PACKRAT PRACTICE EXAM QUESTIONS
Which of the following factors in patients with chronic venous insufficiency predisposes
them to development of skin ulcers?
A. Increased intravascular oncotic pressure
B. Leakage of fibrinogen and growth factors into the interstitial space
C. Decreased capillary leakage
D. Inherited deficiency of protein C - Answers - B. Leakage of fibrinogen and growth
factors into the interstitial space, leukocyte aggregation and activation, and obliteration
of the cutaneous lymphatic network can predispose a patient to skin ulcers
A 26 year-old monogamous female presents with cyclic pelvic pain that has been
increasing over the last 6 months. She complains of significant dysmenorrhea and
dyspareunia. She uses condoms for birth control. On physical examination her uterus is
retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her
serum pregnancy test is negative. Which of the following is the most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Functional ovarian cyst
D. Pelvic inflammatory disease - Answers - B. With endometriosis, the uterus is often
fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or "chocolate
cyst". The patient with endometriosis also often has dysmenorrhea, dyspareunia, and
dyschezia.
At what age does the first tooth usually erupt in an infant?
A. 2-4 months
B. 6-8 months
C. 10-12 months
D. 14-16 months - Answers - B. The first tooth in an infant to erupt is the central incisor
at the average age of 6-8 months.
A 7 year-old boy wets the bed on most nights. Which of the following is the preferred
pharmacological agent to decrease the incidence of bed wetting episodes?
A. Imipramine (Tofranil)
B. Phenytoin (Dilantin)
C. Pramipexole (Mirapex)
D. Hyoscyamine (Urised) - Answers - A. Imipramine is an anti-cholinergic and when
given before bedtime has been shown to decrease the incidence of bed wetting.
A newborn is being evaluated for perioral cyanosis while feeding associated with
sweating. Vital signs are rectal temperature, 37.8 degrees C (100 degrees F), blood
pressure 80/45 mmHg, pulse 180/min, and respirations 40/min.
A grade 3/6 harsh systolic ejection murmur with a single loud S2 is heard at the left
upper sternal border. Electrocardiogram (ECG) shows right ventricular hypertrophy with
right axis deviation. Chest x-ray shows a bootshaped heart and decreased pulmonary
vascular markings. Which of the following is the most likely diagnosis?
,A. Atrial septal defect
B. Total anomalous pulmonary venous return
C. Coarctation of the aorta
D. Tetralogy of Fallot - Answers - D. This is a common presentation for tetralogy of
fallot.
Which of the following is considered to be the modality of choice for the identification of
a pituitary macroadenoma
that is suspected on the basis of a visual field deficit?
A. Skull x-ray
B. PET scan
C. CT of the brain
D. MRI of the brain - Answers - D. MRI of the brain provides the best visualization of
pituitary tumors.
A 2 year-old male presents with a four day history of fever and general malaise. On
examination the vitals reveal an oral temperature of 102 degrees F. The child appears
to have rubor on the trunk which started one day prior to this visit. Physical examination
reveals a maculopapular rash with defervescence. Which of the following is the most
appropriate management at this time?
A. Ibuprofen (Motrin)
B. Aspirin
C. Amoxicillin
D. Valacyclovir (Valtrex) - Answers - A. Motrin is indicated for management of the fever
in Roseola infantum caused by the herpesvirus.
A 42 year-old female experiences pain on the plantar surface of her left foot in the area
of the third metatarsal head. The pain is associated with wearing tight shoes and is
relieved by removing shoes. Examination reveals a palpable mass and reproduction of
pain with deep palpation of the third intermetatarsal space. The patient has tried
wearing wider shoes with metatarsal cushions and taking NSAIDS but her symptoms
persist. What is the best therapeutic option at this point?
A. Casting of the involved foot
B. Physical therapy
C. Steroid injection
D. Surgical excision - Answers - C. Steroid injection is the treatment of choice for
Morton's neuroma when conservative measures fail.
Which of the following is the most likely to develop into a persistent cough in the adult
patient?
A. Pertussis
B. Allergic rhinitis
C. Pharyngitis
D. Heart failure - Answers - A. Pertussis is suspected in patients with persistent cough
that lasts longer than 2-3 weeks. Allergic rhinitis, pharyngitis and heart failure are all
potential causes of acute cough.
