Download PACKRAT EXAM WITH CORRECT ANSWERS. and more Exams Medical Physics in PDF only on Docsity!
PACKRAT EXAM WITH CORRECT
ANSWERS.
23 yo male with recent URI sxs presents c/o chest pain. His pain is worse when lying down and better sitting up and leaning forward. ECG shows widespread ST segment elevation. Dx - correct answer- Pericardial friction rub 75 yo woman presents to the office with complain of vision loss. Exam reveals a palpable cord in the temporal region. Most helpful initial test to order - correct answer- ESR Recommended LDL tor educe risk of CAD in a diabetic pt - correct answer- 100mg/dL What is the reason for giving IV mag sulfate to a pt with pre- eclampsia - correct answer- prevention of seizure by increasing the seizure threshold 53 yo man with h/o HTN presents c/o recent 4/10 left sided chest pain with exertion that is relieved with rest. Heart exam reveals regular rate and rhythm with no S3, S4 or murmur. Lungs are CTA bilat. ECG reveals no acute changes. Most appropriate initial test - correct answer- Nuclear Stress Test
36 yo AA female comes to the clinic for an insurance physical which requires a CXR. She denies any respiratory sxs. Exam of her chest is negative. Xray results show marked LAD in the right paratracheal region. ACE levels are elevated. Most likely dx - correct answer- Sarcoidosis 33 year old presents to your office with a c/o right knee injury associated with pain and swelling. He states he was running after his loose dog and suddently stopped, hyperextended his knee, heard a pop, and noticed immediate swelling. On PE, the Lachman test and anterior drawer test demonstates joint laxity. Most likely injury - correct answer- ACL 22 yo woman comes to the office because her urine is cola colored and she hasnot urinated since yesturday morning. Her past medical hx is significant for pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her BP is 146/92 mmHg. On PE she has edema of her face and hands. Dx - correct answer- glomerulonephritis 15 yo girl hit in the right eye by a golf ball. There is swelling and echymosis of the orbit. She c/o double vision. The right eye doesn't move with downward gaze or right lateral gaze. Dx test that will provide the most information - correct answer- facial x- ray
Hypoglycemia in an elderly pt with diabetes is most likely to manifest as what sx - correct answer- Mental confusion An 85 yo nursing home resident presents witha abrupt onset of cough, sore throat, HA, myalgias, and malaise. On exam pt temp is 102F, the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Tx of choice for this pt - correct answer- Oseltamivir (tamiflu) 36 yo female presents for routine PE. She has no current complaints and her only medication is oral contraceptives. The pt is preparing for a trip in Australia and is worried about the long flight as her Mom has a hx of DVT after a long trip several yaers ago. PE reveals BP 110/60. HR 66, regular. Heart is regular rate and rhythm without murmur, lungs are clear to auscultation bilaterally and extremities are without edema. Most appropriate recommendation - correct answer- recommend walking frequently during the flight 43 yo woman presents with episodes of facial flushing with increased skin temp. followed by the development of tiny papules and pustules primarily on her cheeks and chin. These sxs worsen when she eats spicy food. On exam, telangiectasias are noted along the nasal folds and tiny pustules on both cheeks. Dx - correct answer- rosacea
25 yo male presents to the ED for eval of a wound on his hand. He cut his hand while tearing down a chicken coop. On exam of his right hand you note a dirty 3cm jagged laceration. The pt is unaware of his tetanus immunization status. Besides cleaning and debriding the wound, what is the recommended intervention - correct answer- administer tetanus-diptheria toxoid (Th) and tetanus immune globulin (TIG) 25 yo female presents for a routine gynecological exam. You palpate a 2cm breast mass in her right breast. Her menstrual period was last week. She has no family hx of breast cancer. What is the modality of choice to further evaluate her breast mass - correct answer- ultrasound 60 yo right hand dominant male presents to your office complaining of right shoulder pain and progressively worsening arm weakness. His sxs are aggravated when working above the shoulder level. On PE, 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. Dx - correct answer- rotator cuff tear Newborn weighs 8 pounds at birth. what would you expect her to weigh at 1 year of age - correct answer- 24 pounds
is the most appropriate long term management in this pt - correct answer- Radiofrequency ablation 26 yo woman requests screening after her boyfriend was treated for an STD. On exam you find a painless vulvar ulcer. Most likely dx - correct answer- syphilis 57 yo male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. Treatment of choice - correct answer- NSAID 55 yo female presents to the clinic with lethargy, fatigue, constipation, and menorrhagia. PE reveals an enlarged thyroid, dry skin, and a haert rate of 50bpm. Lab results show a decrease in free T4, and an elevation in TSH. Dx - correct answer- primary hypothyroidism Which of the following diagnostic studies is indicated in the eval of an upper GI bleed - correct answer- upper endoscopy 45 yo male presents to the clinic c/o morning slugishness, daytime fatigue, headaches. he admits to drinking two cocktails each evening. His bed partner reports loud cyclical snoring, breath cessation, and admits thrashing movements of his
