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PACKRAT Test Exam 1 | Questions
and Verified Correct Answers|
Latest Version 2026-2027|
100%Score.
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 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. 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 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. 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
B. wheezing C. sputum production D. inspiratory stridor 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 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. 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 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. 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. 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. hirsutism B. gynecomastia C. anorexia D. dyspareunia 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 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. 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 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 tongue, facial tics, increased blink frequency, and lip-smacking behavior. These involuntary movements are most suggestive of A. tardive dyskinesia. B. Parkinson's disease. C. Huntington's disease. D. Gilles de la Tourette's syndrome. A. Tardive dyskinesia is characterized by abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs and may develop after months or years of treatment with neuroleptic drugs. Typical symptoms of depression include which of the following? A. auditory hallucinations B. panic attacks C. multiple somatic complaints
B. foreskin that cannot be retracted C. chancre on the shaft of the penis D. fibrous band on lateral portion of the penis D. Peyronie disease typically presents with fibrotic areas under the penile skin along with a history of penile curvature during erection. Renal cell carcinoma most commonly presents with which of the following symptoms or signs? A. hypocalcemia B. inguinal pain C. anemia D. hematuria D. The most common presenting symptom/sign of renal cell carcinoma is hematuria (approximately 60%). Flank pain or abdominal mass is present in about 30% of new cases. Which of the following is the diagnostic test of choice for the evaluation of a patient suspected of secondary hypertension due to primary aldosteronism (Conn's syndrome)? A. chest x-ray B. renal scan C. serum electrolytes D. urinalysis for metanephrines C. Patients having primary aldosteronism as a cause of their secondary hypertension are identified for this condition by finding unprovoked hypokalemia on the electrolyte testing.
Which of the following electrocardiographic findings is the hallmark of pericarditis? A. ST elevation B. prolonged Q-T interval C. atrial fibrillation D. tall peaked T waves A. The hallmark of pericarditis is ST segment elevation throughout the precordium along with PR segment depression. Patients with heart failure may have a combination of systolic and diastolic failure. Which of the following studies should be used in diagnosing this condition? A. radionuclide scanning B. echocardiogram C. exercise stress testing D. cardiac catheterization B. An echocardiogram is especially useful for assessing the dimensions of each cardiac chamber. Heart failure is usually associated with cardiac enlargement and the diagnosis should be questioned (but, not excluded) when all chambers are normal in size. Echocardiogram assesses the function of the various chambers along with the ejection fractions of the heart, which is important with systolic dysfunction. The most accurate method of diagnosing thrombophlebitis of the lower leg is A. impedance plethysmography. B. physical exam findings.
A 24-year-old male presents with a generalized erythematous maculopapular rash, including the palms and soles of the feet. He also shows generalized lymphadenopathy and flat, moist lesions in the genital area. The patient admits to having had a lesion on his penis a month or so before, but it did not bother him. Which of the following is the most appropriate to confirm the diagnosis? A. C-reactive protein B. Lyme titer C. FTA-ABS D. Weil-Felix test C. The fluorescent treponemal antibody absorption test is positive in secondary syphilis. A 55-year-old female presents with a mole that has changed appearance over the past few months. She says it has enlarged. Also noted is an asymmetric lesion with an irregular border and variation in color from light brown to dark blue/black. Which of the following is the most appropriate? A. curettage B. shave biopsy C. excisional biopsy D. aspiration for cytology C. An excisional biopsy is indicated for suspected cases of melanoma. Which of the following is the most helpful in establishing the diagnosis of gout? A. analysis of synovial fluid with polarized light B. C-reactive protein C. erythrocyte sedimentation rate D. serum and urine uric acid A. Although sedimentation rate, C-reactive protein, and uric acid levels may be elevated, the most