,A 30 year-old patient presents with weight loss, diarrhea, and steatorrhea. Labs reveal
that the antiendomysial antibody (AEA) is positive. What is the most likely diagnosis?
A. Celiac sprue
B. Ulcerative colitis
C. Whipple's disease
D. Zollinger-Ellison syndrome - Answers - A. Celiac sprue is not only characterized by
these classic symptoms. The antiendomysial antibody has a 90-95% sensitivity and 90-
95% specificity for celiac sprue.
A patient sustained a 6 cm laceration on his anterior tibia that was primarily closed in
the emergency department. What is the most appropriate time frame for removal of
these sutures?
A. 1-2 days
B. 3-5 days
C. 6-8 days
D. 7-14 days - Answers - D. Suture removal is based upon the area of the body that
was sutured. Facial sutures are placed for 3-4 days, scalp sutures for 5-7 days, trunk
sutures are placed for 6-8 days, and sutures on the extremity are placed for 7-14 days.
Sutures on the extremities can stay for longer periods of time if the area is under
maximal tension.
A hospitalized patient is found with confirmed pulseless ventricular tachycardia. IV
access is obtained following the
second shock given. Which of the following medications is to be administered
immediately?
A. Amiodarone
B. Magnesium
C. Atropine
D. Epinephrine - Answers - D. Epinephrine should be given as soon as IV access is
obtained before or after the second shock.
A patient with advanced AIDS complicated by toxoplasmosis presents with altered
mental status, recent onset of seizures, and focal neurologic deficits. Which of the
following diagnostic studies is most helpful?
A. Toxoplasma gondii antibody titers
B. CT scan of the brain
C. Lumbar puncture
D. MRI of brain - Answers - D. An MRI showing multiple isodense or hypodense ring-
enhancing mass lesions is the most useful test for such a patient.
A pediatric patient presents with a history of multiple recurrent respiratory infections
associated with failure to thrive. A sweat chloride test is elevated. Which of the following
is a common cause of death in patients with this condition?
A. Diabetic ketoacidosis
B. Pulmonary infection
, C. Intestinal obstruction
D. Acute respiratory failure - Answers - B. This patient has cystic fibrosis. The most
common causes of death include pulmonary complications, such as infections, and
terminal chronic respiratory failure associated with cor pulmonale.
In addition to tremor, which of the following are cardinal symptoms of Parkinson
disease?
A. Cognitive decline and rigidity
B. Personality change and bradycardia
C. Eye movement abnormalities and hyperkinesias
D. Rigidity and bradykinesia - Answers - D. Tremor, rigidity, bradykinesia and postural
instability are the cardinal features of Parkinsonism and may be present in any
combination.
Normal hemoglobin A is made of what combination of heme and globin chains?
A. 2-alphas and 2-betas
B. 4-gammas
C. 2-alphas and 2-gammas
D. 4-betas - Answers - A. Hemoglobin A1 is composed of two alpha and two beta
chains.
Which of the following is the most important intervention in acute pancreatitis?
A. IV fluid administration
B. Antibiotic administration
C. Calcium replacement
D. Antiemetics - Answers - A. The mainstay of management in acute pancreatitis is
fluid resuscitation. Isotonic solutions are best to maintain renal perfusion and urine
output > 100 ml/hour.
An electrocardiogram (ECG) shows a sinus rhythm with varying T wave heights, axis
changes every other beat and a wandering baseline. Which of the following is most
likely the diagnosis?
A. Artifact
B. Digoxin toxicity
C. Pericardial effusion
D. Poor lead placement - Answers - C. This ECG pattern best represents pericardial
effusion due to a swinging heart in fluid and is known as electrical alternans.
Which of the following is the first-line treatment for a patient with mild syndrome of
inappropriate secretion of ADH
(SIADH)?
A. Sodium supplementation to correct the hyponatremia
B. Restriction of free water
C. High volume hypertonic saline infusion
D. Pituitary ablation via transsphenoidal approach - Answers - B. Restriction of free
water intake is the first-line therapy for patients with euvolemic hyponatremia that is
Which of the following factors in patients with chronic venous insufficiency predisposes
them to development of skin ulcers?
