
shoulder pain and progressively worsening arm weakness. His symptoms are
aggravated when working above the shoulder level. On physical examination, there is
no evidence of muscle atrophy. He has strong (5/5) adduction of his right shoulder but
considerable weakness (1/5) with abduction when raising his arm above his head.
Passive range of motion is intact. Which of the following is the most likely diagnosis?
A. Rotator cuff tear