extremities during sleep. BMI is 40. Heart exam reveals regular rate and rhythm without S3, S4, or murmur and lungs are clear to auscultation. Polysomnography shows apneic episodes lasting as long as 60 seconds. Which of the following clinical interventions would most likely provide for the acute cessation of apneic episodes - correct answer- nasal continuous positive airway pressure (CPAP) 45 yo female presents with her daughter who is concerned because her Mom will not leave the house. The patient descrives feeling anxious in crowds and places where there are no easy means of escape. Most likely dx - correct answer- agoraphobia 18 yo female with DM presents to the ED with altered LOC, deep breathing, and fruity odor to her breath. Which med is indicated for this pt - correct answer- Regular Insulin 69 yo male with a hx of CLL presents to the clinic c/o cough, dyspnea, and production of copious amounts of foul smelling sputum. PE reveals crackles at the lung bases. CXR shows dilated and thickened bronchi that appear as ring-like markings. Most likely dx - correct answer- bronchiectasis
Two hours later, while the pt was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, II, and aVF. Cardiac Cath shows no significant obstruction of the coronary arteries. Treatment of choice - correct answer- nifedipine (Procardia) 62 year old male presents with c/o dyspepsia, early satiety, and dysphagia. diagnostic study for initial workup - correct answer- upper endoscopy 6 yo male, recent immigrant from Latin America, is brough to the ED with difficulty swallowing and breathing. On PE you note a gray-tan pseudomembrane in the back of the pharynx. There is also tender cervical LAD. What PE finding is most specific for dx in this pt - correct answer- pseudo-membrane in pharynx 40 yo male non smoker in good health undergoes a routine CXR for an insurance physical. Results show an isolated, well defined, coin lesion 1cm in size. Which of the following is the next step in teh eval of this problem - correct answer- review old radiographs Lesions of the optic chiasm will produce what deficit - correct answer- bitemporal hemianopsia
75 yo female with a hx of long-standing HTN presents with SOB. On exam you note a diastolic murmur at the left upper sternal border. What maneuver would accentuate this murmur - correct answer- Sitting up and leaning forward 25 yo female, G2 P1001, presents to your office at 11 wks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On exam, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 wks gestation. No other abnormalities are found. Likely dx - correct answer- inevitable abortion what lab test should be closely monitored in pts on long term lithium treatment for bipolar disorder - correct answer- TSH 16 yo female comes to the office because her acne has become more severe and she would like to discuss treatment. She was originally prescribed tropical clindamycin gel 1 yr ago to treat open and closed comedones on her face. Despite regular use of the medication, she now has several comedones and papulopustules across her nose, cheeks, chin, and forehead. Which of the following would be an appropriate additional treatment for moderate acne - correct answer- oral doxycycline
56 yo female with a 35 pack year smoking hx presents to the clinic with SOB and cough. On exam she is think with no recent weight loss. She appears uncomfortable, breath sounds are diminished without adventitious sonds. PFT shows a marked increase in TLC and a decreased FEV1. Dx - correct answer- chronic obstructive pulmonary disease Which of the following Rh genotypes in a mother and father would represent a risk for hemolytic disease of the newborn - correct answer- Mother Rh-negative, Father Rh-positive 76 yo active female with history of HTN and hypothyroidism presents with c/o palpitations and DOE. On exam vital signs are BP 120/80, HR 76 and irregular, RR 16. Heart exam reveals an irregularly ireggular rhythm without murmur. Lungs are clear to auscultation and extremities are without edema. Most important med for chronic therapy in this pt - correct answer- coumadin 32 yo male presents with a one month hx of weakness, anorexia, and weight loss. On PE he is hypotensive and his skin has diffuse hyperpigmentation. Plasma Cortisol levels drawn at 8am are low. Dx - correct answer- Addison Disease
Antinuclear antigen (ANA) is most commonly associated with and monitors the progress of what disorder - correct answer- systemic lupus erythematosis (SLE) 72 yo woman presents to your clinic c/o constipation. Which presentation is most concerning - correct answer- weight loss 58 yo male presents for a six week follow up after an acute anterior wall MI. He denies chest pain and SOB. ECG shows persistent ST segment elevation in the anterior leads. Echo reveals a sharply delineated area of scar that bulges paradoxically during systole. Most likely dx - correct answer- left ventricular aneurysm what is recommended to reduce the risk for perinatal transmission of HIV in a pt with a viral load of > 1000 copies/mL