A. Increased intravascular oncotic pressure
B. Leakage of fibrinogen and growth factors into the interstitial space
C. Decreased capillary leakage
D. Inherited deficiency of protein C - Answers - B. Leakage of fibrinogen and growth
factors into the interstitial space, leukocyte aggregation and activation, and obliteration
of the cutaneous lymphatic network can predispose a patient to skin ulcers
A 26 year-old monogamous female presents with cyclic pelvic pain that has been
increasing over the last 6 months. She complains of significant dysmenorrhea and
dyspareunia. She uses condoms for birth control. On physical examination her uterus is
retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her
serum pregnancy test is negative. Which of the following is the most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Functional ovarian cyst
D. Pelvic inflammatory disease - Answers - B. With endometriosis, the uterus is often
fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or "chocolate
cyst". The patient with endometriosis also often has dysmenorrhea, dyspareunia, and
dyschezia.
At what age does the first tooth usually erupt in an infant?
A. 2-4 months
B. 6-8 months
C. 10-12 months
D. 14-16 months - Answers - B. The first tooth in an infant to erupt is the central incisor
at the average age of 6-8 months.
A 7 year-old boy wets the bed on most nights. Which of the following is the preferred
pharmacological agent to decrease the incidence of bed wetting episodes?
A. Imipramine (Tofranil)
B. Phenytoin (Dilantin)
C. Pramipexole (Mirapex)
D. Hyoscyamine (Urised) - Answers - A. Imipramine is an anti-cholinergic and when
given before bedtime has been shown to decrease the incidence of bed wetting.
A newborn is being evaluated for perioral cyanosis while feeding associated with
sweating. Vital signs are rectal temperature, 37.8 degrees C (100 degrees F), blood
pressure 80/45 mmHg, pulse 180/min, and respirations 40/min.
A grade 3/6 harsh systolic ejection murmur with a single loud S2 is heard at the left
upper sternal border. Electrocardiogram (ECG) shows right ventricular hypertrophy with
right axis deviation. Chest x-ray shows a bootshaped heart and decreased pulmonary
vascular markings. Which of the following is the most likely diagnosis?
,A. Atrial septal defect
B. Total anomalous pulmonary venous return
C. Coarctation of the aorta
D. Tetralogy of Fallot - Answers - D. This is a common presentation for tetralogy of
fallot.
Which of the following is considered to be the modality of choice for the identification of
a pituitary macroadenoma
that is suspected on the basis of a visual field deficit?
A. Skull x-ray
B. PET scan
C. CT of the brain
D. MRI of the brain - Answers - D. MRI of the brain provides the best visualization of
pituitary tumors.
A 2 year-old male presents with a four day history of fever and general malaise. On
examination the vitals reveal an oral temperature of 102 degrees F. The child appears
to have rubor on the trunk which started one day prior to this visit. Physical examination
reveals a maculopapular rash with defervescence. Which of the following is the most
appropriate management at this time?
A. Ibuprofen (Motrin)
B. Aspirin
C. Amoxicillin
D. Valacyclovir (Valtrex) - Answers - A. Motrin is indicated for management of the fever
in Roseola infantum caused by the herpesvirus.
A 42 year-old female experiences pain on the plantar surface of her left foot in the area
of the third metatarsal head. The pain is associated with wearing tight shoes and is
relieved by removing shoes. Examination reveals a palpable mass and reproduction of
pain with deep palpation of the third intermetatarsal space. The patient has tried
wearing wider shoes with metatarsal cushions and taking NSAIDS but her symptoms
persist. What is the best therapeutic option at this point?
A. Casting of the involved foot
B. Physical therapy
C. Steroid injection
D. Surgical excision - Answers - C. Steroid injection is the treatment of choice for
Morton's neuroma when conservative measures fail.
Which of the following is the most likely to develop into a persistent cough in the adult
patient?
A. Pertussis
B. Allergic rhinitis
C. Pharyngitis
D. Heart failure - Answers - A. Pertussis is suspected in patients with persistent cough
that lasts longer than 2-3 weeks. Allergic rhinitis, pharyngitis and heart failure are all
potential causes of acute cough.