specific diagnostic test for gout is the presence of negatively birefringent, needlelike crystals in leukocytes from synovial fluid. A 24-year-old male is initially found to have a single nodule in the right lobe of his thyroid gland. He is clinically and chemically euthyroid. The next step is to A. reassure the patient and reassess yearly. B. recheck in 1-3 months. C. do a fine needle aspiration. D. obtain a CT scan of the neck. C. The combination of fine needle aspiration and radioisotope scanning of a solitary thyroid nodule provides the best diagnostic yield. Because cold nodules may be cancerous, they are generally referred for surgical removal. It is not reasonable to delay the diagnosis. In differentiating a viral pharyngitis from a streptococcal pharyngitis, which of the following must be included? A. complete blood count with differential B. ASO titer C. cold agglutinin antibody test D. throat culture D. The throat culture is the definitive test to identify beta-hemolytic Group A streptococci. A 2-year-old presents with sudden onset of cough and stridor. On examination the child is afebrile and appears well with a respiratory rate of 42 per minute. What is the next best step in the evaluation and
Temperature is 102° F. Visual activity is 20/40 in the right eye and 20/30 in the left eye. The right eye reveals mild proptosis and severe erythema, increased warmth, and swelling involving the eye and surrounding tissues. Which of the following is the most appropriate diagnostic evaluation? A. applanation tonometry B. electronystagmography C. orbital and sinus CT scan D. ultrasonography of sinuses C. This is the typical presentation of orbital cellulitis. A CT scan of the orbit and sinuses is indicated to check for the presence of a subperiosteal abscess and underlying sinusitis, which is often the cause of orbital cellulitis. A 65-year-old patient with a known history of alcohol and tobacco abuse presents with solid-food dysphagia. The patient also had a 24 lb weight loss over the past 6 months. To establish a diagnosis, which of the following studies should be performed? A. CT scan B. chest x-ray C. barium esophagram D. endoscopy D. Endoscopy with biopsy establishes the diagnosis of esophageal carcinoma with a high degree of reliability when biopsy is included as part of the procedure. A 35-year-old male presents to the emergency department with a 4-hour history of abdominal pain, nausea, and vomiting. He denies diarrhea. Examination reveals the following: Temperature 101° F (38.3° C)
Pulse 100 beats/min Respiratory rate 20/min Blood pressure 110/65 mm Hg The patient is in moderate distress and slightly diaphoretic. He has poor oral hygiene and the odor of alcohol is noted. Examination of the heart and lungs are unremarkable except for tachycardia. Abdominal examination reveals hypoactive bowel sounds, diffuse tenderness with more marked tenderness in the epigastric area, without guarding, rebound, masses, or organomegaly. Along with CBC, which of the following diagnostic studies would be most appropriate? A. liver function tests, amylase, and abdominal films B. ESR, urinalysis, and electrolytes C. electrolytes, ECG, and upper GI D. ECG, barium enema, and sonogram A. The clinical presentation suggests acute pancreatitis, which is best evaluated by liver function tests, amylase, and abdominal films. Which of the following is the most helpful serological test in primary biliary cirrhosis? A. anti-smooth muscle antibodies B. anti-mitochondrial antibodies C. anti-hepatitis B antibodies D. anti-nuclear antibodies B. Anti-mitochondrial antibodies are seen in over 90% of cases of primary biliary cirrhosis and are rare in other forms of liver disease. A 26-year-old male patient presents with complaints of diarrhea with marked flatulence and weight loss for the past 6-8 months. In addition, he states that his stools are loose
C. blood culture D. lymph node biopsy A. A heterophile test is the test of choice for the diagnosis of infectious mononucleosis. Which of the following would aid in the diagnosis of Reye's syndrome? A. hyperglycemia B. elevated serum ammonia level C. proteinuria D. elevated cholesterol B. Reye's syndrome results in fatty liver with encephalopathy. It is a complication of influenza and other viral illnesses, particularly in the young and with the use of aspirin. Laboratory characteristics include elevated ammonia levels, elevation of liver enzymes, hypoglycemia, and a prolonged prothrombin time. Which of the following laboratory studies may be used in the prenatal diagnosis of spina bifida? A. hCG B. alpha-fetoprotein C. folic acid levels D. prolactin B. Alpha-fetoprotein, measured at 16-18 weeks of pregnancy, if elevated, would indicate a neural tube defect, such as spina bifida.
In suspected subarachnoid hemorrhage with a negative head CT, which of the following studies should be used to help establish the diagnosis of subarachnoid hemorrhage? A. complete blood count B. lipid profile C. lumbar puncture D. electrocardiogram C. Although 95% of subarachnoid hemorrhages show blood on head CT, the remaining do not show evidence of hemorrhaging. A lumbar puncture should then be performed and the fluid examined for red blood cells or xanthochromia. Which of the following is the best test to confirm the presence of gonorrhea in a female? A. culture of the endocervix B. culture of vaginal discharge C. Gram stain of cervical discharge D. presence of yellow discharge A. The standard for diagnosis of gonorrhea is the isolation of the organism by culture from the endocervix in women. Which of the following is the primary technique for evaluation of an abnormal cervical cytology smear? A. laparoscopy B. colposcopy C. abdominal CT scan D. dilation and curettage B. Colposcopy is the primary method for evaluation of abnormal cervical cytology smear.
