PACKRAT Exam Review Questions with 100% Correct Answers | Verified | Updated 2024, Exams of Advanced Education

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PACKRAT Exam Review Questions with

100% Correct Answers | Verified |

Updated 2024

What test is the single most useful test in establishing the diagnosis of multiple sclerosis? - Correct Answer-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? - Correct Answer-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? - Correct Answer-Compartment Pressure

The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - Correct Answer-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... - Correct Answer-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? - Correct Answer- weeks Cardiac nuclear scanning is done to detect... - Correct Answer- Ventricular Wall Dysfunction A classic skin finding seen in patients with inflammatory bowel disease would be... - Correct Answer-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? - Correct Answer-Pruritus 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? - Correct Answer-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... - Correct Answer-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? - Correct Answer-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? - Correct Answer-Masked Facies (thinking Parkinson's) Primary biliary cirrhosis will have which of the following laboratory results? - Correct Answer-Antimitochondiral antibodies Which of the following historical factors differentiates post- traumatic stress disorder from acute stress disorder? - Correct Answer-A belief that their future has been foreshortened because of the event

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? - Correct Answer-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... - Correct Answer-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? - Correct Answer- 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: - Correct Answer-Sustained PMI, bifid pulse, S4 gallop

CHADS2 Score: - Correct Answer-Determining need for anticoagulation to prevent stroke. CHF, HTN, Age >75, DM all 1 point. Stroke Hx is 2 points. Results: 2 or more points --> hepatin to coumadin bridge (INR of 2-3) 1 point --> ASA or coumadin 0 points --> no therapy or ASA Sawtooth pattern on EKG: - Correct Answer-Atrial Flutter PR interval > 0.2 seconds: - Correct Answer-1st degree AV block PR interval gets longer, longer, then dropped beat. - Correct Answer-2nd degree Type 1 AV block (Wenckebach) PR interval stays the same, then dropped beat - Correct Answer-2nd Degree Type 2 AV block (Mobitz) Complete disagreement of P waves and QRS complexes - Correct Answer-3rd degree AV block

Bunny ears in V4-V6: - Correct Answer-LBBB Bunny ears in V1-V3: - Correct Answer-RBBB Do not give these meds to Wolff-Parkinson-White Pts: - Correct Answer-Adenosine or CCBs Premature beats can be increased in frequency by... - Correct Answer-Caffeine/stimulants Widened QRS, but nothing else: - Correct Answer-PVC Abnormally shaped P wave, but nothing else: - Correct Answer-PAC Periods of bradycardia and/or tachycardia: - Correct Answer- Sick Sinus Syndrome. Give pacemaker. Seen in elderly Pts Irregular tachycardia, narrow QRS complex, abnormally shaped P waves with different morphology - Correct Answer- Multifocal Atrial Tachycardia

Pt presents day after Christmas. He has dyspnea, S3 gallop, rales, JVD. Pt has had too much to drink yesterday. Dx and Tx?

• Correct Answer-Dilated Cardiomyopathy (Holiday Heart). Ventricles are enlarged so have more fluid, but don't have strength to pump it out. Address underlying cause (stop alcohol). Can give ACEIs or diuretics Pt presents with what looks like an anterior MI on EKG. On catherization, Pt has hyperkinetic left ventricle, but remainder of heart is akinetic. Dx and Tx? - Correct Answer-Takotsubo dilated cardiomyopathy (Heartbreak heart - major catecholamine release). Disease is self-limiting What 2 diseases can cause restrictive cardiomyopathy and what is the Tx? - Correct Answer-Amyloidosis, sarcoidosis. Diuretics, ACEIs, CCBs 64 y/o Pt presents w/ syncope and SOB. You do an EKG and find that HR is irregularly irregular w/ no P waves and a narrow QRS complex. Dx and Tx? - Correct Answer-A-fib. Rate: CCB or beta blocker. Rhythm: duration <48 hrs --> cardioversion, amiodarone (echo before cardioversion to look for clot). duration >48 hrs --> anticoagulate for 21 days prior to cardioversion. Anticoagulation: CHADS2 score

Regular, sawtooth pattern, atrial rate of 250-350 bpm, narrow QRS complex on EKG. Dx, Causes, and Tx: - Correct Answer- Atrial flutter. Caused by COPD, CHF, ASD, CAD. Similar Tx as A- fib What can cause a bundle branch block? - Correct Answer-MI Pt has HR of 150-250 bpm, narrow QRS w/ no structural abnormalities. Dx? - Correct Answer-Paroxysmal SVT Pt has HR of 150-250 bpm, narrow QRS w/ delta wave. Dx? - Correct Answer-Wolff-Parkinson-White Tx for SVT's: - Correct Answer-Valsalva for stable Pts. Adenosine for symptomatic Pts. Definitive Tx is radiofrequency ablation. Irregular beat every third beat: - Correct Answer-Trigeminy Irregular beat every other beat: - Correct Answer-Bigeminy

Tx for irregular beats: - Correct Answer-None or beta blockers if symptomatic Wide complex tachycardia on EKG. Dx and Tx? - Correct Answer-V-tach. Amiodarone or lidocaine in stable Pt. CPR and defibrillation in unstable Pt. What can cause long QT syndrome? - Correct Answer- Hypokalemia, antiarrhythmics, antifungals, antimalarials Pt has QT interval >0.45 seconds. Dx, risks, and Tx? - Correct Answer-Long QT syndrome. Risks of syncope and sudden death. Treat underlying cause, beta blockers for congenital disease. Implantable defibrillator. Asian man presents w/ syncope and V-fib. On EKG, ST segment elevation everywhere. Dx and Tx? - Correct Answer- Brugada syndrome. Treat w/ implantable defibrillator Unstable Pt presents w/ no discernible heart contractions. Dx and Tx? - Correct Answer-V-fib. Treat w/ CPR and defibrillation (non-synchronized cardioversion)