- correct answer- cesarean section prior to onset of labor and rupture of membranes 48 yo male with a recent episode of nephrolithiasis comes to the office to discuss prevention of further urinary stone disease. What recommendation can reduce recurrence of nephrolithiasis
- correct answer- increased fluid intake
23 month old male presents to the office with his father who reports the pt has had an acute onset of severe pharyngitis, fever of 103.5, and what sounds like harsh, high pitched breath sounds. His dad states the child has started drooling and seems to be worsening. The child is not presently cyring but has muffled voice sounds. The child has not been immunized due to religious reasons. Next step - correct answer- emergent transfer On PE of a pregnant pt, what can be considered a normal finding - correct answer- increased second heart sound split with inspiration MCC of ascites - correct answer- portal HTN 55 yo male with hx of HTN and DM presents to the ED. Pt's wife states tha tthe pt developed progressive irritability and confusion today after c/o a HA. PE reveals BP 230/130 and papilledema. Dx - correct answer- malignant HTN 19 yo man comes to the office because he has had a fever, frequent urination, urgency, dysuria, and scrotal pain for the past 2 days. On PE, he has a temperature of 101, scrotal swelling, and purulent urethral discharge is visible on penile
exam. Gram stain on the discharge shows gram negative intracellular diplococci. Abx of choice - correct answer- ceftriaxone (rocephin) 74 yo male with a hx of CAD and A Fib presents to the clinic for follow up of his SOB. Pts meds include amiodarone, and metoprolol. His CXR reveals patchy ground glass infiltrates. Dx
- correct answer- pulmonary fibrosis Pt demographic at highest risk for anorexia - correct answer- single, 20 yo, homosexual male. Also at high risk are high school wrestlers and ballet dancers. 58 yo female comes to the office because she noticed a white spot on her tongue. She has a 42 pack yr smoking hx. On exam she has an 8mm white thickened, keratinized lesion on teh ventral tongue. The lesion cannot be removed by rubbing the mucosal surface. Study to confirm the suspected dx - correct answer- incisional biopsy 26 yo male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular sxs are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel
65 yo male with CAD, HTN, and DM is admitted with dyspnea and LE edema. CXR reveals small bilateral pleural effusions. Echo shows an ejection fraction of 30% with no valvular disease. The pt is treated in the hospital with furosemide and lisinopril. What education should be given to this pt upon discharge to help prevent readmission - correct answer- monitor daily weights 67 yo AA male presents for a new pt eval. Hx reveals aphasic CVA which limits his history. Funduscopic exam reveals an abnormal vessel light reflex described as a silver or copperwire appearance. Where the vessels intersect, there appears to be some nicking. He has no carotid bruits and his cardiac exam is normal. MCC of ocular findings - correct answer- HTN retinopathy 14 yo male presents to the ED experiencing a severe asthma attack. His respiratory effort is shallow and he is using accessory muscle to breathe. Auscultation of his chest reveals no audible wheezing. Vital signs include BP 90/60, P 160, RR
- ABG is orderd. Normal ABG values at your institution are. pH 7.35-7.45, CO2 35-45, pO2 80-95. ABG finding that would suggest the poorest prognosis - correct answer- pH 7.27 pCO 46 pO2 56
22 yo male presents to the ED c/o right hand pain after punching a brick wall. Pain on ulnar aspect of his hand worsens with touch and movement. On exam you note obvious swelling and tenderness over the dorusm of the right hand proximal to the MCP joint of the fifth digit. Skin is intact. Xray shows fracture of the proximal 5th metacarpal with good alignment. Tx of choice - correct answer- ulnar gutter splint to immobilize the fx site 22 yo female presents with onset of right eye vision loss 24 hours ago which has partially improved. She has experiences various widespread paresthesias, regional weakness, and fatigue over the past 6 months. Episodes vary in location, severity and duration but invariably lead to recovery. her exam is completely normal but MRI reveals numerous areas of periventricular gadolinium uptake. For this condition, what tx shows the greatest benefit with long term use - correct answer- interferon beta 1a (avonex) 18 month old male presents with his parents who report symptoms of a barking cough and intermittent stridor that has worsened over the past 12 hours. They note improvement in symptoms when he was taken outdoors to the cool night air. Causative organisim - correct answer- Parainfluenza Virus AA is palced on hydroxoychloroquine (Plaquenil) for travel to Africa. Within 6 wks he presents c/o fatigue. CBC shows anemia. Study of choice - correct answer- G6PD assay