,A 30 year-old patient presents with weight loss, diarrhea, and steatorrhea. Labs reveal
that the antiendomysial antibody (AEA) is positive. What is the most likely diagnosis?
A. Celiac sprue
B. Ulcerative colitis
C. Whipple's disease
D. Zollinger-Ellison syndrome - Answers - A. Celiac sprue is not only characterized by
these classic symptoms. The antiendomysial antibody has a 90-95% sensitivity and 90-
95% specificity for celiac sprue.
A patient sustained a 6 cm laceration on his anterior tibia that was primarily closed in
the emergency department. What is the most appropriate time frame for removal of
these sutures?
A. 1-2 days
B. 3-5 days
C. 6-8 days
D. 7-14 days - Answers - D. Suture removal is based upon the area of the body that
was sutured. Facial sutures are placed for 3-4 days, scalp sutures for 5-7 days, trunk
sutures are placed for 6-8 days, and sutures on the extremity are placed for 7-14 days.
Sutures on the extremities can stay for longer periods of time if the area is under
maximal tension.
A hospitalized patient is found with confirmed pulseless ventricular tachycardia. IV
access is obtained following the
second shock given. Which of the following medications is to be administered
immediately?
A. Amiodarone
B. Magnesium
C. Atropine
D. Epinephrine - Answers - D. Epinephrine should be given as soon as IV access is
obtained before or after the second shock.
A patient with advanced AIDS complicated by toxoplasmosis presents with altered
mental status, recent onset of seizures, and focal neurologic deficits. Which of the
following diagnostic studies is most helpful?
A. Toxoplasma gondii antibody titers
B. CT scan of the brain
C. Lumbar puncture
D. MRI of brain - Answers - D. An MRI showing multiple isodense or hypodense ring-
enhancing mass lesions is the most useful test for such a patient.
A pediatric patient presents with a history of multiple recurrent respiratory infections
associated with failure to thrive. A sweat chloride test is elevated. Which of the following
is a common cause of death in patients with this condition?
A. Diabetic ketoacidosis
B. Pulmonary infection
, C. Intestinal obstruction
D. Acute respiratory failure - Answers - B. This patient has cystic fibrosis. The most
common causes of death include pulmonary complications, such as infections, and
terminal chronic respiratory failure associated with cor pulmonale.
In addition to tremor, which of the following are cardinal symptoms of Parkinson
disease?
A. Cognitive decline and rigidity
B. Personality change and bradycardia
C. Eye movement abnormalities and hyperkinesias
D. Rigidity and bradykinesia - Answers - D. Tremor, rigidity, bradykinesia and postural
instability are the cardinal features of Parkinsonism and may be present in any
combination.
Normal hemoglobin A is made of what combination of heme and globin chains?
A. 2-alphas and 2-betas
B. 4-gammas
C. 2-alphas and 2-gammas
D. 4-betas - Answers - A. Hemoglobin A1 is composed of two alpha and two beta
chains.
Which of the following is the most important intervention in acute pancreatitis?
A. IV fluid administration
B. Antibiotic administration
C. Calcium replacement
D. Antiemetics - Answers - A. The mainstay of management in acute pancreatitis is
fluid resuscitation. Isotonic solutions are best to maintain renal perfusion and urine
output > 100 ml/hour.
An electrocardiogram (ECG) shows a sinus rhythm with varying T wave heights, axis
changes every other beat and a wandering baseline. Which of the following is most
likely the diagnosis?
A. Artifact
B. Digoxin toxicity
C. Pericardial effusion
D. Poor lead placement - Answers - C. This ECG pattern best represents pericardial
effusion due to a swinging heart in fluid and is known as electrical alternans.
Which of the following is the first-line treatment for a patient with mild syndrome of
inappropriate secretion of ADH
(SIADH)?
A. Sodium supplementation to correct the hyponatremia
B. Restriction of free water
C. High volume hypertonic saline infusion
D. Pituitary ablation via transsphenoidal approach - Answers - B. Restriction of free
water intake is the first-line therapy for patients with euvolemic hyponatremia that is