Pt presents w/ polymorphic v-tach that appears to be twisting around a baseline. Dx, causes, and Tx? - Correct Answer- Torsades de pointes. Caused by hypokalemia or hypomagnesemia. Treatment is IV magnesium sulfate. HR less than 60 bpm. Dx and Tx? - Correct Answer- Bradycardia. Treat w/ atropine Infant presents w/ FTT. Upon auscultation of heart, you hear a wide fixed split S2 w/ systolic murmur heart best in 2nd left intercostal space. Dx, how is it Dx, causes, and Tx? - Correct Answer-Atrial Septal Defect (non-cyanotic). Caused by foramen ovale failing to close or ostium secondum. Dx by passing catheter through defect. Treat w/ diuretics, ACEIs, or digoxin if symptomatic. Definitive is surgical closure. Pt presents w/ bounding pulses and elevated BP in upper extremities w/ weak pulses in lower extremities. CXR shows "Figure of 3" sign. Dx and cause? - Correct Answer-Coarctation of Aorta (non-cyanotic). Seen in Turner's syndrome Preterm infant presents w/ wide pulse pressures, bounding pulses, and a continuous machine-like murmur heard best @

2nd intercostal space. Dx and Tx? - Correct Answer-PDA (non- cyanotic). Indomethacin if preterm infant. Pt presents w/ pansystolic murmur heard best @ left sternal border. Dx and Tx? - Correct Answer-VSD (non-cyanotic). Most close by age 6. Surgery if large. Pt presents w/ difficulty feeding and FTT. Pt is also having episodes of cyanosis (Tet spells). On PE, you find a systolic ejection murmur radiating to the back. CXR shows boot- shaped heart. Dx and what things are associated w/ this Dx? - Correct Answer-Tetralogy of Fallot: pulmonary stenosis, RVH, overriding aorta, and VSD Pt presents w/ JVD, edema, hepatomegaly. Which side of HF?

• Correct Answer-Right-sided Pt presents w/ PND, S3 gallop, cough, orthopnea, rales. Which side of HF? - Correct Answer-Left-sided Kerley B lines on CXR w/ elevated BNP. Dx and Tx? - Correct Answer-HF. If acute, IV furosemide, upright posture, nitroglycerin. If chronic (EF <40%), diuretic, ACEIs, beta blocker

Labs for your male Pt: Triglycerides: > HDL <40 (<50 for females) BP: >130/ Fasting plasma glucose: >100 mg/dL Waist Circumference: >40 (>35 for females). Dx? - Correct Answer-Metabolic syndrome Pt has 2 BP readings of 140-159/90-99. Dx: - Correct Answer- Stage 1 Essential HTN Pt has 2 BP readings of 160-179/100-109. Dx: - Correct Answer-Stage 2 Essential HTN Resistant essential HTN is defined by... - Correct Answer-HTN not controlled after 3 meds Refractory essential HTN is defined by... - Correct Answer-HTN not controlled after 5 meds

In Pts under 50, (systolic/diastolic) is better indicator of heart disease. - Correct Answer-Diastolic In Pts over 50, (systolic/diastolic) is better indicator of heart disease. - Correct Answer-Systolic Diuretics used for HTN that work @ distal tubule: - Correct Answer-HCT, Chlorthiadone, Indapamide Drugs used to Treat HTN: - Correct Answer-Diuretics, ACEIs, ARBs, CCBs, beta blockers 1st line for HTN: - Correct Answer-Diuretic Side Effects of ACEIs: - Correct Answer-Hyperkalemia, cough, angioedema. Switch to ARB. Not effective in African Americans. 1st line for Pt w/ HTN and CKD/DM: - Correct Answer-ACEIs Side Effects of CCBs: - Correct Answer-Peripheral edema, CHF exacerbation, flushing

Drugs for HTN that are safe in pregnancy: - Correct Answer- Methyldopa, hydralazine, labetalol, nifedipine Causes of secondary HTN: - Correct Answer-Sleep apnea, pheochromocytoma, coarctation of aorta, parenchymal renal disease, renal artery stenosis, Cushing Syndrome, primary Hyperaldosteronism (Conn's Disease). Treat underlying cause Pt presents w/ BP of 190/130 w/ progressing renal failure (or other organ damage). Dx and Tx? - Correct Answer- Hypertensive emergency. Treat w/ IV labetalol or CCB (dihydropyridine) Pt presents w/ BP of 190/130 w/o any signs of organ damage. Dx and Tx? - Correct Answer-Hypertensive urgency. Oral antihypertensive Common causes of cardiogenic shock? - Correct Answer-Acute MI, HF, cardiac tamponade Pt presents w/ hypotension (systolic <90mmHg), cyanosis, cool extremities, altered mental status, crackles. dx and Tx? -

Correct Answer-Cardiogenic shock. Fluid resuscitation, pressors (dopamine), and treat underlying cause Orthostatic Hypotension Definition: - Correct Answer- mmHg drop in systolic BP, 10 mmHg drop in diastolic pressure. 15 bpm increase in pulse when Pt moves from supine to standing